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PubMed2001

Patent ductus arteriosus in elderly patients: clinical and echocardiographic features-a case-based review.

Congenital heart disease in adults is a rapidly growing field, with many operated and unoperated infants and children surviving into adulthood. Patent ductus arteriosus is an example of a congenital cardiac defect, which may enable patients to survive well into adulthood without prior recognition or correction before symptoms arise. This case illustrates the clinical and echocardiographic manifestations of patent ductus arteriosus with special emphasis on its 2-dimensional and Doppler findings. Management options for this condition are also briefly addressed.

Aged↗
PubMed2004

Patents, pills and politics: the Australia-United States Free Trade Agreement and the Pharmaceutical Benefits Scheme.

There is tension between the need of the pharmaceutical innovator for intellectual property protection and the need of society for equitable and affordable access to innovative drugs. The recent Australia-United States Free Trade Agreement provides a nice illustration of this interplay between patents, pills and politics. This article provides a brief history of patent law as applied to pharmaceuticals, describes how the Pharmaceutical Benefits Scheme got caught up in AUSFTA negotiations, analyses the clauses that are likely to impact upon the PBS and describes the political process that reviewed and ultimately amended the AUSFTA.

Australia↗
PubMed1993

Value of intravascular ultrasound in the diagnosis and characterization of patent ductus arteriosus in an adult patient.

We report the case of a 47-year-old patient with a patent ductus arteriosus who underwent angiography and percutaneous intravascular ultrasound examination. The case illustrates that intravascular ultrasound contributes to the characterization of patent ductus arteriosus when a surgical or trans-catheter closure is planned, as calcifications of the wall as well as aneurysmal dilatations can be ruled out. Furthermore, measurements of the diameter of the ductus can be made.

Diagnosis, Differential↗
PubMed1989

Patent ductus arteriosus with Eisenmenger's syndrome detected by first-pass study.

The case of a 20-year-old man with patent ductus arteriosus complicated with Eisenmenger's syndrome is described. Radionuclide angiocardiography characterized the abnormal pattern of blood flow through the central circulation to establish a diagnosis of patent ductus arteriosus with a significant right-to-left shunt, which had not been indicated by other clinical findings.

Adult↗
PubMed1997

Coil on the loop and selectively enhanced stiffness for improved control: feasibility study in the neonatal ovine model of the large patent ductus arteriosus.

RATIONALE AND OBJECTIVES: Several devices have been suggested and tested for interventional closure of the persistent ductus arteriosus. Coils were found effective only in small ducts due to their lack of maneuverability and physical limitation of grip forces leading to risk of embolization. The authors evaluated the feasibility to place single coils with selectively enhanced stiffness into high shunting ductus arteriosus, the coils being deployed and controlled through a veno-arterial loop in a bovine model. METHODS: "Double-cone" shaped, stainless steel coils with enhanced stiffness of the outer rings were mounted on either end on a nitinol core wire. A snap-in mechanism attaches the coil to this delivery wire and is freed by a pusher system of coiled steel wire that is advanced over the core wire. Forming a veno-arterial loop across the patent ductus allows for repositioning into the pulmonary artery or aortic catheter. A chronic lamb model of large patent ductus arteriosus (PDAs) (> or = 9 mm) was used in which ductus patency was secured by a protocol of repetitive angioplasties. Different systems (n = 10) were placed having retrieved the previous coil by a snare after definitive release. RESULTS: Placement of coils was possible in all 10 attempts. The coils were pulled back into the catheters between five and eight times before definitive release. CONCLUSIONS: The device allows controlled placement of single coils in our model of large PDAs and may lead the way to overcome previous limitations of coils. Clinical trials are warranted.

Animals↗
PubMed1987

Prophylactic treatment of asymptomatic patent ductus arteriosus in premature infants with respiratory distress syndrome.

