[Diseases simulating patent ductus arteriosus].
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Diagnosis, Differential↗
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The surgery of patent ductus arteriosus.
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Ductus Arteriosus↗
Use of the Potts-Smith-Gibson clamp for division of patent ductus arteriosus.
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Ductus Arteriosus↗
Patent ductus arteriosus ligation: are we doing better?
Limitation on health care resource use is stimulating critical evaluation of previous preoperative standards. We retrospectively reviewed the clinical and hospital financial records of all children admitted for patent ductus arteriosus ligation from July 1984 to April 1994 for age, perioperative length of stay, readmissions for postoperative surgical problem, and hospital charges adjusted to 1994 dollars. Patients with an isolated patent ductus arteriosus, greater than 3 months of age, without preoperative or postoperative complications were included in this study and stratified into two groups based on date of operation. Group I had operation before January 1, 1991, and group II had operation on or after January 1, 1991. Comparison of these two groups revealed a significant difference in perioperative length of stay (group I, 3.9 +/- 1.2 days [mean +/- standard deviation]; group II, 2.7 +/- 0.9 days; p < 0.0001) and in hospital charges (group I, $8,700 +/- $2,100; group II, $6,600 +/- $1,000; p < 0.0001). These data support the premise that children older than 3 months undergoing elective ligation of a patent ductus arteriosus have been treated with improved efficiency and less charge without an increase in postdischarge morbidity. Health care policy decisions have forced us to evaluate the standards of perioperative care more critically.
Adolescent↗
Interruption of the aortic arch associated with patent ductus arteriosus and ventricular septal defect. Proposal of a new surgical technique for total correction.
A four-year-old girl underwent complete correction of the association of interruption of the aortic arch (Type A, Celoria and Patton's classification), patent ductus arteriosus, and ventricular septal defect. The surgical procedure consists of establishment of a continuity between the ascending and descending aortas utilizing the patent ductus arteriosus and the anterior wall of the pulmonary arterial trunk, reconstruction of the rest of pulmonary arterial trunk with pericardium, and closure of the ventricular septal defect. Though the patient expired from cerebral complications, the hemodynamic result after repair was quite satisfactory. The procedure described makes total correction of this complex anomaly feasible at one operation through a median sternotomy and seems to be a method of choice for most patients with this association of anomalies, unless there is severe narrowing of the patent ductus arteriosus.
Angiocardiography↗
Primary bronchomalacia and patent ductus arteriosus: simultaneous surgical correction in an infant.
We report the clinical course of a 6-month-old girl with recurrent infection of the left lung, persistent wheezing, and a suspected congenital heart anomaly (patent ductus arteriosus. Chest radiography revealed hyperinflation and slight inflammation of the left lung. Tracheobronchoscopy and left-sided bronchography showed a collapsed segment of the left main bronchus, 3 cm long. Computed tomography confirmed hyperinflation of the left lung and atelectasis of the superior lobe. There were no signs of extramural compression. Color-flow Doppler echocardiography confirmed the suspicion of patent ductus arteriosus. To the best of our knowledge, there is no other report in the literature of a patient with this combination of anomalies. After receiving 2 weeks of antibiotic treatment, the patient underwent surgical repair The patent ductus arteriosus was closed by means of a triple-ligature procedure, and during the same operation a bronchopexy was performed, securing the left main bronchus to the closed ductus tissue by means of sutures. There have been no complications in the postoperative period. Clinical follow-up, as well as echocardiography and bronchoscopy, have yielded normal results 14 months after surgery.
Abnormalities, Multiple↗
Patent ductus arteriosus occlusion using detachable coils.
Occlusion of patent ductus arteriosus was performed using detachable coils in 193 cases, with 181 successful implants and a low embolization rate. This technique is safe and effective for occlusion of ductuses of various sizes, and is low cost.
Adolescent↗
[A rare combination: persistent ductus arteriosus and pulmonary stenoses. Is there a correlation with rubella embryopathy?].
