ACC/AHA recommendations for closure of patent ductus arteriosus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

Overview

The decision for closure of patent ductus arteriosus depends on the size of ductus, presence of left or right ventricular hypertrophy and pulmonary arterial hypertension. It is contraindicated in patients with eisenmenger's syndrome and right-to-left shunt.

ACC/AHA recommendations for closure in patients with patent ductus arteriosus(DONOT EDIT)[1]

Class I
"1.Closure of a PDA either percutaneously or surgically is indicated for the following:
1. Left atrial and/or LV enlargement or if PAH is present, or in the presence of net left-to-right shunting.(Level of Evidence: C)
2. Prior endarteritis.(Level of Evidence: C) "
"2. Consultation with adult congenital heart disease (ACHD) interventional cardiologists is recommended before surgical closure is selected as the method of repair for patients with a calcified PDA. (Level of Evidence: C)"
"3. Surgical repair by a surgeon experienced in CHD surgery is recommended when:
1. The PDA is too large for device closure.(Level of Evidence: C)
2. Distorted ductal anatomy precludes device closure (e.g., aneurysm or endarteritis). (Deanfield et al., 2003)(Level of Evidence: B)"
Class III
"1. PDA closure is not indicated for patients with PAH and net right-to-left shunt.(Level of Evidence: C) "
Class IIa
"1. It is reasonable to close an asymptomatic small PDA by catheter device. (Level of Evidence: C)"
"2. PDA closure is reasonable for patients with PAH with a net left-to-right shunt. (Level of Evidence: C)"

References

  1. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.


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