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PubMed2001

The value of contrast echocardiography in the diagnosis of patent ductus arteriosus with Eisenmenger's syndrome.

When patent ductus arteriosus (PDA) is complicated by pulmonary hypertension resulting in a right-to-left shunt, an erroneous diagnosis of primary pulmonary hypertension may be made, even after echocardiographic examination. Among the 8 patients referred to our echocardiography laboratory with the diagnosis of primary pulmonary hypertension between June 1994 and November 1999, 2 patients were found to have PDA with Eisenmenger's syndrome. Patent ductus arteriosus with Eisenmenger's syndrome can be diagnosed by the opacification of the abdominal aorta without opacification of the left-sided chambers during contrast echocardiography.

Adolescent↗
PubMed1980

Histology of the persistent ductus arteriosus in cases of congenital rubella.

Histologic study of the persistent ductus arteriosus in case of a congenital rubella syndrome revealed that this persistency is probably due to an arrest in the development of the ductus. Histologically, it resembles a very immature ductus and not the most common type of persistent ductus arteriosus. The earlier finding, that in the human ductus arteriosus, the presence of an extensive subendothelial elastic lamina is incompatible with anatomic sealing, still holds.

Child↗
PubMed1989

[Report of a case of an atypical huge patent ductus arteriosus].

An atypical huge patent ductus arteriosus (PDA) associated with extreme pulmonary hypertension in a 6-month old female infant was reported. The left 3rd intercostal thoracotomy revealed huge PDA which has an appearance of pulmonary-ductus-descending aorta-trunk (PDDT) on the left side. The right side of the ductus continued to the aortic arch without demarcation between the ductus and the aorta. The median sternotomy clarified the ascending aorta, normal aortic arch, and main pulmonary artery. However, the top of the main pulmonary artery seemed to be fused with the aortic arch. The diagnosis of distal type of aortopulmonary window with wide communication was made and the total circulatory arrest with deep hypothermia and the intracavitary patching for separation of systemic and pulmonary blood flow seemed to be required for the complete repair. Total repair was decided to be postponed one week later and the chest was closed. The patient died of multi-organ failure originating from acute respiratory failure 23 days after exploratory thoracotomy without being repaired. Postmortem examination revealed a huge PDA freely communicating with the ascending aorta and the aortic arch. This is a report of an atypical huge PDA rarely seen and the conventional division or ligation is unfeasible. The circulatory arrest with deep hypothermia and intracavitary patching are obligatory for the surgical repair.

Ductus Arteriosus, Patent↗
PubMed1984

Pulmonary artery velocity patterns in ductus arteriosus.

In 12 patients with ductus arteriosus a characteristic velocity pattern in the pulmonary artery was identified using pulsed Doppler echocardiography. This pattern, which was absent in 52 normal control subjects and 200 consecutive patients with cardiac lesions other than ductus, consisted of a pandiastolic velocity directed away from the transducer. This pattern is thought to represent the diastolic component of flow into the pulmonary tree which occurs as a result of the left to right shunt.

Adolescent↗
PubMed1990

[Aneurysm of the diverticulum of the ductus arteriosus in the adult].

Aneurysm of the diverticulum of the ductus arteriosus is a rarely reported entry in adult. To our knowledge, only two previous patients underwent successful aneurysmectomy in Japan. Three new cases of aneurysm of the ductus arteriosus diverticulum in the adult, all diagnosed preoperatively and successfully repaired, are presented. All three patients are alive 17 to 44 months postoperatively. Our experience with these patients suggests several important features of these aneurysms: (1) CT scanning with contrast enhancement will almost invariably confirm the diagnosis of these aneurysms. (2) Exposure through a median sternotomy is generally good and carries less operative morbidity from rupture than a posterolateral thoracotomy. (3) Because of their critical location and the high incidence of rupture in reported cases, aneurysms producing symptoms, or those showing progressive enlargement should be surgically resected. (4) When a succular aneurysm of the aortic arch is demonstrated expanding toward the aortopulmonary window with adhesion to the pulmonary artery, the possibility of its origin from the ductus arteriosus must be investigated.

Age Factors↗
PubMedDate not supplied

Pathology of the ductus arteriosus treated with prostaglandins: comparisons with untreated cases.

Our histological study of the ductus arteriosus compared 12 infants who were treated with E-type prostaglandins with 12 control infants matched as closely as possible for age and diagnosis. Distinguishing histological features were seen in five of the treated cases and in none of the untreated cases. These features were intimal tears in two and hemorrhage into the media in five. Medial edema, mural thrombosis, and interruption of the internal elastic lamina at sites not beneath intimal cushions occurred both in treated and untreated infants and therefore were not distinguishing features. The gross anatomical features of the ductus arteriosus were assessed in these 24 and in another 85 cases. Significant differences in the ductus arteriosus were noted between cases with pulmonary atresia or aortic atresia and normals, but not between those treated with E-type prostaglandins and controls.

Alprostadil↗
PubMed1994

[Percutaneous closure of patent ductus arteriosus with the Rashkind device].

