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PubMedDate not supplied

Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams.

To determine the relationship of phototherapy and patent ductus arteriosus, we analyzed prospectively collected data on 295 infants with birth weight of 501 to 999 gm admitted from 1984 through 1988. Seventy-four percent were evaluated by an imaging study to aid in the detection of a silent patent ductus arteriosus. Overall incidence of patent ductus arteriosus in the study population was 63%. Infants who received phototherapy (n = 128) had an increased incidence of patent ductus arteriosus compared with those who did not receive phototherapy (76% vs 53%). There was an association of patent ductus arteriosus and phototherapy (p < 0.05) when we analyzed the data with a stepwise regression model that controlled for the effects of gestational age, birth weight, gender, race, diagnosis of hyaline membrane disease, mechanical ventilation, patent ductus arteriosus imaging studies, prophylactic indomethacin, peak total and indirect bilirubin values, and the occurrence of abnormal serum sodium values. We conclude that the use of phototherapy is associated with an increased incidence of patent ductus arteriosus in extremely low birth weight infants.

Ductus Arteriosus, Patent↗
PubMed1993

Noninvasive diagnosis of coarctation of the aorta in the presence of a patent ductus arteriosus.

Although the diagnosis of coarctation of the aorta in the full-term neonate is straightforward when no ductus arteriosus is present, identification of coarctation of the aorta when a ductus arteriosus is patent can be difficult. A patent ductus arteriosus is frequently found in association with coarctation of the aorta, and it may remain open for many days. Thus a reliable method to rapidly identify coarctation of the aorta would obviate the need for cardiac catheterization or an in-hospital observation period until the ductus arteriosus closes spontaneously. Echocardiographic/Doppler examination of 19 consecutive full-term neonates with a birth weight of > 2.9 kg, who subsequently underwent surgical repair of coarctation of the aorta, were reviewed. Fourteen patients with similar weights, a patent ductus arteriosus, and a normal aortic arch were matched for comparison. Based on the findings, the following diagnostic criteria for coarctation of the aorta are suggested: isthmic diameter less than or equal to 3 mm or isthmus equal to 4 mm together with the Doppler finding of continuous antegrade flow in the isthmal segment. Coarctation of the aorta in the full-term neonate can be ruled out when the flow within the ductus arteriosus is exclusively from aorta to pulmonary artery or when the isthmic diameter is equal to or greater than 5 mm.

Aorta, Thoracic↗
PubMed1993

[Persistent ductus arteriosus--is closure indicated also in asymptomatic adults with small ductus and minor shunt?].

We hypothetized that conservative treatment might be justified in asymptomatic adults with a small persistent ductus arteriosus. The data of 100 patients (age, 18-72 years) who later underwent non-operative closure were retrospectively analyzed. Left- and right-heart catheterization as well as angiographic measurement of PDA-size had been performed in all patients. Thirty-five patients were asymptomatic and 65 patients had cardiac symptoms. Six patients had a history of endocarditis. There were no significant differences with respect to Qp/Qs ratio (1.69 +/- 0.45 vs. 1.57 +/- 0.32) and ductus-diameter (4.7 +/- 1.4 mm vs. 4.8 +/- 1.3 mm) between symptomatic and asymptomatic patients. In the six patients with endocarditis the diameter was 4.5-7.0 mm. Symptomatic patients had higher mean pulmonary artery pressures (22.1 +/- 9.7 mm Hg vs. 18.5 +/- 5.1 mm Hg; p < 0.05) and were older (48.4 +/- 14.3 years vs. 30.9 +/- 11.2 years; p < 0.001) than asymptomatic patients. Neither from the size of the ductus nor from the Qp/Qs ratio could the development of cardiac symptoms or the risk of endocarditis be predicted individually. From these data it might be concluded that closure should be performed even in asymptomatic adults with small ductus and insignificant left-to-right shunt.

Adolescent↗
PubMed2003

The use of ibuprofen in neonates in the treatment of patent ductus arteriosus.

