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At least 253 records · Page 14Linked to original sources
PubMed2000

Operation for adult patent ductus arteriosus using cardiopulmonary bypass.

BACKGROUND: Surgical repair of adult patent ductus arteriosus is more hazardous than when performed on young patients. METHODS: Nine adult patent ductus arteriosus patients underwent surgical repair between January 1986 and December 1998. There were 3 male and 6 female patients (mean age 55.0 years). The ratio of pulmonary blood flow to systemic flow was 2.40 +/- 0.95, and pulmonary arterial pressure was 56.0 +/- 26.4 mm Hg. The operation was performed using transpulmonary approach under total cardiopulmonary bypass. Balloon occlusion method was also utilized. RESULTS: Direct closure was made in 5 and patch closure in 4 patients. Cardiopulmonary bypass and balloon occlusion were safely established. Cardioplegic arrest was not required in the 2 most recent patients. No operative death has occurred. Pulmonary arterial systolic pressure decreased to 35.3 +/- 6.6 mm Hg at 6 months after operation. The mean follow-up period for all patients is 55 months. To date, neither recannalization of the ductus nor pseudoaneurysm has been recognized. CONCLUSIONS: Cardiopulmonary bypass with balloon occlusion provides a safe operation for adult patients with complicated patent ductus arteriosus.

Adult↗
PubMed2006

Outcome following patent ductus arteriosus ligation in premature infants: a retrospective cohort analysis.

BACKGROUND: The patent ductus arteriosus (PDA) is an important problem in premature infants. Surgical PDA ligation is usually only be considered when medical treatment has either failed or was contraindicated. The aims of our study were to determine the mortality and morbidity following patent ductus arteriosus ligation in premature infants, and whether prostaglandin synthetase inhibitor (PSI) use prior to ligation affects outcome. METHODS: A retrospective case note review study to determine the outcome of premature infants undergoing patent ductus arteriosus ligation in one tertiary neonatal intensive care unit and two paediatric cardiothoracic centres. RESULTS: We had follow-up data on 87 infants. Cumulative mortality rates at 7 days, 30 days and at hospital discharge were 2%, 8% and 20% respectively. The incidence of chronic lung disease, intraventricular haemorrhage, necrotising enterocolitis and retinopathy of prematurity were 77%, 39%, 26% and 28% respectively. There was no difference in mortality, incidence of chronic lung disease or duration of oxygen dependence between those who had and those who had not received a PSI prior to surgical ligation. In those who had received 2 or more courses of PSI prior to surgical ligation, there was a trend to increase in the duration of oxygen therapy and chronic lung disease, but no difference in mortality. CONCLUSION: This study shows that patent ductus arteriosus ligation is a relatively safe procedure (30 day survival 92%) but there is substantial late mortality and a high incidence of morbidity in the survivors. 2 or more courses of PSI prior to surgical ligation trends to increased oxygen dependence and chronic lung disease. This high risk population requires careful follow-up. A definitive prospective cohort study is lacking.

Cardiovascular Surgical Procedures↗
PubMed2001

Transcatheter coil closure of large patent ductus arteriosus with 0.052-inch Gianturco coils using myocardial biopsy forceps in a 70-year-old woman.

Small patent ductus arteriosus is generally closed in children using a transcatheter coil. This is done less often in older patients or those with large patent ductus arteriosus. We report successful antegrade transcatheter coil closure of patent ductus arteriosus in a 70-year-old woman. Into the patent ductus arteriosus, using flexible myocardial biopsy forceps, we placed two large 0.052-inch Gianturco coils, which were easily used as multipurpose vascular occlusion coils. The forceps and the coils were readily available and provided complete occlusion. Other delivery devices cannot deliver such large coils. Transcatheter coil closure thus appears to be safe and effective for closing large patent ductus arteriosus in the elderly.

Aged↗
PubMed1997

Pulmonary vascular obstructive disease and hemoptysis in a child with tetralogy of Fallot and patent ductus arteriosus.

Tetralogy of Fallot (TOF) and patent ductus arteriosus complicated by pulmonary vascular obstructive disease (PVOD) and hemoptysis in a 5-year-old girl are described. The echocardiogram was typical of TOF, as well as ductus arteriosus and right aortic arch. Cardiac catheterization revealed a pulmonary vascular resistance of 44 hybrid resistance units, and the pulmonary-to-systemic resistance ratio was 1.4. Diagnosis of PVOD was made by cardiac catheterization. Angiography revealed a bronchial artery arising from the left subclavian artery. PVOD itself, rupture of a bronchial artery or both, were considered the contributory causes of hemoptysis in this patient.

