A ten-year follow-up study of twenty-six cases of patent ductus arteriosus, treated surgically.
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Ductus Arteriosus↗
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[Patent ductus arteriosus and pregnancy].
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Ductus Arteriosus↗
New approach to the diagnosis of patent ductus arteriosus during catheterization.
The diagnosis of patent ductus arteriosus (PDA) usually requires catheterization, as does percutaneous treatment of the disorder. To obtain pressure gradients, a catheter can be passed in either direction through the PDA, from the pulmonary artery to the aorta or via the more common route of aorta to pulmonary artery. Several types of catheters have been used, but to date there have been no reports showing the use of a left internal mammary artery (LIMA) angiographic catheter for this purpose. We report successful passage of this catheter from the aorta across a PDA to the pulmonary artery in 15 adult patients who were observed to have no complications.
Adult↗
Evaluation of pulmonary vasodilatory capacity with inhaled nitric oxide in a dog with patent ductus arteriosus.
A female Maltese dog with patent ductus arteriosus (PDA) showing left congestive heart failure and moderate pulmonary hypertension was evaluated for pulmonary vasodilatory capacity using low concentrations of inhaled nitric oxide (NO) in comparison with oxygen during preoperative cardiac catheterization. Increasing the inspired oxygen concentration (FiO2) to 1.0 without adding NO did not reduce the mean pulmonary arterial pressure (mPAP). However, inhalation of NO at FiO2 1.0 reduced mPAP rapidly without changing other hemodynamic and gas exchange parameters. From these results, inhaled NO caused selective pulmonary vasodilation without producing systemic vasodilation, which may provide a safe and effective mean of evaluating the pulmonary vasodilatory capacity of dogs with PDA.
Administration, Inhalation↗
Oxygen consumption in fetal rabbit ductus arteriosus (38590).
Oxygen consumption in fetal rabbit ductus arteriosus and descending aorta was studied after human umbilical artery tissue was used to standardize the technique. A steady state of oxygen consjmption persisted for 90-100 min after dissection, and a tissue dry weight of greater than 15 mg was necessary to obtain reliable data, necessitating pooling of rabbit fetal tissue from 25.75-26.5 day gestation had an oxygen consumption of 2.05 plus or minus 0.22 (4) mul oxygen/10 mg dry wt/hr, and at 27.5-29.5 it was 5.69 plus or minus 0.28 (7) (P less than 0.001). There was no change with gestational age in the oxygen consumption in the descending aorta (2.15 plus or minus 0.23 mul oxygen/10 mg dry wt/hr).
Animals↗
Effect of antenatal glucocorticoids on clinical closure of the ductus arteriosus.
The incidence of clinically detectable patient ductus arteriosus (PDA) in a group of preterm infants whose birth weights were less than 2,000 g was compared with that of a similar group of infants whose mothers received antenatal glucocorticoids. A PDA was diagnosed on the basis of a typical heart murmur, increased precordial activity, and bounding peripheral pulses beyond the third day of life. Whereas 14 (44%) of 32 infants who were not exposed to antenatal glucocorticoids showed evidence of a PDA, only one (6.5% of 15 infants whose mothers received antenatal glucocorticoids had similar findings. The incidence of ruptured membranes (greater than 72 hours), the number of infants who were small for gestational age, and clinical management of the infants in the two groups were similar.
Ductus Arteriosus, Patent↗
Intravascular ultrasound imaging of a patent ductus arteriosus in an adult.
A small patent ductus arteriosus (PDA) is compatible with a normal life span. A non-restrictive PDA may present with signs of heart failure, supraventricular arrhythmia's, bacterial endocarditis or endarteritis later in life. Fewer than 50% of patients, including those with small shunts, are symptomatic by the age of 50. Considering that 40% of patients with PDA's will die before the age of 45 as a result of bacterial endocarditis or heart failure, closure of the PDA is recommended. Exceptions are patients with a nondilated heart, a right-to-left shunt, or age greater than 60 years old. Because of the wider use of echocardiography, especially transesophageal echocardiography, many PDA's are now detected incidentally in patients without symptoms.
