PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “DUCTUS ARTERIOSUS, PATENT”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1993

Primary hypertrophic osteoarthropathy: another heritable disorder associated with patent ductus arteriosus.

Patent ductus arteriosus (PDA) is a congenital malformation that has been linked to diverse heritable and chromosomal disorders. Primary hypertrophic osteoarthropathy (HOA) is a rare heritable syndrome in which digital clubbing and periostosis become evident without any underlying illness. The objective of this article is to describe four patients with coexisting PDA and primary HOA. Surgical closure of the ductus showed no effect on the skeletal changes. Primary HOA should be included among the heritable disorders that may be associated with PDA.

Child↗
PubMed1990

Hemodynamic changes in a term newborn piglet model of patent ductus arteriosus.

Patent ductus arteriosus (PDA) is a common form of congenital heart disease in full-term infants. To investigate the morbidities associated with a left to right PDA shunt, we produced a PDA in six full-term newborn piglets (less than 36 hours old) by bathing the ductus arteriosus with prostaglandin E (PGE) and infiltrating it with formalin. In five age-matched piglets, the ductus arteriosus was ligated to serve as controls. Microsphere determinations of left ventricular output (LVO) and regional blood flow (Q) were made on three consecutive days. We produced left to right shunts of 36 to 47% (mean) in the experimental piglets. The experimental piglets had a 22 to 36% increase in LVO with a one- to twofold reduction in percentage of LVO to the kidneys and carcass (p less than 0.05). Although percentage of LVO to the gastrointestinal tract was reduced (p less than 0.05), no reduction of absolute Q to the gastrointestinal tract was observed. Brain and heart Q were similar in both groups. We conclude that significant hemodynamic changes result from left to right shunting in the full-term newborn piglet with PDA. These hemodynamic changes, such as reduction in renal blood flow, are relevant information that will help explain the morbidities observed in infants with a hemodynamically significant PDA with a left to right shunt.

Animals↗
PubMed2000

Closure of calcified patent ductus arteriosus.

Patent ductus arteriosus (PDA) in adults is occasionally associated with calcification and pulmonary hypertension, for which an anterior approach through a median sternotomy with cardiopulmonary bypass is often used. Sutures are placed without circulatory arrest by using a transpulmonary balloon catheter as an occluder. To secure the suture tie, we used Nélaton's catheters as tourniquets.

Calcinosis↗
PubMedDate not supplied

Ibuprofen: alternative treatment for patent ductus arteriosus.

Patent ductus arteriosus (PDA) is a common problem for premature babies. Indomethacin, traditionally the treatment of choice for PDA closure, varies in effectiveness and can have serious side effects, such as intraventricular cerebral hemorrhage and decreased mesenteric and renal blood flow. Researchers abroad are examining the efficacy and safety of ibuprofen as an alternative PDA therapy. Their findings have been promising and indicate the need for clinical trials in the U.S.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1976

Pharmacologic closure of patent ductus arteriosus in the premature infant.

The prostaglandins affect smooth-muscle tone of the ductus arteriosus. Patent ductus often complicates the clinical course of prematurely born infants with respiratory-distress syndrome. In the present study, a single oral or rectal dose of a potent inhibitor of prostaglandin synthesis, indomethacin, was administered to six consecutive premature infants with the syndrome who would otherwise have undergone surgical ligation of the patent ductus. Within 24 hours all the clinical symptoms and physical, echocardiographic and radiographic signs attributable to substantial left-to-right shunting through a patent ductus arteriosus dramatically and permanently disappeared. A transient reduction in renal function was observed in two infants in whom sustained ill-effects did not occur. The observation that constriction and closure of the patent ductus arteriosus may be induced pharmacologically raises important possibilities for the improved treatment of the respiratory-distress syndrome.

Cyclooxygenase Inhibitors↗
PubMed2002

[Transcatheter treatment of patent ductus arteriosus].

