Exploring the Role of Trial Occlusion Test in Patent Ductus Arteriosus (PDA) Closure: A Serial Case


Authors : Andi Alief Utama Armyn; Andi Yuniar Firmansyah; Yulius Patimang

Volume/Issue : Volume 9 - 2024, Issue 5 - May

Google Scholar : https://tinyurl.com/4s39b3b5

Scribd : https://tinyurl.com/5br2kkhb

DOI : https://doi.org/10.38124/ijisrt/IJISRT24MAY987

Abstract : Background: Patent ductus arteriosus occurs in around 1 in 2000 full-term live newborns, making up 10-15% of cases of congenital heart disease. Percutaneous device closure is largely regarded as the preferred therapy for people diagnosed with PDA. Nevertheless, the closure of the PDA with a device is still a difficult task in patients with severe PAH. The trial occlusion strategy is used to evaluate the response of patients with severe pulmonary hypertension after closing the defect by briefly blocking it. This test has the potential to serve as a reliable predictor of the future progression of pulmonary hypertension. Case Presentation: We provide a report on three instances that underwent percutaneous closure of patent ductus arteriosus (PDA) in the presence of pulmonary hypertension. A 24-year-old adult patient arrived at our hospital with symptoms of intermittent dyspnea, easy fatigability, and occasional non-productive cough. The examination detected a persistent murmur located at the upper left sternal boundary. The patient received a diagnosis of patent ductus aorta and pulmonary hypertension. Discussion: The condition was successfully treated with transcatheter closure, which included a trial occlusion test. In the second instance, a toddler aged 2 was diagnosed with patent ductus aorta and pulmonary hypertension. The procedure of percutaneous PDA closure was scheduled. Following the trial occlusion test using the device occluder, we observed an elevation in pulmonary pressure which persisted and led to a pulmonary crisis. Conclusion: The trial occlusion test aids in identifying individuals who are prone to experiencing long-term regression of pulmonary hypertension and those who may deteriorate due to progressive pulmonary vascular disease (PVD) and right heart failure, therefore determining their suitability for PDA closure.

Keywords : Patent Ductus Arteriosus, Trial Occlusion Test, Pulmonary Hypertension.

References :