Child, Preschool↗
PubMed1976

Maturation of contractile response of ductus arteriosus to oxygen and drugs.

Contractile responses of rings of ductus arteriosus from fetal and neonatal guinea pigs were studied in buffered Krebs-Henseleit solutions of various oxygen tensions. Oxygen-induced contraction of ductus arteriosus increased with gestational age, peaking at term and attenuating within 24 h after birth. Contractions of ductus in response to potassium were not different in term and preterm fetuses. Maximal contractile response of pre- and postductal aortic rings to oxygen was 8.3% of the maximal oxygen-induced contraction of ductal rings from the same fetuses. Pulmonary artery was quite insensitive to oxygen. Of 12 ductus exposed to bradykinin in the absence of oxygen seven contracted (maximal response was obtained with 15.0 ng/ml). Exposure of ductus to bradykinin in the absence of oxygen enhanced subsequent contractions of ductal smooth muscle rings to air. Atropine failed to inhibit the oxygen-induced contraction of ductus. These data suggest that acetylcholine is not essential for oxygen-induced contraction of the guinea pig ductus arteriosus.

Acetylcholine↗
PubMed1990

The timing of spontaneous closure of the ductus arteriosus in infants with respiratory distress syndrome.

Previous studies evaluating the incidence of patent ductus arteriosus have not made a distinction between physiologic ductal patency and abnormally persistent ductus arteriosus. However, it has recently been shown that healthy premature infants without respiratory distress syndrome (RDS) undergo spontaneous closure of the ductus arteriosus in the first 4 days of life at times comparable to full-term infants. Thus, ductal patency within this time frame would appear to be physiologic. Although sick premature infants are well recognized to be at risk for ductal shunting, the purpose of this investigation was to evaluate systematically the actual impact that RDS has on duration of ductal shunting by assessing the timing of spontaneous functional closure. The presence of ductal shunting was evaluated using echocardiographic color flow Doppler techniques. Thirty-six premature infants (30 to 37 weeks gestational age) were evaluated. By the fourth day of life, only 4 of 36 (11.1%) of the infants continued to have evidence of ductal patency. The remainder of the infants underwent spontaneous functional closure of the ductus arteriosus at times comparable to healthy infants without RDS. For most infants greater than or equal to 30 weeks gestation, uncomplicated RDS does not alter the usual timing of functional ductal closure.

Ductus Arteriosus, Patent↗
PubMed2000

[A case of aneurysm of the ductus arteriosus in the adult].

Aneurysm of the ductus arteriosus in the adults is rare. A 60-year-old male with no symptoms was admitted to our hospital. 3 D-CT scans and aortograms indicated a diagnosis of aneurysm of the ductus arteriosus. Operation was done through median sternotomy with the aid of partial cardiopulmonary bypass. The saccular aneurysm was located between the aortic isthmus and the left pulmonary artery. The aneurysm was resected and closed a patch. The post-operative course was uneventful.

Aneurysm↗
PubMed1987

Systemic to pulmonary shunting masquerading as patent ductus arteriosus: a pitfall in clinical diagnosis.

Patent ductus arteriosus (PDA) frequently complicates the course of respiratory distress syndrome in premature infants. A 920-g, 28 weeks' gestation infant with clinical and radiographic evidence of left to right shunting, was presumed to have a patent ductus arteriosus. Following ductal ligation the signs persisted. Aortic angiogram demonstrated multiple collateral vessels arising from the systemic circulation and communicating with pulmonary vessels. Accurate diagnosis of left to right shunting is imperative if such collateral shunting is not to go undiagnosed.

Arteriovenous Malformations↗
PubMed1988

Catheter occlusion of the persistently patent ductus arteriosus.

Catheter occlusion of a persistently patent ductus arteriosus was attempted in 40 patients (11 men and 29 women, mean age 7.2 +/- 8.3 years, range 244 days to 40 years), using a transvenously placed Rashkind umbrella occluder (USCI). Thirty-one 12-mm and six 17-mm diameter devices were successfully placed in the ductus (internal diameter average 3.9 mm, range 2 to 9 mm). One procedure was abandoned when fluoroscopy failed to visualize the device. There were 2 immediate embolizations subjected to surgical recovery. A residual shunt was present on the immediate postocclusion ventriculogram in 12 of 37 procedures (32%). Twenty-eight patients (75%) have had at least a follow-up at 3 months with Doppler study and 6 (21%) continued to have shunting into the pulmonary artery. Three of 4 patients have undergone successful placement of a second device and 1 patient's shunting spontaneously resolved at 1 year postimplant, leaving only 2 patients (7%) with persistent shunts. There has been 1 episode of probable prosthetic endarteritis and 1 patient has developed mild narrowing of the left pulmonary artery related to device placement. Catheter occlusion of the patent ductus arteriosus using the Rashkind umbrella appears to be a safe and effective method of non-surgical management.

