Jason Nathaniel Johnson^1,2, Shyam Sathanandam¹, Ronak Naik¹, Ranjit Philip¹

Congenital Heart Disease, Vol.14, No.1, pp. 74-78, 2019, DOI:10.1111/chd.12725

Abstract Echocardiographic imaging provides real‐time guidance during transcatheter patent ductus arteriosus (PDA) closure in extremely low birth weight (ELBW) infants. Transthoracic echocardiogram provides detailed assessment of the PDA and sur‐ rounding structures prior to, during, and after transcatheter closure. This article aims to review the different echocardiographic techniques and concepts utilized during transcatheter PDA closure in ELBW infants. More >

Anthony Merlocco

Congenital Heart Disease, Vol.14, No.1, pp. 100-104, 2019, DOI:10.1111/chd.12719

Abstract The ductus arteriosus (DA) has been studied since Galen. Initially after birth in neo‐ nates with obstruction to pulmonary blood flow, DA patency is integral to ensure out‐ put and oxygenation. While DA stenting dates back 25 years, there is emerging interest in better understanding how and when to utilize this strategy as an alternative to surgi‐ cal shunt placement or ongoing prostaglandin administration. Understanding the nor‐ mal fetal circulation and the perturbations that affect flow and oxygenation is integral to comprehending how normal DA anatomy and morphology may change and how this may influence technical and clinical considerations. In… More >

John M. Ferguson

Congenital Heart Disease, Vol.14, No.1, pp. 52-56, 2019, DOI:10.1111/chd.12715

Abstract Even though up to 60% of premature infants less than 28 weeks gestation develop persistent patent ductus arteriosus (PDA), there remains controversy regarding if, when, and how to close the PDA. Failure to close the PDA has been associated with significant morbidity but no cause‐and‐effect has been proven for short‐term or long‐term outcomes in modern times. Surgical closure has the advantage of eliminating the PDA, but short‐term complications and long‐term adverse outcomes are worrisome. Intravenous indomethacin has been the “gold standard” for pharmacologic treatment over the past 40 years with high closure rates and decreased incidence of severe intraventricular hemorrhage… More >

Stacey L. Crockett, Courtney D. Berger, Elaine L. Shelton, Jeff Reese

Congenital Heart Disease, Vol.14, No.1, pp. 15-20, 2019, DOI:10.1111/chd.12714

Abstract Regulation of the ductus arteriosus, an essential fetal vessel connecting the pulmo‐ nary artery and aorta, is complex. Failure of this vessel to close after birth may result in a persistent left‐to‐right shunt through the patent ductus arteriosus, a condition associated with significant morbidities. Numerous factors contribute to the shift from fetal ductus patency to postnatal closure, requiring precise coordination of molecular cues with biomechanical forces and underlying genetic influences. Despite significant advances, questions remain regarding signaling dynamics and the natural time course of ductus closure, particularly in preterm neonates. This review highlights the contri‐ butions of early investigators and… More >

Myriam Almeida‐Jones^1,2, Nai Yu Tang^1,2, Aneela Reddy³, Evan Zahn^1,2

Congenital Heart Disease, Vol.14, No.1, pp. 60-64, 2019, DOI:10.1111/chd.12712

Abstract Clinically significant patent ductus arteriosus (PDA) has been associated with signifi‐ cant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a compre‐ hensive review of this emerging procedure. More >

Ruth Seaton, Chandler Williams, Julia Peredo

Congenital Heart Disease, Vol.14, No.1, pp. 65-68, 2019, DOI:10.1111/chd.12711

Abstract The ductus arteriosus is a lifeline for the developing fetus prior to delivery, allowing the circulation of oxygen‐rich blood from the placenta to bypass the lungs and per‐ fuse the body. However, when the ductus fails to close after birth, the pressures can cause blood to shunt from the aorta back into the lungs, causing pulmonary edema. This is called a left‐to‐right shunt. The patent ductus arteriosus (PDA) can also shunt blood from the pulmonary arteries to the aorta, bypassing the lungs and causing oxy‐ gen‐poor blood to mix with the oxygen‐rich blood circulating to the body. This is called… More >

Shyam Sathanandam, Ashley Gianinni, Eric Sefton, Kaitlyn Greer, Nathan Stecchi, Kimberly Allen, Ranjit Philip, B. Rush Waller

Congenital Heart Disease, Vol.14, No.1, pp. 85-89, 2019, DOI:10.1111/chd.12710

Abstract Objective: The objective of this article is to describe a live case transmission of tran‐ scatheter closure of a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) infant during the first International PDA Symposium conducted in Memphis, Tennessee.
Setting: A multidisciplinary team approach including audiovisual specialists, informa‐ tion technology specialists, physicians, nurses, and other health care specialists was required to perform the transcatheter PDA closure (TCPC) in an ELBW infant at LeBonheur Children’s Hospital and the procedure was broadcast live to the attend‐ ees at the International PDA Symposium allowing for a two‐way audiovisual discus‐ sion during… More >

Varun Aggarwal¹, Christopher J. Petit², Andrew C. Glatz^3，4, Bryan H. Goldstein⁵, Athar M. Qureshi¹

Congenital Heart Disease, Vol.14, No.1, pp. 110-115, 2019, DOI:10.1111/chd.12709

Abstract The use of prostaglandin‐E1 immediately after birth and subsequent surgical crea‐ tion of the modified Blalock‐Taussig shunt (BTS) shunt have remarkably improved the prognosis and survival of children with congenital heart disease and ductal‐depend‐ ent pulmonary blood flow (PBF). Despite the advancement in surgical techniques, bypass strategies, and postoperative management, significant morbidity and mortal‐ ity after BTS still remain. Patent ductus arteriosus stenting has been shown to be as an acceptable alternative to BTS placement in select infants with ductal‐dependent PBF. Newer procedural techniques and equipment, along with operator experience have all contributed to procedural refinement associated with improved outcomes… More >

Meera N. Sankar, Shazia Bhombal, William E. Benitz

Congenital Heart Disease, Vol.14, No.1, pp. 46-51, 2019, DOI:10.1111/chd.12708

Abstract Management of patent ductus arteriosus in extremely preterm infants remains a topic of debate. Treatment to produce ductal closure was widely practiced until the past decade, despite lack of evidence that it decreases morbidities or mortality. Meta‐analyses of trials using nonsteroidal anti‐inflammatory drugs have shown ef‐ fectiveness in accelerating ductal closure, but no reduction in neonatal morbidities, regardless of agent used, indication, timing, gestational age, or route of administra‐ tion. Surgical ligation closes the ductus but is associated with adverse effects. Recent experience with conservative approaches to treatment suggest improved neonatal outcomes and a high rate of spontaneous ductal closure… More >

Dana M. Boucek¹, Athar M. Qureshi², Bryan H. Goldstein ³, Christopher J. Petit⁴, Andrew C. Glatz^1,5

Congenital Heart Disease, Vol.14, No.1, pp. 105-109, 2019, DOI:10.1111/chd.12707

Abstract Background: Infants with ductal-dependent pulmonary blood flow (PBF) often undergo a palliative procedure to provide a stable source of PBF prior to definitive palliation or repair. In the current era, a surgical shunt or ductal stent is used to provide PBF. We aimed to review the current literature comparing ductal stents to surgical shunts.
Methods and Results: Four small, single-center studies and two larger multicenter studies were identified comparing ductal stent to surgical shunt. Combined, these studies showed ductal stent resulted in similar or improved pulmonary artery growth, fewer complications, shorter length of stay, less diuretic use, and improved survival… More >