Isolated patent ductus arteriosus accounts for 10 to 18% of all cardiovascular malformations. Transcatheter closure of the patent ductus arteriosus has now become established practice with a high success rate and a low incidence of complications. Many devices have been proposed during the last 20 years. The use of some of these devices has largely been abandoned for different reasons: high costs, the need of large transvenous sheaths and the high incidence of late residual shunts. The devices currently available (Amplatzer duct occluder, buttoned device, DuctOcclud coil, Gianturco-Grifka vascular occlusion device, detachable coils) render the embolization of a patent ductus arteriosus relatively easy, with a short hospital stay. We feel that this is the treatment of choice for the majority of patients with a patent ductus arteriosus. The aim of this article was to review our experience and report the state-of-the-art in transcatheter patent ductus arteriosus therapy.

Balloon Occlusion↗
PubMed1998

Current therapy of the patent ductus arteriosus.

The patent ductus arteriosus (PDA) was the first congenital heart lesion to be treated surgically and also the first to be treated with nonsurgical catheter intervention. Surgical ligation and division of the ductus remains the gold standard for consistently achieving complete occlusion. Transaxillary muscle-sparing thoracotomy and video-assisted thoracoscopic ligation, however, have evolved as surgical alternatives with reduced trauma, shorter hospitalization, and excellent cosmetic result but are associated with a significant rate of residual or recurrent duct patency. With aggressive application of critical pathway methods, significant reduction in cost has been achieved for surgical PDA closure. Nonsurgical transcatheter closure nevertheless has gained widespread acceptance, mostly employing detachable or nondetachable stainless steel coils. Coils have superseded the previously popular Rashkind PDA occluder (USCI/Bard, Tewksbury, MA) because of significantly lower cost, less cumbersome handling, smaller delivery catheters, and superior occlusion rates. Various coil implantation techniques and detachment mechanisms have been devised. Large PDAs with smallest diameter greater than 5 mm, however, still are better treated surgically until appropriate devices become available.

Age Factors↗
PubMed1987

Transfemoral plug closure of patent ductus arteriosus.

A patent ductus arteriosus should be closed because of its hemodynamic significance and/or the risk of infective endocarditis. Mortality of surgery is low. In adults, however, technical problems can arise due to calcification of the ductus walls. Using the transfemoral plug technique, developed by Porstmann, we attempted a ductus closure without surgery on 35 patients. The youngest was an 11-year-old girl, the oldest a 63-year-old woman (mean age of all patients: 37 years). The pressure in the pulmonary artery ranged from 15/5 to 70/27 mmHg, the diameter of the ductus from 2 to 9 mm (mean: 4.4 mm). According to the size and shape of the ductus, a plug of polyvinyl alcohol (Ivalon) with an inner steel wire frame was prepared. Threaded over a long arterio-transductal venous track wire, the plug was introduced into the femoral artery and advanced into the ductus by a pushing catheter. After removal of the track wire the plug remained wedged in the ductus. In all 35 patients, transfemoral ductus closure was possible. Patients with complaints improved remarkably within some days. Heart size and pulmonary congestion decreased considerably. All patients were followed for a period of 1-46 months. In two of them, the ivalon plug embolized into a side branch of the left pulmonary artery 7 and 2 weeks after the procedure, but without serious consequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Historical Aspects of Transcatheter Closure of the Patent Ductus Arteriosus.

The patent ductus arteriosus was the first congenital cardiac lesion to undergo successful closure in the cardiac catheterization laboratory. Porstmann in 1966 reported the successful closure of the ductus with an Ivalon foam plug. Since then numerous devices have been used to close the ductus. For the smaller ductus (< 4 mm in diameter), the Gianturco coil is now routinely used. For a ductus more than 4 mm in diameter, the devices used are currently undergoing clinical trials.

Journal Article↗
PubMed2000

Percutaneous closure of patent ductus arteriosus: complementary use of detachable Cook patent ductus arteriosus coils and Amplatzer duct occluders.