The combination of patent ductus arteriosus, valvular pulmonary stenosis and/or peripheral pulmonary stenosis is very rare. We examined 23 children with this entity. In 9 children there were findings suggestive of rubella syndrome. 17 of the 23 children were born predominantly between October and March. Most of them showed low birth weights. Regarding the cardiac involvement there was no difference between the children with signs of rubella syndrome and those without noncardiac manifestations. In many children the symptoms of the patent ductus are leading. On evaluation of the noninvasive diagnostic procedures the ECG showed often a right ventricular hypertrophy and the x-ray of the chest showed in most cases a cardiac enlargement. In all patients a heart catheterization was necessary to establish the diagnosis. The review of the literature and the interpretation of our findings seems to suggest that the combination of a patent ductus arteriosus with pulmonary stenosis is a typical manifestation of rubella infection in the heart.
Cardiac Catheterization↗
A new device for transcatheter closure of the patent ductus arteriosus. A feasibility study in dogs.
A new device for transcatheter closure of the patent ductus arteriosus was developed and initially evaluated in the vasculature of adult mongrel dogs. The device consists of a nylon sack that can be made in various sizes and shapes. A small flexible crossbar attached to the distal end maintains the position of the sack while it is filled with a segment of modified guide wire. The device is delivered coaxially through a 10-Fr Teflon catheter and is easily repositioned or retrieved before release. The expansile force of the sack against the vessel wall can be varied, and its stability is easily checked prior to detachment. The device produced immediate and permanent vascular occlusion without inflammation or erosion. Over time, the entire unit became incorporated into the vessel wall by neointimal encasement. Nylon sacks offer a simple, unique method of closing virtually any ductus arteriosus without general anesthesia and major surgery.
Animals↗
Indomethacin, but not oxygen tension, affects the sensitivity of isolated neonatal rabbit ductus arteriosus, but not aorta, to noradrenaline.
The effects of increasing oxygen tension from fetal to neonatal levels and of incubation in the cyclo-oxygenase inhibitor, indomethacin, on the response of isolated rings of neonatal rabbit ductus arteriosus and aorta to noradrenaline were studied in vitro. Increasing oxygen tension did not affect the sensitivity, as measured by the pEC50, of either vessel to noradrenaline. Incubation with indomethacin increased ductal sensitivity to noradrenaline tenfold, but had no effect on the aortic response. Since indomethacin caused the ductus arteriosus to contract (by the removal of dilator prostaglandins), the effect of increased muscular tone per se on the response to noradrenaline was investigated by eliciting a contracture by potassium induced depolarisation. This procedure did not alter the vessel's sensitivity to noradrenaline and reduced its maximum response (indomethacin had increased the maximum response). It is concluded that intramurally synthesised cyclo-oxygenase products, most probably prostaglandins, attenuate the sensitivity of the ductus arteriosus to noradrenaline.
Animals↗
[The percutaneous closure of the ductus arteriosus in adults].
From May 1990 to June 1998, 116 patients were submitted to percutaneous closure of patent ductus arteriosus. There were 18 adult patients, aged 18 to 61 years. Two patients had residual ductus after an attempted surgical ligation and two other patients had a calcified ductus. A device was not implanted in three patients, two of whom because of pulmonary hypertension being considered irreversible. Another patient, with a very large duct, underwent attempted occlusion, but the device embolized to the pulmonary artery and was retrieved percutaneously in the same session. This patient was operated later. Complete duct occlusion, confirmed by color Doppler echocardiography, was achieved in 14 of the remaining 15 patients (93%; 95% CL: 81-100). This was performed with a single catheterization in 12 cases, with implantation of one or more detachable coils in 8 patients; with a Rashkind device in 3, and a combination of a Rashkind device and coils in 1. In two cases complete duct occlusion required a second catheterization for implantation of additional detachable coils, including one patient with intravascular hemolysis in whom resolution of this problem was achieved with additional coils. In recent years, we have preferentially used detachable coils implanted through 5 Fr catheters, with a controlled release mechanism. This is a safer and less expensive device. Patients with pulmonary hypertension can be submitted to a trial occlusion of the duct with a balloon catheter to evaluate the response of pulmonary artery pressures. Percutaneous closure of the patent ductus arteriosus can be performed with excellent results in adults. Complete occlusion was achieved in 14 of the 15 patients (93%) without pulmonary hypertension or extremely large ductus. This is similar to our results in the pediatric population.