  1. Amoozgar, H., Salehi, S., Farhadi, P., Edraki, M. R., Borzoee, M., Ajami, G., Cheriki, S., & Mohammadi, H. (2016). Follow-Up Results of Device Occlusion of Patent Ductus Arteriosus. Iranian journal of pediatrics, 26(3), e3621. https://doi.org/10.5812/ijp.3621
  2. Amoozgar, H., Salehi, S., Farhadi, P., Edraki, M., Borzoee, M., Ajami, G., & Mohammadi, H. (2016). Follow-up results of device occlusion of patent ductus arteriosus. Iranian Journal of Pediatrics, In Press(In Press). https://doi.org/10.5812/ijp.3621
  3. Amoozgar, H., Salehi, S., Farhadi, P., Edraki, M., Borzoee, M., Ajami, G., & Mohammadi, H. (2016). Follow-up results of device occlusion of patent ductus arteriosus. Iranian Journal of Pediatrics, In Press(In Press). https://doi.org/10.5812/ijp.3621
  4. Atik-Ugan, S. and Saltik, İ. (2018). Transcatheter closure of ventricular septal defect with occlutech duct occluder. Cardiology in the Young, 28(4), 598-601. https://doi.org/10.1017/s1047951117002463
  5. Baruteau, A., Hascoët, S., Baruteau, J., Boudjemline, Y., Lambert, V., Angel, C., & Pass, R. (2014). Transcatheter closure of patent ductus arteriosus: past, present and future. Archives of Cardiovascular Diseases, 107(2), 122-132. https://doi.org/10.1016/j.acvd.2014.01.008
  6. Bilkis, A. A., Alwi, M., Hasri, S., Haifa, A. L., Geetha, K., Rehman, M. A., & Hasanah, I. (2001). The Amplatzer duct occluder: experience in 209 patients. Journal of the American College of Cardiology, 37(1), 258–261. https://doi.org/10.1016/s0735-1097(00)01094-9
  7. Cassidy, Harvey & Cassidy, Lynsey & Blackshear, Joseph. (2009). Incidental Discovery of a Patent Ductus Arteriosus in Adults. Journal of the American Board of Family Medicine : JABFM. 22. 214-8. 10.3122/jabfm.2009.02.070230.
  8. Gu, X., Zhang, Q., Sun, H., Fei, J., Zhang, X., & Kutryk, M. (2016). Transcatheter closure of calcified patent ductus arteriosus in older adult patients: immediate and 12-month follow-up results. Congenital Heart Disease, 12(3), 289-293. https://doi.org/10.1111/chd.12437
  9. Güvenç, O. (2016). Closure of wide patent ductus arteriosus using a fenestrated muscular vsd occluder device in a pediatric patient with down syndrome and pulmonary hypertension. Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology. https://doi.org/10.5543/tkda.2016.38283
  10. Hildebrandt, N., Schneider, C., Schweigl, T., & Schneider, M. (2010). Long-term follow-up after transvenous single coil embolization of patent ductus arteriosus in dogs. Journal of Veterinary Internal Medicine, 24(6), 1400-1406. https://doi.org/10.1111/j.1939-1676.2010.0605.x
  11. Hoyer, M. (2005). Novel use of the amplatzer plug for closure of a patent ductus arteriosus. Catheterization and Cardiovascular Interventions, 65(4), 577-580. https://doi.org/10.1002/ccd.20347
  12. Ji, Q., Feng, J., Mei, Y., Wang, X., Cai, J., Sun, Y., & Yong-wu, W. (2008). Transcatheter closure of adult patent ductus arteriosus with severe pulmonary hypertension. Hypertension Research, 31(11), 1997-2002. https://doi.org/10.1291/hypres.31.1997
  13. Ji, Q., Feng, J., Mei, Y., Wang, X., Cai, J., Sun, Y., & Yong-wu, W. (2008). Transcatheter closure of adult patent ductus arteriosus with severe pulmonary hypertension. Hypertension Research, 31(11), 1997-2002. https://doi.org/10.1291/hypres.31.1997
  14. Ji, Q., Feng, J., Mei, Y., Wang, X., Cai, J., Sun, Y., Zhou, Y., Li, D., & Wang, Y. (2008). Transcatheter closure of adult patent ductus arteriosus with severe pulmonary hypertension. Hypertension research : official journal of the Japanese Society of Hypertension, 31(11), 1997–2002. https://doi.org/10.1291/hypres.31.1997
  15. K. Elissa, “Title of paper if known,” unpublished.
  16. Kheiwa, A., Ross, R., & Kobayashi, D. (2016). Reversal of severe mitral regurgitation by device closure of a large patent ductus arteriosus in a premature infant. Cardiology in the Young, 27(1), 189-192. https://doi.org/10.1017/s1047951116000998
  17. Kishi, K., Jarutach, J., Ooi, Y., Wong, N., Mood, M., Geetha, K., & Leong, M. (2022). High haemoglobin levels at the time of occlusion predict worse outcome for patients with patent ductus arteriosus and pulmonary hypertension. Cardiology in the Young, 33(8), 1359-1366. https://doi.org/10.1017/s104795112200244x
  18. Köksal, N., Aygün, C., & Uraş, N. (2019). Turkish neonatal society guideline on the management of patent ductus arteriosus in preterm infants. Türk Pediatri Arşivi, 53(sup1), 76-87. https://doi.org/10.5152/turkpediatriars.2018.01808
  19. Ng, B., Schneider, D., & Hokanson, J. (2011). Closure of tubular patent ductus arteriosus in infants and small children with the amplatzer vascular plug ii. Congenital Heart Disease, 6(1), 64-69. https://doi.org/10.1111/j.1747-0803.2010.00466.x
  20. Niu, M., Mallory, G., Justino, H., Ruiz, F., & Petit, C. (2013). Treatment of severe pulmonary hypertension in the setting of the large patent ductus arteriosus. Pediatrics, 131(5), e1643-e1649. https://doi.org/10.1542/peds.2011-1417
  21. Putra, S. T., Djer, M. M., Idris, N. S., & Sastroasmoro, S. (2016). Transcatheter Closure of Patent Ductus Arteriosus in Adolescents and Adults: A Case Series. Acta medica Indonesiana, 48(4), 314–319.
  22. Sallmon, H., Timme, N., Atasay, B., Erdeve, Ö., Hansmann, G., Singh, Y., & Shelton, E. (2021). Current controversy on platelets and patent ductus arteriosus closure in preterm infants. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.612242
  23. Sallmon, H., Weber, S., Dirks, J., Schiffer, T., Klippstein, T., Stein, A., & Koehne, P. (2018). Association between platelet counts before and during pharmacological therapy for patent ductus arteriosus and treatment failure in preterm infants. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00041
  24. Sathanandam, S., Gutfinger, D., Morray, B., Berman, D., Gillespie, M., Forbes, T., & Zahn, E. (2021). Consensus guidelines for the prevention and management of periprocedural complications of transcatheter patent ductus arteriosus closure with the amplatzer piccolo occluder in extremely low birth weight infants. Pediatric Cardiology, 42(6), 1258-1274. https://doi.org/10.1007/s00246-021-02665-3
  25. Schneider, D. and Moore, J. (2006). Patent ductus arteriosus. Circulation, 114(17), 1873-1882. https://doi.org/10.1161/circulationaha.105.592063
  26. Terek, D., Yalaz, M., Ülger, Z., Köroğlu, Ö., & Kültürsay, N. (2018). Patent ductus arteriosus in preterm infants born before 30 weeks’ gestation: high rate of spontaneous closure after hospital discharge. Cardiology in the Young, 28(8), 995-1000. https://doi.org/10.1017/s1047951118000641
  27. Vijayalakshmi, I., Setty, N., Narasimhan, C., Singla, V., & Manjunath, C. (2014). Percutaneous device closure of patent ductus arteriosus with pulmonary artery hypertension: long‐term results. Journal of Interventional Cardiology, 27(6), 563-569. https://doi.org/10.1111/joic.12156
  28. Wang, Z., Wang, Q., & Xianyang, Z. (2023). Iatrogenic or predetermined aortic dysplasia?. Cardiology in the Young, 33(8), 1456-1458. https://doi.org/10.1017/s104795112200419x
  29. Yan, C., Zhao, S., Jiang, S., Xu, Z., Huang, L., Zheng, H., Ling, J., Wang, C., Wu, W., Hu, H., Zhang, G., Ye, Z., & Wang, H. (2007). Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults. Heart (British Cardiac Society), 93(4), 514–518. https://doi.org/10.1136/hrt.2006.091215
  30. Zhang, D. Z., Zhu, X. Y., Lv, B., Cui, C. S., Han, X. M., Sheng, X. T., Wang, Q. G., & Zhang, P. (2014). Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure. Circulation. Cardiovascular interventions, 7(4), 473–481. https://doi.org/10.1161/CIRCINTERVENTIONS.113.001135

