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At least 811 records · Page 45Linked to original sources
PubMed2003

Response of fetal prostanoids, nitric oxide, and ductus arteriosus to the short- and long-term antenatal administration of celecoxib, a selective cyclo-oxygenase-2 inhibitor, in the pregnant rabbit.

OBJECTIVE: The purpose of this study was to test the hypothesis that the maternal administration of therapeutic doses of celecoxib would not affect ductus arteriosus patency or alter renal and hepatic prostanoids in the fetal rabbit. STUDY DESIGN: Pregnant rabbits received celecoxib from 13 to 20 days (celecoxib-A), from 13-28 days (celecoxib-B), or vehicle from 13 to 28 days by gavage. Fetal serum and lung tissue were analyzed for nitric oxide oxidation products. Fetal plasma, liver, and kidney were analyzed for prostaglandin levels. RESULTS: The ductus arteriosus was patent in both treatment groups. Celecoxib induced elevations of plasma prostaglandin E(2) production. In celecoxib-B liver and kidney, the 6-keto-prostaglandin F(1alpha) and prostaglandin F(2alpha) levels were increased, and the prostaglandin E(2) and thromboxane B(2) levels were decreased substantially. CONCLUSION: This preliminary evaluation demonstrates that the maternal administration of celecoxib does not influence fetal ductus arteriosus patency adversely in rabbits.

Analysis of Variance↗
PubMed1990

[Percutaneous closure of ductus arteriosus using the umbrella technic].

In four patients between three and five years of age we performed closure of open ductus arteriosus with the Rashkind umbrella technique after percutaneous approach from the right groin. The smallest internal ductus diameter measured between 2 and 4 mm, and pulmonary blood flow was from 1.4 to 2.0 times systemic flow. In all four patients, pulmonary artery pressure was normal. In three patients the ductus arteriosus was completely closed, in the fourth a small residual shunt persisted. There were no complications. We describe the method in detail.

Catheterization↗
PubMed1999

Surgical treatment of patent ductus arteriosus (PDA) through mini subaxillary extrapleural approach.

In this study, a new surgical technique for the surgical treatment of patent ductus arteriosus (PDA) is evaluated. The subaxillary extrapleural approach was performed on 836 patients with patent ductus arteriosus. And 20 of these patients were evaluated for postoperative outcomes compared with the routine technique. The results indicated that the new method is safe, less traumatic and has better cosmetic effects. It is concluded in this article that the subaxillary extrapleural approach for PDA is a good modification to the routine surgical technique, that is surgery through the posterolateral approach.

Cardiac Surgical Procedures↗
PubMed1976

[Occlusion of the ductus arteriosus in the rabbit. A light and electron microscopic study].

The development of changes appearing with the closure of ductus arteriosus was followed in mature rabbit foetuses with the help of light and electron microscopy. In the foetuses, in which there was no spontaneous respiration of atmospheric air before fixation the ductus remained opened. In smooth muscle cells of the media there were enlarged cisternae of the endoplasmic reticulum being partially decayed. The foetuses that respired for about one minute had the ductus contracted to various degree and the endothelial cells were expelled into the lumen. In the foetuses respiring for 10 minutes the ductus were more contracted. The endothelium was considerably waved and the agglomeration of smooth muscle cells appeared. In the endothelial and musclar cells the endoplasmic reticulum was richer, and in a lot of places considerably disturbed. The ductus of foetuses respiring for 15 minutes had the lumen completely closed. The smooth muscle cells had a significantly changed their internal structure. The possibility of the direct transformation of the endoplasmic reticulum of the smooth muscular cells into inclusion bodies during the ductus arteriosus closure is discussed.

Animals↗
PubMedDate not supplied

Effectiveness of prostaglandin E1 in relieving obstruction in coarctation of the aorta without opening the ductus arteriosus.

The two main theories regarding the pathogenesis of coarctation of the aorta are the Skodaic hypothesis of ductal tissue constricting the aorta at the level of the insertion of the ductus arteriosus and the flow theory of decreased ascending aortic blood flow in the fetus, which results in associated isthmic narrowing and a localized shelf. To document that ectopic ductal tissue constriction can cause coarctation of the aorta in the absence of a patent ductus arteriosus, we report three cases of infants presenting with critical coarctation who responded to prostaglandin E1 infusion without opening the ductus arteriosus.

Alprostadil↗
PubMed2002

VEGF regulates remodeling during permanent anatomic closure of the ductus arteriosus.