PURPOSE: To assess the efficacy and safety of the percutaneous closure of the persistent ductus arteriosus with the Rashkind device. DESIGN: Clinical, angiographic and echocardiographic assessment of the patency of the ductus arteriosus at the time of the implantation of the first or second Rashkind device, followed by clinical and echocardiographic control at one, three and six months and yearly thereafter. PATIENTS: Thirty two patients with patent ductus arteriosus. Twenty seven were female and five male. Their ages ranged between 10 months and 33 years (6.8 +/- 7.7 years) and their weights between 7.3 and 52 (20.1 +/- 12.4) kg. Two patients were excluded due to a ductal diameter greater than 8 mm. Thirty patients had successful device implantation. METHODS: Implantation at cardiac catheterization of the Rashkind double umbrella occluder device in the narrowest portion of the patent ductus arteriosus. Twenty one patients had one device implanted and five had the implantation of a second device four to 12 months later, due to persistent patency of the ductus. RESULTS: Total closure was achieved in 26 out of 30 patients. In 21 patients the occlusion was obtained with a single device and in five patients with two devices. Among the remaining four patients, one is awaiting the implantation of a second device and the other three are under follow-up as their first devices were implanted recently. There were no complications. CONCLUSIONS: Percutaneous closure of the ductus arteriosus with the Rashkind device represents an efficient and safe alternative to surgery in most patients.

Adolescent↗
PubMed1980

Circulating prostaglandin E2 concentrations and incidence of patent ductus arteriosus in preterm infants with respiratory distress syndrome.

In several species prostaglandin E2 (PGE2) appears to be the most important prostanoid to regulate patency of the ductus arteriosus. We measured the arterial plasma concentration of PGE2 in 29 premature infants (17 with respiratory distress syndrome alone and 12 with respiratory distress syndrome and patent ductus arteriosus) to determine if there was an association between circulating PGE2 and patent ductus arteriosus. The PGE2 concentrations during the first two days after birth were higher than PGE2 concentrations after the third postnatal day (17.1 +/- 3.1 pg/ml, mean +/- SEM, n = 23, vs 6.12 +/- 0.63 pg/ml, n = 19, P < .005). By the third postnatal day, arterial concentrations were similar to adult venous values. There was no significant difference between the plasma PGE2 concentrations in the 12 infants with patent ductus arteriosus and the concentrations in the 17 infants who had no signs of patent ductus arteriosus. These findings do not support the hypothesis that an increased concentration of circulating PGE2 is the primary cause for the persistent patency of the ductus arteriosus in preterm infants with respiratory distress syndrome.

Ductus Arteriosus, Patent↗
PubMed2002

[Surgical treatment of aneurysm of the ductus arteriosus in the adult].

Aneurysm of the ductus arteriosus is rare, however, reports on this lesion have increased recently with the progress of thoracic aortic surgery in Japan. We report 3 male cases aged 58, 59, 73 years. Aneurysms and total aortic arch were replaced by artificial graft through median sternotomy using selective cerebral perfusion in 2 cases. Through left posterolateral thoracotomy using deep hypothermia with circulatory arrest, proximal descending thoracic aorta including the aneurysm was replaced in 1 case. Their postoperative courses were uneventful. Surgery for this lesion is safe and various surgical approaches and circulatory supporting methods can be selected depending on the size of aneurysm and associated lesions.

Aged↗
PubMed1978

Formation of prostacyclin (PGI2) by the ductus arteriosus of fetal lambs at different stages of gestation.

Prostaglandins appear to play a role in maintaining patency of the ductus arteriosus during gestation. Prostacyclin (PGI2) is the major product of prostaglandin biosynthesis in the lamb ductus arteriosus. This factor is both a vasodilator and a potent inhibitor of human platelet aggregation. We used inhibition of platelet aggregation as a sensitive bioassay to measure PGI2 generation in rings of ductus arteriosus from fetal lambs. Mechanical manipulation accelerated the rate of PGI2 released from the tissue 10 to 50 times. Tranylcypromine, an antagonist of prostacyclin synthetase, suppressed production of PGI2 by rings of ductus arteriosus. Rings from immature animals (98-103 days gestation, term is 150 days) released significantly more PGI2 (190 +/- 28 ng/g wet weight/ 20 min, n = 9) than did those from near term animals (136-146 days; 106 +/- 23 ng/g wet weight/20 min, n = 10). The capacity of the ductus arteriosus to generate more PGI2 earlier in gestation is consistent with the observation that vessels from animals less than 110 days gestation have a significantly larger indomethacin induced contraction than do vessels near term.

Animals↗
PubMed1982

Patent ductus arteriosus in a cat.

Patent ductus arteriosus is the most common shunting congenital cardiac anomaly in the cat. If it is treated surgically, early in the course of the disease, the prognosis is good.

Animals↗
PubMed1992

Atrial natriuretic peptide in newborn piglets with a patent ductus arteriosus.

