Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.210085
Jornal Vascular Brasileiro
Therapeutic Challenge

Alternative treatment for patent ductus arteriosus: a therapeutic challenge

Tratamento alternativo do canal arterial pervio: um desafio terapêutico

Lauro Henrique Heinsch Domenighi; Guilherme Pinto Quoos; Stela Karine Braun; Alcides André Dezordi Vogel; Romualdo Bolzani dos Santos; Vinícius Matos Menegola

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Abstract

Abstract: The ductus arteriosus is a fetal structure that spontaneously closes in 90% of newborns. Patency 3 months after birth is considered a congenital heart disease that, if untreated, can progress to serious cardiovascular complications. This report aims to review an alternative treatment with an aortic endoprosthesis in a 49-year-old man who presented with dyspnea on moderate exertion associated with a heart murmur. He was diagnosed with persistent ductus arteriosus (PDA) with cardiac complications. Clinical management was unsuccessful and surgical treatment was indicated. Endovascular treatment with a thoracic endoprosthesis was indicated and performed successfully. Percutaneous closure is the preferred method in adult patients. Endovascular intervention using an endoprosthesis is a safe and effective option, in addition to being applicable regardless of the anatomy of the PDA. This case demonstrates the natural history of the pathology and presents a safe and effective alternative for its management.

Keywords

ductus arteriosus patent, endovascular procedures, vascular surgical procedures

Resumo

Resumo: O canal arterial é uma estrutura fetal que se fecha espontaneamente em 90% dos recém-nascidos. A permeabilidade por mais de 3 meses é considerada uma cardiopatia congênita que, se não tratada, pode evoluir para complicações cardíacas graves. Este trabalho relata um tratamento alternativo com endoprótese aórtica. Trata-se de um homem, 49 anos, que apresentou dispneia aos moderados esforços, associada com um sopro cardíaco. Foi diagnosticado com canal arterial persistente (PCA) já com complicações cardíacas. Tentou-se manejo clínico sem sucesso, sendo indicado tratamento cirúrgico. Optou-se pelo tratamento endovascular com uma endoprótese torácica, o qual foi realizado com sucesso. O fechamento percutâneo é o método preferido em pacientes adultos. A intervenção endovascular com o uso da endoprótese é uma possibilidade segura e eficaz, além de ser aplicável independentemente da anatomia do PCA. Este caso, além de demonstrar a história natural desta patologia, apresenta uma alternativa segura e eficaz empregada no seu manejo.
 

Palavras-chave

canal arterial persistente, procedimentos endovasculares, procedimentos cirúrgicos vasculares

References

1 Baruteau AE, Hascoet S, Baruteau J, et al. Transcatheter closure of patent ductus arteriosus: past present and future. Arch Cardiovasc Dis. 2014;107(2):122-32. http://dx.doi.org/10.1016/j.acvd.2014.01.008. PMid:24560920.

2 Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation. 2006;114(17):1873-82. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.592063. PMid:17060397.

3 Mendes TSM. Patent ductus arteriosus [dissertation]. Covilhã, Portugal: Health Sciences, University of Beira Interior; 2015.

4 Zielinsky P, Busato S. Prenatal effects of maternal consumption of polyphenol-rich foods in late pregnancy upon fetal ductus arteriosus. Birth Defects Res C Embryo Today. 2013;99(4):256-74. http://dx.doi.org/10.1002/bdrc.21051. PMid:24339037.

5 Wiyono SA, Witsenburg M, de Jaegere PPT, Roos-Hesselink JW. Patent ductus arteriosus in adults: case report and review illustrating the spectrum of the disease. Neth Heart J. 2008;16(7-8):255-9. http://dx.doi.org/10.1007/BF03086157. PMid:18711613.

6 Fortescue EB, Lock JE, Galvin T, McElhinney DB. To close or not to close: the very small patent ductus arteriosus. Congenit Heart Dis. 2010;5(4):354-65. http://dx.doi.org/10.1111/j.1747-0803.2010.00435.x. PMid:20653702.

7 Gaia DF, Palma JH, Kim HC, Souza AM, Alves CR, Buffolo E. Endovascular treatment of patent ductus arteriosus in an adult. Arq Bras Cardiol. 2008;91(2):17-9.

8 Torsello GF, Austermann M, Van Aken HK, Torsello GB, Panuccio G. Initial clinical experience with the Zenith alpha stent-graf. J Endovasc Ther. 2015;22(2):153-9. http://dx.doi.org/10.1177/1526602815573239. PMid:25809352.

9 Ozmen J, Granger EK, Robinson D, White GH, Wilson M. Operation for adult patent ductus arteriosus using an aortic stent-graft technique. Heart Lung Circ. 2005;14(1):54-7. http://dx.doi.org/10.1016/j.hlc.2004.11.002. PMid:16352254.

10 Saito N, Kimura T, Toma M, et al. Transcatheter closure of patent ductus arteriosus with Inoue single-branched stent graft. J Thorac Cardiovasc Surg. 2005;130(4):1203-4. http://dx.doi.org/10.1016/j.jtcvs.2005.05.032. PMid:16214543.

11 Roques F, Hennequin JL, Sanchez B, Ridarch A, Rousseau H. Aortic stent-graft for patent ductus arteriosus in adults: the aortic exclusion technique. Ann Thorac Surg. 2001;71(5):1708-9. http://dx.doi.org/10.1016/S0003-4975(01)02456-0. PMid:11383840.

12 Doyle T, McHugh AK, Connolly HM, Triedman JK, Armsby C. Clinical manifestations and diagnosis of patent ductus arteriosus in term infants, children, and adults. UpToDate. 2017.

13 Anilkumar M. Patent ductus arteriosus. Cardiol Clin. 2013;31(3):417-30. http://dx.doi.org/10.1016/j.ccl.2013.05.006. PMid:23931103.

14 Krichenko A, Benson LN, Burrows P, Möes CA, McLaughlin P, Freedom RM. Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol. 1989;63(12):877-80.

15 Schneider DJ. The patent ductus arteriosus in term infants, children, and adults. Semin Perinatol. 2012;36(2):146-53. http://dx.doi.org/10.1053/j.semperi.2011.09.025.

16 Pass RH, Hijazi Z, Hsu DT, Lewis V, Hellenbrand WE. Amplatzer patent ductus arteriosus occlusion device trial: initial and one-year results. J Am Coll Cardiol. 2004;44(3):513-9. http://dx.doi.org/10.1016/j.jacc.2004.03.074. PMid:15358013.

17 Jatene MB, Abuchaim DCS, Tiveron MG, et al. Surgical treatment of patent ductus arteriosus in the adult population. Rev Bras Cir Cardiovasc. 2011;26(1):93-7. http://dx.doi.org/10.1590/S0102-76382011000100017. PMid:21881717.
 


Submitted date:
05/15/2021

Accepted date:
06/20/2021

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