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PubMed1989

Percutaneous catheter closure of the ductus arteriosus in children and young adults.

The double-disk occluding device suitable for use in infants and children with patent ductus arteriosus, developed by Rashkind and Mullins, has been available to this institution since December 1987 on an investigational basis. Results of 43 nonsurgical ductal closure attempts using this device in children and young adults between December 1987 and October 1988 are presented. Successful implantation was achieved in 42 patients (98%). In 25 patients a residual shunt was seen on angiography immediately after implantation. In 12 patients a residual ductal shunt was detected by Doppler 24 hours after implantation; 6-week follow-up studies showed a small residual shunt in only 3 patients. After a second occluder device was implanted in 2 of these patients, complete closure of the patient ductus arteriosus was achieved. In 1 patient, early in the series, the occluder device embolized to the left pulmonary artery, necessitating surgical removal at the time of ductus division. This event was the only serious complication; there were no deaths.

Adolescent↗
PubMed1990

Topical prostaglandin E2 gel for cervical ripening and closure of the ductus arteriosus in the newborn.

The closure time of the ductus arteriosus was investigated in 29 full term babies born vaginally after induction with prostaglandin E2 and in 22 controls. Serial Doppler echocardiography studies showed a significantly prolonged closure time in babies induced by prostaglandin E2. Whether the difference is related to changes in fetal prostaglandin E2 concentration remains to be established.

Administration, Topical↗
PubMed1997

Combined use of detachable coil against persistent mechanical hemolysis after transcatheter occlusion using Rashkind umbrella device in adult patient with patent ductus arteriosus.

Mechanical hemolysis after transcatheter occlusion of the patent ductus arteriosus using the Rashkind umbrella device has been postulated as a rare, but serious complication, even necessitating surgical repair. A rare, case of an adult patient with massive hemolytic anemia, successfully controlled by the combined use of several detachable coil devices is reported. The use of coil devices might be considered as a therapeutic option in such cases.

Anemia, Hemolytic↗
PubMed2001

Transcatheter closure of the patent ductus arteriosus using an Amplatzer duct occluder in adults.

Patent ductus arteriosus (PDA) is a congenital heart disease that frequently escapes detection until the patient reaches adulthood. Percutaneous closure of the PDA has been established as a safe alternative to surgery, the Amplatzer duct occluder (ADO) is a new device that has been recently reported in paediatric patients. Our initial experience with an of ADO in an adult population appears to be encouraging and as good as in paediatric patients.

Adolescent↗
PubMed1976

Doppler ultrasonic flow detection as an adjunct in the diagnosis of patent ductus arteriosus in premature infants.

Since ligation of a patent ductus arteriosus in the neonate with idiopathic respiratory distress syndrome seems to improve the clinical condition of the infant, we have attempted to identify those neonates earlier with the noninvasive Doppler ultrasonic technique, recording brachial arterial flow signals. Sixteen patients were studied. In the 5 with reversed brachial flow who were operated upon, ligation of a PDA resulted in improvement and postoperative correction of brachial flow reversal as evidenced by the Doppler ultrasonic technique.

Doppler Effect↗
PubMed1976

Effects of acetylsalicylic acid on the ductus arteriosus and circulation in fetal lambs in utero.

Intra-arterial and intravenous catheters were inserted in six fetal lambs at 125-130 days of gestation. On the following day, fetal arterial pressures and blood gases were monitored and fetal cardiac output and its distribution were measured by injection of radionuclide-labeled microspheres 15 mum in diameter. Acetylsalicylic acid, 55-90 mg/kg of estimated fetal weight, then was administered into the fetal stomach. Fetal pulmonary arterial pressure rose significantly after an average of 58 minutes, increasing the pressure difference between the pulmonary artery and the aorta from 2 +/- 0.3 (SEM) mm Hg during control to 11.2 +/- 1.6 mm Hg. Resistance across the ductus arteriosus rose from 4.2 +/- 0.5 (SEM) to 27.4 +/- 4.01 units, and flow fell from 495 +/- 44 (SEM) to 409 +/- 20 ml/minute. The proportion of combined ventricular output distributed to the placenta, adrenals, heart, and lungs increased, whereas the proportion of combined ventricular output distributed to the brain, liver, intestine, kidneys, and upper and lower body fell. In two fetuses infusion of prostaglandin E1 reversed the pulmonary hypertension. Inhibition of prostaglandin synthesis in fetal lambs produced constriction of the ductus arteriosus and redistribution of cardiac output. It is probable that prostaglandins, particularly E1, are involved in regulation of blood flow through the ductus arteriosus and various vascular beds in the normal resting fetus.

Animals↗
PubMed2003

Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases.

OBJECTIVE: To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction. METHODS: Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants. RESULTS: The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]). Mean gestational age was 32.5 +/- 3.1 (27-38) weeks and maternal age was 28.2 +/- 8.5 (17-42) years. Mean systolic velocity in the ductus was 2.22 +/- 0.34 (1.66-2.81) m/s, diastolic velocity 0.79 +/- 0.28 (0.45-1.5) m/s, and pulsatility index 1.33 +/- 0.36 (0.52-1.83). Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13 +/- 0.33) than in group B (0.68 +/- 0.15) (P=0.008). The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension. CONCLUSION: The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.

