Percutaneous Patent Ductus Arteriosus Closure in a Conjoined Twin: Case Report

Calamita, Paulo Correia; Lombardi, Jonathan Guimarães; Barreto, Mayra Rosana Palmeira; Barbosa, Orlando Carlos; Prudente, Maurício Lopes; Hamu, Zacarias Calil; Gardenghi, Giulliano

doi:10.36660/abc.20240351

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Research Letter • Arq. Bras. Cardiol. 121 (12) • 2024 • https://doi.org/10.36660/abc.20240351i linkcopy

Percutaneous Patent Ductus Arteriosus Closure in a Conjoined Twin: Case Report

Authorship SCIMAGO INSTITUTIONS RANKINGS

Conjoined twin patients with patent ductus arteriosus and hemodynamic repercussions have a worse prognosis. In the present case report, we demonstrate the first successful percutaneous closure of the ductus arteriosus with the Piccolo© device (Abbot Structural Heart, Plymouth, MN, USA) in this type of clinical situation.

Keywords
Conjoined Twins; Patent Ductus Arteriosus; Catheterization

Authorship

person Paulo Correia Calamita

Conception and design of the research · Acquisition of data · Writing of the manuscript · Critical revision of the manuscript for content

0009-0000-9003-4121

person Jonathan Guimarães Lombardi

Conception and design of the research · Acquisition of data · Writing of the manuscript · Critical revision of the manuscript for content

0009-0002-4476-9551

person Mayra Rosana Palmeira Barreto

Acquisition of data · Critical revision of the manuscript for content

schoolHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilschoolHospital Estadual da Mulher (HEMU), Goiânia, GO – BrazilHospital Estadual da Mulher (HEMU), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital Estadual da Mulher (HEMU), Goiânia, GO – Brazil

0009-0005-1601-6052

person Orlando Carlos Barbosa

Acquisition of data · Critical revision of the manuscript for content

0009-0005-2891-2110

person Maurício Lopes Prudente

Conception and design of the research · Acquisition of data · Critical revision of the manuscript for content

schoolHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilschoolHospital ENCORE, Aparecida de Goiânia, GO – BrazilHospital ENCORE, Aparecida de Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital ENCORE, Aparecida de Goiânia, GO – Brazil

0000-0002-9832-426X

person Zacarias Calil Hamu

Conception and design of the research · Acquisition of data · Critical revision of the manuscript for content

schoolHospital Estadual da Mulher (HEMU), Goiânia, GO – BrazilHospital Estadual da Mulher (HEMU), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital Estadual da Mulher (HEMU), Goiânia, GO – Brazil

0009-0004-3163-6703

person Giulliano Gardenghi

Conception and design of the research · Analysis and interpretation of the data · Writing of the manuscript · Critical revision of the manuscript for content

schoolHospital ENCORE, Aparecida de Goiânia, GO – BrazilHospital ENCORE, Aparecida de Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital ENCORE, Aparecida de Goiânia, GO – BrazilschoolClínica de Anestesia (CLIANEST), Goiânia, GO – BrazilClínica de Anestesia (CLIANEST), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilClínica de Anestesia (CLIANEST), Goiânia, GO – Brazil

0000-0002-8763-561X

personMailing Address:Giulliano Gardenghi • Hospital ENCORE – Rua Gurupi, Quadra 25, Lote 6 a 8. Postal Code
74905-350, Vila Brasília, Aparecida de Goiânia, GO – Brazil E-mail:
coordenacao.cientifica@ceafi.edu.br

Potential conflict of interest

No potential conflict of interest relevant to this article was reported.

Editor responsible for the review:

Vitor Guerra

SCIMAGO INSTITUTIONS RANKINGS

Hospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital Estadual de Urgências Governador Otávio Lage Siqueira (HUGOL), Goiânia, GO – Brazil

Hospital Estadual da Mulher (HEMU), Goiânia, GO – BrazilHospital Estadual da Mulher (HEMU), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital Estadual da Mulher (HEMU), Goiânia, GO – Brazil

Hospital ENCORE, Aparecida de Goiânia, GO – BrazilHospital ENCORE, Aparecida de Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilHospital ENCORE, Aparecida de Goiânia, GO – Brazil

Clínica de Anestesia (CLIANEST), Goiânia, GO – BrazilClínica de Anestesia (CLIANEST), Goiânia, GO – BrazilBrazilGoiânia, GO, BrazilClínica de Anestesia (CLIANEST), Goiânia, GO – Brazil

Figures

Figures (4)

Thumbnail

Figure 1 Conjoined twins fused ventrally through the thorax, showing abdomen with asymmetry of the lower limbs.

