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PubMedDate not supplied

Anomalous left coronary artery from the main pulmonary trunk: physiologic and clinical importance of its association with patent ductus arteriosus and pulmonary hypertension.

Origin of the left main coronary artery from the pulmonary trunk is an extremely rare, fatal, but potentially treatable anomaly. Left ventricular perfusion with desaturated blood with low pressure from the pulmonary artery results in early death. Associated pulmonary hypertension can help to prevent ischemia. We present a four-month-old boy with this anomaly associated with patent ductus arteriosus and pulmonary hypertension.

Cardiac Catheterization↗
PubMed1976

Improving the results of ligation of patent ductus arteriosus in small preterm infants.

Thirty-two consecutive preterm infants with birth weights under 1,500 grams and with respiratory distress syndrome (RDS) complicated by a patent ductus arteriosus (PDA) underwent ligation of PDA. The indications for operation were massive left-to-right shunting associated with heart failure (cardiomegaly and pulmonary edema) unresponsive to medical treatment. The clinical manifestations of heart failure were related to the severity of RDS. Infants with mild-to-moderate RDS (21) often recovered and later developed typical findings of PDA (bounding pulses, hyperactive precordium, and murmur). They are now operated upon as soon as respiratory support is required. Infants with severe RDS (11) develop cardiomegaly earlier, and retrograde aortography may show massive left-to-right shunting before the presence of a murmur. Ligation is indicated when blood-gas values deteriorate despite medical treatment. Nineteen (59 per cent) of these extremely preterm infants survived to be discharged and 16 (50 per cent) are developing normally. Three have neurologic impariment. None of the survivors has clinical respiratory disease, and their radiologic findings of bronchopulmonary dysplasia are improving.

Birth Weight↗
PubMed2003

Transcatheter closure of patent ductus arteriosus in Chinese adults: immediate and long-term results.

BACKGROUND: Transcatheter closure of patent ductus arteriosus (PDA) has been established as a safe and effective treatment for pediatric patients. However, long-term experience in adults remains limited. Therefore, our purpose is to report our experience with this approach in Chinese adults. METHODS: Twenty-five patients (mean age, 34 years) who underwent transcatheter closure of PDA in a tertiary cardiology center in Hong Kong were recruited. RESULTS: The mean PDA diameter measured by angiogram was 3.1 mm (range, 1.3 6.6 mm) and the mean pulmonary-to-systemic shunt was 1.65 (range, 1.3 1.8). All procedures were performed under local anesthesia. The average procedure and fluoroscopy times were 54 14 minutes and 14 4 minutes, respectively. The mean period of hospitalization was 4 days (range, 3 5 days). Immediate, one-month and late success rates were 96%, 92% and 84%, respectively. CONCLUSIONS: Percutaneous closure of PDA in adults is a safe and feasible procedure. It should be a reasonable alternative for adult patients who are either not fit for open-chest surgery or who prefer a less invasive approach.

Adult↗
PubMed2002

Snare-assisted transcatheter coil occlusion of patent ductus arteriosus.

Transcatheter occlusion of a small or moderate patent ductus arteriosus (PDA) using Gianturco coils is safe and effective. Several investigators have reported using different techniques with variable results. To eliminate the serious potential complications of inadvertent coil embolization to undesirable sites and to improve control of the coil throughout the procedure, a modified snare-assisted method with approach from the main pulmonary artery was developed. However, articles discussing this technique are still limited. Herein, we report our successful experience of the snare-assisted technique to occlude small or moderate PDAs in three children aged from 1 to 8 years old. We achieved immediate total occlusion in all three cases with no complications. All three patients were discharged the next day and there was no coil dislodgement, left pulmonary stenosis, or residual shunting during the follow-up period of up to 3 years. This technique had the advantages of safety, optimal positioning, and improved stability of coil implantation.

Cardiac Catheterization↗
PubMedDate not supplied

Successful combined orthotopic liver transplant and transcatheter management of atrial septal defect, patent ductus arteriosus, and peripheral pulmonic stenosis in a small infant with Alagille syndrome.

