Open Access

INTRODUCTION

Douglas S. Moodie¹, Shyam Sathanandam², Athar M. Qureshi³
Congenital Heart Disease, Vol.14, No.1, pp. 5-5, 2019, DOI:10.1111/chd.12761
Abstract This article has no abstract. More >

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Shyam Sathanandam¹, Stephanie Whiting¹, Jorden Cunningham¹, David Zurakowski², Leah Apalodimas¹, B. Rush Waller¹, Ranjit Philip¹, Athar M. Qureshi³
Congenital Heart Disease, Vol.14, No.1, pp. 6-14, 2019, DOI:10.1111/chd.12729
Abstract Background: Patent ductus arteriosus (PDA) is highly prevalent in extremely low birth weight (ELBW), preterm infants. There are diverse management approaches for the PDA in ELBW infants. The objectives of this research were to identify current PDA management practices among cardiologists and neonatologists in the United States, describe any significant differences in management, and describe areas where practices align.
Methods: A survey of 10 questions based on the management of PDA in ELBW infants was conducted among 100 prominent neonatologists from 74 centers and 103 prominent cardiologists from 75 centers. Among the cardiologists, approximately 50% were interventionists who perform transcatheter… More >

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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 >

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Jennifer L. Shepherd, Shahab Noori
Congenital Heart Disease, Vol.14, No.1, pp. 21-26, 2019, DOI:10.1111/chd.12727
Abstract Objective: There is no consensus on the definition of a hemodynamically significant patent ductus arteriosus (hsPDA). In this review article, our objective is to discuss the main variables that one should consider when determining the hemodynamic signifi‐ cance of a PDA.
Results: We describe the various approaches that have been utilized over time to define an hsPDA and discuss the strengths and weaknesses of each echocardio‐ graphic index. Finally, we propose a comprehensive and individualized approach in determining the hemodynamic significance of the PDA.
Conclusion: There are several PDA‐related clinical, echocardiographic, and other ob‐ jective variables to take into consideration… More >

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Kent A. Willis, Mark F. Weems
Congenital Heart Disease, Vol.14, No.1, pp. 27-32, 2019, DOI:10.1111/chd.12691
Abstract Patent ductus arteriosus (PDA) is prevalent in premature newborns and has been linked to the development of bronchopulmonary dysplasia (BPD), a serious pulmonary complication of premature birth. Although a causal relationship has not been proven, the link is greatest among infants born at lower gestational age who are treated with mechanical ventilation in the presence of a large ductal shunt. Despite strong association in epidemiological studies, treatment of a patent ductus arteriosus has not been shown to prevent BPD, and some therapies may increase the risk of BPD. We describe preclinical and clinical data demonstrating the association of a PDA… More >

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Ranjit Philip¹, Jeffrey A. Towbin¹, Shyam Sathanandam ¹, Jason Goldberg¹, Thomas Yohannan¹, Nithya Swaminathan¹, Jason Nathaniel Johnson^1,2
Congenital Heart Disease, Vol.14, No.1, pp. 33-36, 2019, DOI:10.1111/chd.12701
Abstract There continues to be controversy on the long‐term effects of a patent ductus arte‐ riosus (PDA) and its management. However, the hemodynamic effects of a large PDA in a preterm infant are well known. This article aims to provide insight into the adap‐ tive changes and remodeling effects of a PDA on the myocardium in preterm infants. More >

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1061

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Ranjit Philip¹, Jason Nathaniel Johnson^1,2, Ronak Naik¹, Dai Kimura^1,3, Umar Boston¹, Sandeep Chilakala¹, Benjamin Hendrickson¹, Benjamin Rush Waller¹, Shyam Sathanandam¹
Congenital Heart Disease, Vol.14, No.1, pp. 37-41, 2019, DOI:10.1111/chd.12702
Abstract The hemodynamic effects of a patent ductus arteriosus (PDA) are well known including systemic hypoperfusion and volume overload on the left ventricle. This article aims to provide a review of the long-standing effect of a hemodynamically significant PDA on the pulmonary vasculature and the role of cardiac catheterization in preterm infants with a PDA and pulmonary hypertension. More >