UNLABELLED: Several different devices were evaluated for the percutaneous closure of patent ductus arteriosus (PDA), and important drawbacks were found in all of them. To overcome these drawbacks, both detachable Cook PDA coils and Amplatzer duct occluders (ADO) were used for the percutaneous closure of PDA. A total of 54 patients underwent transcatheter occlusion of PDA at a median age of 4.5 years (range 0.5-29 years) and at a median weight of 19.5 kg (range 6-69 kg). Three patients were adults. Detachable Cook PDA coils were used in 26 patients with a median PDA diameter of 1.7 mm (range 1.1-2.2 mm) and ADO were used in 28 patients with a median PDA diameter of 3.8 mm (range 1.9-7.5 mm). Devices were successfully implanted in all 54 patients. Complete closure was achieved in 53 of 54 patients (98% closure rate). Median fluoroscopy time was 12 min (range 4-47 min). CONCLUSION: According to our experience, the complementary use of detachable Cook patent ductus arteriosus coils and Amplatzer duct occluders for the percutaneous closure of PDA can be recommended.

Adolescent↗
PubMedDate not supplied

Effect of dexamethasone therapy on the neonatal ductus arteriosus.

Patent ductus arteriosus (PDA) is believed to be a contributing factor in the etiopathogenesis of bronchopulmonary dysplasia (BPD). We studied the effects of early dexamethasone therapy on persistent ductal patency and the role of PDA in the etiopathogenesis of BPD during the course of a randomized double-blind trial of dexamethasone to prevent BPD. Infants, who weighed between 700 and 999 g, had severe RDS, and had been given surfactant, were randomized to receive a 12-day course of dexamethasone (n = 13) or placebo (n = 17) starting within the first 12 hours of postnatal life. The diagnosis of PDA was made clinically and was confirmed by cardiac ultrasound. The incidence of clinically significant ductus in infants who weighed less than 1000 g was 23% in the dexamethasone-treated group, as compared with 59% in infants who were given placebo. This difference was marginally significant, p = 0.05, odds ratio 0.21, 95% confidence interval 0.04-1.05. None of the infants in the dexamethasone group had recurrence of PDA after indomethacin therapy as compared with three infants in the placebo group. Dexamethasone significantly reduced the number of days infants required ventilator and supplemental oxygen as compared with infants who received placebo. Dexamethasone, as compared with placebo, also reduced the incidence of BPD, p = 0.025, odds ratio 0.08, 95% confidence interval 0.01-0.58. Dexamethasone may reduce the incidence of PDA in premature infants who weigh less than 1000 g at birth and thereby reduce the incidence of BPD.

Anti-Inflammatory Agents↗
PubMed1997

Truncus arteriosus with patent ductus arteriosus and normal aortic arch.

In hearts with a common arterial trunk (truncus arteriosus), there is almost always an inverse development of the aortic arch and the ductus arteriosus. Truncus with a normal aortic arch and a patent ductus is a rare echocardiographic and surgical finding. In this report, we describe 2 neonates in whom truncus arteriosus with a normal aortic arch and a medium or large patent ductus was diagnosed by preoperative echocardiography (without catheterization) and confirmed intraoperatively.

Aorta, Thoracic↗
PubMed1997

Retrievable patent ductus arteriosus plug for interventional, transvenous occlusion of the patent ductus arteriosus. Evaluation in lambs and preliminary clinical results.