Ductus Arteriosus, Patent↗
Pharmacokinetics of indomethacin in the neonate. Relation of plasma indomethacin levels to response of the ductus arteriosus.
To identify factors affecting the efficacy of indomethacin in closing symptomatic patent ductus arteriosus (PDA), we studied the pharmacokinetics of intravenous indomethacin, 0.2 mg per kilogram of body weight, in 35 premature infants with symptomatic PDA. Most infants responded to indomethacin with ductus constriction. Indomethacin infusions that were ineffective (seven doses in six patients) were associated with significantly faster clearance, a shorter half-life, and lower plasma levels (p less than 0.05). Six infants had later reopening of the ductus. All six received indomethacin in the first postnatal week; they could not be distinguished from infants with permanent closure on the basis of indomethacin kinetics, but they were of low gestational age. There was a 20-fold variation in plasma indomethacin levels 24 hours after a dose. In view of this variation and the relation between plasma levels and ductus constriction, we suggest that measurement of the plasma indomethacin level could be of value in infants with no response to a first dose.
Ductus Arteriosus↗
Transarterial coil embolization for canine patent ductus arteriosus occlusion.
Left to right shunting patent ductus arteriosus (PDA) is the most common canine congenital heart defect. If not occluded PDA is associated with high morbidity and mortality. Historically, surgical ligation has been the standard method of correction. Although highly successful, surgical ligation is associated with some operative morbidity and mortality. More recently, minimally invasive transcatheter techniques have been employed for PDA occlusion. Transarterial PDA coil embolization is a safe, cost effective, less invasive alternative offered by many specialty centers for PDA occlusion. This procedure involves catheterization of the femoral artery under general anesthesia. An angiogram is then performed to delineate PDA morphology and facilitate coil selection. Coils are commercially available and composed of surgical stainless steel with prothrombotic poly-Dacron fibers. Coils are advanced through a catheter into the PDA under fluoroscopic guidance until satisfactory angiographic occlusion is documented. Patients are then recovered and released the following day. This procedure requires substantial technical expertise and specialized equipment.
Animals↗
Endothelin-1 release from lamb ductus arteriosus: relevance to postnatal closure of the vessel.
Our previous investigations have shown that endothelin-1 (ET-1) is a singularly potent constrictor of the ductus arteriosus and that a cytochrome P-450 system located in the sarcolemma is crucial for the contractile response of the vessel to oxygen. We have now studied the release of ET-1 from isolated ductus arteriosus preparations of near-term fetal lambs. Preparations produced measurable amounts of ET-1 under basal conditions (about 0.04 pg/100 mg wet weight.min) both in the presence and absence of the endothelium. Anisomycin (10(-4) M) reduced this release by 50%, while thrombin (1 U/mL) doubled the release. Treatment with a CO mixture (CO/O2 ratio, 0.27) inhibited ET-1 release from intact and endothelium-denuded preparations. We propose that oxygen triggers closure of the ductus arteriosus at birth by causing a conformational change in a specific cytochrome P-450, which, in turn, provides the signal for the synthesis of the constrictor ET-1.
Animals↗
The effects of indomethacin on renal function and intracranial hemorrhage in infants with patent ductus arteriosus.
The effects of indomethacin on patent ductus arteriosus (PDA) were retrospectively studied by evaluating 1,600 consecutive infants less than 36 weeks gestation from 1983 to 1986. Two hundred thirteen infants were diagnosed with a PDA, and 102 infants received indomethacin. Indomethacin was associated with successful PDA closure in 81 infants (79%), with 59 infants (58%) closing after a single dose. No cases of renal failure were observed after indomethacin. Nine infants were treated despite a creatinine (Cr) value greater than or equal to 1.5 mg/dl. Cr improved in all these infants after therapy. Blood urea nitrogen values were greater than or equal to 30 mg/dl in 22 infants at the time of treatment; 18 infants (82%) improved. An intracranial hemorrhage (ICH) was detected in 23 infants (22%) by cranial ultrasound prior to indomethacin; there was no progression after treatment. Data suggest that indomethacin is highly associated with closure of a PDA, and therapy did not result in prolonged renal dysfunction or worsening ICH.
