Patent ductus arteriosus indications for surgery: Difference between revisions
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{{CMG}}; '''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org], {{CZ}}; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@perfuse.org] | {{CMG}}; '''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org], {{CZ}}; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@perfuse.org] | ||
==Overview== | ==Overview== | ||
==[[Risks associated with patent ductus arteriosus surgery]]== | |||
==Risks associated with patent ductus arteriosus | |||
==Small and medium-sized ductus== | ==Small and medium-sized ductus== | ||
Three risks exist: | Three risks exist: | ||
*[[Endocarditis]] | *[[Endocarditis]] | ||
*Deposition of calcium in the walls of the ductus which can compromise surgical results | *Deposition of calcium in the walls of the ductus which can compromise surgical results | ||
*[[Heart failure]] with a medium-sized ductus. | *[[Heart failure]] with a medium-sized ductus. | ||
Because of these risks, the mere presence of a ductus in childhood is an indication for operation at age 1 to 2 years. | Because of these risks, the mere presence of a ductus in childhood is an indication for operation at age 1 to 2 years. | ||
==Large PDAs with severe pulmonary vascular obstructive disease== | ==Large PDAs with severe pulmonary vascular obstructive disease== | ||
If the pulmonary vascular resistance is > 10 units/m2 then this contraindicates closure. The risk of death from repair at all ages is < 2%, and is under 1% when patients with pulmonary hypertension and small infants are excluded. LVH regresses, but if there is pulmonary hypertension, RVH does not regress. The risk of endocarditis disappears. The lesion can also be closed using a Rashkind device. There is a 15% risk of embolization of the occluder in a multicenter report of 156 patients. | If the pulmonary vascular resistance is > 10 units/m2 then this contraindicates closure. The risk of death from repair at all ages is < 2%, and is under 1% when patients with pulmonary hypertension and small infants are excluded. LVH regresses, but if there is pulmonary hypertension, RVH does not regress. The risk of endocarditis disappears. The lesion can also be closed using a Rashkind device. There is a 15% risk of embolization of the occluder in a multicenter report of 156 patients. | ||
Revision as of 15:27, 16 August 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Risks associated with patent ductus arteriosus surgery
Small and medium-sized ductus
Three risks exist:
- Endocarditis
- Deposition of calcium in the walls of the ductus which can compromise surgical results
- Heart failure with a medium-sized ductus.
Because of these risks, the mere presence of a ductus in childhood is an indication for operation at age 1 to 2 years.
Large PDAs with severe pulmonary vascular obstructive disease
If the pulmonary vascular resistance is > 10 units/m2 then this contraindicates closure. The risk of death from repair at all ages is < 2%, and is under 1% when patients with pulmonary hypertension and small infants are excluded. LVH regresses, but if there is pulmonary hypertension, RVH does not regress. The risk of endocarditis disappears. The lesion can also be closed using a Rashkind device. There is a 15% risk of embolization of the occluder in a multicenter report of 156 patients.
Indications for Surgery [1]
- Symptomatic patients with left to right shunt (left sided volume overload).
- Reversible pulmonary arterial hypertension.
Contraindication
- Severe and irreversible pulmonary artery hypertension
- Eisenmenger's syndrome.
There is some lack on consensus on the management strategies of silent and small patent ductus arteriosus.
Small PDA
Small PDA may present with audible murmur with or without symptoms of left volume overload. The American College of Cardiology/American Heart Association (ACC/AHA)recommends closure of small PDA, even without evident left sided volume overload. In case the PDA is left untreated, a follow-up every 3-5 year is recommended.
Silent PDA
Silent PDA
- No audible murmur.
- Detected incidentally on diagnostic procedures done for other conditions.
- Some experts are of opinion that silent PDA should be closed to decrease the risk of future endocarditis. Others believe that since silent PDA have very less risk for causing any hemodynamic complications in future so it could be left without any surgical intervention.
References
- ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease)". Circulation. 118 (23): e714–833. doi:10.1161/CIRCULATIONAHA.108.190690. PMID 18997169.