Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern
Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-t...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2020.591441/full |
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| author | Ming-Chun Yang Ming-Chun Yang Ming-Chun Yang Hsien-Kuan Liu Hsien-Kuan Liu Hsuan-Yin Wu Hsuan-Yin Wu Shu-Leei Tey Shu-Leei Tey Yung-Ning Yang Yung-Ning Yang Yung-Ning Yang Chien-Yi Wu Chien-Yi Wu Jiunn-Ren Wu |
| author_facet | Ming-Chun Yang Ming-Chun Yang Ming-Chun Yang Hsien-Kuan Liu Hsien-Kuan Liu Hsuan-Yin Wu Hsuan-Yin Wu Shu-Leei Tey Shu-Leei Tey Yung-Ning Yang Yung-Ning Yang Yung-Ning Yang Chien-Yi Wu Chien-Yi Wu Jiunn-Ren Wu |
| author_sort | Ming-Chun Yang |
| collection | DOAJ |
| description | Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA.Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups.Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05).Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery. |
| first_indexed | 2024-12-13T05:30:42Z |
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| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-13T05:30:42Z |
| publishDate | 2020-10-01 |
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| series | Frontiers in Pediatrics |
| spelling | doaj.art-da4ed514e025473ea7e2c8da783e1a682022-12-21T23:58:04ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602020-10-01810.3389/fped.2020.591441591441Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt PatternMing-Chun Yang0Ming-Chun Yang1Ming-Chun Yang2Hsien-Kuan Liu3Hsien-Kuan Liu4Hsuan-Yin Wu5Hsuan-Yin Wu6Shu-Leei Tey7Shu-Leei Tey8Yung-Ning Yang9Yung-Ning Yang10Yung-Ning Yang11Chien-Yi Wu12Chien-Yi Wu13Jiunn-Ren Wu14Department of Pediatrics, E-Da Hospital, Kaohsiung City, TaiwanSchool of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, TaiwanSchool of Medicine for International Students, I-Shou University, Kaohsiung City, TaiwanDepartment of Pediatrics, E-Da Hospital, Kaohsiung City, TaiwanSchool of Medicine for International Students, I-Shou University, Kaohsiung City, TaiwanSchool of Medicine for International Students, I-Shou University, Kaohsiung City, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, E-Da Hospital, Kaohsiung City, TaiwanDepartment of Pediatrics, E-Da Hospital, Kaohsiung City, TaiwanSchool of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, TaiwanDepartment of Pediatrics, E-Da Hospital, Kaohsiung City, TaiwanSchool of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, TaiwanSchool of Medicine for International Students, I-Shou University, Kaohsiung City, TaiwanDepartment of Pediatrics, E-Da Hospital, Kaohsiung City, TaiwanSchool of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, TaiwanDepartment of Pediatrics, E-Da Hospital, Kaohsiung City, TaiwanBackground: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA.Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups.Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05).Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.https://www.frontiersin.org/articles/10.3389/fped.2020.591441/fullpre-term infantpulmonary hypertensionpatent ductus arteriosus ligationoutcomesbidirectional shuntcontraindication |
| spellingShingle | Ming-Chun Yang Ming-Chun Yang Ming-Chun Yang Hsien-Kuan Liu Hsien-Kuan Liu Hsuan-Yin Wu Hsuan-Yin Wu Shu-Leei Tey Shu-Leei Tey Yung-Ning Yang Yung-Ning Yang Yung-Ning Yang Chien-Yi Wu Chien-Yi Wu Jiunn-Ren Wu Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern Frontiers in Pediatrics pre-term infant pulmonary hypertension patent ductus arteriosus ligation outcomes bidirectional shunt contraindication |
| title | Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern |
| title_full | Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern |
| title_fullStr | Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern |
| title_full_unstemmed | Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern |
| title_short | Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern |
| title_sort | initial experience with patent ductus arteriosus ligation in pre term infants with bidirectional shunt pattern |
| topic | pre-term infant pulmonary hypertension patent ductus arteriosus ligation outcomes bidirectional shunt contraindication |
| url | https://www.frontiersin.org/articles/10.3389/fped.2020.591441/full |
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