Case Presentation By Dr. Islam Galal Sayed Ahmed Assistant - - PowerPoint PPT Presentation

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Case Presentation By Dr. Islam Galal Sayed Ahmed Assistant - - PowerPoint PPT Presentation

Nov 14, 2023 441 likes •722 views

Case Presentation By Dr. Islam Galal Sayed Ahmed Assistant Lecturer at Cardiology Department , Faculty of Medicine , Zagazig University Marked Improvement Of Left Ventricular Function And Valvular Regurgitation After Percutaneous Closure

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Case Presentation

By Dr. Islam Galal Sayed Ahmed

Assistant Lecturer at Cardiology Department , Faculty of Medicine , Zagazig University

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Marked Improvement Of Left Ventricular Function And Valvular Regurgitation After Percutaneous Closure Of Patent Ductus Arteriosus

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Introduction

  • Patent

ductus arteriosus (PDA) is a congenital anomaly causing left ventricular (LV) volume overload, which may be a compensatory phenomenon to maintain systemic cardiac

  • utput.
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  • Previous reports demonstrated

that PDA closure led to immediate deterioration of LV systolic function, which recovered within 6 months in children.

  • Furthermore, LV remodeling

and changes in LV systolic function after PDA closure in adult patients have not been sufficiently reported. .

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Case

  • 29 year-old female suffering

from dyspnea and palpitation with rapid AF was examined.

  • Echocardiography

showed 15mm PDA causing severe pulmonary hypertension.

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  • She

had moderate mitral regurgitation (MR) and moderate aortic regurgitation (AR) with healthy leaflets.

  • LV

dimensions were

  • dilated. Ejection fraction (EF)

was 47%.

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Procedure

  • We decided to close the PDA

percutaneously .

  • Balloon closure test of PDA

was done first using sizing balloon for 20 minutes.

  • Mean

pulmonary artery pressure significantly decreased (from 72mmHg to 47mmHg) and LV systolic pressure improved (from 85mmHg to 123mmHg).

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  • We closed the PDA using

ASD Amplatzer

  • ccluding

device of size 17mm with good result without significant residual shunt.

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Follow Up

  • 1month later, no significant

shunt was detected by echocardiography,

  • LV size was reduced,
  • MR

and AR were both reduced from GIII/IV to GII/IV.

  • EF became 62%.
  • AF was controlled without

digoxin.

  • 4 months later, the patient

was symptom free.

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Discussion

  • Recently,

Eerola et al demonstrated, using 2- and 3- dimensional echocardiography, that changes in LV volume and function caused by PDA closure disappeared by 6 months after percutaneous closure in children.

  • our current case demonstrated

that LV recovered during the long-term follow-up period in adult PDA patients.

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  • Cont. Discussion
  • Recently,

transcatheter device

  • cclusion

has become the first choice treatment for adult PDA.

  • There

are several publications describing subsequent deterioration

  • f LV systolic function after PDA

closure.

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  • Reduced muscle fiber stretch

by the sudden reduction in LV volume overload and increased LV afterload may be the cause.

  • Deterioration

after PDA closure is more pronounced in adults than in children because the LV has been subjected to prolonged remodeling induced by the volume overload .

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Conclusion

  • PDA device closure reduces

LV size and improves its function.

  • Valvular regurgitation could

be improved after PDA closure providing that the leaflets are healthy.

  • Hence, it doesn't necessarily

motivate surgical closure.

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Much more to come Are we all still awake?

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