Hostname: page-component-77c89778f8-9q27g Total loading time: 0 Render date: 2024-07-21T18:36:11.913Z Has data issue: false hasContentIssue false
  • English
  • Français

Interventions on patent ductus arteriosus and its impact on congenital heart disease

Part of: Surgery

Published online by Cambridge University Press:  23 November 2020

Mariam Zaidi ,
Nilofer Sorathia ,
Hannah Abbasi ,
Arwa Khashkhusha  and
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window]
Mariam Zaidi
Affiliation:
Charing Cross Hospital, Imperial College London, London, UK
Nilofer Sorathia
Affiliation:
St George’s University of London, London, UK
Hannah Abbasi
Affiliation:
St George’s University of London, London, UK
Arwa Khashkhusha
Affiliation:
University of Liverpool, Liverpool, UK
Amer Harky*
Affiliation:
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK Department of Cardiac Surgery, Alder Hey NHS Foundation Trust Hospital, Liverpool, UK Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool, Heart and Chest Hospital, Liverpool, UK
*
Author for correspondence: Amer Harky, MSc, MRCS, Department of Cardiothoracic surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. Tel: +0044-151-600-1616. E-mail: aaharky@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

The ductus arteriosus (DA) connects the pulmonary artery to the aorta to bypass the pulmonary circulation in utero. It normally closes within 24–72 hours after birth due to increased pulmonary resistance from an increase in oxygen partial pressure with the baby’s first breath. Medical treatment can help close the DA in certain situations where closure is delayed. However, in duct-dependent cardiac defects, the presence of the DA is crucial for survival and as such medical and surgical techniques have evolved to prevent closure. This review aims to outline the two main management options for keeping a ductus arteriosus patent. This includes stenting the PDA and shunting via a modified Blalock–Taussig shunt. Whilst both techniques exist, multicentre trials have found equal mortality end points but significantly reduced morbidity with stenting than shunting. This is also reflected by shorter recovery times, reduced requirement for extracorporeal membrane oxygenation (ECMO), and improved quality of life, although stent longevity remains a limiting factor.