Acute Kidney Injury↗
Longevity in patients ductus arteriosus.
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Ductus Arteriosus↗
Aortic stent-graft for patent ductus arteriosus in adults: the aortic exclusion technique.
The risk of closure of a patent ductus arteriosus in the elderly is high because of the fragility of the aorta and aneurysmal change in the ductus. Stent-grafting has emerged as a method of treatment of pathology of the aorta. We describe a case where this new endovascular technique has been successfully applied for closure of a patent ductus arteriosus in a high-risk patient. It may become part of the armamentarium for this pathology in adults.
Aged↗
[Catheter closure of open ductus arteriosus--the first 100 patients].
BACKGROUND: Patent ductus arteriosus is increasingly treated with catheter based techniques. We present our results as by the end of 1998 of the first 100 patients given such treatment. MATERIAL AND METHODS: The 100 patients between 0.6 and 31.4 years were initially treated with one of these devices: The Rashkind umbrella (60 patients), Cook PDA coils (31 patients) or Amplatzer ductal occluders (ten patients). Seven umbrella patients were treated twice, one with an additional umbrella, six with coils; two coil patients twice, one with another coil and one--after embolisation--with a peg. RESULTS: The overall complete closure rate for all groups was 90% after nine patients had been treated a second time. The primary complete closure rate in pegs was 100%, after reintervention 85% in umbrella and 97% in coil patients. Neither umbrellas nor pegs have embolised. One coil embolised in the course of implantation of 40 coils (2.5%). No other complication has occurred. INTERPRETATION: The closure of the arterial duct with catheter techniques compares favorably with surgery and is now established as the method of choice. Following the investigational introduction of pegs there is no longer an upper limit in the size of ducts suitable for such treatment.
Adolescent↗
Stroke volume and left ventricular output in preterm infants with patent ductus arteriosus.
To assess the effect of patent ductus arteriosus (PDA) on left ventricular output (LVO) we studied stroke volume (SV), LVO, and heart rate (HR) in 21 very low birth wt preterm neonates with clinically symptomatic PDA before and after surgical ligation. Six additional infants were also studied before PDA with left-to-right shunt was detectable by the pulsed Doppler technique. Gestational age (median and range) was 28 (24-32) wk. SV was measured by duplex Doppler and M-mode echocardiography, and LVO was calculated as product of SV and HR. LVO was 419 (305-562) mL/min/kg during symptomatic PDA. It decreased to 246 (191-292) mL/min/kg after ligation (n = 21, p less than 0.001). SV was 2.69 (1.98-4.10) mL/kg during symptomatic PDA decreasing to 1.63 (1.22-1.98) mL/kg after ductal closure (n = 21, p less than 0.001). HR did not change after ductal closure. In the six infants with three examinations, LVO and SV were normal before detectable ductal left-to-right shunt and after ligation, but LVO was increased by 59.5 +/- 23% (mean +/- SD) (p less than 0.05), and SV by 60 +/- 32% (p less than 0.05) during symptomatic PDA. In conclusion, preterm neonates with RDS, requiring mechanical ventilation, increased LVO during symptomatic PDA by increasing their SV, and not by changing their HR.
Cardiac Output↗
Conservative treatment for patent ductus arteriosus in the preterm.