Adult↗
PubMed1996

[Closure of patent ductus arteriosus by video thoracoscopy in 282 children].

Closure of patent ductus arteriosus by video thoracoscopy is a standardised procedure. The authors report their experience of closure of patent ductus arteriosus by video-thoracoscopy from May 1991 to December 1995. The series included 282 patients divided into 3 groups according to age: under 6 months (78 patients, 27.6%), from 6 months to 4 years (135 patients, 42.88%) and over 4 years of age (69 patients, 24.6%) with an average weight of 12.6 kg (range: 1.2 to 65 kg). Symptomatic pulmonary hypertension was observed in 39 cases and 9 children had associated intracardiac malformations (ostium secundum: 3; ventricular septal defect: 5; abnormal pulmonary venous drainage: 1) which were not corrected. The technique consisted of placing two titanium clips in position under video-thoracoscopy to close the ductus. An echo performed immediately afterwards confirmed closure of the ductus. The main complications were: persistence of a shunt (4 cases) at the beginning of our experience requiring immediate reoperation by video-thoracoscopy in 3 cases and by thoracotomy in one case; left recurrent laryngeal nerve palsy in 6 cases (2.1%) with regression in 5 and persistence in one case; one case of postoperative chylothorax which regressed rapidly. There were no fatalities or haemorrhages and no blood transfusions were required in this series. The average operating time was 20 +/- 15 minutes and the duration of hospital stay around 48 hours when the patients were over 6 months old and 72 hours when less than 6 months of age. Video-thoracoscopic closure of patent ductus arteriosus is rapid, safe, economical, it provides excellent results and may be used in children of all ages.

Age Factors↗
PubMed1977

Ductus arteriosus responses to prostaglandin E1 at high and low oxygen concentrations.

It previously has been suggested that prostaglandin E1 (PGE1) relaxes the ductus arteriosus in a low but not in an elevated oxygen environment. However, in the experiments reported here PGE1 relaxed rings on fetal lamb ductus arteriosus in vitro at both low (14 to 20 torr) and high (680 to 720 torr) oxygen tensions. The threshold concentration for PGE1 was 10(-10) M in either PO2 and the ED50's of PGE1 relaxation in high and low oxygen were 8.5 +/- 3.4 x 10(-10) M and 5.5 +/- 0.7 x 10(-10) M respectively. The magnitude of the relaxation was greater for the oxygen contracted ductus arteriosus than for that exposed to low oxygen. It is suggested that earlier reports of the lack of response of the ductus arteriosus to PGE1 in a high oxygen environment following relaxation in a low oxygen environment may be related to loss of response of the ductus arteriosus to repeated doses of PGE1 rather than to differences in PO2. Prostaglandin E1 therefore may play a significant role in the regulation of ductus arteriosus tone in the elevated oxygen environment of the newborn as well as the low oxygen environment of the fetus.

Animals↗
PubMed1999

Comparative anatomy and ontogeny of the ductus arteriosus, a vascular outsider.

In its function of separating pulmonary and systemic arterial blood flow, the ductus arteriosus, which connects both circuits, either closes permanently at a certain stage in development or attains a capacity to close and reopen depending on the physiological needs in certain species. In air-breathing vertebrates varying from lungfish to mammals, the ductus arteriosus derives from the sixth pharyngeal arch artery, and in preparation for its specific task, undergoes its own unique differentiation programme, starting early in development. To date, the mechanisms involved in defining this unique status, as compared to the other great arteries, are unclear. This review clarifies some of the elusiveness of the ductus arteriosus. It includes a comparative description of this artery in species exemplifying the different classes of air-breathing vertebrates, and illustrates similarities and differences in morphogenesis and closure mechanisms among the species. It also deals with possible influences of vascular innervation and with congenital anomalies in which the ductus arteriosus is involved. New data suggest that HOXB5 expression in the neural crest along the dorsal half of the sixth arch artery may be involved in the instigation of ductus arteriosus differentiation.

Animals↗
PubMed1977

Management of bilateral ductus arteriosus in complex cyanotic heart disease.

