We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

Aged, 80 and over ; Ductus Arteriosus, Patent ; surgery ; Female ; Humans ; Septal Occluder Device

Adult ; Balloon Occlusion ; instrumentation ; Cardiac Catheterization ; instrumentation ; Ductus Arteriosus, Patent ; surgery ; Female ; Humans ; Ligation ; instrumentation ; Recurrence

Objective: To summarize the outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting. Methods: This study was a retrospective cohort study. A total of 19 neonates who had pulmonary atresia treated by ductus arteriosus stenting in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from April 2014 to June 2021 were included. They were divided into the intact ventricular septum (PA-IVS) group and the ventricular septal defect (PA-VSD) group. Ductus arteriosus stents were implanted by different approaches. These children were followed up regularly at the 1, 3, 6, and 12 months after the surgery and annually since then to evaluate the outcome. Independent sample t-test was used for the statistical analysis. Results: There were 12 children in PA-IVS group and 7 in PA-VSD group. All of them were full term in fants. The gestational age of the PA-IVS group and the PA-VSD group was (38.8±1.1) and (37.7±1.8) weeks, the birth weights were (3.2±0.4) and (3.4±1.1) kg, and the age at operation was (10±9) and (12±7) days, respectively, without significant difference (all P>0.05). Among the 12 children with PA-IVS, 9 had stents successfully implanted through the femoral artery and 3 through the femoral vein. Of the 7 children with PA-VSD, 2 had the stents successfully implanted via the femoral artery and 2 failed, and the remaining 3 had stents successfully implanted via the left carotid artery. There was no postoperative thromboembolism, arteriovenous fistula, pseudoaneurysm or other vascular complications. Five children with PA-VSD who had successful operations were followed up at 6 months of age. They all had the operation for pulmonary atresia, repair of the ventricular septal defect, removal of arterial duct stents, and ligation of the arterial duct. All children survived without any stent displacement or stenosis and biventricular circulation was achieved during the follow-up. Conclusions: Ductus arteriosous stenting can be the first-stage treatment for children with PA-IVS and PA-VSD. In addition to the traditional femoral vein and femoral artery approach, the carotid artery can be used as a route for stent placement.
Child ; Infant, Newborn ; Humans ; Infant ; Pulmonary Atresia/surgery* ; Ductus Arteriosus ; Retrospective Studies ; China ; Heart Defects, Congenital ; Ductus Arteriosus, Patent/surgery* ; Heart Septal Defects, Ventricular ; Stents

Surgical interruption through a left posterolateral thoracotomy and percutaneous transcatheter closure of ductus arteriosus were popular procedures of treatment. However, concerns over postthoracotomy syndrome and postoperative pain and complications such as persistent shun-ting, hemolysis, possible migration, and problem of prophylaxis against bacterial endocarditis in residual shunt were reported. Therefore, we present our procedure using video-assisted thoracoscopy for PDA clipping. 6 patients underwent video assisted-thoracoscopic clipping of PDA, but one case was converted into minithoracotomy. Postoperative examination showed the absence of murmur and decreased pulmonary vascularities progressively in all patients. In our series, we had no cases of ductal rupture during operation, incomplete ductal closure, pneumothorax, or hoarseness. Mean hospital stay was 3.4days. Postoperative echocardiography revealed no cases of ductal patency or residual shunt. We concluded that the technique described here is an effective procedure in view of the prevention of postthoracotomy syndrome, successful closure of ductus, cosmetic effect, and a short hospital stay.
Ductus Arteriosus ; Ductus Arteriosus, Patent* ; Echocardiography ; Endocarditis, Bacterial ; Hemolysis ; Hoarseness ; Humans ; Length of Stay ; Pain, Postoperative ; Pneumothorax ; Rupture ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy

OBJECTIVETo evaluate the feasibility of angiography combined with transthoracic echocardiography (TEE) as a modified management of the transcatheter occlusion of patent ductus arteriosus (PDA).

METHODSForty children with PDA were randomly divided into two groups (n=20 each): observed and control. The control group accepted traditional transcatheter occlusion, and the observed group received a modified management (angiography combined with TEE). The children in the observed group were monitored by realtime TTE.

RESULTSA complete occlusion was acquired by one occlusion operation in each child in the observed group. The TTE demonstrated that the occlusion device was in place, and that the blood flow velocities in the left and right pulmonary artery and the descending aorta were in normal ranges. There were shorter X-ray exposure time, shorter recovering time and less ICU stay time in the observed group than in the control group. The complications associated with blood vessel puncturation occurred in four children from the control group, but none of the observed group had the complications. The total hospitalization cost in the observed group was less than in the control group.

CONCLUSIONSAngiography combined with TEE as a modified management of the transcatheter occlusion of PDA is recommended.