Adolescent↗
[Transcutaneous transvenous occlusion of patent ductus arteriosus].
Transvenous closure is described of the patent ductus arteriosus with a conical device that consists of polyurethane foam mounted on a stainless steel flame. Since 1981, the procedure has been performed in 273 patients in Russia. Permanent complete ductus closure was achieved in 258 (95%) patients. In eight cases (3%), the occlusion was incomplete. Complications occurred in 10 patients (4%), seven of whom required emergency surgery. The new technique combines certain advantages of both alternative methods. The conical shape of the occlusion device is well suited for the anatomic structure of the ductus. The possibility of selecting the size of the device permits reduction in the rate of incomplete closure while still taking advantage of transvenous delivery to avoid entryside problems. In the initial 10 years of experience, the described technique proved effective, safe, and applicable in the vast majority of patients older than 2 years.
Adolescent↗
Flow velocity wave forms in the human fetal ductus arteriosus during the normal second half of pregnancy.
Maximum flow velocity wave forms in the ductus arteriosus were studied longitudinally in 40 fetuses from 18 to 38 wk of gestation at 3- to 4-wk intervals. Median maternal age was 29 y (range 18-41 y), median parity was 1 (range 0-6). All flow velocity wave forms were obtained using a mechanical sector scanner with a continuous Doppler system (carrier frequency 3.5 MHz). The flow velocity parameters studied were peak-systolic, peak-diastolic, and time-averaged velocity and acceleration time. There was considerable variability in measurements between fetuses at any particular gestational age. An increase of ductal flow parameters with advancing gestational age was found. They showed no correlation with heart rate. These results suggest that the normal second half of pregnancy is characterized by a reduction in right ventricular afterload. This may be a result of decreased placental vascular resistance or increased pulmonary vascular flow. Acceleration time in ductal flow velocity wave forms was significantly higher than that observed in the pulmonary artery and ascending aorta, suggesting a lower afterload in the ductus arteriosus compared with the other two outflow tract vessels.
Adolescent↗
Impaired elastin fiber assembly related to reduced 67-kD elastin-binding protein in fetal lamb ductus arteriosus and in cultured aortic smooth muscle cells treated with chondroitin sulfate.
In the fetal ductus arteriosus (DA) disruption in the assembly of elastin fibers is associated with intimal thickening and we previously reported that fetal lamb DA smooth muscle cells incubated with endothelial conditioned medium produce two-fold more chondroitin sulfate (CS) compared with aorta (Ao) cells (Boudreau, N., and M. Rabinovitch. 1991. Lab. Invest. 64:187-199). We hypothesized that CS or dermatan sulfate (DS), both N-acetylgalactosamine glycosaminoglycans (GAGs), may be similar to free galactosugars in causing release of the 67-kD elastin binding protein (EBP) from the smooth muscle cell surfaces and impaired elastin fiber assembly. Using immunohistochemistry, immunoelectron microscopy, and western immunoblot we demonstrated a reduction in the 67-kD EBP in fetal lamb DA smooth muscle in tissue and in cultured cells. Also, reduced EBP was observed in fetal lamb and neonatal rat Ao smooth muscle cells incubated with N-acetylgalactosamine GAGs, CS, and DS, but not with N-acetylglucosamine containing GAGs, heparan sulfate (HS), or hyaluronan. Reduction in EBP was related to shedding from cell surfaces into the conditioned medium. This was associated with impaired elastin fiber assembly in cultured cells, assessed both morphologically and by a relative increase in tropoelastin and decrease in desmosines. The EBP extracted from smooth muscle cell membranes binds to an elastin affinity gel and can be eluted from it with CS but not with HS. Moreover, the amount of EBP extractable from smooth muscle cell membranes correlated with the morphologic assessment. We propose that increased CS or DS, may impair assembly of newly synthesized elastin in the media of the ductus arteriosus associated with the development of intimal thickening.