Bilateral ductus arteriosus (BDA) usually is associated with complex cyanotic heart disease. Since pulmonary valve atresia often is part of the complex, hypoxia may necessitate emergency cardiac catheterization and surgery for these critically ill newborn infants. Optimum management depends on accurate delineation of the intracardiac and great vessel anatomy. Since the ductus arteriosus has a tendency to close spontaneously, the true anatomy of the fourth to sixth aortic arch connections should be determined on the first catheterization. An over-all plan for future care by the medical-surgical team should have been made at the time of the initial surgical procedure. The case histories of four newborn infants with BDA associated with cyanotic heart diseases are reported. The anatomy and basic embryology of the fourth to sixth arch system is reviewed and recommendations for long-term management are given.

Aorta, Thoracic↗
PubMed1994

[Prenatal diagnosis of severe stenosis of the ductus arteriosus Botalli in a twin pregnancy].

Premature ductus arteriosus stenosis is a rare cardiovascular disease, which has a poor prognosis. The case presented was detected even in early pregnancy and was progressed rapidly to the stage of severe foetal heart failure. The patient was first seen at 20 weeks of gestation with one of the foetuses of a twin pregnancy, showing signs of cardiac decompensation and advanced hydrops fetalis universalis. Obstruction of the ductus arteriosus may result from maternal tocolysis treatment with prostaglandin synthetase inhibitors, such as indomethacin or maternal salicylate or in conjunction with foetal post maturity.

Adult↗
PubMed1981

Effects of antenatal glucocorticoid administration on ductus arteriosus of preterm lambs.

We have previously shown that the incidence of patent ductus arteriosus (PDA) in premature infants whose mothers received prenatal glucocorticoid therapy was significantly lower than that of an untreated group. In addition, the incidence of respiratory distress syndrome was lower in the treated than in the untreated group. To determine whether glucocorticoids affect the ductus arteriosus itself, we studied the effects of a 48-h intravenous infusion of 1 mg/h hydrocortisone in prematurely born lambs (120-129 days, 0.84 gestation). Estimations of ductus patency were made on 1-h-old lambs by radioactive microsphere injections. We found that hydrocortisone infusions facilitate the closure of the ductus without altering the severity of respiratory distress in premature lambs. In the lamb, prostaglandin E2 (PGE2) inhibits the ability of the ductus to contract in response to O2. Because production of PGE2 has been shown to be inhibited by hydrocortisone in several isolated organ systems, we measured PGE2 plasma concentrations in treated and untreated animals. We found circulating PGE2 concentrations to be similar in the two groups; furthermore, release of PGE2 by isolated ductal rings in vitro was similar in treated and untreated animals. This contradicts the hypothesis that diminished PGE2 concentrations, either circulating or in the tissue, are the cause for ductus arteriosus closure in hydrocortisone-treated animals. However, hydrocortisone treatment decreases the sensitivity of the ductus arteriosus in vitro to the relaxing action of PGE2. These findings suggest that glucocorticoid treatment decreases the incidence of PDA in premature infants by affecting the interaction of PGE2 with ductal tissue.

Animals↗
PubMed1987

Noninvasive Doppler echocardiographic evaluation of shunt flow dynamics of the ductus arteriosus.

The pulsed Doppler technique was used to record the flow velocity patterns in the ductus arteriosus and the pulmonary artery in 26 patients with either isolated or complicated patent ductus arteriosus (PDA). In all patients, abnormal Doppler signals indicating left-to-right (L-R) or right-to-left shunt flow or both could be obtained at the site of the ductus arteriosus. These Doppler flow patterns determined within the ductus coincided with the direction of ductal flow seen on the contrast two-dimensional echocardiogram. No Doppler signals of shunt flow were demonstrated in any of 42 control subjects. The peak, mean, and diastolic velocities of the L-R shunt flow within the ductus were measured from the ductal flow velocity profiles. With the Doppler-derived measurements of the mean and diastolic velocities, patients with normal pulmonary arterial pressure and those with evidence of pulmonary hypertension could be correctly identified. In addition, the mean velocity of the diastolic antegrade flow portion obtained from the proximal left pulmonary artery, which was related to ductal L-R shunting, was measured in 16 patients with isolated PDA. This Doppler flow determinant showed a good linear correlation with the L-R shunt ratio determined by Fick's method (r = .88, p less than .01). Our technique permits the noninvasive evaluation of shunt flow dynamics in patients with PDA.

Blood Flow Velocity↗