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At least 1,135 records · Page 63Linked to original sources
PubMed1983

Introduction of plasma indomethacin level monitoring and evaluation of an effective threshold level in very low birth weight infants with symptomatic patent ductus arteriosus.

First results are described of individually tailored indomethacin dose rates employing on-line drug level monitoring for pharmacologically induced ductal constriction in very low birth weight infants with symptomatic patent ductus arteriosus (sPDA). In addition prolonged indomethacin therapy was introduced. From our data it appears that the effective threshold indomethacin level for the induction of ductus constriction has to be about 1000 ng/ml 10 h postdosing, while ductus closure can be maintained with a dose rate that exceeds a plasma level of 500 ng/ml for at least 1 week. These maintenance levels were also effective in completely suppressing the urinary metabolite excretion rates of PGI2 and PGE2, which are potential mediators of ductal relaxation. On-line indomethacin level monitoring appears to be practically essential for prolonged indomethacin therapy to overcome the marked variation of indomethacin disposition in preterm infants with sPDA.

Ductus Arteriosus, Patent↗
PubMedDate not supplied

Persistent hemolysis after transcatheter occlusion of a patent ductus arteriosus: surgical ligation of the duct over the occlusion device.

A 14-month-old child underwent routine transcatheter closure of her patent ductus arteriosus (PDA) using the Rashkind double-umbrella device. She developed severe persistent hemolysis in association with residual ductal flow. The problem was managed by the previously unreported approach of standard surgical ligation of the duct via a left thoracotomy, leaving the occlusion device in situ.

Cardiac Catheterization↗
PubMed1993

Effect of patent ductus arteriosus on Doppler-derived right ventricular systolic time intervals.

Right ventricular systolic time intervals (RVSTI) and noninvasive Doppler-derived pulmonary blood flow were measured before and after surgical ductus ligation in 18 otherwise healthy infants and children who were older than 3 months of age. Right ventricular preejection period (PEP) and the ratio of preejection period and right ventricular ejection time (PEP/RVET), both corrected or uncorrected for heart rate, decreased significantly following surgery (PEP 71 +/- 14 vs. 50 +/- 13, p < 0.001 and PEP/RVET 0.29 +/- 0.06 vs. 0.21 +/- 0.05, p < 0.001). The volume of pulmonary blood flow correlated with PEP/RVET (r = 0.48, p = 0.003). The magnitude of the change in pulmonary blood flow correlated with the change in PEP/RVET (r divided by 0.56, p = 0.016). The velocity of circumferential fiber shortening (VCFc) increased after surgery, but not significantly. We speculate that patent ductus arteriosus has a similar effect on right ventricular performance when other congenital heart defects are present.

Blood Flow Velocity↗
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↗
PubMedDate not supplied

Color Doppler flow mapping of the patent ductus arteriosus in very low birthweight neonates: echocardiographic and clinical findings.

Forty-eight preterm infants (mean birthweight 1.0 +/- 0.3 kg; mean gestational age 28 +/- 3 weeks) underwent serial echocardiograms and physical examinations in order to determine the correlation between color Doppler flow mapping (CDFM) results and physical findings of a patent ductus arteriosus (PDA), the predictive value of early CDFM as an indicator of subsequent requirement for treatment of a PDA, and to determine the direction and duration of ductal shunting and the rate of ductal closure and opening. CDFM analysis and cardiac physical examination of left-to-right ductal shunting were usually concordant in infants with a large PDA shunt, the most reliable physical finding being increased precordial activity. CDFM studies on day 2 or 3 of postnatal life had prognostic value with regard to subsequent need for closing the PDA. Additional findings included the absence of right-to-left PDA shunting in infants < 1 kg and < 28 weeks gestation and the absence of ductal reopening in infants in whom it had closed spontaneously. After complete PDA closure using indomethacin, subsequent ductal reopening is uncommon, except in infants < 25 weeks gestation and < 700 g bodyweight.

Ductus Arteriosus, Patent↗
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↗
PubMedDate not supplied

Genetics of patent ductus arteriosus.

