PATENT ductus arteriosus and maternal rubella.
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Ductus Arteriosus↗
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[Aneurysm of a diverticulum of the ductus arteriosus in an adult: a case report].
An aenurysm of a diverticulum of the ductus arteriosus in a 33-year-old man was presented. The chest radiography revealed a mass obscurring the aortic window above the hilus of the left lung. His blood pressure was 130/70 mmHg, and there was no difference in pressures between the upper and lower or between the right and left extremities. A CT scan of the chest showed 30 X 34 mm angioma adjacent to the descending aorta and pulmonary artery. Aortography and contrast radiography of the right ventricle revealed a cystic pedunculated aneurysm at the superior portion of the descending aorta. The base of the left pulmonary artery was slightly displaced. There was no communication between the aorta and pulmonary artery, nor was any significant difference in pressure between the ascending and descending aorta. This case was diagnosed as an aneurysm of the diverticulum of the ductus arteriosus, and then it was resected. The abnormality was confirmed by the localization of the aneurysm and histopathologic findings, but the presence of the ligamentum arteriosum was not confirmed. This is the 23rd case of the aneurysm of the diverticulum of the ductus arteriosus in adults, and the first case in Japan in which the diagnosis was made in a living patient, followed by successful surgery.
Adult↗
[A simplified catheter technique for the occlusion of a large persistent ductus arteriosus].
Transcatheter occlusion of a persistent ductus arteriosus with a diameter of more than 9 mm is considered difficult or impossible with the currently available techniques. Usually, these patients have to be operated. We used a simple technique to occlude a 13-mm ductus using two Rashkind umbrellas introduced simultaneously through the left and right femoral veins. Complete closure was demonstrated by echo- and angiography.
Adult↗
In vivo constriction of the fetal and neonatal ductus arteriosus by a prostanoid EP4-receptor antagonist in rats.
Indomethacin is used to constrict the patent ductus arteriosus in premature infants. To clarify possible prostanoid receptor antagonists that can constrict the ductus, we studied in vivo constriction of the fetal and neonatal ductus arteriosus by AE3-208, a prostanoid EP4-receptor antagonist, in rats. Following quick cesarean section of near-term pregnant rats (21 d), neonates were incubated in room air at 33 degrees C. The inner diameter of the ductus was measured with a microscope and a micrometer following rapid whole-body freezing of the fetus and neonate, and sectioning of the thorax in the frontal plane on a freezing microtome. In the control, the ductus arteriosus constricted quickly after birth, and the inner diameter was 0.80 mm in the fetus and 0.06 mm at 90 min after birth. AE3-208, administered orogastrically to the dam, constricted the fetal ductus dose dependently. Maximal ductal constriction was observed 4 h after administration, and the ductal diameters were 0.06 mm and 0.26 mm after administration of 10 mg/kg and 10 ng/kg of AE3-208, respectively. In neonatal rats, AE3-208 injected subcutaneously at 30 min after birth, inhibited dilatation of the ductus by PGE1 dose dependently. PGE1 (10 microg/kg) was injected subcutaneously to the 1-h-old neonatal rat, and the ductal diameters were 0.53 mm and 0.19 mm without and with pretreatment of AE3-208 (10 microg/kg), respectively. These results indicate the major role of EP4 in the fetal and neonatal ductus and show that an EP4 antagonist can be used to constrict the patent ductus of premature infants.
Animals↗
[Endoluminal occlusion, using a catheter, of patent ductus arteriosus in an adult].
The risk of surgical closure of the ductus arteriosus in the adult is greater than in children. The ductus arteriosus can now be occluded by venous catheterisation using a Rashkind umbrella. This procedure vas performed in a 63 year old woman. The diagnosis was confirmed and the anatomy of the lesion defined by catheterisation with aortography. The patent ductus was then occluded with a balloon catheter to assess the reversibility of the pulmonary hypertension. A 17 mm Rashkind umbrella was then used to completely occlude the ductus. The advantages of the method over surgical closure are: absence of morbidity related to thoracotomy, to general anaesthesia, to blood transfusion and the reduction of hospital stay to 3 days.
Cardiac Catheterization↗
Indomethacin and fetal ductus arteriosus: complete closure after cessation of prolonged therapeutic course.
Indomethacin is a very effective tocolytic agent. However, concern about its possible constrictive effect on fetal ductus arteriosus has limited the use of this medication in pregnancy. A 29-year-old woman was treated with indomethacin at 27 weeks of gestation for preterm labor and polyhydramnios. She received a dose of 75 mg/day for 5 weeks. At 35 weeks of gestation, she had a cesarean delivery due to fetal distress, and a hydropic baby was delivered. The infant died shortly after. Nonimmune hydrops fetalis and closed ductus arteriosus were the only pathological findings at autopsy. In utero, irreversible, complete closure of the ductus arteriosus is very rare. In the case presented, prolonged use of indomethacin during pregnancy was associated with complete closure of the ductus arteriosus that developed most probably after discontinuation of therapy. This case emphasizes the need for frequent fetal echocardiography examinations during as well as after maternal indomethacin treatment.
Adult↗
A safe technique for closure of the recurrent patent ductus arteriosus.
In an early series of 73 operations for patent ductus arteriosus, closure was by the triple ligation method. Over a short period, recurrence of patency was observed in 2 cases and after that the technique of division and suture rather than ligation became standard. For closure of the recurrent ductus, a modification of the usual technique is necessary to minimize danger of injury to the recurrent nerve and the great vessels. A safe method was devised which involves an intrapericardial approach to the superior aspect of the ductus and dissection inferiorly which avoids denudation of the aorta. This technique was used with satisfaction in 6 cases of recurrent patent ductus arteriosus.
Adult↗
Characterisation of the effect of oxygen tension on response of fetal rabbit ductus arteriosus to vasodilators.
OBJECTIVE: The aims of the study were (1) to elucidate the effects of raised oxygen tension on the response of the ductus arteriosus to a range of vasodilators; and (2) to establish the effect, if any, of cyclo-oxygenase inhibition on the interaction between oxygen and prostaglandin (PG)E2. METHODS: Rings of ductus arteriosus were isolated from fetal New Zealand White rabbits at 28 d gestation (term = 31) and precontracted with 10 microM noradrenaline in the presence of the cyclo-oxygenase inhibitor indomethacin (1 microM). Cumulative relaxation response curves were obtained from a range of vasodilators and their pEC50 (-log10 of the interpolated molar concentration causing 50% of the maximum response) and maximum relaxant response (MRR) were determined in 15% oxygen (neonatal oxygen tension, 13-14.3 kPa) and 2% oxygen (fetal oxygen tension, 2.5-3.0 kPa). In addition, the effects of (1) omitting indomethacin and (2) its substitution by 1 microM flubriprofen were studied on the interaction between oxygen and PGE2. RESULTS: In 1 microM indomethacin, nifedipine and atrial natriuretic peptide had no effect on ductal tone in either oxygen tension. In 15% oxygen, the rank order of MRR was forskolin > cicaprost > PGE2 >> cromakalim >> sodium nitroprusside approximately adenosine approximately 0. The MRR of all agonists was increased in 2% oxygen except forskolin which caused complete relaxation in 15% oxygen. In 15% oxygen, the rank order of pEC50 was PGE2 >> cicaprost approximately cromakalim approximately forskolin. PGE2 was 70.8 times more potent than cicaprost. The pEC50 of all four agonists was increased in 2% oxygen. The increase in pEC50 could not be explained by a decreased extent of precontraction. The MRR to PGE2 in 15% oxygen and the magnitude of the increase in pEC50 to PGE2 going from 15% to 2% oxygen were the same in 1 microM flubriprofen, 1 microM indomethacin, or in the absence of these drugs. However, in 2% oxygen, the MRR to PGE2 was increased in 1 microM indomethacin or 1 microM flubriprofen compared with control. CONCLUSIONS: (1) Increasing oxygen tension from fetal to neonatal levels desensitises the ductus arteriosus to a range of vasodilators. (2) There is evidence that prostacyclin has a physiological role in the control of the rabbit ductus arteriosus. (3) The effect of oxygen on the potency of PGE2 is independent of cyclo-oxygenase products, whereas its effect on the efficacy of PGE2 is modulated by an endogenous cyclo-oxygenase product.
Adenosine↗
Patent ductus arteriosus in hyaline membrane disease: chest radiography.
Sequential chest radiographs of 45 consecutive neonates with respiratory distress were reviewed prospectively. Nineteen had hyaline membrane disease, 16 had infiltrates of other etiology, three had transient tachypnea of the newborn, and seven had no pulmonary pathology on chest radiography. Ten of the 19 infants with hyaline membrane disease and one of the 16 with pulmonary infiltrates had clinical and radiologic evidence of a patient arteriosus; there was echocardiographic confirmation in seven. Radiologic evidence of the patent ductus arteriosus was detected in all cases with no false positives. The radiographic criterion of the patent ductus was the appearance in sequential frontal chest films of pulmonary plethora, that is, pulmonary vascular engorgement and perihilar edema "haze." The radiographic appearance of the patent ductus arteriosus was detected prior to the clinical signs in seven of 11 cases and simultaneously with the clinical picture in three cases. In one the radiographic abnormally occurred later. Chest radiography is a valuable adjunct in the early diagnosis of a patent ductus arteriosus in infants with hyaline membrane disease.
Ductus Arteriosus, Patent↗
[Closure of a persistent ductus arteriosus Botallo without thoracotomy].
A persisting ductus arteriosus (PDA) was closed with the Rashkind occlusion system in 15 patients (12 children, aged 1.0 to 10.8 years, and three adults, aged 21, 33 and 56 years). The method consists of the implantation of a double umbrella of polyurethane foam mounted on platinum or steel wire introduced into the PDA via a transport catheter, the ductus being closed by thrombosing and epithelialization of the implant. The mean diameter of the PDA (as measured in the lateral aortogram) was 2.4 (1.4-5.3) mm. There were no complications of the procedure, nor any embolization or other serious complications. The PDA was completely occluded in eight patients, while a residual shunt remained in seven. In the oldest patient, aged 56 years, who had a residual shunt, increasing haemolysis required surgical closure of the ductus with a pericardial patch. These results indicate that, for patients weighing over 5 kg and with a ductus diameter of less than 10 mm, the closure method after Rashkind is a sparing and only slightly invasive procedure.
Adult↗
Transcatheter closure of the patent ductus arteriosus: a comparative study between occluding coils and the Rashkind umbrella device.
This study was performed to evaluate the efficacy of transcatheter coil closure of the patent ductus arteriosus in comparison to our experience with the Rashkind umbrella device. Transcatheter coil closure of the patent ductus arteriosus has been reported with encouraging results. We present our experience with ducti up to 5.0 mm in diameter and report the short-term follow-up. We compare the results with our previous experience with the Rashkind umbrella device. Seventy-one patients underwent transcatheter coil closure. Median age was 3.1 years, and median weight was 13.6 kg. Mean ductus diameter was 2.0 +/- 1.1 mm. These were compared with 105 patients who underwent transcatheter closure using a single Rashkind umbrella device. The median age was 3.2 years and the median weight was 14.0 kg. The mean ductus diameter for this group was 2.1 +/- 0.6 mm. The ductus murmur in the coil group disappeared in all patients. Immediate (< or = 24h), complete closure was achieved in 89% of the coil group as compared to 71% for the Rashkind umbrella device group (P < 0.005). Closure rate for the coil group was 97% at the 6-month follow-up, vs. 82% for the Rashkind umbrella device group at the 6-12 month follow-up (P < 0.05). In almost all patients requiring more than one coil, the ductus was crossed serially from the aortic end. All patients with ductus diameter > or = 3.0 mm required two or more coils. Eleven coils in six patients embolized to the pulmonary arteries. All coils except one were retrieved with subsequent successful foil placement. Sixty-seven patients (94%) in the coil group were discharged in < or = 24 h. Transcatheter closure of the patent ductus arteriosus using multiple coils is a more effective technique than the Rashkind umbrella closure and has excellent short-term results. This can be performed safely as an outpatient procedure.
Adolescent↗
Familial persistent ductus arteriosus.
The occurrence of isolated persistent ductus arteriosus in three generations of one family with surgical correction is described. The high incidence of the malformation in this family suggests autosomal dominant inheritance rather than a polygenic mode of inheritance.
Adult↗
Prediction of ductus arteriosus closure by neonatal screening echocardiography.
AIMS: We reported the incidence, clinical manifestations and outcome of patent ductus arteriosus (PDA) in full-term infants by screening echocardiography. METHODS AND RESULTS: Total 1230 infants received echocardiographic screening and periodic follow-up. On the third day of life, there were 109 infants with isolated ductus arteriosus aneurysm (DAA), those with persistent patency of the ductus arteriosus (DA) in 26. The DA closed within 48 h in 828 infants, and persisted beyond 48 h in 180. The incidence of PDA in full-term infants was 0.91, 0.83 and 0.66% at 1, 4 and 6 months follow-up, and 0.82, 0.73 and 0.64% if infants with DAA were excluded. Infants with PDA had lower birth body weight (BBW) than those with closed DA (p = 0.02). The DA width on the third day of life ranged from 0.23 to 0.43 cm (0.32+/-0.08 cm) and 0.08 to 0.44 cm (0.16+/-0.06 cm) in infants with or without PDA, respectively, which was significantly different (p < 0.05). The sensitivity, specificity, predictive positive and negative values were 87.5, 92.5, 36.8 and 99% respectively for the cuff-off point at 0.25 cm of DA width. CONCLUSIONS: Risk factors in infants with PDA included lower BBW and larger measured DA width at the third day of life. We predicted the arterial duct would close if DA width <0.25 cm, and suggested follow up earlier if >0.25 cm on the third day of life.
Cardiac Surgical Procedures↗
Transcatheter closure of patent ductus arteriosus using occluding spring coils.
The purpose of this study is to report our initial experience with the use of spring coils to close the patent ductus arteriosus in the dog. There are few large-patient series reported in the veterinary literature. Coil closure was attempted in 15 dogs (median weight, 6.5 kg; range, 1.2 to 38.7 kg) presenting with a patent ductus arteriosus between May 1997 and May 1999. Arterial catheterization followed by angiography was used to decide if coil placement was adequate. A 5- or 8-mm embolization coil, depending on the angiographic diameter of the ductus, was delivered, with 1 loop in the pulmonary arterial side and the remainder of the coil in the aortic side of the duct. Additional coils were used if a residual shunt was present, and closure was confirmed by aortography. Patients were discharged the day after the procedure. Successful coil closure, without residual shunt on angiography, was achieved in 11 of 13 dogs in which coils were released. In 6 dogs, a coil embolized to the pulmonary artery. Four of these dogs had successful closure with multiple coils, and 2 others had surgery. None of these dogs experienced adverse effects. In 2 dogs with conical patent ductus arteriosus >5 mm in minimal diameter, coil closure was not done. We conclude that the patent ductus arteriosus size and anatomical shape are crucial in deciding whether coil closure is the method of choice. In selected cases, coil closure represents an elegant alternative to surgical ligation. Although pulmonary embolism occurred commonly, it did not cause any obvious clinical problem.
Animals↗
Aneurysm of the ductus arteriosus: a congenital lesion.
The objective of this study was to evaluate the clinical, radiological, and echocardiographic findings in 11 neonates with aneurysm of ductus arteriosus presented in our institutions between 1993 and 1996, and to postulate a new theory for the pathogenesis of this lesion. Medical records, radiographic studies, and echocardiograms were reviewed. All infants underwent follow-up echocardiograms every 2 to 3 days until the aneurysm spontaneously resolved or surgery was performed. The infants were predominantly term males; six had evidence of fetal distress, two were diagnosed prenatally by fetal echocardiogram, chest X ray evidenced mediastinal mass in six patients. The first echocardiogram showed structurally normal heart with an aneurysmal patent ductus arteriosus. In eight patients the aneurysm completely resolved by 5 to 10 days. One infant underwent surgical resection of the aneurysm after observation for 11 days with no change in size. Thrombosis of the aneurysm was noted in two patients; both underwent surgery. Increasing reports of ductal aneurysms in infants may reflect the availability of high-resolution echocardiography and more frequent use of echocardiography in the neonatal intensive care unit. Spontaneous resolution occurred in the majority of cases as in previous reports. We postulate that, at least in some cases, aneurysm of the ductus arteriosus is a congenital lesion that may represent poststenotic dilation of the ductus due to turbulent flow through a stenotic segment at its pulmonary artery end during fetal life. The presence of aneurysm of the ductus arteriosus should be excluded in selected cases of fetal distress, by fetal echocardiography.
Aortic Aneurysm, Thoracic↗
Cost-effectiveness of transaxillary muscle-sparing same-day operative closure of patent ductus arteriosus.
Transaxillary muscle-sparing patent ductus arteriosus closure performed as same-day surgery is described in 10 patients. This approach provides a superb cosmetic result while obviating the need for thoracostomy tube placement.
Adolescent↗
[Surgical treatment for patient ductus arteriosus in an aged patient].
A successful closure of patent ductus arteriosus (PDA) in a 70-year-old women is described. The patient had poor pulmonary function and calcification of the aortic arch and the descending aorta, as well as arteriosclerosis obliterans bilaterally in the iliac arteries. We therefore performed trans-pulmonary artery direct closure of the ductus arteriosus via a median strenotomy. In surgery, we used a Foley balloon catheter inserted into the aorta through the ductus to prevent backflow. Leakage of blood from the ductus, even with use of balloon occlusion, required the reduction of perfusion flow to 500 ml/min and temporary circulatory arrest. Rectal temperature was 27 degrees C when the aorta was cross-clamped. The ductus orifice was primarily closed with three mattress sutures with pledgets, and this sutured orifice was secondarily covered with a bovine pericardial patch. The postoperative course was satisfactory. Trans-pulmonary artery direct closure of the PDA using cardiopulmonary bypass is useful for aged patients. This patient is, as far as our knowledge, the oldest surgical report in Japan.
Aged↗
Patency of the ductus arteriosus after balloon dilatation: an experimental study.
Balloon dilatation of the ductus arteriosus was carried out in vivo in newborn pigs and on postmortem specimens from humans and piglets. The ductus was functionally closed in all newborn animals but patency resulted in all animals after balloon dilatation. Left-to-right shunts of 50% to 70% were found with anatomic lumen sizes of 3 to 5 mm. Patency was demonstrated up to 6 weeks after dilatation. Histologic examination showed splitting of the internal elastic layer and media, areas of hemorrhage confined to the media, and preservation of the adventitia. Mediastinal hemorrhage did not occur. This new technique is useful as an animal model of patent ductus arteriosus and could theoretically be used for palliative treatment of ductus-dependent congenital heart disease.
Angioplasty, Balloon↗