Patent Duktus Arteriyozus Transkateter Kapama
Özet
Patent duktus arteriyöz (PDA), fetal dolaşım sırasında gerekli olan ve doğumdan sonra kapanması beklenen bir vasküler yapıdır. Term infantlarda genellikle doğumdan sonra 3-4 gün içinde kapanırken, preterm infantlarda bu kapanma ihtimali düşüktür. PDA, konjenital kalp defektlerinin %10’unu oluşturur ve kadınlarda daha yaygındır. Klinik olarak asemptomatik olabileceği gibi kalp yetmezliği, pulmoner hipertansiyon veya Eisenmenger sendromu gibi ciddi durumlara yol açabilir.
PDA tanısı ekokardiyografi ile konur ve tedavi edilmezse sol kalp yetmezliği gibi komplikasyonlara neden olabilir. Transkateter kapatma, günümüzde PDA tedavisinde ilk tercih edilen yöntemdir ve %80-90 oranında başarıyla uygulanabilir. Gelişen cihaz teknolojisi sayesinde, bu yöntem minimal invaziv ve düşük komplikasyon riskine sahiptir. Amplatzer ductal ocluder (ADO) cihazları en sık kullanılan kapatma cihazlarıdır. Pulmoner hipertansiyonu olan hastalarda kapatma öncesi kateterizasyon gereklidir.
Transkateter kapama işleminde femoral arter ve ven yoluyla PDA'ya ulaşılır ve uygun cihaz yerleştirilir. Komplikasyonlar nadirdir ve genellikle cihaz seçimindeki hatalardan kaynaklanır. Erken tanı ve uygun tedavi ile PDA’nın komplikasyonları önlenebilir, böylece hastaların yaşam kalitesi artırılabilir. Transkateter kapatma, PDA tedavisinde güvenli ve etkili bir yöntem olarak kabul edilmektedir.
Patent ductus arteriosus (PDA) is a vascular structure necessary for fetal circulation, expected to close shortly after birth. In term infants, it typically closes within 3-4 days, whereas in preterm infants, the likelihood of spontaneous closure decreases. PDA accounts for 10% of congenital heart defects and is more prevalent in females. Clinically, PDA may be asymptomatic or lead to severe conditions such as heart failure, pulmonary hypertension, or Eisenmenger syndrome.
The diagnosis of PDA is primarily made via echocardiography, and untreated PDA can result in left heart failure and other complications. Transcatheter closure is the preferred treatment method today, with a success rate of 80-90%. Advances in device technology have made this method minimally invasive and low-risk. The Amplatzer ductal occluder (ADO) devices are the most commonly used for closure. In patients with pulmonary hypertension, catheterization is necessary before closure.
During the transcatheter closure procedure, access is gained through the femoral artery and vein to reach the PDA and deploy the appropriate device. Complications are rare and typically arise from device selection errors. Early diagnosis and appropriate treatment can prevent PDA-related complications, thereby improving patients’ quality of life. Transcatheter closure is considered a safe and effective method for PDA treatment.
Referanslar
Gournay V. The ductus arteriosus: physiology, regulation, and functional and congenital anomalies. Arch Cardiovasc Dis 2011;104:578-85
Dice JE. Patent Ductus Arteriosus: An Overview. 2007;12(3):138- 46.
Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation. 2006;114(17):1873-82.
Clyman R.I. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. Semin Perinatol. 2018;42(4):235–242.
Philip, Ranjit & Waller, Benjamin & Agrawal, Vijaykumar & Wright, Dena & Arevalo, Alejandro & Zurakowski, David & Sathanandam, Shyam. (2015). Morphologic characterization of the patent ductus arteriosus in the premature infant and the choice of transcatheter occlusion device. Catheterization and Cardiovascular Interventions. 87. n/a-n/a. 10.1002/ccd.26287.
Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645.
Habib G, Lancellotti P, Antunes MJ, et al. [2015 ESC Guidelines for the management of infective endocarditis. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)]. G Ital Cardiol (Rome). 2016;17(4):277- 319
Perloff JK, Marelli A. Patent Ductus Arteriosus Aortopulmonary Window In: Perloff JK, editor. Clinical Recognition of Congenital Heart Disease: Saunders; 2012
Becker TE, Ensing GJ, Darragh RK, Caldwell RL. Doppler derivation of complete pulmonary artery pressure curves in patent ductus arteriosus. Am J Cardiol. 1996; 78: 1066–1069.
Taneja K, Gulati M, Jain M, Saxena A, Das B, Rajani M. Ductal arteriosus aneurysm in the adult: role of computed tomography in diagnosis. Clin Radiol. 1997; 52: 231–234.
