title: Iatrogenic obstruction of the aorta - a sequence of delayed, fatal complications after 'off-label' interventional persistent ductus arteriosus closure.
abstract: A 10-month-old girl was admitted to the Intensive Care Unit with the symptoms of critical cardiac decompensation. In the 3rdmonth of life, 3 kg bw, she underwent an interventional persistent ductus arteriosus (PDA) closure in a high-reference pediatric cardiology center. Echocardiography performed on admission showed myocardial injury, with poor contractility, mild pulmonary hypertension and severe stenosis of the isthmus of aorta. The girl was urgently referred for surgical removal with the use of extracorporeal circulation (ECC) and deep hypothermia circulatory arrest (DHCA) technique. In the 4thpostoperative day (POD), she developed cardiovascular decompensation and died in the 7thPOD due to circulatory arrest in the mechanism of refractory ventricular fibrillation. In autopsy there were found microscopic signs of apoptosis in parenchymal organs below iatrogenic 'coarctation', typical for chronic ischemia. In the segments proximal to iatrogenic aortic stenosis there were evident vascular changes characteristic for chronic severe arterial hypertension.
authors.affiliation: Department of Physiotherapy, Faculty of Rehabilitation and Kinesiology, Gdansk University of Physical Education and Sport, Gdansk, Poland; Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Haponiuk
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Paczkowski
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Chojnicki
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Jaworski
keywords: complications; congenital heart defect; interventional cardiology; pediatric cardiac surgery