Anatomic remodeling and permanent closure of the newborn ductus arteriosus appears to require the development of intense hypoxia within the constricted vessel wall. Hypoxic ductus smooth muscle cells express vascular endothelial cell growth factor (VEGF). We studied premature baboons and sheep to determine the effects of VEGF inhibition (in baboons) and VEGF stimulation (in sheep) on ductus remodeling in vivo. For study of VEGF inhibition, 13 premature newborn baboons (68% gestation) were treated with inhibitors of both prostaglandin and nitric oxide production to constrict the ductus and induce ductus wall hypoxia. Six received a neutralizing monoclonal antibody against VEGF (A.4.6.1, mAbVEGF), while seven did not. Both groups developed the same degree of ductus constriction, tissue hypoxia, and VEGF expression. The mAbVEGF treatment produced a significant (P < 0.05) reduction in ductus vasa vasorum ingrowth and neointima formation (due to both a decrease in luminal endothelial cell proliferation and a decrease in smooth muscle cell migration into the neointima). For study of VEGF stimulation, nine sheep fetuses (70% gestation) had their ductus wall injected with either VEGF (n = 6) or vehicle (n = 4) in vivo. VEGF administration produced a significant (P < 0.05) increase in vasa vasorum ingrowth and neointima formation. We conclude that VEGF plays an important role in the formation of neointimal mounds and vasa vasorum ingrowth during permanent ductus closure.

Animals↗
PubMed1978

Medical management of small preterm infants with symptomatic patent ductus arteriosus.

During 1975, 38 of 44 infants with a birth weight of less than or equal to 1,500 gm who developed pulmonary edema and congestive heart failure due to a patent ductus arteriosus were managed medically until the ductus closed spontaneously days or weeks later. Overall survival was 71%, and there were no deaths among 11 infants weighing more than 1,250 gm. Pulmonary complications were prevalent and were attributed to the extensive use of mechanical ventilation required to control pulmonary edema. The results of this study document the results to be expected when small preterm infants with a symptomatic patent ductus arteriosus are managed without surgical or pharmacologic intervention and provide a basis for the rational design of clinical trials evaluating other management approaches.

Blood Transfusion↗
PubMed2001

Surgical closure of patent ductus arteriosus in very-low-birth-weight infants.

In many very-low-birth-weight (VLBW) infants the ductus arteriosus fails to close spontaneously, and they subsequently develop signs and symptoms of poor tissue perfusion and heart failure. This study evalutes the results of early surgical closure of patent ductus arteriosus (PDA). We retrospectively reviewed the records of all 101 VLBW infants who weighed 1,500 g or less when their PDA was surgically ligated in Turku University Hospital between 1988 and 1998. The mean gestational age at birth was 27.2 weeks and mean birth weight 963+/-239 g. The operation was performed at 12+/-8 days of age; the infants' weight at operation was 969+/-231 g and they were tracheally extubated 11+/-14 days after the operation. The surgery-related mortality was 3% (3/101) and overall mortality 10% (10/101). We conclude that surgical closure of PDA is safe and effective in VLBW infants.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Successful placement and re-expansion of a new balloon expandable stent to maintain patency of the ductus arteriosus in a newborn animal model.

OBJECTIVE: We performed this study in order to evaluate the usefulness of a new balloon expandable stent for maintaining ductal patency in a neonatal piglet model and to evaluate the ability to re-expand the stent weeks following initial implantation. BACKGROUND: Maintaining patency of the ductus arteriosus without administration of Prostaglandin E has been reported previously using balloon dilation and stent implantation techniques. However, the experience is limited and the currently available stents are not modified for neonates. METHODS: 14 newborn piglets all at age 12 days and median weight 3.6 Kg (range 2.7-4.3 Kg), underwent initial balloon dilation of the ductus arteriosus. Angiography after dilation demonstrated no significant left to right shunt. All piglets underwent successful stent (3.5 mm x 17 mm) placement in the ductus arteriosus. RESULTS: Percutaneous ductal stent implantation via the arterial route was successful in all piglets with angiographic demonstration of a significant left to right shunt. Follow-up studies at weekly intervals with color flow Doppler were used to confirm patency of the stents. In 3 piglets the stent was not patent at initial follow-up and autopsy revealed sub-optimal stent placement. In two animals the stent was later re-expanded to 4 mm at 22 days, in one to 4 mm at 30 days and in one to 6 mm at 15 days, maintaining flow for an additional period of 15 to 34 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

DuctOcclud--implant for transcatheter closure of patent ductus arteriosus.

The DuctOcclud implant is a metal coil device designed for transcatheter closure of small to moderate size patent ductus arteriosus, a Congenital Heart Disease in which a vessel-like communication between the aorta and the pulmonary artery persists after birth. The paper describes the design of the device, its delivery system, and the implant procedure. It also reviews and reports the experimental and the clinical experiences accumulated utilizing the device for occlusion of patent ductus arteriosus.

Animals↗
PubMed1997

Comparative evaluation of the effects of indomethacin and ibuprofen on cerebral perfusion and oxygenation in preterm infants with patent ductus arteriosus.