A genetic study of 119 correlative cases of patent ductus arteriosus has been performed. The isolated cases showed female predominance, but there was a three times higher risk for the sibs of male cases, suggesting a multifactorial causative mechanism. Dermatoglyphs presented an excess of arches in male, and a tendency to distal axial triradius in female. There were 15 cases belonging to polymalformative syndromes, such as mongolism, Turner, Noonan, Holt-Oram, Lewis and rubella embryopathy.

Adult↗
PubMed1994

Pulmonary effects of closure of patent ductus arteriosus in premature infants with severe respiratory distress syndrome.

UNLABELLED: The pulmonary effects of closure of a patent ductus arteriosus (PDA) were investigated in 11 premature infants with severe respiratory distress syndrome. Successful closure of a PDA did not improve the short-term severity of pulmonary disease (24 and 48 h after treatment) as judged by the arterial/alveolar oxygen tension ratio or the amount of ventilatory support. Also, pulmonary mechanics measured 24 h before, 24 and 48 h after treatment, were not statistically different. CONCLUSION: Infants with severe respiratory disease requiring high ventilation pressure and high oxygen concentration, where structural changes in the lungs are already established, will rarely show short-term improvement in pulmonary disease as a result of closure of a PDA. The overall clinical condition may, however, improve as a result of reduced cardiovascular strain. Earlier treatment of a PDA could reduce the ventilation period and the possible risk of developing chronic lung disease.

Ductus Arteriosus, Patent↗
PubMed1989

Pharmacokinetics of intra-arterial indomethacin treatment for patent ductus arteriosus.

We present pharmacokinetic data of prolonged, intra-arterial indomethacin treatment (i.e. induction plus maintenance dose) for symptomatic patent ductus arteriosus (sPDA) in 26 ventilated premature infants. sPDA was assessed by two-dimensional and pulsed Doppler echocardiography. Permanent ductal closure occurred in 20 (76%) infants. Plasma levels of indomethacin were 1.18 +/- 0.74; 1.8 +/- 1.0; 1.51 +/- 0.93 and 1.25 +/- 0.98 micrograms/ml (mean +/- SD) at 12, 24, 48 and 72 h after initial dose administration. All except one patient who responded with ductal closure, showed plasma levels above 0.25 microgram/ml throughout the 3 day treatment period and no case of sPDA reopening was noted. Although target concentrations over time were not defined, the data indicate that the maintenance levels measured were within the therapeutic range. A negative correlation was found for plasma drug levels and postnatal age (r = 0.52; P less than 0.01). Volume of drug distribution was 0.23 +/- 0.18 l/kg, total clearance 0.1 +/- 0.11 ml/min and elimination constant 0.06 +/- 0.05 h-1 (mean +/- SD). The great variation in pharmacokinetic data reflects the heterogeneity of the population studied with respect to extracellular fluid space, cardiovascular status, serum protein and other parameters.

Ductus Arteriosus, Patent↗
PubMed1990

Effects of highly overdosed indomethacin in a preterm infant with symptomatic patent ductus arteriosus.

We describe a preterm infant with severe idiopathic respiratory distress syndrome (iRDS, hyaline membrane disease) who needed artificial ventilation with high inspiratory pressure, high frequencies, 100% oxygen and developed a symptomatic patent ductus arteriosus (sPDA) in the course of the disease. The infant was given indomethacin to induce constriction of sPDA. Due to an error in drug dilution the patient received a 100-fold overdose of indomethacin. Compared to the normal study protocol side-effects such as renal failure were not observed probably due to sufficient fluid intake and good clinical condition prior to treatment and to the rapid and persistent ductal closure.

Drug Overdose↗
PubMed1990

Indications for open lung biopsy in patients with ventricular septal defect and/or patent ductus arteriosus with pulmonary hypertension.