Early treatment of premature infants with indomethacin has been proposed as a means of reducing the morbidity associated with respiratory distress syndrome complicated by symptomatic patent ductus arteriosus. We identified 26 infants less than 48 hours old with severe respiratory distress syndrome who had an asymptomatic patent ductus arteriosus. These infants were treated with either indomethacin or placebo. There was a significant difference in the frequency of ductal closure after receiving indomethacin treatment. No significant difference was observed in the time required for mechanical ventilation, time receiving supplemental oxygen, or time in the hospital, and there were no significant differences in the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, or death between the two groups.

Clinical Trials as Topic↗
PubMed1985

Indomethacin therapy of patent ductus in preterm infants controlled by plasma levels.

Indomethacin was given by suppository to 18 neonates for the treatment of patent ductus arteriosus. The plasma levels of the drug were measured by high pressure liquid chromatography. Permanent closure of the ductus was achieved in 12 of 21 treatments and took up to 48 h. Successful treatment was strongly associated with a plasma indomethacin level greater than 0.5 micrograms/ml in the 8 h after a dose. Decreased urinary output was more likely at the same level, but was also found with substantially lower figures. It is suggested that indomethacin therapy for patent ductus should be rationalized by measurement of the plasma level.

Ductus Arteriosus, Patent↗
PubMed1990

Cerebral and abdominal arterial hemodynamics in preterm infants with patent ductus arteriosus.

Using Doppler echocardiography we evaluated the effect of ductal shunt flow on the cerebral and abdominal arterial blood flow in 25 preterm infants. Eligible for inclusion in this study were healthy preterm newborn infants. They were divided into two groups based on their gestational age: group A, 33-36 weeks (15 infants) and group B, 28-32 weeks (10 infants). Two-dimensional Doppler echocardiograms were obtained in each infant during the first 8 hours of life and repeated every 6-12 hours until no ductal shunt flow could be detected. Flow in the ductus arteriosus, the basilar artery and the coeliac artery were examined. Closure of the ductus arteriosus occurred significantly later (p less than 0.05) in group B than in group A. Pulsatility indices of flow in the basilar and coeliac arteries were high when the ductus was patent, decreasing to a fixed level with closure. This study suggests that a shunt of the patent ductus arteriosus (PDA) adversely influences the cerebral and abdominal blood flow in preterm infants.

Abdomen↗
PubMed2003

Comparison of ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants.

BACKGROUND: Patent ductus arteriosus (PDA) is commonly found in very low-birthweight (VLBW) infants. The presence of respiratory distress syndrome (RDS) is also associated with increased frequency of significant PDA. Intravenous indomethacin has been used to treat and to prevent PDA in premature infants since 1976. However, concern remains regarding the safety of indomethacin, which affects renal, gastrointestinal and cerebral perfusion. Intravenous ibuprofen has recently been used to treat and to prevent PDA premature infants with PDA without reducing cerebral blood flow or affecting intestinal or renal hemodynamics. The aim of the present study is to compare intravenous ibuprofen and indomethacin with regard to efficacy and safety for the early treatment of PDA in preterm infants. METHODS: A total of 63 preterm infants with RDS who had a birthweight of < or =1500 g and gestational age of < or =32 weeks, were enrolled in the present study. All patients were treated with nasal continuous positive airway pressure with additional oxygen supply in inspired air>30%, or with mechanical ventilation. The patients' serum platelet counts were>100,000/uL, and serum creatinine values were <1.5 mg/dL. There were no 3-4 grade intraventricular hemorrhages before randomization, and all patients were aged 2-7 days and had echo-cardio-graphic evidence of significant PDA. Patients were randomized into two groups: the first group of neonates (group A, n = 32) received intravenous ibuprofen lysine 10 mg/kg, followed by 5 mg/kg after 24 and 48 h; the second group (group B, n = 31) received intravenous indomethacin 0.2 mg/kg every 12 h for three doses. RESULTS: Patent ductus arteriosus closed in 27 patients from the ibuprofen group (84.4%) and in 25 patients from the indomethacin group (80.6%). PDA reopened in three patients from the ibuprofen group (9.4%) and in three patients from the indomethacin group (9.7%). One patient in the ibuprofen group and two patients in the indomethacin group required ductal ligation. Serum creatinine and blood urea nitrogen (BUN) concentrations were lower in the ibuprofen group than in the indomethacin group. Urine output and creatinine clearance values were higher in the ibuprofen group than in the indomethacin group. CONCLUSIONS: Ibuprofen therapy is as efficacious as indomethacin for the treatment of PDA in preterm infants. Infants treated with ibuprofen have higher creatinine clearance and urine output and lower serum creatinine and BUN values than infants treated with indomethacin.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1983

