Digital subtraction angiography of patent ductus arteriosus

Digital subtraction angiography (DSA) was performed in 31 patients with the open arterial duct (OAD), of them 15 were outpatients. Diagnosis was made in all primary patients using DSA, indications and contraindications for endovascular occlusion of the OAD were defined. Of 17 patients examined at varying time after endovascular occlusion of the duct, valid signs of reliable occlusion of the duct were obtained in 16. In one patient a contrast medium got from the aorta to the pulmonary artery via the arterial duct indicating OAD incomplete closure. DSA can be used under outpatient conditions to define indications and contraindications for endovascular occlusion of the OAD and to assess its long-term effectiveness.     

Results of the treatment of patent ductus arteriosus

Since the first effective surgical treatment of PAD, the indications for such a treatment have been more extensive and its results and methods have been changing. We present 123 patients who underwent surgery for PAD in the Clinic of Cardiosurgery, Institute of Cardiology, Medical Academy of Lód? within 1978-1987. In 101 cases PAD was dissected and both ends were sutured in two layers with continuous sutures, and in 22 cases PAD was ligated with 3 ligatures. In 30 patients PAD coincided with other congenital defects of the circulatory system. No cases of recanalization were observed in our patients. One death in the postoperative course was noted.     

Percutaneous closure of an adult patent ductus arteriosus

A 23-year-old asymptomatic male was referred to our outpatient clinic because of an incidentally discovered grade III continuous machinery murmur at the third intercostal space on the left sternal edge. The echocardiography showed the presence of a patent ductus arteriosus (PDA).     

Clinical patent ductus arteriosus in adult genetically epilepsy-prone rats

Persistent patent ductus arteriosus (PDA) and clinically silent PDAs are relatively common congenital cardiac defects in humans. We report here the occurrence of symptomatic PDA in adults from a colony of genetically epilepsy-prone rats (GEPRs). Affected rats displayed severe ventral edema. Echocardiography revealed PDA in several animals. Necropsy findings included cardiomegaly, hepatic hyperemia and centrilobular necrosis indicative of passive congestion, and vascular changes consistent with pulmonary hypertension. All affected rats were descendants of one of two brother-sister breeding pairs established from a single litter in April 2000. Clinically silent PDAs were also detected in the colony. Histological examination of the ligamentum arteriosus showed normal vascular tissue in asymptomatic GEPR and Sprague-Dawley rats. PDAs are likely to have a genetic component in the GEPR colony and may provide a novel model for the study of pathogenesis and therapy of this condition.     

Mathematical model of flow through the patent ductus arteriosus

The ductus arteriosus is one of several shunts in the cardiovascular system. It is a small vessel connecting the aortic arch and pulmonary artery that allows blood to bypass the pulmonary circulation. It is open during foetal development because the foetal lungs cannot function and oxygenation of the blood occurs by exchange with the maternal blood in the placenta. Normally it closes a few days after birth; however, in a small number of people closure does not occur, leading to a condition known as patent ductus arteriosus. In this paper our aim is to investigate the resulting cardiovascular effects. We develop a mathematical model of the haemodynamics in three different idealised geometries by assuming that the entry flow is irrotational and remains so in the core until at least the shunt position. We argue that separation or diffusion of vorticity into the core flow is delayed due to the high frequency associated with the pulsatile component of the flow profile. The analysis uses complex potential theory, Schwarz–Christoffel transformations, conformal mappings and Fourier series. The main results are based on the assumption that the flow in patients with patent ductus arteriosus is similar to the flow in healthy adults, and we apply this assumption using boundary conditions that are representative of physiological values in healthy adults. The model suggests that the pressures in the aorta and pulmonary artery are likely to equalise, that the shear stress increases near the edges of the shunt and that backflow of large volumes may occur from the pulmonary artery into the aorta or towards the ventricles due to the presence of the patent shunt. Our results strongly suggest that an abnormal compensatory physiology develops in patients with patent ductus arteriosus.     

DuctOcclud--implant for transcatheter closure of patent ductus arteriosus.

The DuctOcclud implant is a metal coil device designed for transcatheter closure of small to moderate size patent ductus arteriosus, a Congenital Heart Disease in which a vessel-like communication between the aorta and the pulmonary artery persists after birth. The paper describes the design of the device, its delivery system, and the implant procedure. It also reviews and reports the experimental and the clinical experiences accumulated utilizing the device for occlusion of patent ductus arteriosus.     

Morphology of aortic arch obstruction with patent ductus arteriosus

Thirty-one hearts with aortic arch obstruction and patent ductus arteriosus were examined with special reference to associated cardiac anomalies. Six presented with complete interruption of the aortic arch, four with atretic isthmus, twelve with coarctation, and three with tubular hypoplasia. Associated cardiac anomalies were divided into two main groups: (1) septal defect with left-to-right shunt, and (2) left ventricular inflow and/or outflow obstruction. A high incidence (9/19=47.4%) of ventriculo-infundibular malalignment type of ventricular septal defect with subaortic stenosis was observed. Associated cardiac lesions that reduce blood flow in the aortic arch during fetal life may be responsible for poor development of this structure.     

Structural changes in cardiac vessels in experimental patent ductus arteriosus

In 43 puppies an experimental arterial duct was produced. The animals were observed for 1--2 months and then killed. Their hearts were separately weighed, and their vessels were studied by means of a complex histomicrometry method. In the puppies with the artificially produced arterial duct, hypertrophy of both cardiac ventricles was gradually developing, combined with thickening medial tunica of the coronary arteries at all levels of their branching. Simultaneously, the oblique-longitudinal musculature of the vascular walls grew stronger. In the distributing arteries it occurred at the expense of the muscular fasciculi situated in adventitia, in the resistance arteries--at the expense of the fasciculi situated in intima. The hypertrophic-hyperplastic changes noted in the vessels of the coronary system were connected with cardiac hypertrophy and with disorders of coronary hemodynamics.