In a previous paper, it was stated that open lung biopsy for determination of operative indications could be recommended if pulmonary vascular resistance (PVR) were higher than 8 units.m2 in patients with ventricular septal defect (VSD) and/or patent ductus arteriosus (PDA) with severe pulmonary hypertension. In the present study, oxygen inhalation or Tolazoline administration tests with or without occlusion of ductus arteriosus were performed during cardiac catheterization in 47 patients with VSD and/or PDA with severe pulmonary hypertension. The results obtained were compared with the operability based on our histopathological diagnostic criteria. There was no correlation between the oxygen, Tolazoline, or ductus occlusion hemodynamics and the baseline hemodynamics for better prediction of the biopsy should be performed for the determination of operative indication when patients with VSD and/or PDA have a PVR higher than 8 units.m2, and if the PVR is greater than 4 units.m2 with the oxygen inhalation test or 7 units.m2 with the Tolazoline test.

Adult↗
PubMed1995

Re-occlusion of residual leaks after transcatheter occlusion of patent ductus arteriosus.

Between March 1990 and November 1993 175 patients underwent successful closure of patent ductus arteriosus using the Rashkind double umbrella device. Of those patients seen on follow up, 13 (9 female, 4 male) had a residual leak and were admitted for implantation of a second device alongside the first device. The interval between the procedures ranged from 6 to 22 months. The mean age at the first procedure was 73.9 months (range 24-204 months) and the mean weight was 18.9kg (range 8.4-64). The mean age at the second procedure was 86.9 months (30-213) and the mean weight was 21.4 kg (8.6-64). The first device was 17 mm in 11 patients and 12 mm in two. The second device was 17 mm in four patients and 12 mm in nine. Four patients required two 17 mm devices in total. There was no difference in the two procedures regarding the fluoroscopy time, procedure time, complications and length of hospital stay. The second procedure was uneventful; however, in one patient the residual ductus had to be dilated before successfully deploying a 12 mm device. Ten patients had immediate total occlusion and three had a trivial leak on echocardiography 24 h later. One of the three patients was found to have total occlusion on Doppler echocardiography 1 year later. The other patients are yet to be seen for follow-up. Hence a total occlusion rate was in 11/13 patients (85%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Patent ductus arteriosus in premature infants: a review of current management.

Problems related to the ductus arteriosus confront the pediatrician more than any other isolated cardiac defect. Due to increased awareness of the problems of prematurity, the reported frequency of patent ductus arteriosus increased threefold between 1970 and 1975. Aggressive therapy directed toward closure of the ductus is indicated within the first week of life in the very immature infant. Pharmacologic closure of the PDA with indomethacin is effective about half the time.

Ductus Arteriosus, Patent↗
PubMed1982

Use of echocardiography in newborns with patent ductus arteriosus: a review.

Assessment of the contribution of left-to-right shunted ductal flow to the clinical state of a newborn with respiratory distress syndrome is difficult. Echocardiography has aided in the bedside diagnosis and management of these infants. M-mode echocardiography allows evaluation of left atrial dimension in both precordial and suprasternal planes, left ventricular dimension, and indices of function. M-mode echocardiography combined with saline contrast aortic injections allows a very sensitive demonstration of the presence of left-to-right shunting patent ductus arteriosus even if no murmur is present. Two-dimensional echocardiography demonstrates the physical appearance of the ductus and helps rule out associated congenital cardiac lesions. Incorporation of venous and arterial contrast injections help demonstrate flow direction as well. Range gated pulsed Doppler echocardiography helps evaluate flow characteristics and aids in differential diagnosis. In the future, ultrasonic evaluation will probably combine Doppler echocardiography with two-dimensional echocardiography allowing clearer noninvasive definition of anatomy and flow direction. None of these techniques should be used by itself. Careful clinical assessment by standard techniques along with judicious use of ultrasonic methodology should result in improved diagnosis and management.

Ductus Arteriosus, Patent↗
PubMed1988

Early treatment of patent ductus arteriosus in premature infants with severe respiratory distress syndrome.

