• Clinical and Experimental Pediatrics
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• v.60 no.6
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• pp.175-180
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• 2017

Purpose: Plasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA). Methods: Before March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved. Results: The BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment. Conclusion: Individualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA.

• Journal of Veterinary Clinics
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• v.32 no.3
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• pp.243-246
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• 2015

A 9 month-old female Chihuahua (weighing 1.5 kg) was referred with loud left basal murmur and exercise intolerance. Diagnostic imaging studies revealed the elongation of left ventricle (LV) with classic triple bumps on the main pulmonary artery, aorta and left atrium on the dorsoventral view of radiograph. Echocardiography revealed patent ductus arteriosus (PDA) duct and continuous turbulent shunt flow (maximal velocity 5.73 m/s) between the aorta and pulmonary artery with left to right direction. The PDA in this dog was successfully closed though femoral vein (transvenous approach) using an Amplatzer$^{(R)}$ vascular plug. To the best of author's knowledge, this is the first case of PDA occlusion treated with vascular plug through femoral vein.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1270-1275
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• 1996

Pulmonary artery aneurysms are extremely rare conditions usually associated with congenital cardiac defects that cause increased pulmonary blood flow and pulmonary hypertension. The prognosis of pulmonary artery aneurysms is fatal due to the potential for rupture of the aneurysm and the underlying severe pulmonary hypertension. A 40-year old woman was admitted to our hospital with headache following traffic accident. On admission a continuous murmur was heard over the 2nd to 3rd intercostal space along left sternal border and a calcified cystic mass at left hilar portion was incidentally discoverd on chest reontgenogram. Cardiac catherization was diagnostic of a left to right shunt at main pulmoanry artery level and pulmonary hypertension. Pulmonary angiogram demonstrated a large aneurysm of main pulmonary artery extending into proximal left pulmonary artery. The pulmonary artery aneurysm associated with patent ductus arteriosus was diagnosed definitively and the patient was underwent resection of pulmonary artery aneurysm, closure of PDA and Dacron prosthetic graft replacement under cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged without any problem.

• The Korean Journal of Nuclear Medicine
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• v.21 no.2
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• pp.155-165
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• 1987

The noninvasive nature of the radionuclide angiocardiography provided a useful approach for the evaluation of left-to-right cardiac shunts (LRCS). While the qualitative information can be obtained by inspection of serial radionuclide angiocardiograms, the quantitative information of radionuclide angiocardiography can be obtained by the analysis-of time-activity curves using advanced computer system. The count ratios method and pulmonary-to-systemic flow ratio (QP/QS) by gamma variate fit method were used to evaluate the accuracy of detection and localization of LRCS. One hundred and ten time-activity curves were analyzed. There were 46 LRCS (atrial septal defects 11, ventricular septal defects 22, patent ductus arteriosus 13) and 64 normal subjects. By computer analysis of time-activity curves of the right atrium, ventricle and the lungs separately, the count ratios modified by adding the mean cardiac transit time were calculated in each anatomic site. In normal subjects the mean count ratios in the right atrium, ventricle and lungs were 0.24 on average. In atrial septal defects, the count ratios were high in the right atrium, ventricle and lungs, whereas in ventricular septal defects the count ratios were higher only in the right ventricle and lungs. Patent ductus arteriosus showed normal count ratios in the heart but high count ratios were obtained in the lungs. Thus, this count ratios method could be separated normal from those with intra cardiac or extracardiac shunts, and moreover, with this method the localization of the shunt level was possible in LRCS. Another method that could differentiate the intracardiac shunts from extracardiac shunts was measuring QP/QS in the left and right lungs. In patent ductus arteriosus, the left lung QP/QS was higher than those of the right lung, whereas in atrial septal defects and ventricular septal defects QP/QS ratios were equal in both lungs. From this study, it was found that by measuring QP/QS separately in the lungs, intracardiac shunt could be differenciated from extracardiac shunts.

• Clinical and Experimental Pediatrics
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• v.61 no.12
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• pp.397-402
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• 2018

Purpose: Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. Methods: We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6-12 months in the same study period were reviewed. Results: A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was $3.3{\pm}1.5months$, and weight was $5.7{\pm}1.3kg$. The duct diameter at the narrowest point was $3.0{\pm}0.8mm$ as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6-12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P<0.01). Conclusion: A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.

• Korean Journal of Veterinary Service
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• v.47 no.1
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• pp.55-59
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• 2024

A 4-year-old, spayed female German Shepherd dog (GSD) weighing 22.4 kg was referred to Chungnam National University Veterinary Medicine Teaching Hospital with the chief complaint of a cardiac murmur. A continuous murmur was detected at the left basilar region upon auscultation. In the thoracic radiographs, slight bulging of the aorta, the main pulmonary artery, and the left atrium were observed. Echocardiography revealed continuous turbulent flow directed from the main pulmonary artery towards the pulmonary valve and consistently within the main pulmonary artery. Based on all the results, a diagnosis of type II A patent ductus arteriosus (PDA) was made, and plans were established to treat it with transcatheter occlusion. Transcatheter occlusion was performed using a vascular plug and successfully deployed at the PDA. The patient did not exhibit any complications. GSDs are relatively less common compared to small-breed dogs in South Korea. Considering that GSDs are predisposed to PDA, it is crucial to periodically assess the presence of PDA through auscultation and echocardiography, even in the absence of clinical signs. Transcatheter occlusion using a vascular plug can be an option for treatment and can yield favorable outcomes.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.542-548
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• 1985