Indomethacin has long been used to treat patent ductus arteriosus but it is associated with a relatively high risk of adverse effects; recent evidence suggests that ibuprofen is effective and may be safer. In a randomised trial to compare the efficacy and safety of ibuprofen and indomethacin in the treatment of patent ductus arteriosus, 144 infants received three doses of ibuprofen lysine (10, 5 and 5 mg/kg) at 24-hour intervals or indomethacin 0.2 mg/kg at 12-hour intervals. Ductal closure occurred in 70% of children treated with ibuprofen and 66% of those given indomethacin on the first treatment (P = 0.41). Nineteen children underwent surgical ligation, equally distributed between the treatment groups (P = 0.81). Urine production was significantly greater than in children given indomethacin from day 3 to day 7 and the serum creatinine concentration was significantly lower from day 7. Ductal closure was associated with higher serum concentrations of ibuprofen and a concentration of 10-12 mg/l appears to be the minimum level for efficacy. In a randomised, placebo-controlled, double-blind trial of prophylaxis with ibuprofen, the rate of patent ductus arteriosus associated with ibuprofen was 19% compared with 42% with placebo. Urine output was comparable in the two groups except on day 1, when it was significantly lower among infants given ibuprofen. Ibuprofen is therefore as effective as indomethacin in the treatment of patent ductus arteriosus, and effective as prophylaxis, in premature infants.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1985

Human ductus arteriosus. A histological study on the relation between ductal maturation and gestational age.

The present study deals mainly with the ductus arteriosus of preterm infants of gestational age less than 29 weeks, birth weight less than 1200 g, and postnatal age less than 72 hours. Excised ductus were histologically examined postmortem and compared to those of infants of more advanced gestational age. Intimal cushion and duplication and/or interruption of the internal elastic lamina of the ductus arteriosus were employed as the indicators of the maturation of the ductus arteriosus. The ductus arteriosus of infants with gestational age more than 29 weeks showed histologically more mature features than those of 28 weeks or less. It is considered that there is a relation between gestational age and histologic maturation of the ductus arteriosus.

Aorta↗
PubMed2003

Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants.

BACKGROUND: Patent ductus arteriosus (PDA) with significant left to right shunt in preterm infants increases morbidity and mortality. Early closure of the ductus arteriosus may be achieved pharmacologically using cyclooxygenase inhibitors, or by surgery. The efficacy of both treatment modalities is well established. However, the preferred initial treatment of a symptomatic PDA in a preterm infant, surgical ligation or trial of indomethacin, has not been well established. OBJECTIVES: To compare the effect of surgical ligation of PDA versus medical treatment with cyclooxygenase inhibitors (using indomethacin, ibuprofen, or mefenamic acid), each used as the initial treatment, on neonatal mortality in preterm infants with a symptomatic PDA. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included search of electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2002), MEDLINE (1966 - December 2002), CINAHL (1982 - December 2002), EMBASE (1980 - December 2002); and hand search of abstracts of Pediatric Academic Societies annual meetings published in Pediatric Research (1990 - April 2002). No language restrictions were applied. SELECTION CRITERIA: All trials 1) using randomized or quasi-randomized patient allocation, 2) in preterm infants < 37 weeks gestational age or low-birth-weight infants (< 2500 grams) with symptomatic PDA in the neonatal period (< 28 days) and 3) comparing surgical ligation with medical treatment with cyclooxygenase inhibitors, each used as the initial treatment for closure of PDA. DATA COLLECTION AND ANALYSIS: Assessment of methodological quality and extraction of data for included trials was undertaken independently by the authors. RevMan 4.1 was used for analysis of the data. MAIN RESULTS: Only one study, trial B in the report of Gersony 1983, was found eligible. The trial compared the effect of surgical ligation of PDA versus medical treatment with indomethacin, each used as the primary treatment. No trials comparing surgery to other cyclooxygenase inhibitors (ibuprofen, mefenamic acid) were found. Trial B of Gersony 1983 enrolled 154 infants. The study found no statistically significant difference between surgical closure and indomethacin treatment in mortality during hospital stay, chronic lung disease, other bleeding, necrotizing enterocolitis, sepsis, creatinine level, or intraventricular hemorrhage. There was a statistically significant increase in the surgical group in incidence of pneumothorax [RR 2.68 (95% CI 1.45, 4.93); RD 0.25 (95% CI 0.11, 0.38); NNH 4 (95% CI 3, 9)] and retinopathy of prematurity grade III and IV [RR 3.80 (95% CI 1.12, 12.93); RD 0.11 (95% CI 0.02, 0.20), NNH 9 (95% CI 5, 50] compared to the indomethacin group. There was as expected a statistically significant decrease in failure of ductal closure rate in the surgical group as compared to the indomethacin group: [RR 0.04 (95% CI 0.01, 0.27); RD -0.32 (95% CI -0.43, -0.21), NNT 3 (95% CI 2, 4)]. REVIEWER'S CONCLUSIONS: The data regarding net benefit/harm are insufficient to make a conclusion as to whether surgical ligation or medical treatment with indomethacin is preferred as initial treatment for symptomatic PDA in preterm infants.