We report on a 4-kg infant with Alagille syndrome and congenital heart disease consisting of atrial septal defect (ASD), patent ductus arteriosus (PDA), and severe peripheral pulmonic stenosis. He underwent successful orthotopic liver transplant along with catheter closure of the ASD and PDA using the Amplatzer device and placement of Palmaz stents in both pulmonary arteries.

Alagille Syndrome↗
PubMed2001

[Determination of puerarin in three traditional Chinese patent medicines by high performance liquid chromatography].

A simple and accurate reversed-phase high performance liquid chromatographic method to determine puerarin in three traditional Chinese patent medicines, namely "Xiao'er qingganling" tablet, "Buchang xinnaoxintong" capsulae and "Ganmao qingre" granule is described. "Xiao'er qingganling" tablet and "Buchang xinnaoxintong" capsulae were extracted with methanol in an ultrasonic bath and "Ganmao qingre" granule was extracted with water and ethanol. After being centrifuged and filtered, the samples were separated on an ODS column with a mobile phase of 100 mmol/L ammonium acetate buffer (pH 5.0)-methanol(75:25, volume ratio). The flow rate was 0.8 mL/min, and the detection wavelength was 250 nm. The calibration curve was linear in the range of 2 mg/L-20 mg/L puerarin (r = 0.9999). The average recoveries were 99.0%, 93.4% and 97.5% for "Xiao'er qingganling" tablet, "Buchang xinnaoxintong" capsulae, "Ganmao qingre" granule respectively. The average contents of puerarin in the medicines were 3.48 mg/g, 1.08 mg/g and 1.52 mg/g (sucrose), and the relative standard deviations were 1.9%, 1.4% and 1.4% respectively.

Chromatography, High Pressure Liquid↗
PubMed2002

Oral ibuprofen and indomethacin for treatment of patent ductus arteriosus in premature infants: a randomized trial at Ramathibodi Hospital.

BACKGROUND: Ibuprofen given intravenously to premature newborn infants is a proven treatment for patent ductus arteriosus (PDA). The efficacy of ibuprofen is comparable to indomethacin in many clinical trials with fewer renal side effects. However, the intravenous form of ibuprofen is not available in Thailand, whereas, the oral suspension form is widely used for antipyretic treatment in children. Therefore, the authors investigated the possibilities of using oral ibuprofen for the treatment of PDA in premature newborn infants. OBJECTIVE: To assess whether oral ibuprofen at 10 mg/kg/dose daily for 3 days was as effective as indomethacin to treat symptomatic PDA in premature infants and to compare the side effects of oral ibuprofen to indomethacin. SUBJECTS AND METHOD: Eighteen premature infants with gestational ages less than 34 weeks born at Ramathibodi Hospital who developed symptomatic PDA were randomly assigned to receive three doses of either indomethacin (oral or intravenous administration 0.2 mg/kg/dose for three doses given at 12 hourly intervals or oral ibuprofen (10 mg/kg/dose for three doses given at 24 hourly intervals). The rates of ductal closure, infants' clinical courses, side effects and complications were recorded. RESULTS: Birth weight, gestational age, gender, age onset and number of infants who had respiratory distress syndrome were similar in both groups, PDA was closed in 7 of 9 infants given ibuprofen (78%) and in 8 of 9 infants given indomethacin (89%) (p > 0.05). The mean plasma concentration of ibuprofen was 28.05 microg/ml at 1 hour after the third dose. Neonates in the ibuprofen group had more urine output. However, the increment of serum BUN and creatinine were not significantly different in both groups. There were no significant differences in duration of ventilator support as well as number of patients with bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and death in both groups. CONCLUSION: Oral ibuprofen therapy is as effective as indomethacin for the treatment of PDA in premature infants and seems to have fewer renal side effects.

Administration, Oral↗
PubMed1976

Incidence and clinical features of patent ductus arteriosus in low-birthweight infants: a prospective analysis of 150 consecutively born infants.

