Hypothyroidism after Percutaneous Patent Ductus Arteriosus Device Closure in an Extremely Preterm Infant: Possible Role of Iodinated IV Contrast.

We report a case of contrast-induced hypothyroidism in an extremely preterm infant after percutaneous patent ductus arteriosus (PDA) device closure. Iodine-induced hypothyroidism after exposure to iodine-containing antiseptics and contrast media has been previously reported in extremely preterm infants. However, this is the first report of contrast-induced hypothyroidism in an extremely preterm infant undergoing percutaneous PDA device closure. This is timely, given percutaneous PDA device closure is more frequently utilized. Guidelines for screening thyroid function pre and post contrast-requiring procedures may be warranted. Hypothyroidism if left untreated can have detrimental effects on developing brain, especially in the preterm population. Therefore, the earlier detection and treatment of iodine-induced hypothyroidism is imperative.

The patent ductus arteriosus in term infants, children, and adults.

During fetal life, the ductus arteriosus is a normal and essential structure that connects the pulmonary artery to the distal aortic arch, permitting right ventricular ejection into the aorta. After birth, with commencement of pulmonary blood flow and a 2-ventricle circulation, a variety of physiological and biochemical signals normally result in complete closure of the ductus. Persistent patency of the ductus arteriosus may impair systemic cardiac output and result in deleterious effects on the cardiovascular system and lungs. Although surgery is still the treatment of choice for most premature infants with patent ductus arteriosus (PDA), transcatheter techniques have largely supplanted surgery for closure of PDA in children and adults. This article is a review of the PDA in term infants, children, and adults, with focus on the clinical manifestations and management.

Closure of tubular patent ductus arteriosus in infants and small children with the Amplatzer Vascular Plug II.

Percutaneous closure of a tubular patent ductus arteriosus can be challenging in the infant and small child. In this report, we describe the successful closure of tubular patent ductus arteriosus with the Amplatzer Vascular Plug II in two patients, ages 3 months and 13 months.

Interventional treatment of patent ductus arteriosus in 2004.

In 2004, the interventional treatment of patent ductus arteriosus (PDA) is definitive and curative. In current practice, coils are used for smaller PDA, and devices are employed for larger PDA. Developing technologies offer small improvements in control and results, but do not appear to promise major changes in practice. This review summarizes the current and emerging interventional technologies directed at PDA closures.

Total cavopulmonary connection to one lung.

The status of pulmonary circulation is of utmost importance to the success of the modified Fontan operation. Pulmonary artery distortion, hypoplasia of the total pulmonary vascular bed, and elevated pulmonary vascular resistance are all risk factors for adverse outcome after modified Fontan operations. In cases of irreparable acquired atresia of one or the other branch pulmonary artery, clinicians are forced to contemplate the possibility of total cavopulmonary connection to one lung. The combined experience of the authors with 12 cases suggests that the likelihood of operative survival following Fontan's operation to one lung is predicted based on the usual hemodynamic parameters: pulmonary artery pressure and flow, ventricular end diastolic pressure, transpulmonary gradient, and pulmonary vascular resistance. In this series, there were no operative mortalities among patients undergoing Fontan's operation to one lung, all of whom meet the usual criteria for hemodynamic acceptability. There may, however, be a higher incidence of protein-losing enteropathy than in Fontan patients with normal pulmonary vascular beds. All possible means of resuscitating the lost elements of the pulmonary vascular bed and re-establishing pulmonary artery continuity should be attempted to minimize pulmonary vascular capacitance of patients undergoing Fontan's operation. It is clear, however, that the presence of only one pulmonary artery does not in and of itself preclude satisfactory outcome.

Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure.

This study examines the safety and efficacy of transthoracic echocardiographic (TTE) guidance of atrial septal defect (ASD) device closure. We evaluated 74 patients for TTE-guided ASD closure. Fifty-six patients had successful device implantation using TTE guidance. Twelve patients were referred for surgical ASD closure on the basis of TTE evaluation. Five patients with multiple ASDs or poor transthoracic acoustic windows had ASD device closure guided by transesophageal echocardiography (TEE).