Animals↗
[Transfemoral plug closure in 45 cases of patent ductus arteriosus].
Forty five consecutive patients with simple patent ductus arteriosus were successfully closed using transfemoral catheter method originally introduced by Porstmann in 1967. However, some improvements of instrumentation and technic were made for achieving much more safety and reliability. The diameter of ductus shown in aortography was from 0.3 to 1.0 cm. Primary success was achieved after the first trial, two trials were necessary only in one case. Emphasis was put on the proper size and shape of plug in order to obtain excellent result. 1-54 months follow-up study after procedure revealed no residual shunt.
Adolescent↗
[Persistent and patent ductus arteriosus. Different forms and sizes].
In 563 consecutive heart catheter investigations in sucklings, infants and children 109 open ducti were diagnosed. 75 children (13.3%) had a ductus arteriosus persistens (DAP) and 34 a ductus arteriosus (DAA). We were able to measure 89 ducti. Groups were formed according to the age of the children, of DAP or DAA and the intended treatment. The sizes of the ducti constitute a set of data for improving the methods for closure or newly developed transvasal methods of conservation of the ductus as an aortopulmonary shunt.
Aortography↗
Effect of indomethacin on the fetal ductus arteriosus during treatment of symptomatic polyhydramnios.
Ten pregnancies with 13 fetuses complicated by symptomatic polyhydramnios were treated with indomethacin. A baseline fetal echocardiogram was obtained before therapy, repeated 24 hours after the initiation of indomethacin and then performed weekly provided that the ductus arteriosus remained patent. The mean duration of indomethacin therapy was 28.3 +/- 18.9 days. The starting dose in all patients was 25 mg orally every six hours. The ductus arteriosus was noted to constrict in four patients, with the development of tricuspid regurgitation in one. One of the constrictions occurred after 23 days of therapy. In one patient with constriction a reduction of the indomethacin dosage was not associated with constriction, while in the other three, constriction was still evident at a reduced dosage. All constrictions and the tricuspid regurgitation resolved in utero within 24 hours after discontinuation of the indomethacin. We recommend careful monitoring of the fetal ductus arteriosus when treating symptomatic polyhydramnios with indomethacin.
Ductus Arteriosus↗
Randomized trial of prolonged low-dose versus conventional-dose indomethacin for treating patent ductus arteriosus in very low birth weight infants.
OBJECTIVE: Indomethacin is used for closing the patent ductus arteriosus in premature infants. Prolonged low-dose indomethacin given over 6 days could potentially improve closure rates because ductal constriction is maintained long enough for more effective anatomic closure. We compared the efficacy of this regimen to conventional dosing in a cohort of very low birth weight infants. METHODS: In a 2-arm clinical trial, 140 infants were randomized to either conventional dose (0.2 mg/kg/dose every 12 hours for 3 doses) or prolonged low-dose indomethacin (0.1 mg/kg/dose daily for 6 doses). The primary outcome measure was ductal closure rate, and the secondary outcomes were the need for a second course of treatment, surgical ligation rates, and side effects. RESULTS: Ductal closure after 1 course of indomethacin was similar between the 2 groups: 68% for the conventional dose group and 72% for the prolonged low dose (mean difference -4%; 95% confidence interval: -19% to 11%). The incidence of transient oliguria was higher in the conventional dose group, 31% versus 9%. There was a trend toward more necrotizing enterocolitis in the prolonged low-dose group, 7.0% versus 1.4%. CONCLUSIONS: There was no difference in efficacy between the 2 dosing regimens. In view of this and with its higher incidence of necrotizing enterocolitis, we do not recommend using prolonged low-dose indomethacin for closing the patent ductus arteriosus in very low birth weight infants.
Anti-Inflammatory Agents, Non-Steroidal↗