Left ventricular systolic time intervals in preterm infants with patent ductus arteriosus.

Left ventricular systolic time intervals were recorded by a non-invasive technique, from the axillary artery, in 13 preterm infants with patent ductus arteriosus. At the onset of clinical symptoms, consistent with a large left-to right ductal shunt, the preejection intervals were shorter than in a control group of nine preterm infants without a patent ductus. The most pronounced difference was found in the shortening of the isovolumic contraction time, 10.7 msec in the ductus group compared with 22.4 msec in the control group. Ductal closure normalized the isovolumic contraction time to 22.1 msec. The very short preejection intervals, associated with a large ductal shunt, are suggested to reflect a combination of reduced aortic diastolic pressure and increased left ventricular filling pressure. In spite of increased volume load to the left ventricle there were no detectable changes in the systolic time intervals indicating impaired left ventricular function. The left ventricle seems to be competent to handle increased volume load in the presence of reduced afterload in preterm infants with symptomatic left-to right ductal shunts.

Blood Pressure↗
PubMed1983

Early closure of patent ductus arteriosus with indomethacin in preterm infants with idiopathic respiratory distress syndrome.

Thirty-seven preterm infants with idiopathic respiratory distress syndrome were prospectively studied for the effect of the early closure of patent ductus arteriosus with indomethacin on the course of idiopathic respiratory distress syndrome. Serial retrograde aortograms were performed in all infants in order to visualize the ductus arteriosus, apart from three patients, who died early and were evaluated aortographically only once. The ductus was initially open in 27 infants and closed in 10 infants. The infants with open ductus arteriosus were randomly divided into two groups. The first group consisted of 13 infants, in whom the ductus was closed with indomethacin at a median age of 18 hours. The other 14 infants served as controls. Total time on assisted ventilation and duration of exposure to additional oxygen were significantly shorter in medicated infants than in controls. Oxygenation of infants with an initially closed ductus was better from birth and duration of their ventilatory assistance and oxygen exposure were shorter than in infants with initial ductal shunting. The data suggest that the early closure of the patent ductus arteriosus with indomethacin in distressed preterm infants has a favourable effect on the course of idiopathic respiratory distress syndrome.

Clinical Trials as Topic↗
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↗
PubMed2006

Gender differences in patenting in the academic life sciences.

We analyzed longitudinal data on academic careers and conducted interviews with faculty members to determine the scope and causes of the gender gap in patenting among life scientists. Our regressions on a random sample of 4227 life scientists over a 30-year period show that women faculty members patent at about 40% of the rate of men. We found that the gender gap has improved over time but remains large.

Authorship↗
PubMed2000

Patent disputes. Biotech giants butt heads over cancer drug.

On 8 June, Chiron challenged Genentech's patent on an important new breast cancer drug called Herceptin and sued for a share of the profits. Chiron's 4-page complaint, filed in the federal district court in Sacramento, California, accuses Genentech of "willful, wanton, and deliberate" infringement of one of its patents. The case is being closely watched in the biotech industry not just because of the money at stake but also because it involves one of the first therapies to emerge from the burgeoning field of cancer genetics

Antibodies, Monoclonal↗
PubMed2005

Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management.

