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PubMed1975

Medical manipulation of the ductus arteriosus.

Prostaglandin E-1 was infused into two children with cyanotic congenital heart-disease where patency of the ductus arteriosus was necessary to maintain arterial oxygen saturation. With each infusion oxygen saturation rose, probably as a result of dilatation of the ductus. Administration of the non-specific antagonist of prostaglandin synthesis, indomethacin, to one patient was associated with a fall in arterial saturation. The prevention of ductus closure by p.g.E-1 infusions over the first few weeks of life is a possiblility.

Blood Pressure↗
PubMed1998

Epinephrine-induced constriction of the persistent ductus arteriosus and its relation to distensibility.

The aim of this study was to investigate whether distensibility of the persistent ductus arteriosus (PDA) might predict its potential for vasoconstriction. Epinephrine-induced constriction and stretching were investigated in 10 patients with PDA. Age, sex, ductus type, its minimal diameter, its stretched minimal diameter, and its stretch index were compared between epinephrine responders and non-responders. Age, sex, weight or the configuration or size of the PDA did not predict stretchability. The stretch index was significantly greater in responders (1.7-2.0, 1.8+/-0.1) than in non-responders (1.3-1.7, 1.4+/-0.2, p<0.01). Stretching of the PDA may depend on the elasticity of the vascular wall, which in turn is determined by preservation of vascular smooth muscle.

Child↗
PubMed1992

Transcatheter stenting of the ductus arteriosus: evaluation as an alternative to surgical shunts.

Implantation of 3.5 mm Gianturco-Roubin coronary artery stents into the ductus arteriosus was evaluated as an alternative to surgical systemic to pulmonary arterial shunts in 3 weanling piglets. Thrombosis of the ductus occurred in all 3 animals (95% confidence limits 29-100%) within 1 hour, despite pretreatment with heparin. In each case, thrombus filled the ductus arteriosus but did not extend to any extraductal portion of the stents. Rapid, heparin-resistant thrombus formation precludes use of this stent procedure as an alternative to surgical shunts.

Animals↗
PubMedDate not supplied

[Transcatheter closure of patent ductus arteriosus with Rashkind's occluder. Experience during 3.7 years].

Thirty eight transcatheter umbrella closure (TUC) of a persistently patent ductus arteriosus using the Rashkind umbrella occluder (USCI), were attempted in thirty four patients. Mean age 8.5 +/- 9.0 years (range 1.5 to 31). Internal diameter of ductus arteriosus (DA) average 4.0 +/- 1.5 mm (range 2 to 9 mm). Successful implantation was achieved in 36 procedures (94.7%). Complete closure immediately postimplantation was achieved in 15 (45.4%), 12 (36.3%) had trivial and 6 (18.1%) severe residual shunt. In four cases we implanted successfully a second device. At the follow-up (average 24 months) in 31 patients, 87.0% (n = 27) had complete closure and 96.7% (n = 30) did not need another intervention. Device embolization to distal left pulmonary artery occurred in two cases (5.2%), one was retrieved by surgery and in the other case it was allowed to remain. No mortality was observed. This results confirm the efficacy, with low morbidity and no mortality of TUC, especially in those with smaller PDA (< 4 mm).

Adolescent↗
PubMed1980

Endothelial alterations in the constricting rabbit ductus arteriosus: relationship to smooth muscle cell bleb formation.

Light, scanning, and transmission electron microscopy of the constricting rabbit ductus arteriosus just before and after birth reveal that as the vessel contracts, its endothelial cells lift up and protrude into the lumen. This endothelial protrusion is associated with the reorientation of subendothelial smooth muscle cells and the appearance of smooth muscle cell cytoplasmic blebs or "ghost bodies," especially just beneath the endothelial cells and in the expanded subendothelial space. These blebs are relatively clear extensions of smooth muscle cell cytoplasm which occur when smooth muscle cells contract and they may play a role in the lifting, separation or removal of endothelial cells in the closing ductus arteriosus and other vigorously contracting vessels.

Animals↗
PubMed1996

Transcatheter closure of the patient ductus arteriosus in adults using the Gianturco coil.

BACKGROUND AND HYPOTHESIS: Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross-clamping is necessary but increases surgical risk. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising. METHODS: Six adults with mean age of 39.1 years (range 23.1-62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0-5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occlusion of the PDA using Gianturco coils. RESULTS: Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure. CONCLUSION: Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.