The incidence of persistent patency of the ductus arteriosus beyond the third day of life was prospectively determined in 100 preterm infants with birthweights of 2,000 gm or less and 50 infants with birthweights of 2,001 to 2,500 gm. The overall incidence was 21% and was inversely related to increasing gestational age and birthweight. The data suggest that immaturity is the major determinant of the persistent patency of the ductus arteriosus. Spontaneous delayed closure of the ductus occurred in 79% of patients that survived the immediate neonatal period. There was a high degree of association between the presence of a patent ductus arteriosus (PDA) and respiratory distress syndrome (RDS). Eight infants with severe RDS and PDA developed heart failure and four required surgical ligation of the ductus. None of the infants with birthweights greater than 2,000 gm who had PDA developed heart failure or required surgical ligation of the ductus arteriosus.

Birth Weight↗
PubMed2003

An overview on the advances of Gymnema sylvestre: chemistry, pharmacology and patents.

Chemistry and pharmacology of Gymnema sylvestre is reviewed relying on research papers and patent literature. Extracts of this plant are widely used in Australian, Japananese, Vietnamese and Indian folk medicine. Gymnema preparations have a profound action on the modulation of taste, particularly suppressing sweet taste sensations. It is used in the treatment of diabetes mellitus and in food additives against obesity and caries. Anti-allergic, antiviral, lipid lowering and other effects are also reported. From a technological point of view, muchefforts have been made to mask the biter taste of Gymnema preparations.

Animals↗
PubMed2002

[Echocardiographic assessment of early and midterm results of transcatheter closure of a narrow patent ductus arteriosus in children].

This paper presents the echocardiographic assessment of early and midterm results of transcatheter closure of a narrow patent ductus arteriosus (PDA) in children using Jackson and Gianturco coils. The preliminary criterion for qualifying patients for the procedure was the PDA diameter (< or = 4 mm) at the narrowest site, as assessed echocardiographically. The criterion was met by 22 of 116 children with PDA treated at the Department of Pediatric Cardiology, Faculty of Medicine, Jagiellonian University, between January 1, 1996 and December 31, 2000. Angiography revealed, that in one case, the PDA diameter was larger (6.5 mm) and the patient required two Gianturco coils. Of 22 patients (8 males and 14 females) aged 2.7-16 years (x = 6.5 +/- 3.8), the procedure was successful in 21 children (95.5%). One patient with PDA was referred to the surgical department due to complications (the coil was displaced to the periphery of the left pulmonary artery and required removal by an Amplatzer device). The analysis of the follow-up echocardiography performed within 48 hours after the procedure and 1, 6, 12, 24 and 48 months later, revealed immediate total PDA closure in 29% of children. In 33% of patients, the PDA closed within 24 months. One child did not report to follow-up, however, the others are asymptomatic and show residual negligible shunts. The authors determined that the incidence and time of closure of residual shunts is dependent on the magnitude of the left-to-right shunt before the procedure.

Adolescent↗
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↗
PubMed2003

Morphinan derivatives--A review of the recent patent literature.

Alkaloids extracted from the Papaverum somniferum are among the most powerfully acting and clinically used drugs for diseases of the central nervous system, in particular for pain. The basic ring system, common to these opiate alkaloids, is the morphinan skeleton, which in the last 50 years has been chemically manipulated to obtain compounds with improved potency and increased selectivity toward different populations of opioid receptors. Despite a huge amount of research, interest surrounding these compounds is still high. This review will discuss the patent applications published from January 2001 to June 2002, focusing on new chemical entities that could become drugs over the next few years, new chemical processes for the production of the morphinans currently used in therapy, novel formulations and combined compositions.

Ligands↗
PubMed2003

Inhibitors of the NOS enzymes: a patent review.

This review covers the recent literature on inhibitors of nitric oxide synthase (NOS) between 2001 and June 2002. Some of the potential therapeutic uses of selective NOS inhibitors are highlighted in the introduction, while the main part of the review covers the patent literature of small molecule NOS inhibitors being investigated primarily by the pharmaceutical industry.

Animals↗
PubMed2003

Percutaneous occlusion of the patent ductus arteriosus with the amplatzer device for atrial septal defects.