OBJECTIVE: To compare the effects on cerebral perfusion and oxygenation of intravenous ibuprofen and indomethacin as treatment for patent ductus arteriosus in preterm infants. STUDY DESIGN: Sixteen infants receiving mechanical ventilation (< 31 weeks gestation) with patent ductus arteriosus received either 0.2 mg/kg indomethacin (n = 8) or 10 mg/kg ibuprofen (n = 8) infused over 1 minute. Near-infrared spectroscopy was used to measure changes in cerebral blood volume and in oxidized cytochrome oxidase concentration. Cerebral blood flow velocity in the pericallosal artery was measured using Doppler ultrasonography. RESULTS: Indomethacin caused a significant reduction of CBV (maximal changes in cerebral blood volume: -320 +/- 171 microL/100 gm) and, in four of eight patients, a fall in oxidized cytochrome oxidase concentration (maximal change in oxidized cytochrome oxidase concentration in the eight patients: -0.68 +/- 0.98 mumol/L, NS). Cerebral blood flow velocity fell significantly. Ibuprofen caused no significant reduction of cerebral blood volume, oxidized cytochrome oxidase concentration, or cerebral blood flow velocity, whereas a significant increase of cerebral blood volume (+207 +/- 200 microL/100 gm) was observed after 60 minutes. Ductus closure was seen in six of eight infants after the first dose of indomethacin and in five of eight infants after the first dose of ibuprofen. The therapeutic cycle involved administration of a second and third dose, provided no side effects occurred. Treatment was effective in all infants. CONCLUSION: Compared with indomethacin, treatment with ibuprofen does not significantly reduce cerebral perfusion and oxygen availability; the observed increase in cerebral blood volume requires further investigation.

Blood Flow Velocity↗
PubMed1985

Bronchial compression by a patent ductus arteriosus associated with pulmonary atresia.

Two infants with pulmonary atresia are presented, wherein a large, vertically oriented patent ductus arteriosus, acting as the only source of pulmonary blood supply, compressed the left bronchus, causing significant respiratory distress. Hyperinflation of the left lung was the clue to this circumstance. After bronchographic confirmation, surgical repair was accomplished by placement of aortopulmonary shunts and division of the patent ductus. Other causes of airway compression in congenital heart disease are briefly reviewed. The embryology of the ductus arteriosus is discussed, emphasizing its anatomic configuration and physiologic role in pulmonary atresia.

Airway Obstruction↗
PubMedDate not supplied

[Gianturco-Grifka device in the percutaneous closure of patent ductus arteriosus].

We present our early experience with the Gianturco-Grifka device for transcatheter closure of patent ductus arteriosus. Grifka occlusion was attempted in 13 patients (7 female, 6 male), median patient age was 6.5 years. Echocardiographic evaluation showed a mean ductal diameter of 5.47 +/- 1.09 mm, and the morphology was type C in 7 patients, type A in 5 and type E in 1 patient. The angiographic ductal morphology was 6 type A, 5 type C and 2 type E. Mean PDA diameter was 5.69 +/- 1.15 mm. Three patients had pulmonary hypertension. They were given supplemental oxygen (100%), decreasing their pulmonary pressures. A total of 13 devices were implanted, 5 of 7 mm and 8 of 9 mm. Twelve patients had complete ductal occlusion documented by aortic angiography (92%), one patient presented residual shunt (8%). Color echocardiography at 24 hrs documented complete occlusion in 12 cases. One device embolized to the descending aorta 2 hours after closure, and it was successfully retrieved in the catheterization lab. We conclude that the Gianturco-Grifka device is an appropriate alternative for transcatheter closure of the PDA. This technique can be performed in ductus arteriosus type C, D and E, with diameter < 9 mm. More clinical trials are needed to establish the long-term results of this technique.

Cardiac Surgical Procedures↗
PubMed1991

Patent ductus arteriosus increases lung fluid filtration in preterm lambs.

Previous studies showed that increased pulmonary blood flow from a patent ductus arteriosus had little or no effect on the amount of fluid in the lungs of mechanically ventilated preterm lambs. The purpose of this study was to examine the effect of a patent ductus arteriosus on lung vascular permeability and to see whether increased pulmonary lymph flow might compensate for the increased rate of fluid filtration. Using a model that allows mechanical control of ductus patency, we studied the effects of increased pulmonary blood flow on lung vascular pressures in six mechanically ventilated premature lambs at 136 +/- 2 d gestation (mean +/- SD) (term = 145 d). We measured lung lymph flow and protein concentrations in lymph and plasma to assess pulmonary vascular fluid filtration and protein permeability. We studied each lamb during sequential steady state periods, first with the ductus open and then with it closed. When the ductus was open, pulmonary blood flow was twice what it was when the ductus was closed. Mean pulmonary artery pressure and left ventricular end-diastolic pressure were greater with the ductus open [40 +/- 5 torr (5.3 +/- 0.7 kPa) and 8 +/- 3 torr (1.1 +/- 0.4 kPa), respectively] than when it was closed [24 +/- 3 torr (3.2 +/- 0.4 kPa) and 4 +/- 2 torr (0.5 +/- 0.3 kPa), respectively]. When the ductus was open, lymph flow was 68% greater and lymph protein concentration was 17% lower than when the ductus was closed. Lymph protein clearance (lymph flow x lymph protein concentration/plasma protein concentration) was 39% greater when the ductus was open.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