Atrial natriuretic peptide (ANP) is a hormone involved in fluid and blood pressure homeostasis. We studied the effects of left-to-right shunting through a patent ductus arteriosus on blood pressure changes and plasma ANP concentrations in newborn piglets. In five experimental piglets, the ductus arteriosus was bathed with PGE1 and infiltrated with formalin to maintain its patency. In four age-matched control piglets, the ductus arteriosus was ligated. Plasma ANP concentrations and blood pressure determinations were obtained prior to (base-line) and 25 +/- 1 h (day 1), and 48 +/- 1 h (day 2) after surgery. Radionuclide-microsphere determinations of left-to-right patent ductus arteriosus shunts were performed on days 1 and 2 in the 5 piglets with a patent ductus arteriosus. Plasma ANP concentrations were significantly elevated in the left atrium on day 1 and the right atrium on day 2 in the PDA piglets. No correlation was demonstrated between plasma ANP concentrations and right or left atrial pressures. We conclude that left and right plasma atrial ANP concentrations are significantly elevated in newborn piglets with left-to-right patent ductus arteriosus shunts.

Animals↗
PubMed1990

Changes in distribution of elastin and elastin receptor during intimal cushion formation in the ductus arteriosus.

Changes in distribution of elastin and elastin receptor were studied during maturation of the ductus arteriosus. In this vessel intimal thickening is a normal process. It starts with separation of endothelial cells from the internal elastic lamina by the formation of a wide subendothelial region, followed by an increase in number of radially orientated cells in the inner media and subendothelial region. For the first time the nature of these originally inner media cells could be definitely determined as being derived from smooth muscle cells. Areas rich in these modified smooth muscle cells contained less elastin as compared with regions rich in circularly orientated smooth muscle cells. The internal elastic lamina had disappeared underneath intimal cushions of the canine ductus arteriosus, whereas in the fetal human ductus arteriosus, splitting of the internal elastic lamina was observed. Elastin was not present underneath separated endothelial cells, which suggests that these cells do not synthesize elastin, at least not after separation. Both smooth muscle cells and endothelial cells demonstrated the presence of the elastin receptor. Changes in its distribution were not observed. The temporal and spatial association between the altering distribution of elastin and the absence of normal cushion formation in the persistent ductus arteriosus suggests a role of the elastin receptor in the process of intimal thickening.

Animals↗
PubMed1988

Ductus arteriosus in pilot whales.

The ductus arteriosus (DA), connecting the aorta with the pulmonary artery in the fetus, which normally closes up just after birth in terrestrial mammals, has been claimed not to close, but to remain open in normal, adult cetaceans, just as in the adult lungfish. We have examined the hearts from two Pilot Whales. In those we found no persisting DA, but an almost totally obliterated lumen. Blood flow through the ductus of these two whales could be excluded. Instead of an anatomical shunt mammals may use a functional pulmonary shunt. To the extent diving mammals can empty their alveoli for air at depth through reinforced bronchioli, and their very compliant thorax, they block alveolar gas exchange, and thus avoid decompression sickness, nitrogen narcosis and pulmonary squeeze.

Animals↗
PubMed1984

Prostaglandin biosynthetic activities of isolated fetal lamb ductus arteriosus, other blood vessels, and lung tissue.

Experimental evidence from many laboratories implicates products of arachidonic acid metabolism in perinatal homeostasis of the circulation of the ductus arteriosus. Studies were conducted to define the potential prostaglandin and prostanoid biosynthetic capabilities of the isolated fetal lamb ductus arteriosus, other fetal blood vessels, and isolated fetal and neonatal lung tissue as possible humoral sources of vasoactive products. Because the biosynthetic pathway is a sequential cascade of enzyme reactions, both radiolabeled synthetic endoperoxide (PGH2) and arachidonic acid were used as substrates. Prostacyclin (PGI2) synthase was the primary enzymatic pathway for metabolism of exogenous PGH2 by the isolated ductus arteriosus; no conclusive evidence was found for enzymatic formation of PGE2 or thromboxane A2 (TXA2). The PGI2 synthase activity of the ductus arteriosus was intermediate between arterial tissues (high) and veins (low). A relatively high cyclooxygenase activity was apparent in isolated lung tissue exhibited enzymatic activity for the formation of PGI2, PGE2, and TXA2 from synthetic PGH2. Lung thromboxane synthase activity was markedly elevated late in term due to an apparent increase in Vmax without change in Km, indicative of increased enzyme concentration. Although exogenous PGE2 has been shown to be a more potent relaxant of the ductus arteriosus than PGI2, our study could not positively identify an enzymatic pathway for the total intramural biosynthesis of PGE2. Similarly, no evidence was found for a locally generated constrictor prostanoid, e.g., TXA2. Our results suggest that humoral sources of vasodilator (PGE2 and PGI2) and vasoconstrictor (TXA2) products may be more important than local production in control of the ductus arteriosus and point to the importance of the fetal and neonatal lung in cardiovascular adaptations and homeostasis.

6-Ketoprostaglandin F1 alpha↗