Adolescent↗
PubMed1986

[Indications for ligation of ductus arteriosus Botalli persistens in premature infants].

Ligation of patent ductus arteriosus can be safely performed even in the smallest prematures and may be life-saving. Medical treatment with prostaglandin-inhibitors may be substituted in selected cases. From 1976-1985 a total of 215 prematures was treated. 52 of those experienced spontaneous closure. In 68 infants closure occurred following indomethacin-treatment. 48 had operation after failure of medical therapy and 53 with contraindications to indomethacin were primarily operated. The overall mortality reached 20% and was highest among those with combined medical and surgical treatment.

Birth Weight↗
PubMed1979

Patent ductus arteriosus in Malaysia.

Findings are reviewed of isolated Patent Ductus Arteriosus after infancy as seen in 181 patients studied at the University Hospital, Kuala Lumpur, during the period 1967 to 1975. The ages of patients ranged from nine months to 54 years. Eighty-two patients underwent cardiac catheterization. More than 50% of patients were above ten years of age; the sex ratio was 1 male: 2.93 females. Thirty-two per cent of the patients had significant effort dyspnoea or were in heart failure. The complications noted were elevated pulmonary vascular resistance, Eisenmenger syndrome, bacterial endocarditis and cardiac failure.

Adolescent↗
PubMed1978

The silent ductus arteriosus.

Preterm infants at risk of developing a patent ductus arteriosus were followed sequentially by physical examination, echocardiographic determinations of the LA/AO ratio, and chest roentgenograms. The results show that a significant number of infants who have no clinical signs or symptoms of a PDA have large left-to-right shunts. The presence of this shunt was suggested by acute increase in left atrial size by ECHO determination and confirmed by retrograde single-film aortography. Clinical signs and symptoms often developed several days after documentation of the left-to-right shunt.

Aortography↗
PubMed1991

Clinical profile and management of symptomatic patent ductus arteriosus in premature infants.

Twenty cases of symptomatic patent ductus arteriosus (PDA) in preterm inborn infants were studied retrospectively. The diagnostic criteria were a systolic or a systolodiastolic murmur, tachycardia (greater than 160 per minute), hyperdynamic precordium, collapsing arterial pulses, cardiomegaly or a need for intermittent positive pressure ventilation or continuous distending airway pressure. The incidence was found to be 2.48/1000 live births and 1.5% of SCBU admission. All babies were less than 35 weeks gestation and 18/20 weighed less than 1750 g at birth. Ten babies were treated with indomethacin (0.2 mg/kg) and two of these babies died before the course of treatment was completed. Ten babies were treated with conservative therapy. They could not be administered indomethacin because two died of fulminant sepsis soon after the diagnosis was made; two babies had sepsis and DIC but recovered from it, three had thrombocytopenia, one had azotemia, two babies had hyperbilirubinemia requiring exchange transfusion. The two groups of babies matched in respect to gestational age, sex, age at presentation, birth weight and associated illnesses. Two babies in each group died soon after diagnosis. Of the eight babies in each group, six babies closed the ductus on indomethacin therapy as against two on conservative therapy. This difference was significant (p less than 0.05). The babies who responded to indomethacin were all treated within two weeks of age. None of them showed any complication of drug therapy or recurrence of PDA. We conclude that intragastric indomethacin given early in the management of symptomatic PDA in term infants is a safe and effective modality.

Ductus Arteriosus, Patent↗
PubMedDate not supplied

Supplemental nitrogen inhalation therapy in very low-birth-weight infants with patent ductus arteriosus.

Very low-birth weight infants with patent ductus arteriosus (PDA) accompanied by severe heart failure do not respond to indomethacine therapy. It is essential to stabilize the general condition of these infants until surgical intervention. We tried to regulate the pulmonary blood flow to control congestive heart failure by administering supplemental nitrogen inhalation therapy to six very low-birth-weight infants with PDA. After the inhalation of supplemental nitrogen gas was begun, the arterial oxygen saturation and partial oxygen pressure immediately decreased. Furthermore, the blood pH, systolic pressure, and urine output significantly increased. The infants were well stabilized. Furthermore, there were no complications related to nitrogen gas inhalation. Supplemental nitrogen inhalation therapy is an effective and feasible therapy for severe congestive heart failure in very low-birth-weight infants with PDA.

Ductus Arteriosus, Patent↗
PubMed1982

Precordial contrast echocardiographic detection of patent ductus arteriosus in small preterm infants.

Clinical detection of patent ductus arteriosus (PDA) remains an important and challenging problem in the small preterm infant with respiratory distress. In this study, PDA was diagnosed in 28 small preterms using an improved contrast echocardiographic method. In these infants, the injection of saline into the aorta generated echoes which were imaged at the pulmonary valve. This was accomplished using a conventional M-mode ultrasound transducer applied at the usual precordial position. Contrast echo studies were compared with the degree of ductal patency shown by single film aortography. Ductal patency was detected by contrast echo in 29 of 31 instances of aortographically proven PDA. Indirect echo indices commonly used for detection of PDA (cardiac chamber enlargement) may be limited since factors other than left-to-right shunt can cause cardiac enlargement in distressed small preterms. This direct contrast echo technique is an easily performed, sensitive, qualitative method for confirmation of the diagnosis of PDA in small preterm infants.

Aortography↗