Cyclooxygenase Inhibitors↗
PubMed1995

Increasing curvature of the normal fetal ductus arteriosus with advancing gestational age.

In order to determine whether the configuration of the normal fetal ductus arteriosus changes with increasing gestational age, we prospectively collected oblique transverse sonographic images of the fetal thorax through the ductus arteriosus. Scans from 240 consecutive normal fetuses with gestational age 20 weeks or more were included in the study. The images were reviewed independently by two sonologists and the ductus arteriosus was graded as: (1) straight; (2) mildly curved (C-shaped, bending < 90 degrees from a straight line); or (3) markedly curved (C-shaped, bending > 90 degrees, or S-shaped). In cases where the two sonologists' gradings did not concur, the images were re-reviewed jointly by both sonologists and a grading was assigned by consensus. Forty-two cases were rejected, due to inadequate images. The ductus arteriosus was graded in 42 fetuses aged 20-25.9 weeks, 48 at 26-31.9 weeks, 74 at 32-37.9 weeks, and 34 at 38 weeks or more for a total of 198 cases. There was a significant trend to greater curvature with increasing gestational age (p < 0.0001). The frequency of a straight ductus arteriosus decreased steadily from 55% of fetuses aged 20-25.9 weeks to 3% of fetuses at 38 weeks or older, while the frequency of marked curvature increased from 2% in the youngest age group to 56% in the oldest. The proportion with mild curvature showed little variation throughout gestation. In summary, the configuration of the ductus arteriosus is variable but tends to become more curved as pregnancy proceeds. Marked curvature or tortuosity of the ductus arteriosus should not be misinterpreted as a great vessel anomaly.

Ductus Arteriosus↗
PubMedDate not supplied

Histologic observation of the ductus arteriosus in premature infants with intrauterine growth retardation.

The ductus arteriosus of 19 premature infants with intrauterine growth retardation (IUGR) (study group) was compared histologically with that of 22 infants without IUGR (control group). The two groups exhibited no significant differences in gestational age, age at death, and frequency of disseminated intravascular coagulation. Maternal complications, that is, pregnancy-induced hypertension, cesarean section, and low umbilical artery oxygen tension values, were seen more frequently (p < 0.01) in the study group than in the control group. The histologic changes of ductus arteriosus, such as fragmentation, coagulation necrosis of the intimal elastic lamina, hemorrhage with necrosis, and loosening of elastic fibers and muscles in the tunica media, were seen more frequently in the study group. These findings are suggestive of both the maturation process and the prenatal hypoxic response of premature IUGR fetuses with chronic hypoxia. These changes may have produced subsequent patent ductus arteriosus, which in turn may have induced pulmonary hemorrhage.

Ductus Arteriosus↗
PubMed1996

Transvascular catheter infiltration of the ductus arteriosus with formalin in the newborn lamb: a novel method of establishing and maintaining ductal patency.