Adolescent ; Cardiac Catheterization ; Cardiac Surgical Procedures ; methods ; Child ; Child, Preschool ; Ductus Arteriosus ; diagnostic imaging ; Ductus Arteriosus, Patent ; diagnostic imaging ; surgery ; Echocardiography ; Humans ; Infant ; Radiography

BACKGROUND AND OBJECTIVES: Video-Assisted Thoracoscopic surgery for Patent Ductus Arteriosus is an efficient method to reduce the risk of postoperative residual shunt as well as various complications that can be caused by a thoracotomy. The aim of this study was to analyze the safety and efficacy of ductus arteriosus clipping, using videothoracoscopy in sixty-five patients, and the results and prognosis of the operations. SUBJECTS AND METHODS: After general anesthesia of the sixty-five Patent Ductus Arteriosus (PDA) patients, double skin incisions of 7 and 5 mm were made and a thoracoscope inserted at the point of the 5 mm skin incision, with clipping of ductus arteriosus using the 7 mm skin incision were conducted. During the procedure, the tidal volume was kept at the minimum level to maintain O2 saturation, without insertion of a chest tube. RESULTS: There have been reported complications in fourteenth cases, with four of these caused by injury to the recurrent laryngeal nerve; however, they recovered after two weeks, with the other ten receiving a remnant residual shunt. Nine of ten residual shunt cases cured naturally after about six months, with no special treatments. CONCLUSION: Surgery using Video-Assisted thoracoscopic surgery for the PDA patients can decrease the complications due to a thoracotomy, and is therefore, a much safer and more effective method than other existing solutions.
Anesthesia, General ; Chest Tubes ; Ductus Arteriosus ; Ductus Arteriosus, Patent* ; Humans ; Prognosis ; Recurrent Laryngeal Nerve ; Skin ; Surgical Instruments ; Thoracic Surgery, Video-Assisted* ; Thoracoscopes ; Thoracotomy ; Tidal Volume

OBJECTIVETo evaluate the feasibility of a valved stent on closure patent ductus arteriosus in a Chinese miniswine model.

METHODSSelf-expandable nitinol stents were made of Ni-Ti shape memory alloy (9 mm in diameter). Bovine pericardium was shaped and sutured onto the stents. Fluid passing test, pre-releasing test and static test of pressure in tube were performed in all devices before use. In eight Chinese miniswine, vascular grafts (PTFE vascular prosthesis) were surgically inserted between the descending thoracic aorta and pulmonary artery for establishment of patent ductus arteriosus model. Valved stents were deployed to occlude the patent ductus arteriosus. Echocardiography was performed two hours post operation. Aortic angiography was made 30 days post operation in survived animals. Animals were then sacrificed for autopsy and electron microscopy examinations.

RESULTSIn vitro testing showed that the closure of the valved stent leaflets was satisfactory and fluid flows were not restricted in the opposite direction. The valved stents could be released through catheter, expanded completely, rapidly fixed in the tube. Closure of patent ductus arteriosus was succeeded in 6 out of 8 animals. One animal died of respiratory failure 2 hours post operation, another one died of pulmonary embolism due to valved stent displacement. Resident shunt was not evidenced by echocardiography, aortic angiography and dissection examinations in the remaining 6 animals. The new endothelial tissue fully covered the pulmonary and aortic sides of patent ductus arteriosus in 4 and 3 animals respectively. The electron microscopic observation revealed endothelial coverage of dives.

CONCLUSIONThe valved stent could effectively close artificial patent ductus arteriosus in vivo with satisfactory new intima covering on both sides of patent ductus arteriosus.

Animals ; Ductus Arteriosus, Patent ; surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Materials Testing ; Stents ; Swine ; Swine, Miniature

BACKGROUNDOccluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses. The Amplatzer vascular plug I (AVP1) has not been licensed for use for closure of patent ductus arteriose. We report our initial experience to occluding special type patent ductus arterioses with the AVP1-a single lobe device of single layer Nitinol mesh for short vessel landing zones.

METHODSPatients referred with small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter underwent occlusion using AVP1. All cases underwent pre-, intra- and post-procedural echocardiography and chest X-ray at the completion of the procedure, the next day and at a 30-day, 3-month and 6-month follow-up visits. Device sizing for device waist diameter and length was based on aortography.

RESULTSFrom April 2008 to June 2012, 26 patients with a mean age of (7.6 ± 8.0) years (range 6 months-32 years) and a mean weight of (23.8 ± 14.8) kg (range 7-67 kg) underwent successful patent ductus arteriose closure. The mean ductus diameter was (2.1 ± 0.7) mm (range 1-3 mm). Transpulmonary (22/26) and transaortic approaches (4/26) were used. No persistent patency was observed after 24 hours and after one month. No device displacement, residual flow and iatrogenic coarctation of the aorta were observed after three months and six months.

CONCLUSIONSThe AVP1 makes it easy to close some Krichenko E patent ductus arterioses. Smaller delivery catheter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter and small patients through transaortic approaches. Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.

Adolescent ; Adult ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; surgery ; Female ; Humans ; Infant ; Male ; Septal Occluder Device ; Young Adult