Thumbnail

Figure 2 Complementary echocardiogram and tomography angiography. A) Echocardiogram showing 2 hearts sharing the same pericardium. B) Echocardiographic section identifying the following structures: descending aorta, left pulmonary artery, and persistence of the ductus arteriosus and its measurements, where 1 = pulmonary ampulla, 2 = aortic ampulla, and 3 = length. C) Tomography with bone reconstruction individualizing the twins. D) * Heart of the second twin. E) ** Patent ductus arteriosus. Desc Ao: descending aorta; LPA: left pulmonary artery; PDA: persistence of the ductus arteriosus.

Thumbnail

Figure 3 Step by step of the percutaneous intervention. A) Angiography in the venous introducer showing the inferior vena cava draining into the heart of the second twin. B, C, D) Fluoroscopy showing the ductus arteriosus crossed with guide and catheter passing through the right atrium, right ventricle, pulmonary trunk in the descending aorta in an anterograde fashion, and aorta and being positioned in the descending aorta. E) Angiography of the ductus arteriosus. F) Fluoroscopy showing the advancement of the sheath from the pulmonary trunk to the descending aorta. G) Piccolo^© device and its radiopaque marks being positioned. The esophageal thermometer is usually a radiopaque landmark to delimit the aortic ampulla, and the orotracheal cannula is usually a radiopaque landmark to delimit the pulmonary ampulla. Ao: aorta; Desc Ao: descending aorta; PT: pulmonary trunk; RA: right atrium; RV: right ventricle.

Thumbnail

Figure 4 Angiographic (A) and echocardiographic (B) correlation showing the measurements of the ductus arteriosus, being * pulmonary ampulla, ** aortic ampulla, and *** length of the ductus arteriosus, fundamental for choosing the device. C) Piccolo© device. D and E) Device released showing good final positioning, without residual shunt. AO: aorta; Desc Ao: descending aorta; LPA: left pulmonary artery; PDA: persistence of the ductus arteriosus; PT: pulmonary trunk.

imageFigure 1 Conjoined twins fused ventrally through the thorax, showing abdomen with asymmetry of the lower limbs. open_in_new

imageFigure 2 Complementary echocardiogram and tomography angiography. A) Echocardiogram showing 2 hearts sharing the same pericardium. B) Echocardiographic section identifying the following structures: descending aorta, left pulmonary artery, and persistence of the ductus arteriosus and its measurements, where 1 = pulmonary ampulla, 2 = aortic ampulla, and 3 = length. C) Tomography with bone reconstruction individualizing the twins. D) * Heart of the second twin. E) ** Patent ductus arteriosus. Desc Ao: descending aorta; LPA: left pulmonary artery; PDA: persistence of the ductus arteriosus. open_in_new

imageFigure 3 Step by step of the percutaneous intervention. A) Angiography in the venous introducer showing the inferior vena cava draining into the heart of the second twin. B, C, D) Fluoroscopy showing the ductus arteriosus crossed with guide and catheter passing through the right atrium, right ventricle, pulmonary trunk in the descending aorta in an anterograde fashion, and aorta and being positioned in the descending aorta. E) Angiography of the ductus arteriosus. F) Fluoroscopy showing the advancement of the sheath from the pulmonary trunk to the descending aorta. G) Piccolo^© device and its radiopaque marks being positioned. The esophageal thermometer is usually a radiopaque landmark to delimit the aortic ampulla, and the orotracheal cannula is usually a radiopaque landmark to delimit the pulmonary ampulla. Ao: aorta; Desc Ao: descending aorta; PT: pulmonary trunk; RA: right atrium; RV: right ventricle. open_in_new

imageFigure 4 Angiographic (A) and echocardiographic (B) correlation showing the measurements of the ductus arteriosus, being * pulmonary ampulla, aortic ampulla, and * length of the ductus arteriosus, fundamental for choosing the device. C) Piccolo© device. D and E) Device released showing good final positioning, without residual shunt. AO: aorta; Desc Ao: descending aorta; LPA: left pulmonary artery; PDA: persistence of the ductus arteriosus; PT: pulmonary trunk. open_in_new

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