OBJECTIVES: This study sought to establish and maintain patency of the ductus arteriosus by a new method of transvascular formalin infiltration of the ductus arteriosus wall. BACKGROUND: Maintaining patency of the ductus arteriosus postnatally is necessary with many forms of congenital heart disease to ensure survival until definitive surgical repair. A variety of approaches have to date met with variable success. METHODS: Seven newborn lambs underwent catheterization at 1 to 5 days of age. A functionally closed ductus arteriosus was traversed with a specially designed porous balloon catheter, and the wall was infiltrated with 10% formalin. The ductus was then further dilated with either a 7- or 8-mm diameter balloon. RESULTS: The ductus arteriosus wall was successfully infiltrated and dilated in all animals. Two lambs were euthanized within 24 h with congestive heart failure from a large ductus, and one lamb was electively euthanized 5 days after transvascular infiltration. Four lambs underwent serial follow-up catheterizations, one of which required repeat balloon dilation 47 days after infiltration. At latest follow-up (mean age [+/- 1 SD] 83 +/- 34 days, range 33 to 108), the pulmonary/systemic flow ratio (2.7 +/- 1.2) was unchanged from immediately after infiltration (1.9 +/- 0.5, p > 0.1). The narrowest diameter of the ductus arteriosus (4.3 +/- 0.4 mm vs. 6.9 +/- 2.6 mm, p > 0.1) and its ratio to that of the adjacent descending aorta (0.5 +/- 0.1 vs 0.4 +/- 0.1, p > 0.1) were also unchanged at latest follow-up. No systemic toxicity was observed. At postmortem study, the ductus was patent, and histologic analysis showed variable intimal and medial destruction, endothelial regeneration, loss of elastic tissue and calcification. Adjacent pulmonary artery and aorta were normal. Based on the small sample size and the observed maximal effect size of 70%, the power of the study is at most 40% to detect significant differences. CONCLUSIONS: To our knowledge, this is the first time that transvascular formalin infiltration of the ductus arteriosus wall has been applied successfully to maintain ductal patency in the newborn lamb. This method may provide a means of palliation for neonates with certain forms of congenital heart disease.

Animals↗
PubMed1991

Bidirectional flow through the ductus arteriosus in normal newborns: evaluation by Doppler color flow imaging.

To determine the duration of bidirectional flow through the ductus arteriosus and to confirm the time of functional closure of the ductus arteriosus, 25 normal full-term newborns were studied serially using Doppler color flow imaging beginning at 2-7 h after birth and continuing until no ductal flow was detected (defined as functional closure). At the first examination, blood flow was bidirectional in 19 of 25 infants and continuously left-to-right in the remaining six. Subsequent studies revealed that bidirectional ductal flow changed to continuous left-to-right flow in 17 of 19 infants, whereas two of 19 abolished the flow completely at the second examination. Three of the 19 infants still had bidirectional flow through the ductus arteriosus at 12, 18.5, and 24 h after birth. The percentage of newborns who had bidirectional flow through the ductus arteriosus decreased roughly as a negative exponential function of age. The earliest functional closure of the ductus arteriosus was at 8 h after birth: by 24 hours 44% and by 48 h, 88% were functionally closed. By 72 h of age, the ductus arteriosus was functionally closed in all 25 infants. This study shows that bidirectional flow through the ductus arteriosus changes to continuous left-to-right flow before the functional closure, but can persist up to 24 h after birth.

Ductus Arteriosus↗
PubMed1988

The role of beta-adrenoreceptor stimulation and contractile state in the preterm lamb's response to altered ductus arteriosus patency.