RATIONALE AND OBJECTIVES: The clinically most widely used devices (Porstmann-plug, Rashkind-umbrella, Botallooccluder) have inherent specific limitations (eg, transarterial approach, residual shunts, limited retrieval). The authors assess practicability, efficacy, and tissue reaction of the new retrievable transvenous plug device for the occlusion of the persistent patent ductus arteriosus (PDA). METHODS: A foam plug (polyvinyl alcohol) is mounted on a titanium core pin where, at both ends, small legs (titanium nickel alloy) with titanium heads are anchored, to ensure safe fixation in the ductus. The device is introduced transvenously through a long sheath (Mullins sheath) and held by a modified biopsy forceps allowing complete retrieval until final release. A common lamb model of large PDAs (n = 11) was used to test for practicability and the histomorphologic outcome. Clinical results were obtained from a consecutive series of 16 patients (aged 13 to 71 years). RESULTS: In all lambs, placement of the plug within the PDA was possible. Histopathology (follow-up 10 to 215 days; mean 112 days) revealed an adequate ingrowing of the device and no pathologic foreign body reaction. The diameter of the human PDAs ranged from 3 to 7 mm (mean 5 mm). The size of the sheath used for introducing the plug (diameter 8 to 16 mm) ranged from 8 to 16 French. Fourteen of 16 PDAs were closed immediately after or on day 1 after implantation, 1 was closed after the 12-month follow-up, and 1 needed an additional plug after 30 months for definitive closure. CONCLUSIONS: The device demonstrated practicability and biocompatibility in our experimental lamb model and effectively closed the PDA in a consecutive series of 16 patients. A greater number of patients and a longer follow-up period are necessary for the definitive clinical assessment of the new device.

Adolescent↗
PubMed2000

Furosemide for symptomatic patent ductus arteriosus in indomethacin-treated infants.

BACKGROUND: Inhibition of prostaglandin synthesis mediates closure of the ductus arteriosus and renal side effects after indomethacin administration. Because furosemide increases prostaglandin production, it could potentially help prevent indomethacin-related toxicity but also decrease ductal response to indomethacin. OBJECTIVES: The primary objectives of this review were to assess (1) whether furosemide affects the incidence of failure of ductal closure after indomethacin and that of indomethacin-related toxicity and (2) the effect of furosemide on mid-term and long-term outcome. The secondary objective was to determine whether the effect of furosemide on renal function and water balance depends on prior extracellular volume (assessed by blood urea nitrogen [BUN]/creatinine ratio). SEARCH STRATEGY: We searched electronic databases (Medline, Embase and Cochrane) and selected abstract books, without language restriction. SELECTION CRITERIA: We selected studies with (1) random allocation to either indomethacin alone or indomethacin and furosemide and (2) analysis of either short-term risk-benefit ratio of furosemide, mid- or long-term outcome, or the relationship between extracellular volume at study entry and changes in renal function. DATA COLLECTION AND ANALYSIS: We assessed studies for possible bias and for quality of assessment of ductal patency. We assessed categorical variables using relative risk and absolute risk reduction. We assessed the effects of furosemide on renal function and fluid balance by comparing changes from baseline in the treatment group with those in controls. Subsets were determined a priori based on BUN/creatinine ratio at study entry. MAIN RESULTS: All 3 studies fulfilling the entry criteria had limitations, including possible or definite bias. There was substantial heterogeneity among studies. Furosemide administration did not significantly increase the risk of failure of ductal closure; however, sample size was insufficient to rule out even a 31% increase. In the subset with initial BUN/creatinine ratio > 20 mg/mg, 2 of 18 patients receiving furosemide could not complete a 3-dose course of indomethacin because of toxicity. Minimal or no information was available about any of the other main outcome variables. Furosemide increased urine output regardless of the initial BUN/creatinine ratio, leading to a 5% weight loss during a 3-dose course, an undesired effect in patients with initial BUN/creatinine ratio > 20 mg/mg. Furosemide increased creatinine clearance only in patients with initial BUN/creatinine ratio <20 mg/mg. REVIEWER'S CONCLUSIONS: There is not enough evidence to support the administration of furosemide to premature infants treated with indomethacin for symptomatic patent ductus arteriosus. Furosemide appears to be contraindicated in the presence of dehydration in those infants.

Cyclooxygenase Inhibitors↗
PubMedDate not supplied

Etiology of patent ductus arteriosus in dogs.