We report two cases in which adult patients with large and short patent ductus arteriosus with shallow/no aortic ampulla and associated pulmonary hypertension had the defects successfully closed percutaneously using Amplatzer devices designed for atrial septal defect occlusion. The defects were stretched with a sizing balloon for optimal ductal size determination and device selection. Surgical treatment for associated discrete membranous subaortic stenosis was deferred in one patient because of significant gradient reduction in the left ventricular outflow tract after ductal occlusion. The technique of this novel approach and its possible advantages are discussed.

Cardiac Catheterization↗
PubMed1992

[Catheter closure of patent ductus arteriosus without thoracotomy].

Transcatheter plugging of patent ductus arteriosus with modified Porstmann's method was performed in children of school age and adults (130 cases) in recent 10 years. We devised a set of instrument, self-made plastic Ivalon for tailoring the plugs, developed the technique of retrograde aortic angiography to measure the diameter of the ductus, and determined the criteria of definite lodgement of the plug. 3 cases failed because their femoral arteries were too small to have the catheter sheath introduced. The other 3 cases developed thrombosis of the femoral arteries after the procedure, and the thrombi were removed by surgery.

Adolescent↗
PubMed2003

Canadian Supreme Court upholds, but limits, AZT patent.

On 5 December 2002, the Supreme Court of Canada ended a long-running dispute when it unanimously upheld the validity of the Canadian patent on the antiretroviral drug zidovudine (AZT) held by Glaxo Wellcome (now GlaxoSmithKline).

Canada↗
PubMed2003

Selection of coil for transcatheter closure of small patent ductus arteriosus.

The authors reported the results in transcatheter coil occlusion of patent ductus arteriosus (PDA) less than 4 mm, based on a policy in selection of the appropriate type and number of coils for size of PDA. The authors used one 0.035 inch detachable coil, 5 mm in diameter, in PDA less than or equal to 2 mm, and two 0.035 inch detachable coils or one controlled release 0.052 inch Gianturco coil in PDA larger than 2 mm. The present study included 32 pediatric patients. There were 31 cases of successful coil implantation and 1 case failed. Of the 31 successful cases, PDA size varied from 1.4 to 4.0 mm (mean of 2.7 +/- 0.9 mm). Ten patients had a PDA size of less than or equal to 2 mm (group A), while the other 21 patients had a PDA size of larger than 2 mm (group B). In group A, 9 cases had single-detachable-coil occlusion and one case had double-detachable-coil occlusion. In group B, double-detachable-coil occlusion was performed in 17 cases and controlled release 0.052 inch coil in 4 cases. There were no cases of coil migration or other serious complications. The immediate complete occlusion rate was 58 per cent (18 of 31 cases), which rose to 97 per cent (30 of 31 cases) at the mean follow-up of 2.6 +/- 2.5 months (range from 1 day to 9 months). Transcatheter coil occlusion is an alternative to surgical closure of small PDA (less than 4 mm). Selection of type and number of coils appropriate to the size of PDA will allow safe and excellent results.

Adolescent↗
PubMed1992

Non-surgical closure of patent ductus arteriosus with the Rashkind PDA occluder system.

Transcatheter closure of Patent Ductus Arteriosus (PDA) was done in 18 children using the USCI Rashkind PDA occluder system. Patient age ranged from 1.2 to 14 years and their weights ranged from 8 to 36 kg. Isolated restrictive PDA was present in 15 patients; 3 had additional cardiac defects. The diameter of the PDA ranged from 2 to 6 mm as determined by lateral aortogram. PDA occlusion was successfully done in all 18 children. Ten 12 mm and eight 17 mm occluders were implanted with no complications. Post-implant aortogram showed complete ductal closure in 6 and trivial or small residual ductal flow in 12 cases. Doppler color flow mapping done within 3 days of the procedure showed complete ductal closure in 9, 8 had trivial ductal flow and 1 had small ductal flow. Transcatheter technique using a Rashkind PDA occluder system is a safe and effective method of non-surgical PDA occlusion.

Adolescent↗