Adult↗
PubMed1984

Prolonged bleeding time in preterm infants receiving indomethacin for patent ductus arteriosus.

Sequential bleeding times were performed on 25 preterm infants receiving intravenous indomethacin for closure of the patent ductus arteriosus. Prolongation of bleeding time was observed after the initial dose of indomethacin, with an increase from a pretreatment mean of 3.6 minutes to 8.7 minutes. The bleeding time was not further prolonged at the end of the three-dose course of indomethacin, but was still elevated 48 hours after the completion of therapy. Clinical bleeding developed in six of the patients, but was generally limited to occult hematuria. Serial echoencephalography during indomethacin therapy showed progression from mild periventricular-intraventricular hemorrhage to moderate or severe grades in five of 21 infants at risk for this complication. However, no clear temporal relationship between indomethacin administration and intraventricular hemorrhage extension was observed, and no difference in the degree of bleeding time prolongation was noted between infants with and without hemorrhage extension. Other factors, including surfactant deficiency, amount of volume expansion used, and lowest PO2 in the first day of life, did distinguish those with hemorrhage extension. The results suggest that indomethacin-induced platelet dysfunction is not associated with major hemorrhagic complications in the majority of preterm infants with patent ductus arteriosus.

Bleeding Time↗
PubMed1977

Prostaglandins and the control of muscle tone in the ductus arteriosus.

Several lines of evidence implicate E-type PGs in the maintenance of patency of the foetal ductus arteriosus. The PGE mechanism is functional in man, sheep, rat and rabbit, but it is seemingly absent in guinea pig. The role of the PGs in the closure of the vessel at birth is uncertain. Work with different species suggests that as PO2 rises at birth the relaxant effect of PGEs on the ductal muscle decreases. This decreased sensitivity may facilitate the oxygen triggered contraction. The calf ductus is an exception and its closure may be mediated by PGF2alpha. An important fact emerging from this review is that species may differ with regard to the occurrence and possible function of the PGs in the ductus arteriosus. The significance of these differences to the function of the oxygen-sensing mechanism remains a major question for future research.

5,8,11,14-Eicosatetraynoic Acid↗
PubMed1994

Ductus arteriosus smooth muscle cell migration on collagen: dependence on laminin and its receptors.

During permanent closure of the ductus arteriosus, smooth muscle cells migrate through the extracellular matrix (ECM) to form intimal mounds that occlude the vessel's lumen. Smooth muscle cells (SMC) migrate over surfaces coated with collagen in vitro. During the migration SMC also synthesize fibronectin (FN) and laminin (LN). Antibodies against FN and LN inhibit migration on collagen by 30% and 67%, respectively. Because of the apparent importance of LN in migration, we examined how SMC interact with LN and LN fragments (P1, E8, P1', E1', E3, E4, and G). Ductus SMC adhere to high concentrations of LN and two fragments of the molecule: P1 and E8. They use a unique set of integrin receptors to bind to LN (alpha 1 beta 1, alpha 6 beta 1 and alpha v beta 3), to P1 (alpha 1 beta 1, alpha v beta 3), and to E8 (alpha 6 beta 1, alpha v beta 3). The alpha v beta 3 integrin binds to the P1 fragment of LN in an RGD peptide-dependent manner, and to the E8 fragment in an RGD-independent manner; the RGD site on the P1 fragment probably is not available to the cell in intact LN. Antibodies against beta 1 integrins completely inhibit SMC adhesion to LN; antibodies against the alpha v beta 3 integrin do not block SMC adhesion to LN, but do prevent cell spreading. LN is also capable of interfering with SMC adhesion to other ECM components. The antiadhesive effect of LN is located in the E1' domain. Both exogenous and endogenous LN increase SMC motility on collagen I. The locomotion-promoting activity of LN resides in the E1' antiadhesive domain, and not in its adhesive (P1, E8) domains. LN causes a decrease in the number of focal contacts on collagen I. This might enable SMC to alter their mobility as they move through the extracellular matrix to occlude the ductus arteriosus lumen.

Amino Acid Sequence↗
PubMed1986

[New aspects on the pathogenesis of patent ductus arteriosus in premature infants].