BACKGROUND: A patent ductus arteriosus (PDA) is common among preterms, and prophylactic medical treatment has been advocated as the first-line approach. Conservative treatment may result in similar outcome, but without exposure to the harmful side effects of medication. A retrospective analysis revealed a ductal closure rate of 94% after conservative treatment with adjustment of ventilation (lowering the inspiratory time and increasing positive end expiratory pressure) and fluid restriction. OBJECTIVE: To study prospectively over one year the rate of PDA closure, and morbidity and mortality following conservative treatment. METHOD: Prospective study (1 January 2005 - 31 December 2005) including 30 newborns <or=30 weeks' gestation, all of whom were being ventilated and required surfactant. Echocardiography was performed 48-72 h after birth. Clinically important PDA was conservatively treated as described above. The percentage of children with PDA, ductal ligation and major complications was determined. RESULTS: Ten neonates (33%) developed a clinical important PDA. Following conservative treatment the duct closed in all neonates (100%), and none required ductal ligation or medical treatment. The rates of major complications were no higher than those reported by the Vermont Oxford Network and in the literature. CONCLUSION: The managed care plan resulted in an overall ductal closure rate of 100%. These results suggest that conservative treatment of PDA is a worthy alternative to prophylactic medical treatment.
Anti-Inflammatory Agents, Non-Steroidal↗
Persistent ductus arteriosus complicating the respiratory distress syndrome.
Persistent ductus arteriosus (PDA) complicated the clinical course in 45 (15%) of 299 babies with the respiratory distress syndrome (RDS) presenting over a 3-year period. The incidence of PDA complicating RDS rose with decreasing birthweight and was highest in babies with severe RDS as judged by the use of assisted ventilation. In babies with a birthweight of less than 1500 g, PDA occurred as a complication of RDS in 25% of cases. In babies who recieved intermittent positive pressure ventilation (IPPV) for management of RDS, the incidence of PDA was 35%. Overall mortality for babies with RDS was 17%; when PDA occurred as a complication mortality was 31%. In survivors, spontaneous closure of the PDA occurred in all except one infant. The development of signs of PDA in 19 babies either necessitated a renewal of IPPV or prevented "weaning" from IPPV or from continuous positive airways pressure. 9 (47%) of these babies died, 8 of them after the first week of life. The frequency of PDA complicating RDS and the relatively high mortality in this conservatively-treated group of babies is emphasized. The incidence reported here is likely to increase with the increased survival of very low birthweight infants with severe RDS. The high incidence of late deaths in babies who develop signs of PDA associated with an inability to wean from assisted ventilation suggests that early surgical ligation of the PDA in these babies should be considered. The results of a conservative approach to management of these infants are presented.
Birth Weight↗
Hemodynamic, pulmonary vascular, and myocardial abnormalities secondary to pharmacologic constriction of the fetal ductus arteriosus. A possible mechanism for persistent pulmonary hypertension and transient tricuspid insufficiency in the newborn infant.
The prostaglandin synthetase inhibitor indomethacin was given orally or intravenously to pregnant ewes. This resulted in a significant rise in the fetal pulmonary-to-systemic arterial mean blood pressure difference across the ductus arteriosus, presumably secondary to constriction of the ductus arteriosus. In five experiments the pressure difference could be promptly but temporarily reversed by the administration of prostaglandin E1 (PGE1) into the fetal inferior vena cava. Fetal lungs from study and control animals were fixed by perfusion at measured pulmonary arterial mean blood pressure, and fifth-generation resistance vessels were studied. The medial width/external diameter ratio was significantly increased in the study vs the control lungs due to increased smooth muscle and decreased external diameter. In addition, study fetuses had acute degenerative myocardial changes in the tricuspid valve papillary muscles, the right ventricular free wall and the interventricular septum. Similar changes were not seen in control fetuses. Indomethacin administration during pregnancy causes constriction of the fetal ductus arteriosus, fetal pulmonary arterial hypertension, and right ventricular damage. If severe, this may cause rapid fetal death. If less severe, in the newborn infant, this mechanism may be one cause of persistent pulmonary hypertension due to vasoconstriction and increased pulmonary arterial smooth muscle and/or tricuspid insufficiency due to papillary muscle infarction.
Animals↗