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A mother and son are described with unusual facies, patent ductus arteriosus, fusion of distal interphalangeal joints and mild learning difficulties. The facial features include hypertelorism, strabismus, flat nasal bridge, short philtrum and a triangular mouth. This autosomal dominant syndrome has been reported in one other family by F. Char (1978).
Three patients were submitted to the Rashkind device technique for closure of a patent ductus arteriosus. The percutaneous transvenous technique was employed in every cases. A 12 mm prosthesis was utilized in one case and 17 mm prostheses in the other two cases. In the first case, after temporary occlusion of the ductus arteriosus, the prostheses was removed due to the technical impossibility of evaluation of the proximal umbrella position. In the second and third cases, the prostheses were duly liberated in the proper position, thus occluding the defects. This technique does not require general anesthesia, is indicated in patients over 6 kgs of body weight, and is a therapeutic alternative to the habitual surgical procedure.
OBJECTIVE: Clinical assessment of newborns requiring surgical ligation of patent ductus arteriosus (PDA). MATERIAL AND METHOD: 51 newborns operated on PDA in Department of Neonatology in Poznań in years 2000 and 2001. Newborns were classified for surgical ligation after echocardiographic examination (ACUSON 128 XP/10 or HDI 3500, sector scanhead 5MHz). Following data were analyzed: antenatal steroid therapy, gestational age, birth weight, Apgar score, the reason of respiratory insufficiency after birth, duration of mechanical ventilation and oxygen therapy, incidence of bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH) and deaths. RESULTS: 30 of 51 analyzed patients had very low birth weight (< or = 1000 g). Antenatal steroids were used in 21 cases, 20 newborns were delivered by caesarean section. The status of 22 newborns was assessed after birth as bad (0-3 points in Apgar scale). In 38 newborns respiratory distress syndrome was diagnosed and 32 required surfactant therapy. Surgical ligation of PDA was performed on 19.8 +/- 14.4 day of life in neonates born in our hospital and on 24.3 +/- 11.9 day of life in newborns admitted for ligation from other wards. Surgery of one patient was complicated by pneumothorax. 42 patients required mechanical ventilation before operation. Mean duration of mechanical ventilation was 33.4 +/- 26.9 days. 30 infants developed BPD and 15 infants IVH III or IV degree, 6 infants died. CONCLUSIONS: PDA is a serious clinical problem especially for very low birth weight newborns. Surgical ligation of a PDA, without transportation of a patient, is associated with a low incidence of complications.
The article presents a reflection on one of the greater challenges which the contemporary State is confronted with, related to guaranteeing the effective application of the fundamental rights, besides having to solve the conflicts that arise due to the rivalry between either fundamental rights or between some of these and others known as second or third generation rights. The conflict between the protection to the intellectual property rights, as in the case of the patents of the pharmaceutical multinationals, and the fundamental right to life is considered. It is observed that the interests of these companies have prevailed, as if the fundamental value to protect was the profit of these multinationals, or their efficiency, and not the right to health of the individuals which bears a direct relation with the right to the life. This situation is aggravated still more when the State, instead of being on the side of the weaker and offering him protection, safeguards the stronger who abuse of their dominant position, exerting the monopoly on the production of many essential medicines.
On 12 September 2002, the UK Commission on Intellectual Property Rights, an independent body established in May 2001 by the British government, released its report analyzing the impact of international agreements on patents. The report, Integrating Intellectual Property Rights and Developmental Policy, makes 55 recommendations "aimed at aligning [intellectual property] protection with the goal of reducing poverty".