In 1983, a US National Collaborative Study (NCS) proposed criteria for the diagnosis of hemodynamically significant patent ductus arteriosus (PDA) in premature infants with respiratory distress syndrome (RDS), but the widespread use of pulsed Doppler cross-sectional echocardiography (PD-CSE) in neonatal intensive care units has made direct assessment of the ductus possible thus providing more timely therapy. We have compared the results in 30 premature infants with severe RDS, assessed according to the guidelines of the US NCS, with those in 51 infants whose PDA was diagnosed by PD-CSE. Together with a significant reduction in the age at treatment (7.8 +/- 3.9 vs 2.4 +/- 1.1 days), there was a reduced dependence on artificial ventilation (14.8 +/- 11.0 vs 7.8 +/- 2.7 days), a reduction in the number requiring surgical ligation of PDA (9 vs 2), a decreased incidence of bronchopulmonary-dysplasia (BPD) (40% vs 16%), and a reduction of unfavorable outcome of treatment (death or BPD) (76% vs 49%).

Bronchopulmonary Dysplasia↗
PubMed1982

Surgical treatment of patent ductus arteriosus in preterm infants. Four-year experience with ligation in the newborn intensive care unit.

Seventy-nine consecutive patent ductus arteriosus (PDA) ligations were performed in our newborn intensive care unit (NBICU) over a four-year period. Seven infants (9%) died within one month after surgery. The deaths were not attributed to the surgery but were associated with preexisting medical complications or new intracranial hemorrhages. Significant surgical morbidity was rare. We conclude that ligation of the PDA in the premature infant can be a safe and effective procedure, when pharmacologic closure is ineffective or contraindicated. Furthermore, PDA ligation may be safely performed in the NBICU.

Ductus Arteriosus↗
PubMed1988

Subcostal cross-sectional echocardiographic imaging of patent ductus arteriosus.

A modified subcostal short-axis cross-sectional echocardiographic view for imaging the patent ductus arteriosus (PDA) was studied. A total of 22 newborns with PDA and various associated cardiac anomalies and 16 newborns without PDA were examined. The PDA was imaged in the subcostal view in 19 newborns. In the control group, the absence of the PDA was established in 13 newborns and considered probable in three. The PDA was optimally imaged in the subcostal view in patients with normal or enlarged pulmonary artery, mainly those with the hypoplastic left heart. Among the eight patients with small pulmonary artery (pulmonary atresia or severe tetralogy of Fallot), the PDA was imaged in the subcostal view in three and in the suprasternal view in eight. By combining the suprasternal and the subcostal views, the PDA was imaged in each instance.

Ductus Arteriosus, Patent↗
PubMed1987

Prolonged indomethacin treatment in preterm infants with symptomatic patent ductus arteriosus: efficacy, drug level monitoring, and patient selection.

Indomethacin treatment for 1 week monitored by drug level determinations was evaluated in 32 preterm infants with symptomatic patent ductus arteriosus (sPDA). Inter- and intra-individual indomethacin dispositions varied considerably with the need for marked dosage adjustments to maintain the drug level within the proposed therapeutic range. The overall success rate of this prolonged treatment was 63%. There were no significant differences between the groups of responders (n = 20), relapsers (n = 5) and non-responders (n = 7) with respect to postnatal age, sex, total indomethacin dose, and indomethacin serum concentrations. The responders, however, had significantly higher birth weights. Eighty-five percent of infants weighing more than 1000 g (n = 20) were treated successfully. Only four of these children experienced adverse reactions. The benefit-to-risk ratio was lowest in the group of infants weighing 1000 g or less (n = 12) with a success rate of only 25% and, potentially, severe adverse reactions in ten infants. In conclusion, prolonged indomethacin treatment is an alternative to conventional short-term treatment and appears to be particularly efficacious and safe in infants weighing more than 1000 g. In infants weighing 1000 g or less and suffering from severe pulmonary diseases, this treatment cannot generally be recommended. The advantage of on-line drug level monitoring during indomethacin treatment deserves further investigation.

Ductus Arteriosus, Patent↗