It is generally accepted that vasodilator prostaglandins are involved in the pathogenesis of persistent ductus arteriosus (PDA) in preterm infants suffering from respiratory distress syndrome (RDS). When studying the prostaglandin metabolism it became apparent that in about 80% of these infants the activity of PGI2 and/or PGE2 was increased. In parallel to weaning infants from the respirator a decrease in prostaglandin activity was observed which was associated with ductal closure. The inhibition of prostaglandin synthesis with indomethacin had the same effect. Considering the various lines of evidence that an artificially ventilated lung is releasing vasodilatory prostaglandins into the circulation we postulated the following sequence of events in the pathogenesis of PDA in preterm infants: development of RDS or other pulmonary lesions which require artificial ventilation; this mechanical intervention causes permanent shear stress and barotrauma on the pulmonary tissue; this stress causes release of arachidonic acid from phospholipids; subsequently vasodilatory prostanoids, such as PGI2 and PGE2 are released and reach the pulmonary circulation and the ductus arteriosus. As a consequence the left-to-right shunt causes pulmonary hypercirculation with further need to continue artificial ventilation. A vicious circle is established. This circle can be broken by ductus ligation, by indomethacin treatment, by less traumatic artificial ventilation or by early weaning from the respirator with theophylline.

6-Ketoprostaglandin F1 alpha↗
PubMed2004

[Syncope in ventricular tachycardia as a first clinical sign of patent ductus arteriosus in an adulthood].

The case-report describes a 48-year-old-female patient with the patent ductus arteriosus with the following structural changes leading to the malignant arrhythmias manifested as a syncope. The patient was treated by Amplatzer occluder and the implantation of the cardioverter-defibrillator. The authors discuss the patent ductus arteriosus, arrhythmias and sudden cardiac death in the patients with the congenital heart disease in an adulthood.

Ductus Arteriosus, Patent↗
PubMed1987

Prediction of symptomatic patent ductus arteriosus in preterm infants using Doppler and M-mode echocardiography.

To investigate whether the development of symptomatic patent ductus arteriosus could be predicted, 26 preterm infants dependent on mechanical ventilation were examined daily with Doppler and M-mode echocardiography until 3 days after birth. The presence or absence of a hemodynamically significant ductus shunt, as judged from echocardiographic criteria, was tested for predictive power in terms of sensitivity, specificity and total error rate. Out of the 26 infants 13 developed symptomatic patent ductus arteriosus at a median age of 5 days (range 2-8). These 13 infants developed echocardiographic evidence of a large shunt at a median age of 2 days (range 1-3). The sensitivity of prediction was 18, 46 and 100% at 1, 2 and 3 days after birth. The specificity was 80, 92 and 85% and the total error rate was 52, 32 and 8%. Thus, accurate prediction was possible 3 days after birth.

Ductus Arteriosus, Patent↗
PubMed2005

In vivo dilatation of the fetal and postnatal ductus arteriosus by inhibition of phosphodiesterase 3 in rats.

BACKGROUND: Clinically, it appears that phosphodiesterase 3 (PDE 3) inhibitors, which are used for acute cardiac failure in premature infants, dilate the ductus arteriosus (DA). OBJECTIVES: To clarify the ductus-dilating effects of PDE 3 inhibitors in near-term rat pups and their differential effects in near-term and preterm fetal rats, in in vivo studies. METHODS: The in vivo ductal diameter of rat pups and fetuses was measured using a rapid whole-body freezing method, by cutting on a freezing microtome and measuring with a microscope and micrometer. Eight to twenty pups and fetuses were studied in each group. Milrinone and amrinone (specific inhibitors of PDE 3) were injected into 1-hour-old pups and the DA was studied 0.5 and 1 h later. The differential effects of these PDE 3 inhibitors on the near-term and preterm ductus were studied by injecting indomethacin (10 mg/kg) and PDE 3 inhibitors into 21D (21st day of pregnancy: term-21.5 days) and 19D dams and studying the fetal ductus 4 and 8 h later. RESULTS: Milrinone and amrinone dilated the postnatal ductus dose-dependently. Large doses of these drugs dilated it completely, and clinically equivalent doses dilated it minimally. Milrinone and amrinone prevented constriction of the fetal ductus by indomethacin. Their ductus-dilating effects were more potent in the preterm than in the near-term fetuses, and clinically equivalent doses of these PDE 3 inhibitors dilated preterm ductus completely. CONCLUSION: In rats, PDE 3 inhibitors reopen the constricted postnatal DA slightly. PDE 3 inhibitors dilate the fetal DA constricted with indomethacin effectively and more sensitively in preterm than in near-term fetuses.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1991

Day case ligation of patent ductus arteriosus in preterm infants: a 10 year review.