Background: Patent ductus arteriosus occurs in around 1 in 2000 full-term live newborns, making up 10-15% of cases of congenital heart disease. Percutaneous device closure is largely regarded as the preferred therapy for people diagnosed with PDA. Nevertheless, the closure of the PDA with a device is still a difficult task in patients with severe PAH. The trial occlusion strategy is used to evaluate the response of patients with severe pulmonary hypertension after closing the defect by briefly blocking it. This test has the potential to serve as a reliable predictor of the future progression of pulmonary hypertension. Case Presentation: We provide a report on three instances that underwent percutaneous closure of patent ductus arteriosus (PDA) in the presence of pulmonary hypertension. A 24-year-old adult patient arrived at our hospital with symptoms of intermittent dyspnea, easy fatigability, and occasional non-productive cough. The examination detected a persistent murmur located at the upper left sternal boundary. The patient received a diagnosis of patent ductus aorta and pulmonary hypertension. Discussion: The condition was successfully treated with transcatheter closure, which included a trial occlusion test. In the second instance, a toddler aged 2 was diagnosed with patent ductus aorta and pulmonary hypertension. The procedure of percutaneous PDA closure was scheduled. Following the trial occlusion test using the device occluder, we observed an elevation in pulmonary pressure which persisted and led to a pulmonary crisis. Conclusion: The trial occlusion test aids in identifying individuals who are prone to experiencing long-term regression of pulmonary hypertension and those who may deteriorate due to progressive pulmonary vascular disease (PVD) and right heart failure, therefore determining their suitability for PDA closure.

Keywords : Patent Ductus Arteriosus, Trial Occlusion Test, Pulmonary Hypertension.

Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe