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PubMed1986

Operative closure of patent ductus arteriosus in premature infants in the neonatal intensive care unit.

Fifty-two premature infants underwent hemoclip closure of patent ductus arteriosus in the neonatal intensive care unit after a brief trial of fluid restriction and diuretics. Indomethacin was used in only four patients. The median time from diagnosis to operation was 3 days. There were no deaths directly attributable to operation. Nine operative complications developed in nine patients (17 percent). There were no surgical infections. Complications related to prematurity resulted in 20 deaths (38 percent). Patent ductus arteriosus closure in the neonatal intensive care unit prevented the complications of hypothermia, inadvertent extubation, and interruption of vascular access and monitoring. Early operative closure in the neonatal intensive care unit is the treatment of choice in most premature infants with patent ductus arteriosus.

Ductus Arteriosus, Patent↗

PubMed2005

[Ibuprofen versus indomethacin in the treatment of patent ductus arteriosus in preterm infants].

INTRODUCTION: Persistent patent ductus arteriosus (PDA) is a common entity in preterm infants. The most commonly used pharmacological treatment to close the ductus is indomethacin but it can affect cerebral, renal and mesenteric blood flow. Ibuprofen has recently been shown to be effective in closing PDA with fewer hemodynamic effects. In this study we compared the safety and efficacy of ibuprofen and indomethacin in the treatment of PDA in preterm infants. MATERIAL AND METHODS: A randomized trial was performed. Premature infants with symptomatic PDA confirmed by echocardiography in the first week of life and who required respiratory support were included. The patients were randomly assigned to receive either intravenous indomethacin or ibuprofen. The rate of ductal closure, need for additional treatment, complications, and clinical course were evaluated. RESULTS: Twenty-four patients were treated with indomethacin and 23 with ibuprofen. The clinical characteristics before treatment were similar in both groups. Both treatments were effective in closing PDA (87.5% in the indomethacin group and 82.6% in the ibuprofen group). The two cohorts did not differ in the rate of reopening, need for a second pharmacologic treatment, or surgical ductal ligation. No patient in the ibuprofen group developed gastrointestinal adverse effects, but two infants in the indomethacin group had isolated bowel perforation and one had necrotizing enterocolitis. Transient renal dysfunction developed in seven patients (29%) in the indomethacin group versus two (9%) in the ibuprofen group. Transient renal insufficiency was found in one patient in the indomethacin group and in none in the ibuprofen group. The rate of other complications was similar in both groups. CONCLUSIONS: In our trial ibuprofen was as effective as indomethacin in closing PDA. No significant differences were found in the incidence of complications but fewer renal complications and no gastrointestinal complications were found in the ibuprofen group.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2000

Intraoperative recurrent laryngeal nerve monitoring during video-assisted throracoscopic surgery for patent ductus arteriosus.

OBJECTIVE: To develop a technique to identify and localize the recurrent laryngeal nerve (RLN) during video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus. DESIGN: Prospective clinical study. SETTING: Children's hospital. PARTICIPANTS: Sixty infants and children scheduled for elective closure of patent ductus arteriosus. INTERVENTIONS: With parental informed consent, 60 infants and children undergoing elective VATS for patent ductus arteriosus were studied. A thin, pencil-point, Teflon-coated, stimulating probe allowed direct stimulation (<2 mA, 100-msec pulse width) of the left RLN inside the thorax. A commercially available 4-channel neurologic monitor recorded compound evoked electromyograms (EMGs) from the left RLN and right RLN (as control) by needle electrodes placed percutaneously in the neck. Hoarseness, stridor, feeding difficulties, and voice changes were assessed postoperatively. MEASUREMENTS AND MAIN RESULTS: Left RLN EMGs were easily obtained in 59 of the 60 patients. The surgeon correctly identified the RLN visually once in the first 7 patients; this ability subsequently improved. EMG localization of the location or course of the RLN altered dissection, clip size, or clip position in 37 of 59 patients. CONCLUSION: Intraoperative EMG to identify location and route of the RLN was easy to perform, was effective in identifying RLN position, and appeared to facilitate dissection and clipping of the ductus.

Adolescent↗

PubMedDate not supplied

[Transcatheter closure of ductus arteriosus with coils. Immediate results. Initial experience in Mexico].

From March to May 1996 we performed transcatheter closure of patent ductus arteriosus with spring coils in 4 patients. Age ranged from 5 month to 11 years (mean 4.3 years). One of them had two previous Rashkind occluders with persistant shunt and other case had pulmonary valve stenosis, in this case we performed pulmonary valvuloplasty and after that closure of ductus arteriosus. Mean pulmonary arterial pressure was 10 to 38 mmHg (mean 18), QP/QS was 1.2 to 5.0 (mean 3.2). Immediate total occlusion occurred in two cases and the other had trivial shunt by doppler echocardiography. No complications were detected. In conclusion we believe that this device is another no surgical alternative to treat persistant ductus arteriosus. It is effective, it has a low cost, and all the patients are candidates. The procedure carries minimum risk and has no mortality.

Child↗

PubMed1990

[The relationship between ligation of the ductus arteriosus and intracranial hemorrhage in preterm infants].

Surgical closure of patent ductus arteriosus (PDA) and perioperative time have been proposed as conditions of increased risk of peri-intraventricular hemorrhage (PVH-IVH) in preterm infants. We examined by pre- and postoperative ultrasound (US) scan 15 low birth-weight neonates who underwent PDA ligation within the first two weeks of life. They were assessed with regard to clinical state, perioperative management and development of PVH-IVH. Fourteen did not show onset or extension of intracranial hemorrhage in the immediate postoperative period. One patient developed a wide III grade IVH in the 24 perioperative hours. His conditions were particularly severe, suggesting that many factors such as acidosis, hypoxia, hypercapnia and hypotension might have combined to lead to hemorrhage. We conclude that PDA ligation is not likely to increase the risk of PVH-IVH per se.

Cerebral Hemorrhage↗

PubMed1977

Prolonged rupture of fetal membranes and decreased frequency of respiratory distress syndrome and patent ductus arteriosus in preterm infants.

Observations were made on 153 preterm infants (25 to 34 weeks' gestation) in an attempt to answer the following questions: dose prolonged rupture of the fetal membranes (ROM) correlate with a decreased frequency of respiratory distress syndrome (RDS) and patent ductus arteriosus, and, if so, what is the duration of ROM required? An analysis of the data indicates that as the duration of ROM is lengthened the incidence of RDS and patent ductus arteriosus decreases. In fact, after 48 hours of prolonged ROM (PROM), there is a virtual absence of RDS. In addition, after 72 hours of PROM, the frequency of patient ductus arteriosus was markedly reduced to only 12 per cent (three of 25 infants). PROM beyond 24 hours was also associated with a significant decrease in deaths (p less than 0.05). Amnionitis occurred in 33 per cent of pregnancies with PROM greater than 48 hours; however, only one infant died of sepsis. These findings support the hypothesis put forth by the others 1-5 that PROM is indeed associated with a decreased frequenct of RDS in preterm infants. Moreover, our findings suggest that PROM greater than 72 hours is associated with a relatively low frequency of patent ductus arteriosus. The question is then raised that perhaps pregnancies less than or equal to 34 weeks' gestation with PROM should be allowed to continue for 72 hours in the absence of amnionitis.

Birth Weight↗

PubMed1984

Studies of pulmonary prostaglandin biosynthetic and catabolic enzymes as factors in ductus arteriosus patency and closure. Evidence for a shift in products with gestational age.

The mechanisms underlying patency of the ductus arteriosus in utero and closure shortly after birth should permit optimal regulation of this important physiologic process. Although many studies indicate that vasodilatory prostaglandins contribute to patency, the contribution of the prostaglandin or prostanoid pathways to the closure mechanism has been less evident. The present studies tested a hypothesis which relates products of the cyclooxygenase pathway to modulation of ductal caliber. We began by defining the prostaglandin biosynthetic and catabolic activities of isolated fetal and neonatal lung as a function of gestational age. Inasmuch as biosynthetic enzymes compete for the same substrate, namely PGH2, the competitiveness of the enzymes was explored by varying endoperoxide concentration. The results indicate that the types and quantities of products formed by lung tissue are dependent markedly on both gestational age and substrate concentration. Cyclooxygenase activity was relatively constant through term, but increased sharply in neonatal lung tissue Although PHG2-PGE2 isomerase activity was high throughout gestation, prostacyclin synthase activity was only moderate and age-invariant after 130 d gestation. Lung thromboxane synthase activity increased markedly at 144 d gestation and in the neonatal lung. Catabolic activity (represented by 15-hydroxyprostaglandin dehydrogenase) was relatively high up to 130 d, became sharply minimal at term but increased in activity rapidly in the neonatal lung. These findings support the concept of a "balance" between dilatory and constrictor products of the cyclooxygenase pathway as one determinant of both patency of the ductus arteriosus and closure at birth or after administration of prostaglandin synthetase inhibitors.

Animals↗

PubMed1997

Changes in left ventricular diastolic filling patterns before and after the closure of the ductus arteriosus in very-low-birth weight infants.

To evaluate serial changes in left ventricular diastolic filling patterns in preterm infants, we performed echocardiographic examinations in 18 very-low-birth weight infants and 20 fullterm infants before and after the closure of the ductus arteriosus. In the fullterm infants, the ductal closure induced significant decreases in the peak velocity and flow velocity integral of early diastole, first third filling fraction, and mitral stroke volume. In the preterm infants, by contrast, there were significant increases in the flow velocity integral of early diastole, first third filling fraction, and mitral stroke volume after the ductal closure. No differences following the ductal closure were found in the atrial phase of filling and peak filling rate normalized to stroke volume in either group. When the ductus arteriosus was open, essentially the same left-to-right shunting of the ductus arteriosus was detected in both preterm and fullterm infants, but the Doppler flow patterns of the patent foramen ovale were different: the fullterm infants had a single flow peak mainly during ventricular late systole and early diastole, but the preterm infants had two or three flow peaks with nearly equal amplitudes lasting from ventricular systole to diastole, which resembled the Doppler flow pattern of atrial septal defect. Only a faint Doppler flow signal of the foramen ovale was observed after the ductus arteriosus closed. Our results obtained from the preterms suggest that the left-to-right shunt through the foramen ovale may be one important factor to alter the Doppler transmitral filling patterns during the fetal to neonatal cardiovascular changes.

Ductus Arteriosus↗

PubMed1992

Formation of intimal cushions in the ductus arteriosus as a model for vascular intimal thickening. An immunohistochemical study of changes in extracellular matrix components.

There is a great resemblance in the sequence of events that take place in the pathological development of intimal thickening, so called arteriosclerosis and the formation of intimal cushions in both the normal ductus arteriosus (DA) and the persistent ductus arteriosus (PDA). The human DA was used as a model to study the changes in the extracellular matrix during this process with immunohistochemistry. The formation of intimal cushions was studied in 4 normal fetal DA, 4 normal mature DA and 3 persistent DA. The process of intimal thickening in the fetus starts in the second trimester of pregnancy with an accumulation of glycosaminoglycans in the subendothelial region (SER), accompanied by separation of endothelial cells from the internal elastic lamina and followed by migration of smooth muscle cells into the subendothelial region. This phenomenon was also observed in the mature DA in the neonate, indicating that cushion formation is a continuous process. Intimal cushions had also developed in the persistent DA, although they were morphologically different from the cushions found in the normal mature DA. It was remarkable that two elastic lamellae could be distinguished: one at the original site on the borderline of intimal cushion and media and the other in a subendothelial position. The endothelial cells were firmly attached to this subendothelial lamina, which was wrapped in the basal lamina components laminin and type IV collagen. The main morphological difference between the normal mature DA and the persistent DA is the close relation between endothelial cells and the subendothelial elastic lamina, suggesting an altered elastin metabolism in the PDA. PGI2 synthase was increased in the wall of both the normal and persistent DA as compared with the aorta. It may be related to a role of PGI2 in the formation of intimal cushions.

Aorta↗

PubMed1992

Ductus arteriosus in pulmonary atresia with and without ventricular septal defect. Anatomic and functional differences.

The pulmonary circulation is dependent on the ductus arteriosus in all patients with pulmonary atresia and intact ventricular septum and in some with pulmonary atresia and ventricular septal defect (tetralogy of Fallot type). To assess the time of ductal closure in these two patient categories, we compared the ages at first operation in 58 patients with pulmonary atresia and intact ventricular septum and 32 with pulmonary atresia and septal defect. The age distribution differed significantly between the groups. Whereas 90% of the children with intact ventricular septum required surgery in the first week of life, 50% of those with ventricular septal defect underwent surgery after the first month and 25% after the third month. The previously described and now confirmed anatomic differences of ductus arteriosus or different levels of endogenous prostaglandins may explain persistent patency of the ductus in pulmonary atresia with ventricular septal defect. The phenomenon may have important clinical implications regarding the timing and choice of surgical procedure.

Abnormalities, Multiple↗

PubMedDate not supplied

[Spontaneous constriction of the fetal ductus arteriosus].

The case report describes the pre- and postnatal clinical and sonographic findings of a fetus with spontaneous constriction of Ductus arteriosus at 39 weeks gestation. An abnormal four-chamber view due to a hypertrophied and enlarged right ventricle, increased peak systolic (2.39 m/sec), increased peak diastolic (0.88 m/sec) velocities and the decreased pulsatility index of 0.92 were the diagnostic criteria. The flow of the right pulmonary artery was retrograde. After birth estimated pulmonary pressure was 50 mmHg. It is concluded that constriction of the fetal ductus arteriosus may also occur spontaneously in the absence of maternal drugs.

Adult↗

PubMed1955