Patent ductus arteriosus (PDA) is the most common congenital heart disease in dogs and usually causes heart failure and death unless corrected at a young age. Previous histologic studies in a line of dogs derived from Miniature Poodles with hereditary PDA identified varying degrees of hypoplasia and asymmetry of ductus-specific smooth muscle and the presence of aortalike elastic tissue in the ductus wall sufficient to cause patency. To determine if similar structural abnormalities cause PDA in other dogs, serial-section, 3-dimensional histology of ductal architecture was studied in 8 non-Poodle purebred dogs with PDA with no immediate family history of PDA. Morphologic abnormalities were observed in 7 of 8 dogs with PDA and essentially were the same as those in dogs known to have a hereditary form of PDA. These findings suggest that apparently sporadic PDA in these breeds is caused by a genetic defect in the structure of the ductus arteriosus that is similar or identical to that in the Poodle. The relatives of dogs with PDA, particularly parents, offspring, and siblings, should be screened for evidence of PDA. Dogs with PDA should not be used for breeding, regardless of breed.

Animals↗
PubMed1999

Cerebral blood flow velocity during occlusive manipulation of patent ductus arteriosus in children.

Patent ductus arteriosus (PDA) with left-to-right shunting modifies the Doppler flow pattern of the intracranial circulation. The ability of increases in cerebral blood flow velocity (CBFV) to predict shunt resolution during PDA occlusion was evaluated. A 2 MHz transcranial Doppler (TCD) monitored diastolic and mean CBFV, plus the systolic/mean CBFV ratio in the middle cerebral artery from before (baseline) to immediately after PDA occlusion. Shunt resolution was verified by echocardiography and/or angiography. A minimum of 40% increase in diastolic-CBFV from baseline was considered successful resolution. Patients were age-stratified into group I (< 15 months; n = 23) and group II (> 15 months; n = 10). Thirty-three children were studied (age, 0.1 to 109 months) during surgical (n = 22) or coil occlusions (n = 11). Transcranial Doppler successfully identified shunt resolution in 78% of cases in group I, as compared to 0% in group II (p < 0.01). Identification rate decreased from 79% in cases of minimum ductal diameter of 3 mm (n = 19) to 21% in smaller ductuses (n = 14) (p < 0.01). Body weight and left-atrium size (p = 0.004) in group I and PDA diameter in group II (p = 0.02), were the only preoperative ductal parameters associated with diastolic-CBFV changes after ductus occlusion. Transcranial Doppler detects shunt resolution in infants with moderate to large PDAs.

Blood Flow Velocity↗
PubMed1993

Transfemoral closure of patent ductus arteriosus in adult patients.

Patent ductus arteriosus is an uncommon anomaly in adult patients. Surgical closure of patent ductus arteriosus in this age group presents difficult problems to the surgeon. We report our experience of 21 adult patients (19-62 years of age, mean 40 years) who underwent closure of the ductus by transfemoral implantation of a Rashkind double umbrella device. The patients came to light because of atrial fibrillation, congestive heart failure, residual flow after surgical ligation of the duct or because of incidental diagnosis made during physical examination or chest X-ray. In ten patients the pulmonary arterial pressure was normal (systolic pressure < 30 mmHg), in eleven it was elevated (systolic pressure from 30 to 100 mmHg, mean 50 mmHg). In seven patients the duct was clearly calcified and the size of the duct varied from 3 to 9 mm (mean 4.3 mm). In 16 patients the ductus resulted perfectly closed after implantation of the first double umbrella device, two patients had minimal residual aortopulmonary flow, whereas in three patients the residual shunt was significant; two of these also developed haemolysis and went to surgery, in the latter the shunt was completely abolished after implantation of a second 17-mm device 16 months later. In conclusion transcatheter closure of patent ductus arteriosus in adults is feasible, even in the presence of calcifications and/or pulmonary hypertension; taking into account the significant surgical risk, PDA umbrella closure should be considered the first choice procedure in this group of patients.

Adult↗