Keywords

Surgeryaortadissectionaortic dissection
Type
Review Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1566 - 1571
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hermes-DeSantis, ER, Clyman, RI. Patent ductus arteriosus: pathophysiology and management. J Perinatol 2006; 26(Suppl 1): S14–S18.CrossRefGoogle ScholarPubMed
Schneider, DJ, Moore, JW. Patent ductus arteriosus. Circulation 2006; 114: 1873–1882. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.592063 CrossRefGoogle ScholarPubMed
Dice, JE, Bhatia, J. Patent ductus arteriosus: an overview. J Pediatr Pharmacol Ther: JPPT : Off J PPAG 2007; 12: 138–146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462096/ Google ScholarPubMed
Smith, GC. The pharmacology of the ductus arteriosus. Pharmacol Rev 2019; 50. https://pubmed.ncbi.nlm.nih.gov/9549757/ Google Scholar
Clyman, RI, Mauray, F, Rudolph, AM, Heymann, MA. Age-dependent sensitivity of the lamb ductus arteriosus to indomethacin and prostaglandins. J Pediatr 1980; 96: 94–98. https://pubmed.ncbi.nlm.nih.gov/6985662/ CrossRefGoogle ScholarPubMed
Huff, T, Chaudhry, R, Arora, Y, Mahajan, K. Anatomy, thorax, heart ductus arteriosus. Nih.gov. StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK470160/ Google Scholar
Drougia, A, Giapros, V, Krallis, N, et al. Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review. Early Hum Dev 2007; 83: 541–547. https://www.sciencedirect.com/science/article/pii/S0378378206002982?via%3Dihub CrossRefGoogle ScholarPubMed
Mitra, S, de Boode, WP, Weisz, DE, Shah, PS. Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews. Cochrane Database Syst Rev 2020; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013588/full CrossRefGoogle Scholar
Gillam-Krakauer, M, Mahajan, K. Patent ductus arteriosus, 2020. https://pubmed.ncbi.nlm.nih.gov/28613509/ Google Scholar
Saldeño, YP, Favareto, V, Mirpuri, J. Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants. J Perinatol 2012; 32: 953–958. https://www.nature.com/articles/jp201231 CrossRefGoogle ScholarPubMed
McNamara, P, Weisz, D. Patent ductus arteriosus ligation and adverse outcomes: Causality or bias? J Clin Neonatol 2014; 3: 67. –https://www.jcnonweb.com/article.asp?issn=2249-4847;year=2014;volume=3;issue=2;spage=67;epage=75;aulast=Weisz CrossRefGoogle Scholar
Sankar, MN, Bhombal, S, Benitz, WE. PDA: to treat or not to treat. Congenital Heart Dis 2019; 14: 46–51. https://onlinelibrary.wiley.com/doi/full/10.1111/chd.12708 CrossRefGoogle ScholarPubMed
Deshpande, P, Baczynski, M, McNamara, PJ, Jain, A. Patent ductus arteriosus: the physiology of transition. Semin Fetal Neonatal Med 2018; 23: 225–231. https://www.ncbi.nlm.nih.gov/pubmed/29779927 CrossRefGoogle ScholarPubMed
Clyman, RI. The role of patent ductus arteriosus and its treatments in the development of bronchopulmonary dysplasia. Semin Perinatol 2013; 37: 102–107. https://pubmed.ncbi.nlm.nih.gov/23582964/ CrossRefGoogle ScholarPubMed
Sullivan, MM, Theleman, KP, Choi, JW. Percutaneous closure of patent ductus arteriosus in an asymptomatic adult. Proc (Bayl Univ Med Cent) 2008; 21: 386–388. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566910/ CrossRefGoogle Scholar
Valentík, P, Omeje, I, Poruban, R, Sagát, M, Nosál, M. Surgical closure of patent ductus arteriosus in pre-term babies. Images Paediatr Cardiol 2007; 9: 27–36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232578/ Google Scholar
Avila-Alvarez, A, Serantes Lourido, M, Barriga Bujan, R, Blanco Rodriguez, C, Portela-Torron, F, Bautista-Hernandez, V. Surgical closure of patent ductus arteriosus in premature neonates: does the surgical technique affect the outcome? Anales de Pediatría (English Edition) 2017; 86: 277–283. https://www.analesdepediatria.org/en-surgical-closure-patent-ductus-arteriosus-articulo-S2341287917300674 CrossRefGoogle ScholarPubMed
Odim, J, Portzky, M, Zurakowski, D, et al. Sternotomy approach for the modified Blalock-Taussig shunt. Circulation 1995; 92: 256–261. https://www.ahajournals.org/doi/10.1161/01.CIR.92.9.256 CrossRefGoogle ScholarPubMed
Alwi, M, Choo, KK, Latiff, HA, Kandavello, G, Samion, H, Mulyadi, MD. Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation. J Am Coll Cardiol 2004; 44: 438–445. https://pubmed.ncbi.nlm.nih.gov/15261945/ CrossRefGoogle ScholarPubMed
Glatz, AC, Petit, CJ, Goldstein, BH, Qureshi, AM. Response by Glatz et al to letter regarding article, “Comparison between patent ductus arteriosus stent and modified blalock-taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative”. Circulation 2018; 138: 436–437. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.118.035223 CrossRefGoogle Scholar
Gewillig, M, Boshoff, DE, Dens, J, Mertens, L, Benson, LN. Stenting the neonatal arterial duct in duct-dependent pulmonary circulation: new techniques, better results. J Am Coll Cardiol 2004; 43: 107–112. https://pubmed.ncbi.nlm.nih.gov/14715191/ CrossRefGoogle ScholarPubMed
Aggarwal, V, Dhillon, GS, Penny, DJ, Gowda, ST, Qureshi, AM. Drug-eluting stents compared with bare metal stents for stenting the ductus arteriosus in infants with ductal-dependent pulmonary blood flow. Am J Cardiol 2019; 124: 952–959. https://www.ajconline.org/article/S0002-9149(19)30717-9/fulltext CrossRefGoogle Scholar
Garg, G, Mittal, DK. Stenting of patent ductus arteriosus in low birth weight newborns less than 2 kg- procedural safety, feasibility and results in a retrospective study. Ind Heart J 2018; 70: 709–712. https://www.sciencedirect.com/science/article/pii/S0019483217302456 CrossRefGoogle ScholarPubMed
Petrucci, O, O’Brien, SM, Jacobs, ML, Jacobs, JP, Manning, PB, Eghtesady, P. Risk factors for mortality and morbidity after the neonatal blalock-taussig shunt procedure. Ann Thoracic Surg 2011; 92: 642–652. https://www.annalsthoracicsurgery.org/article/S0003-4975(11)00454-1/fulltext CrossRefGoogle ScholarPubMed
Santoro, G, Capozzi, G, Caianiello, G, et al. Pulmonary artery growth after palliation of congenital heart disease with duct-dependent pulmonary circulation. J Am Coll Cardiol 2009; 54: 2180–2186. https://pubmed.ncbi.nlm.nih.gov/19942090/ CrossRefGoogle ScholarPubMed