In 1966 Porstmann was the first to successfully apply a new method by which a PDA was closed by a Plug transported by catheters through the femoral artery. We Successfully closed the isolated PDA in 6 consecutive patients using the transfemoral catheter method. To Perform this technique more safely and reliably, some instrumental and technical improvements was made. The Indications for this method have been Expanded to include the cylindrical or window Type ductus as well as the conical-shaped ductus. Classification into three Groups of the configuration of the by Angiography has been useful in selecting the shape of the closing plug. Whenever feasible, we consider the catheter technique to be the method of choice to close the ductus.

• Journal of Veterinary Clinics
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• v.26 no.2
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• pp.123-129
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• 2009

Patent ductus arteriosus(PDA) is an abnormal shunt between the descending aorta and pulmonary artery through the incompletely closed ductus arteriosus and is the most common congenital heart defect in dogs. Recent human genetic studies found that a the gene mutation in transcription factor AP-2 beta(TFAP2B) was responsible for syndromic cases of PDA. Mutations in the TFAP2B gene are associated with certain congenital cardiac defects in humans that include PDA. In this study, we isolated the entire coding exons of canine TFAP2B gene for genetic screening in dogs with PDA. Analysis of the deduced amino acid sequence suggested that the canine TFAP2B are phylogenetically closer to the human TFAP2B(100% identity in amino acid sequence) than mouse and rat. In cTFAP2B gene screening, one single c.936+203G>A base change was found in affected Maltese dogs with PDA. However, further screening found the same base change in one unaffected control dog, suggesting this base change might be polymorphism. No other base changes were found in other dog breeds enrolled in this study. Because the base change was located in the intronic region and found in an unaffected control dog, TFAP2B might not be responsible for familial PDA in Malteses and sporadic cases of other dog breeds, although the gene promoter region should be investigated before reaching to this conclusion. A future study that may take this study further would be to collect more samples and to screen TFAP2B in various breeds of dogs with PDA and other various congenital heart defects.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.16-21
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• 1999

Background: This study is to suggest the optimal method as a treatment for the patent ductus arteriosus in the premature infants. Material and Method : Between April 1994 and April 1997, 45 premature infants with evidence of a hemodynamically significant patent ductus arteriosus associated with cardiopulmonary compromise underwent indomethacin therapy, surgical treatment, or both. Thirty-nine infants received indomethacin and twelve infants among them were surgically ligated because of indomethacin failure(5) or complications(7). Six infants, who weighed less than 1,500 gm at birth, were referred for primary surgical ligation because of contraindication to indomethacin therapy. Result: The failure rate of indomethacin therapy was 43%(17/39) and the complications(13/39, 33%) to the indomethacin were associated with a high morbidity and mortality. Among the infants who underwent ligation, there were no failures and complications related to the operation. This data suggests that in the premature neonate with a hemodynamically significant PDA, (1) indomethacin therapy is associated with a high failure rate and significant complications, (2) surgical duct closure is associated with minimal morbidity. Conclusion: Although the results of this study cannot suggest the optimal management for PDA in premature infants, primary surgical ligation may be considered. However, long-term studies will be needed to confirm this later.

• Korean Journal of Veterinary Research
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• v.46 no.2
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• pp.171-175
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• 2006

Three dogs with suspected patent ductus arteriosus were referred to Veterinary Medical Teaching Hospital of College of Veterinary Medicine, Konkuk University because of cough, shortness of breath, exercise intolerance, and syncope, Continuous murmur and thrill were detected in physical examination. Left ventricular enlargement, cardiomegaly, bulged main pulmonary artey were found in radiography. Tall R wave, wide P wave, atrial fibrillation, and turbulent flow were observed in electrocardiogram and echocardiogram. Thoracotomy was performed at left fourth intercostal space under isoflurane anesthesia. Patent ductus arteriosus was double ligated with 1-0 silk. The median (mean ${\pm}$ SD) diameter of patents was $8.0{\pm}2.0mm$. The median operation time was $36{\pm}6.6min$. On examination right after surgery, continuous murmur, thrill, atrial fibrillation, and turbulent flow were disappeared. On 30 days after surgery, clinical signs, left ventricular enlargement, and, bulged main pulmonary artery were disappeared. VHS 12.5 and 13.5, R wave 3.3 and 3.0 mV, and P wave 0.05 and 0.05 sec were decreased to 10.0 and 10.5, 1.8 and 2.0 mV, and 0.04 and 0.04 sec respectively in case 1 and 2. Ratio of aorta and main pulmonary artery in diameter was changed 1 : 1.3 and 1 : 1.6 into 1 : 1.1 and 1 : 1 respectively in case 1 and 2. Mild tear developed during dissection in case 3 and hemorrhage was controlled by vascular Devakey forceps. However, the dog died. On 12 months after surgery, patients (case 1 and case 2) have not showed abnormal signs.