A model of patent ductus arteriosus in premature lambs was created to study the relative importance of beta-adrenoreceptor stimulation and increased myocardial contractility. In 39 fetal lambs (133 +/- 2, +/- SD days gestation, term 145 days), the ductus arteriosus was infiltrated with formalin, and a snare was placed around it to regulate its patency. One day later, the lambs were delivered, given sheep surfactant, paralyzed, and mechanically ventilated. Microsphere measurements of left ventricular output were made between 4 and 6 h after delivery. When the ductus was opened, there was no change in heart rate, but there were significant increases in left ventricular output, stroke volume, left ventricular end-diastolic pressure, and peak dP/dt. The increase in peak dP/dt due to opening the ductus was greater than that due to an increase in left ventricular end-diastolic pressure alone and was accompanied by an increase in norepinephrine secretion from the left ventricle. Propranolol (1 mg/kg) was used to evaluate the effect of beta-adrenergic tone on left ventricular output and contractility. The left atrium was paced in both control and propranolol-treated lambs. When the ductus was closed, propranolol significantly decreased stroke volume and peak dP/dt without changing left ventricular end-diastolic pressure or systemic vascular resistance. During a saline volume load (50 ml/kg over a 3-min period), propranolol-treated lambs had a reduced stroke volume and peak dP/dt despite similar values of left ventricular end-diastolic pressure and resistance as those of control lambs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Endothelin is a potent constrictor of the lamb ductus arteriosus.

Endothelin was tested on isolated ductus arteriosus preparations from mature fetal lambs. At low PO2 (18-24 Torr; 1 Torr = 133.3 Pa), the compound constricted the vessel dose-dependently over the range from about 10(-10) to 10(-7) M. The contraction was sustained and did not subside even after an extended period of washing. Endothelin was also effective on tissues (PO2,217-231 Torr; indomethacin, 2.8 X 10(-6) M) that had been completely relaxed with CO (CO/O2 ratio, 0.28). CO treatment interferes with a cytochrome P-450 mechanism, which is considered crucial for the contractile response of the vessel to oxygen. These findings are consistent with a role of endothelin in the closure of the ductus arteriosus at birth.

Animals↗
PubMed1980

Age-dependent sensitivity of the lamb ductus arteriosus to indomethacin and prostaglandins.

Endogenous prostaglandins inhibit the ability of the ductus arteriosus to contract in response to oxygen. We studied the effects of endogenous prostaglandins and indomethacin (an inhibitor of endogenous prostaglandin production) on isometric contraction of isolated rings of lamb ductus arteriosus from animals of different gestational ages (98 to 103 days and 136 to 147 days; term is 150 days). Rings from animals at about 100 days' gestation have a significantly larger indomethacin-induced contraction than rings from animals near term. The lamb ductus arteriosus forms two prostaglandins that relax the vessel: postaglandin E2 and prostacyclin. PGI2 was three orders of magnitude less potent than PGE2. Rings from the younger animals were significantly more sensitive to the relaxing action of PGE2 and PGI2 than were rings from animals near term. This increased sensitivity of immature animals to endogenous prostaglandins is consistent with the more potent effect of indomethacin on rings from immature animals. These observations are also consistent with the findings that preterm infants have an increased incidence of patent ductus arteriosus and that indomethacin can constrict the ductus arteriosus in preterm infants.

Animals↗
PubMed2003

Vocal cord paralysis after transcatheter coil embolization of patent ductus arteriosus.

BACKGROUND: In patients with patent ductus arteriosus (PDA) after Gianturco coil embolization, vocal cord paralysis (VCP) had not been previously described. This study investigates the risk factors of coil embolization associated with VCP. METHODS: We reviewed the medical records of all patients who had undergone transcatheter closure of PDA with a Gianturco coil between March 1998 and May 2001, and 75 patients (age range, 6 months to 55 years; mean age, 5.5 years) were identified. The procedure was performed with local anesthesia and with sedation in some young children. No patient required general anesthesia or endotracheal intubation. RESULTS: Three of the 75 patients had hoarseness caused by VCP after coil embolization. Patients with VCP had a longer ductus length (P <.01) and a smaller ductus diameter (P <.01) than patients without VCP. The pathogenesis of VCP may be caused by tense stretching and angulation of the ductus arteriosus induced by the implanted coil, which leads to compression injury of the adjacent left recurrent laryngeal nerve. CONCLUSIONS: A long ductus length (> or =12 mm) and a small ductus diameter (<1 mm) are significant risk factors of VCP after coil embolization in children <1 year of age. We recommend that coil embolization be performed very carefully in patients with PDA.

Adolescent↗
PubMed1990

[The ductus arteriosus in healthy newborn infants studied by continuous Doppler guided by two-dimensional Doppler color echocardiography].