Brenner LD, Caputo GR, Mostbeck G, Steiman D, Dulce M, Cheitlin MD, O’Sullivan M, Higgins CB. Quantification of left to right atrial shunts with velocity-encoded cine nuclear magnetic resonance imaging. J Am Coll Cardiol. 1992; 20: 1246–1250.
Gross RE, Hubbard JP. Surgical ligation of a patent ductus arteriosus: a report of first successful case. JAMA. 1939; 112: 729–731.
Portsmann W, Wierny L, Warnke H. Closure of persistent ductus arteriosus without thoracotomy. Ger Med Monthly. 1967; 12: 259–261.
Rashkind WJ, Cuaso CC. Transcatheter closure of a patent ductus arteriosus: successful use in a 3.5-kg infant. Pediatr Cardiol. 1979; 1: 3–7.
Rao PS.Transcatheter closure of moderate to large patent ductus arteriosus. J Invasive Cardiol 2001;13:303-5.
Saliba Z, El-Rassi I, Abi-Warde MT, et al. The Amplatzer Duct Occluder II: a new device for percutaneous ductus arteriosus closure. J Interv Cardiol 2009;22:496-502.
Pass RH, Hijazi Z, Hsu DT, Lewis V, Hellenbrand WE. Multicenter USA Amplatzer patent ductus arteriosus occlusion device trial: initial and one-year results. J Am Coll Cardiol 2004;44(3):513-9.
McMullan DM, Moulick A, Jonas RA. Late embolization of Amplatzer patent ductus arteriosus occlusion device with thoracic aorta embedment. Ann Thorac Surg 2007;83:1177-9.
Referanslar
Gournay V. The ductus arteriosus: physiology, regulation, and functional and congenital anomalies. Arch Cardiovasc Dis 2011;104:578-85
Dice JE. Patent Ductus Arteriosus: An Overview. 2007;12(3):138- 46.
Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation. 2006;114(17):1873-82.
Clyman R.I. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. Semin Perinatol. 2018;42(4):235–242.
Philip, Ranjit & Waller, Benjamin & Agrawal, Vijaykumar & Wright, Dena & Arevalo, Alejandro & Zurakowski, David & Sathanandam, Shyam. (2015). Morphologic characterization of the patent ductus arteriosus in the premature infant and the choice of transcatheter occlusion device. Catheterization and Cardiovascular Interventions. 87. n/a-n/a. 10.1002/ccd.26287.
Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645.
Habib G, Lancellotti P, Antunes MJ, et al. [2015 ESC Guidelines for the management of infective endocarditis. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)]. G Ital Cardiol (Rome). 2016;17(4):277- 319
Perloff JK, Marelli A. Patent Ductus Arteriosus Aortopulmonary Window In: Perloff JK, editor. Clinical Recognition of Congenital Heart Disease: Saunders; 2012
Becker TE, Ensing GJ, Darragh RK, Caldwell RL. Doppler derivation of complete pulmonary artery pressure curves in patent ductus arteriosus. Am J Cardiol. 1996; 78: 1066–1069.
Taneja K, Gulati M, Jain M, Saxena A, Das B, Rajani M. Ductal arteriosus aneurysm in the adult: role of computed tomography in diagnosis. Clin Radiol. 1997; 52: 231–234.
Brenner LD, Caputo GR, Mostbeck G, Steiman D, Dulce M, Cheitlin MD, O’Sullivan M, Higgins CB. Quantification of left to right atrial shunts with velocity-encoded cine nuclear magnetic resonance imaging. J Am Coll Cardiol. 1992; 20: 1246–1250.
Gross RE, Hubbard JP. Surgical ligation of a patent ductus arteriosus: a report of first successful case. JAMA. 1939; 112: 729–731.
Portsmann W, Wierny L, Warnke H. Closure of persistent ductus arteriosus without thoracotomy. Ger Med Monthly. 1967; 12: 259–261.
Rashkind WJ, Cuaso CC. Transcatheter closure of a patent ductus arteriosus: successful use in a 3.5-kg infant. Pediatr Cardiol. 1979; 1: 3–7.
Rao PS.Transcatheter closure of moderate to large patent ductus arteriosus. J Invasive Cardiol 2001;13:303-5.
Saliba Z, El-Rassi I, Abi-Warde MT, et al. The Amplatzer Duct Occluder II: a new device for percutaneous ductus arteriosus closure. J Interv Cardiol 2009;22:496-502.
Pass RH, Hijazi Z, Hsu DT, Lewis V, Hellenbrand WE. Multicenter USA Amplatzer patent ductus arteriosus occlusion device trial: initial and one-year results. J Am Coll Cardiol 2004;44(3):513-9.
McMullan DM, Moulick A, Jonas RA. Late embolization of Amplatzer patent ductus arteriosus occlusion device with thoracic aorta embedment. Ann Thorac Surg 2007;83:1177-9.
