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Biomedical subjects

A Hastreiter

Publications and source records attributed to A Hastreiter.

8 recordsLinked to original sources
PubMed1983

Efficacy of pulmonary artery banding in infants with complete atrioventricular canal.

Total correction in infants less than 1 year old with complete atrioventricular (AV) canal carries a significant operative mortality. However, past reports suggest that the alternative palliative procedure, pulmonary artery banding (PAB), may be contraindicated in the presence of severe mitral insufficiency and/or a large left ventricular to right atrial shunt. Contrary to these previous reports, we report the results in 21 consecutive patients with congestive heart failure who underwent PAB at a mean age of 3.9 +/- 2.8 months and at a weight of 3.6 +/- 0.9 kg. (17/21 less than 6 months). Regardless of mitral valve competency, PAB was performed in conjunction with ligation of a patent ductus arteriosus (11 patients) and coarctation repair (two patients) with one death secondary to gastrointestinal bleeding (4.7% in-hospital mortality); one patient required early band readjustment because of hypoxemia. Repeat cardiac catheterization in 10 patients performed 4 to 41 months after PAB showed significant reduction in pulmonary hypertension and flow with no change in pulmonary vascular resistance. All infants were symptomatically improved after PAB and four have undergone successful total correction. Previous reports since 1977 indicate a significantly higher risk for total repair of complete A V canal before 1 year of age (36/147, 24%) than the risk for PAB in this series (p less than .05). Therefore, we believe that PAB is a rational alternative to total repair as the initial surgical treatment for symptomatic infants with complete A V canal, particularly when anatomic variants known to increase operative risk are recognized before cardiotomy.

Cardiac Catheterization↗
PubMed1981

A comparison of oral and intravenous indomethacin dispositions in the premature infant with patent ductus arteriosus.

Plasma concentrations of indomethacin were studied in 18 premature infants exhibiting significant patent ductus arteriosus (sPDA) after either intravenous or oral drug administration. Oral absorption of indomethacin was prolonged and bioavailability, based on area under the curve (AUC), was less than 20%. The mean volume of distribution for indomethacin was 0.36 l/kg and showed only a small variation between subjects. The drug elimination half-life ranged from 10-25 hours and demonstrated a significant correlation with gestational age. There was no evidence to support dose-dependent clearance or enterohepatic circulation in this study. Side effects of indomethacin were limited in one infant. No significant changes were observed in hematocrit, platelet count, and serum creatinine. The results from this study support the continued use of intravenous sodium indomethacin trihydrate at doses of 0.2 mg/kg and intervals of 18-24 hours for pharmacological treatment of sPDA.

Administration, Oral↗
PubMed1980

Pharmacokinetics of oral and intravenous indomethacin in preterm infants.

The pharmacokinetic profile of indomethacin administered either orally or intravenously in 13 preterm infants with significant patent ductus arteriosus (PDA) is reported. 9 infants received oral indomethacin and 4 received intravenous therapy. Plasma half-life was significantly prolonged as compared to adult values and demonstrated significant correlation with gestational age. Mean half-life in neonates less than 32 weeks gestation was 17.2 (0.8) vs. 12.5 (0.5) h for neonates greater than 32 weeks gestation. Bioavailability of the oral dosage based on AUC was 13% but no difference was observed in the plasma protein binding or distribution volume of drug as compared to adult values. No serious complications could be attributed to the use of indomethacin at these dose levels in the premature infant.

Administration, Oral↗
PubMed1979

Gestational age and indomethacin elimination in the neonate.

The disposition of oral indomethacin was studied in 9 premature infants with significant patent ductus arteriosus (sPDA) with birth weights ranging from 800 to 1,960 gm and gestational ages of 28 to 36 wk. Peak plasma concentrations in most of the subjects were not observed until 3 to 4 hr after administration and ranged from 0.027 to 0.31 microgram/ml. Plasma half-life (t1/2) of indomethacin ranged from 11 to 20 hr and correlated with gestational age. Plasma protein binding studies, in samples from the premature infant using radiolabeled indomethacin, showed no difference in binding from values obtained with adult plasma (greater than 98%). Absorption of orally administered indomethacin appears to be incomplete and plasma clearance much longer than in the adult.

Blood Proteins↗
PubMed1979

Disposition of indomethacin in preterm infants.

Indomethacin is currently used for the pharmacologic closure of PDA in preterm infants with respiratory distress syndrome. However, the response to the drug has been variable and the disposition of the drug in preterm infants is not well understood. We studied the pharmacokinetics of indomethacin in nine preterm infants with birth weights ranging from 800 to 1,960 gm and gestational ages of 28 to 36 weeks. Three different dose schedules (0.1, 0.25, 0.3 mg/kg dose) were used. The plasma half-life of indomethacin ranged from 11 to 20 hours. Peak levels were achieved within four hours and ranged from 0.027 to 0.310 microgram/ml. The half-life in infants less than 32 weeks' gestation was significantly prolonged compared to that in infants greater than 32 weeks. Protein-binding studies with 14C indomethacin showed that 98% of indomethacin was protein bound. Absorption of orally administered indomethacin appears to be poor and incomplete. No immediate major complications could be correlated to indomethacin therapy in this study.

Birth Weight↗
PubMed1975

Surgical bifascicular block.

Electrophysiological studies were performed in 18 patients who developed bifascicular block after repair of ventricular septal defect (VSD) or tetralogy of Fallot (TF). Two had transient complete heart block (CHB) in the immediate postoperative period. The P-A intervals were normal in all. A-H and H-V intervals were prolonged in three and four cases, respectively. Atrial pacing at progressively increasing heart rates was performed in 15 patients; two developed type II block distal to the His bundle (H). The effective and functional refractory periods (ERP and FRP) of the atrium (11 cases) were normal in all. The ERP of the A-V node (seven cases) was prolonged in found and the FRP was increased in three. The ERP of the ventricular specialized conduction system was measured in two cases and was prolonged in one. In all, seven cases had abnormalities indicating disease of the A-V node and/or His-Purkinje system. Recording of intervals, atrial pacing, and determination of refractory periods (RPs) was necessary to reveal all conduction abnormalities. One patient died of unrelated causes. The others are alive and in sinus rhythm with intact conduction 3 to 16.5 years following surgery (mean follow-up of 8.3 plus or minus 0.95 years). The clinical course in patients with normal and abnormal findings was equally benign. Prophylactic insertion of demand pacemakers does not appear indicated in these patients.

Adolescent↗