To characterize the ductus arteriosus shunt after birth, 53 normal newborn infants (36-41 weeks gestation), appropriate in size for gestational age, were examined using two dimensional Doppler echocardiography directed continuous Doppler for evidence of patent ductus arteriosus. The infants were examined within six hours of birth, and every six-eight hours thereafter until ductus arteriosus shunt could no longer be detected. In 51/53 infants, an adequate examination was possible and ductus arteriosus was detected in every infant using the standard precordial approach. Using two dimensional Doppler echocardiography a yellow-orange-red jet, sometimes blue in the central area, directed at the lateral wall of the pulmonary artery was recorded; using continuous Doppler a diastolic or continuous spectral flow into the main pulmonary artery was recorded. Ductus arteriosus shunt could no longer be detected in 7 infants 12 hours after birth, in 26 infants 12-24 hours after birth, in 11 infants 24-36 hours after birth, in 5 infants 36-48 hours after birth and in 2 infants 48-60 hours after birth. A diastolic spectral Doppler flow was present in 38 infants and became continuous before duct closure in 27 infants. In 13 infants it was continuous at first examination and until the ductus arteriosus closure. Both diastolic or continuous spectral Doppler flow could present a flat waveform profile, or a protodiastolic or protosystolic peak velocity. The shunt peak velocity increased significantly with the age i.e. (1.5 +/- 0.7 m/sec mean and SD-), at first examination, vs 2.3 +/- 0.6 m/sec at last examination before ductus arteriosus closure (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Ductus Arteriosus↗
PubMedDate not supplied

Transcatheter closure of patent ductus arteriosus in adults using the Amplatzer duct occluder: initial results and follow-up.

BACKGROUND: Surgical closure of patent ductus arteriosus in adult patients may be problematic. Transcatheter closure of patent ductus arteriosus is an established procedure. Recently, transcatheter closure of patent ductus arteriosus using the Amplatzer duct occluder has been shown to be safe and efficacious. We present our experience with this device in adults. METHODS AND RESULTS: Between January 2000 and January 2002,41 adult patients (31 females and 10 males) with a patent ductus arteriosus were referred for closure with the Amplatzer duct occluder. The median age was 35.6 years (range 18-70.7 years) and the median weight was 65.8 kg (range 32.7-164.5 kg). Of these 41 patients, 37 underwent attempted closure of the patent ductus arteriosus using the Amplatzer duct occluder. The device was successfully deployed in all patients except 1. Complete angiographic closure was seen Immediately after device deployment in 29 out of 36 patients (81%). Complete echocardiographic closure was demonstrated within 24 hours post-procedure in 34 out of 36 patients (94%), and at 6-month follow-up in 35 out of 36 patients (97%). No complications related to device implantation occurred in any patient. CONCLUSIONS: Closure of patent ductus arteriosus using the Amplatzer duct occluder is safe and effective in adults.

Adolescent↗
PubMed1995

Cerebral blood flow and EEG changes in preterm infants with patent ductus arteriosus.

It is unknown whether the decreased cerebral blood flow seen in infants with a large patent ductus arteriosus is associated with cerebral dysfunction. Decreased cerebral blood flow in adult human and animal models has been associated with altered electroencephalography (EEG), spectral-analyzed EEG, and EEG response to photic stimulation. Cerebral blood flow velocity, EEG, spectral analysis of EEG, and photic alteration of EEG spectra were evaluated in 8 infants before and after closure of a significant patent ductus arteriosus and in 10 control infants without a patent ductus arteriosus. All infants with patent ductus arteriosus had moderate or large shunts associated with a 25% mean reduction in cerebral blood flow velocity. There were no differences, however, in EEG, spectral analysis of EEG, or photic alteration of the spectral analysis for these infants before and after patent ductus arteriosus closure as compared to controls. It is concluded that the degree of decreased cerebral blood flow in infants with a significant patent ductus arteriosus is not sufficient to cause measurable alteration in electrocortical activity.

Blood Flow Velocity↗