Since 1978, 136 preterm babies received ligation of a patent ductus arteriosus as day cases. A total of 122 babies whose notes were available for review, with a median gestational age of 27 weeks (range 23-35) and median birth weight of 960 g (range 470-2750), were transported distances of up to 80 miles. The median ages at ligation with and without previous medical management with indomethacin were 23 and 15 days, respectively. One hundred and ten (90%) babies were dependent on ventilatory support, but extubation was achieved at a median time of 10 days after ligation, regardless of postnatal age at the time of ligation. There were no deaths associated with the operation, and no complications resulting from transportation. The hospital mortality was 15 (12.3%), and the most important (and significant) adverse factor was a preoperative fractional inspiratory oxygen content greater than 0.3. The results of this study show that day case ligation of the patent ductus arteriosus is safe, and if it is carried out early will reduce the time before extubation and discharge from the intensive care unit.

Birth Weight↗
PubMed1991

Prostaglandin E2 and fetal oxygen tension synergistically inhibit response of isolated fetal rabbit ductus arteriosus to norepinephrine.

We wished to determine the effect of prostaglandin E2 (PGE2) on the response of the ductus arteriosus to norepinephrine (NE) and whether any effect of PGE2 was influenced by O2 tension. The vessel was isolated from fetal New Zealand White rabbits and studied in vitro. The response to NE was assessed in terms of both sensitivity (pEC50) and maximum contractile response (MCR) as determined from cumulative concentration-response curves. PGE2 caused a concentration-dependent inhibition of ductal sensitivity to NE. This was maximal in nanomolar concentrations of PGE2, in which ductal sensitivity to NE was decreased by approximately 50 times. This action was only minimally potentiated by 3% O2 (simulating fetal O2 tension, PO2). PGE2 could also inhibit the MCR to NE, but this was entirely dependent on PO2. In 95% O2, PGE2 had no effect on the MCR to NE, whereas in fetal PO2, PGE2 decreased the MCR. This decrease was maximal in 1 nM PGE2, in which the MCR in 3% O2 was about one fifth the size of the MCR in 95% O2. In 1 nM nM PGE2, 10% O2 also largely abolished the inhibitory effect of PGE2 on ductal MCR to NE, indicating that this effect of O2 is also observed in the range of the physiologic increase of arterial PO2, tension that occurs at birth. PGE2 also inhibited ductal sensitivity to 5-hydroxytryptamine, histamine, and potassium. We conclude that physiologic and therapeutic concentrations of PGE2 inhibit sensitivity of the ductus arteriosus to certain vasoconstrictors and can inhibit the maximum response to NE in fetal but not increased PO2.

Animals↗
PubMedDate not supplied

[Patent ductus arteriosus in the adult: transcatheher treatment immediate and medium term results].

INTRODUCTION: The anatomic changes of the patent ductus arteriosus (PDA) in adult patients, such as aortic aneurysm, calcification, or being short and sometimes friable, could complicate the surgical treatment. The transcatheter occlusion of PDA with different devices is currently accepted as safe and effective. We presented our experience with percutaneous occlusion of PDA in adult patients by means of three different devices. METHODS AND RESULTS: Between January 2000 and March 2005, 53 adult patients (47 women and 6 men) with PDA were treated for occlusion by means of percutaneous procedures. Average age was 25.3 years (Range, 16 to 54.7 years). Three different devices were used, 39 patients with Amplatzer for ductus arteriosus, 1 patient with Amplatzer for muscular interventricular communication, 11 with Gianturco coils, and 1 patient with Nit-Occlud. All devices were implanted successfully. Immediate complete closure was achieved in 31 patients (58.4%), in 20 patients (37.7%) with minimal leakage, and in 2 patients (3.89%) with moderate leak. Previous systolic pulmonary pressure had an average of 37.08 +/- 22.8. mm Hg (Range: 12-138 mm Hg) and went down to 28.75 +/- 10.25 mm Hg (Range: 16-57 mm Hg) with p d x 0.001. The average time follow-up was of 16.8 months (Range: 0.9 to 51.8 months) the occlusion was completed in 100%, in neither patients were observed complications related to implant of the devices. CONCLUSION: Transcatheter closure at PDA in adult patients with different devices is safe and feasible.

Adolescent↗