BACKGROUND: Surgical ligation of patent ductus arteriosus (PDA) is widely practised in preterm infants despite no clear evidence that this improves outcomes. Geographical isolation meant that ductal ligation was not an option in King Edward Memorial Hospital until recently. OBJECTIVE: A retrospective data analysis to test the hypothesis that outcomes of infants with persistent PDA were no worse than those of infants with no significant duct or a duct that closed after medical treatment. PATIENTS AND METHODS: A total of 252 infants (gestation < or =28 weeks) born between 1 January 2000 and 30 June 2002 were divided into three groups: group 1, no significant PDA (n = 154); group 2, significant PDA which closed after medical treatment (n = 65); group 3, significant PDA remaining patent after medical treatment (n = 33). A significant PDA was defined by a left atrium to aortic root ratio of >1.4 or a ductal diameter >1.5 mm with a left to right shunt. RESULTS: Twenty four (10%) infants died at median (interquartile range) 15.5 (9-35) days. After adjustment for gestational age, relative to group 1, the infants from group 3 were at a 4.02 times increased risk of death (95% confidence interval 1.12 to 14.51). There was no significant difference between groups in the incidence of chronic lung disease, chronic lung disease or death, necrotising enterocolitis, intraventricular haemorrhage, duration of oxygen, or hospital stay. CONCLUSION: Mortality was higher in infants with a persistent PDA, but other morbidities were not significantly different. A randomised trial is needed to determine whether surgical ligation will reduce mortality in such infants.

Cardiovascular Agents↗
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↗
PubMed1992

Protrusion of the device: a complication of catheter closure of patent ductus arteriosus.

OBJECTIVE: To assess the medium term results of percutaneous transvenous closure of patent ductus arteriosus, in particular with regard to protrusion of the device with or without turbulence of the bloodflow. DESIGN: Clinical examination and echocardiographic study (cross sectional Doppler, and colour Doppler examination) within 24 hours of and at least 6 months after implantation (range 6-26 (mean 15) months). SETTING: Multicentre study at the departments of paediatric cardiology of three academic hospitals. Tertiary clinical care of the first group of patients in the Netherlands treated by the percutaneous transvenous method. PATIENTS: 36 patients (12 male, 24 female) mean age 8.2 years, (range 1.7-58.3), mean weight 25.5 kg (range 11-67.8 kg). The total group consisted of 46 patients. In one the implantation had failed and nine others were not available for regular follow up. All 36 patients underwent non-surgical closure of the patent ductus arteriosus with a Rashkind double umbrella prosthesis. MAIN OUTCOME MEASURES: Diagnosis or exclusion of protrusion of the Rashkind device with or without turbulence of the blood flow with follow up of changes in protrusion and turbulence. RESULTS: In 17 patients the prosthesis protruded into an arterial lumen: the aorta in 13 and the (left) pulmonary artery in four, with turbulence in seven and two cases respectively. After six months the aortic protrusion disappeared in three, including one who had had turbulent blood flow. At the end of follow up the prosthesis still protruded into the aorta in 10 but in three the turbulence had vanished. In two of the three remaining patients with turbulence in the descending aorta the degree of turbulence had decreased. There was no lessening of turbulence in the four patients in whom the device protruded into the pulmonary artery. CONCLUSIONS: The Rashkind double umbrella can protrude into the descending aorta and the left pulmonary artery without causing turbulent blood flow. Turbulence and the protrusion itself can disappear. Endocarditis prophylaxis may be required for as long as the device causes turbulence.

Adolescent↗
PubMed1997

Simultaneous delivery of two patent arterial duct coils via one venous sheath.

A female child, 10 months of age, weighing 7.2 kg, was catheterised for closure of a patent arterial duct. Aortography was performed in the lateral projection and the minimum diameter of the arterial duct was assessed by comparing it to the size of the catheter. The duct size was estimated between 3 and 3.5 mm at the narrowest point, therefore, it was decided to deliver two 5 mm patent arterial duct coils to avoid placement of an 8 mm coil in this small child. Similar operations were subsequently performed in two further children. Simultaneous delivery of two coils via a single long venous sheath is easy, fast, and safe. This simple and inexpensive procedure can reduce irradiation and anaesthesia time.

Ductus Arteriosus, Patent↗