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Difficulties generated by the small, persistently patent, arterial duct

Published online by Cambridge University Press:  19 August 2008

Brigitte Raaijmaakers ,
Aagje Nijveld ,
Anton van Oort ,
Ronald Tanke  and
Otto Daniëls
Brigitte Raaijmaakers*
Affiliation:
Children's Heart Centre, University Hospital Nijmegen, The Netherlands
Aagje Nijveld
Affiliation:
Children's Heart Centre, University Hospital Nijmegen, The Netherlands
Anton van Oort
Affiliation:
Children's Heart Centre, University Hospital Nijmegen, The Netherlands
Ronald Tanke
Affiliation:
Children's Heart Centre, University Hospital Nijmegen, The Netherlands
Otto Daniëls
Affiliation:
Children's Heart Centre, University Hospital Nijmegen, The Netherlands
*
Brigitte Raaijmaakers, MD, University Hospital Nijmegen, Children's Heart Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel: +31 (24) 3614427; Fax: +31 (24) 3619052; e-mail: B.Raaijmaakers@ckskg.azn.nl
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Abstract

Over recent years, echo-Doppler cardiography has shown that a small, sometimes silent, arterial duct exists in more patients than previously recognized. To know the incidence of an arterial duct subsequent to therapy, we studied retrospectively our patients undergoing open-heart surgery and surgical or catheter closure. Three groups of patients were studied: those with patency of the duct subsequent to open heart surgery without any sign of patency before or during surgery, those with persistent duct after surgical ligation and those with persistent patency after attempted catheter occlusion with the Rashkind device. In the first group (of 431 children) four (0.9%) had persistence of this duct, of which three were silent. In the second group, patency persisted in four of 100 patients (4%), three being silent. In the last group there were five persisting shunts, three producing no murmur, in 30 patients (17%). We compared our results with those reported in the literature and conclude that echo-Doppler cardiography is needed to detect persistent shunting across a duct after therapy, since most of the residual ducts in this study were silent. This means that clinical findings alone cannot be relied upon, and careful echo-Doppler cardiography is essential. Also, the process of closure of a persistent duct by surgical ligation or transcatheter intervention is no guarantee of success. The risk of infective endocarditis is important in such persistent ducts and, at present, it is unknown either for a small, silent duct or in a persistent duct that remains open after attempted transcatheter closure, but now is in association with a foreign body.

Keywords

Silent arterial ductpersistent arterial ductduct after therapyecho-Doppler cardiographyendocarditis
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 4 , July 1999 , pp. 392 - 395
Copyright
Copyright © Cambridge University Press 1999

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References

1.Sherman, FS, Sahn, DJ. Pediatric Doppler echocardiography 1987: major advances in technology. J Pediatr 1987; 110: 333–342.CrossRefGoogle ScholarPubMed
2.Liao, PK, Su, WJ, Hung, JS. Doppler echocardiographic flow characteristics of isolated patent ductus arteriosus: better delineation by Doppler color flow mapping. J Am Coll Cardiol 1988; 12: 1285–1291.CrossRefGoogle ScholarPubMed
3.McGrath, RL, McGuinness, GA, Way, GL, Wolfe, RR, Nora, JJ, Simmons, MA. The silent ductus arteriosus. J Pediatr 1978; 93: 110–113.CrossRefGoogle ScholarPubMed
4.Houston, AB, Gnanapragasam, JP, Lim, MK, Doig, WB, Coleman, EN. Doppler ultrasound and the silent ductus arteriosus. Heart J 1991; 65: 97–99.CrossRefGoogle ScholarPubMed
5.Schumann, D, Schickendantz, S, Borowski, A, Mennicken, U. Der stumme persistierende Ductus arteriosus. Klin p,,diatr 1993; 205: 354–356.CrossRefGoogle ScholarPubMed
6.Musewe, NN, Benson, N, Smallhorn, JF, Freedom, RM. Two-dimensional echocardiographic and color flow Doppler evaluation of ductal occlusion with the Rashkind prosthesis. Circulation 1989; 80: 1706–1710.CrossRefGoogle ScholarPubMed
7.Sorensen, KE, Kristensen, BO, Hansen, OK. Frequency of occurrence of residual ductal flow after surgical ligation by color-flow mapping. Am J Cardiol 1991; 67: 653–654.CrossRefGoogle ScholarPubMed
8.Gray, DT, Fyler, DC, Walker, AM, Weinstein, MC, Chalmers, TC. Clinical outcomes and costs of transcatheter as compared with surgical closure of patent ductus arteriosus. N Engl J Med 1993; 329: 1517–1523.CrossRefGoogle ScholarPubMed
9.Zucker, N, Qureshi, SA, Baker, EJ, Deverall, PB, Tynan, M. Residual patency of the arterial duct subsequent to surgical ligation. Cardiol Young 1993; 3: 216–219.CrossRefGoogle Scholar
10.Rashkind, WJ, Mullins, CE, Hellenbrand, WE, Tait, MA. Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System. Circulation 1987; 75: 583–592.CrossRefGoogle ScholarPubMed
11.Latson, LA, Hofschire, PJ, Kugler, JD, Cheatham, JP, Gumbiner, CH, Danford, DA. Transcatheter closure of patent ductus arteriosus in pediatric patients. J Pediatr 1989; 115: 549–553.CrossRefGoogle ScholarPubMed
12.Rohmer, J, Hess, J, Talsma, MD. Sluiting van de persisterende ductus arteriosus (Botalli) door middel van catheter-interventie; de eetste 50 in Nederland behandelde pati‰nten. Ned Tschr Geneeskd 1990; 134: 2347–2351.Google Scholar
13.Hosking, MCK, Benson, LN, Musewe, N, Dyck, JD, Freedom, RM. Transcatheter occlusion of the persistently patent ductus arteriosus: forty-month follow-up and prevalence of residual shunting. Circulation 1991; 84: 2313–2317.CrossRefGoogle ScholarPubMed
14.Transcatheter occlusion of persistent arterial duct. Report of the European Registry. Lancet 1992; 340: 1062–1066.CrossRefGoogle Scholar
15.Campbell, M. Natural history of persistent ductus arteriosus. Br Heart J 1968; 30: 4–13CrossRefGoogle ScholarPubMed
16.Balzer, DT, Spray, TL, McMullin, D, Cottingham, W, Canter, CE. Endarreritis associated wirh a clinically silent patent ductus arteriosus. Am Heart J 1993; 125: 1192–1193.CrossRefGoogle Scholar