Optimum age for surgical closure of patent ductus arteriosus.
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Progesterone substitution in the rat during pregnancy days 17-21 or administration 6 h before spontaneous delivery constricted the fetal ductus arteriosus. The rapid whole-body freezing technique was used. Indomethacin-induced constriction of the fetal ductus arteriosus was not affected by progesterone treatment.
Gianturco coils (Cook Cardiology, Bloomington, IN) are commonly employed to occlude restrictive patent ductus arteriosus. The clinical experience of the 1990s demonstrated efficacy and safety. This article reviews the current status of Gianturco coil occlusion of the patent ductus arteriosus. It covers the design of the available coils, patient selection for the procedure, coil selection and delivery methods, results and complications of occlusion, and financial considerations.
We studied 17 fetal rats with vascular ring composed of the left aortic arch and right ductus arteriosus and 7 fetal rats with the mirror-image arrangement. The vascular ring of this type was induced by administration of bis-diamine (200 mg) on the 9th and 10th day of pregnancy in rats. In the most severe case, the esophagus and trachea were compressed completely and no inner space was left, and localized and diffuse tracheal stenosis was prominent. The fetal lung mass was increased as the stenosis of the ring was severe. The thoracic descending aorta was positioned in the left side, and was contrasted with the clinically observed right descending aorta in this postnatal anomaly. Thus we are reporting two new findings in the fetal vascular ring with the left aortic arch and the right ductus arteriosus: increased lung mass and left descending aorta in a fetal animal model.
A sixteen-month-old child presented with cyanosis of the right arm. Investigation revealed bilateral persistent ductus arteriosus with isolation of the right subclavian artery from the aorta. Pulmonary vascular resistance and pulmonary arterial pressure were elevated so that the right subclavian artery received desaturated blood from the right pulmonary artery via the persistent right ductus arteriosus.
A volumetric Doppler technique was used to measure net ductus arteriosus shunt during the first 48 hours of life in 30 infants of less than 33 weeks' gestation, and in 10 full term infants. In the full term infants a left to right shunt of 62 ml/kg/minute (95% confidence limits 43-82) shortly after birth decreased rapidly over the first 12 hours and was not measurable by 48 hours. The preterm infants had smaller left to right shunts shortly after birth--49 ml/kg/minute (95% confidence limits 38-59). There was no obvious subsequent change in the mean shunt, although by 48 hours there was greater variation in the size of the shunt. The respiratory distress syndrome did not affect the size of the ductal shunt, but the shorter the gestation period the larger the shunt by 48 hours. A ductal flow of greater than 70 ml/kg/minute at 48 hours of age predicted the subsequent development of a ductal murmur with 75% sensitivity and 100% specificity.
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