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Govinda Paudel, Vijaya Joshi
Congenital Heart Disease, Vol.14, No.1, pp. 42-45, 2019, DOI:10.1111/chd.12703
Abstract Management of the patent ductus arteriosus (PDA) in the premature infant has been a point of controversy for decades as smaller and earlier gestational age infants have been surviving. Increasing experience with catheter‐based device closure has gener‐ ated a new wave of interest in this subject. In this era, echocardiography plays a cen‐ tral role for collaboration within a multispecialty team. Reliability of echocardiography is improved by applying an institutionally derived standard approach to imaging, data collection, and reporting. The key aspects of both the physiology and anatomy of the PDA to distinguish infants that may benefit from intervention are… More >

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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 >

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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 >

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1035

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Thittamaranahalli Kariyappa Susheel Kumar
Congenital Heart Disease, Vol.14, No.1, pp. 57-59, 2019, DOI:10.1111/chd.12699
Abstract Surgical ligation of patent ductus arteriosus can be performed safely by following standard steps of operation. Familiarity of the anatomical landmarks and simple pre‐ cautions result in high degree of safety. The technique of surgical ligation varies with the age of the patient. Surgical ligation of ductus is associated with well‐recognized complications, although they occur only in a small number of patients. More >

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1096

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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 >

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1023

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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 >

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1068

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Adam Willis, Lillia Pereiras, Tim Head, Genevieve Dupuis, Janet Sessums, Gordon Corder, Kim Graves, Jack Tipton, Shyam Sathanandam
Congenital Heart Disease, Vol.14, No.1, pp. 69-73, 2019, DOI:10.1111/chd.12706
Abstract Objective: The objective of this article is to describe the elements involved with transporting extremely low birth weight (ELBW) infants from referring centers to our center’s neonatal intensive care unit (NICU) and then from the NICU to the catheterization lab for transcatheter closure of patent ductus arteriosus (PDA).
Setting: Several referring centers are over 300 miles away. ELBW infants are transferred in to our NICU safely for the procedure and transferred back following the procedure. A multidisciplinary team approach is necessary in order to achieve a safe transport of these fragile patients.
Patients: To date, we have over 12 centers… More >

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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 >

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1005

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Shyam Sathanandam, Hitesh Agrawal, Sandeep Chilakala , Jason Johnson, Kimberly Allen, Christopher Knott‐Craig, B. Rush Waller, Ranjit Philip
Congenital Heart Disease, Vol.14, No.1, pp. 79-84, 2019, DOI:10.1111/chd.12700
Abstract Objective: Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants.
Design: The techniques employed are very specific to this population and are drasti‐ cally different when compared to the procedure performed in patients weighing >5 kg.
Setting: A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success. It is important that specific techniques with venous‐only approach outlined in this article… More >

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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 >

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1111

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Leah Apalodimas, Benjamin Rush Waller III, Ranjit Philip, Judy Crawford, Jorden Cunningham, Shyam Sathanandam
Congenital Heart Disease, Vol.14, No.1, pp. 90-94, 2019, DOI:10.1111/chd.12705
Abstract Objectives: Patent ductus arteriosus (PDA) is a common finding in preterm infants. A hemodynamically significant PDA may require intervention for closure. This article aims to describe a transcatheter PDA closure (TCPC) program for preterm infants and the components of a comprehensive outpatient follow-up strategy.
Setting: A multidisciplinary team approach including neonatology, cardiology, anesthesiology, medical transport team, pulmonology, cardiac surgery, neurodevelopmental specialist, nutrition, speech therapy, social work, research collaborators, and other health care specialists is integral to the dedicated care and promotion of wellness of extremely low birth weight (ELBW) infants.
Patients: To date, we have performed TCPC on 134 ELBW… More >

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Courtney C. Mitchell¹, Brian K. Rivera¹, Jennifer N. Cooper ^2,4, Charles V. Smith³, Darren P. Berman^4,5, Jonathan L. Slaughter^1,4, Carl H. Backes^1,4,5
Congenital Heart Disease, Vol.14, No.1, pp. 95-99, 2019, DOI:10.1111/chd.12704
Abstract The optimal treatment method for infants with a patent ductus arteriosus (PDA) necessitating closure remains a subject of controversy and debate. While the risks associated with surgical PDA ligation are well described, the available evidence base for alternative management strategies during infancy, including percutaneous closure or conservative (nonintervention) management, are not well explored. Among infants, the goals of this review are to: (a) use rigorous systematic review methodology to assess the quality and quantity of published reports on percutaneous closure vs surgical ligation; (b) compare outcomes of percutaneous closure vs conservative management; and (c) based on recommendations from the International… More >

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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 >

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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 >

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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 >

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