Between January 1997 and June 2002, we retrospectively reviewed the records of all premature infants (birth weight less than 2000 g) admitted to the newborn intensive care unit (NICU) at Chi Mei Medical Center. Among the 399 premature infants (birth weight less than 2000 g) surviving more than one week, 111 infants were diagnosed with patent ductus arteriosus (PDA). Seventeen premature infants underwent surgical closure of PDA after failure of indomethacin treatment. The indication for surgical closure of PDA was ventilator dependence and/or congestive heart failure in infants with echocardiographic evidence of a ductus arteriosus. The mean gestational age and birth weight were 26.9 +/- 2.4 weeks (range 23-32 weeks) and 978.8 +/- 360.1 g (range 494-1920 g), respectively. The mean age and weight at the time of operation were 28.1 +/- 12.4 days (range 13-61 days) and 950.8 +/- 390.4 g (range 402-2120 g), respectively. All the operation procedures were performed in our NICU, using operating room personnel, thus eliminating the risks of patient transport. There was no intraoperative death. Three infants died in hospital due to other problems. One died of sepsis and the other two died due to bronchopulmonary dysplasia (BPD) and suspected sepsis. There were only two infants who had complications after surgical closure of PDA. One infant had left pneumothorax with subcutaneous emphysema and the other one had right upper lung collapse. We conclude that surgical closure of the PDA for the premature infant can be a safe and effective procedure performed in the NICU, when indomethacin closure is ineffective or contraindicated.
Transcatheter techniques for occlusion of the persistently patent arterial duct using coils have become standard therapy at many centers for pediatric cardiology, and in selected patients have demonstrated comparable efficacy to surgical ligation. Surgical ligation may still be required in many cases, including premature infants or those born with low weight, those with ducts of large diameter, those with associated structural heart disease, and in circumstances of unsuccessful occlusion subsequent to attempted closure using coils. We report on the successful surgical ligation of an arterial duct of moderate size that exhibited residual patency despite two separate attempts at occlusion using coils.
This report describes a case of patent ductus arteriosus (PDA) which was found in a calf during an experiment on an implantable ventricular assist device. This is the first case report of PDA confirmed in the calf in Korea.
AIM: To determine the efficacy and the renal side effects of indomethacin treatment for closure of a patent ductus arteriosus (PDA) in premature infants during an individualized fluid regime that avoids hypovolaemia and subsequent prostaglandin-dependent renal perfusion. METHODS: Observational retrospective analysis of the efficacy of indomethacin in premature infants with PDA treated in a single institution from June 1992 to May 2000. The clinical course and renal effects were analysed in the subgroup of infants born from June 1995 to May 2000. The management of infants at risk and the treatment of infants with PDA followed a standardized protocol that included echocardiographic screening for PDA, indomethacin treatment before congestive failure develops (early symptomatic treatment) and an individualized fluid intake. RESULTS: In total, 412 infants with a gestational age < or = 32 wk were identified. Fifty-six infants with a PDA (14%) were treated with indomethacin [mean birthweight 936 (95% confidence interval 866-1006) g; gestational age 27.3 (26.8-27.9) wk]. Indomethacin treatment was successful in 52 infants (93%). The clinical course and renal effects were analysed in 41 infants. Most infants received three indomethacin doses of 0.2 mg kg(-1) every 12 h. Urine output transiently decreased from 5.6 (4.6-6.4) to 4.6 (3.9-5.3) ml kg(-1) (h(-1). Serum creatinine temporarily increased from 0.90 (0.83-0.98) to 1.06 (0.87-1.24)mg dl(-1). Fluid intake was 158 (148-168) ml kg(-1) d(-1) before indomethacin and decreased to 142 (131-154) ml kg(-1) d(-1). CONCLUSION: Indomethacin is very effective for closure of a PDA, even in very premature infants, and is not associated with clinically significant renal side effects.
UNLABELLED: Percutaneous closure of the patent ductus arteriosus (PDA) has become an efficient and safe technique in children. We report the first Lebanese series of 8 children who had their PDA closed percutaneously with a coil or an Amplatzer Duct Occluder. METHODS: Patients median age was 3.2 years (range 1.2 to 12 years). The median minimal diameter of the PDA was 2.1 mm (1.2 to 4 mm). A coil was used in 4 children and an Amplatzer occluder in the 4 other patients. The device was chosen according to the diameter of the PDA. RESULTS: The results were excellent in all patients. A trivial shunt present in 3 cases, disappeared within 8 weeks. No complication were noted in this series. CONCLUSION: Percutaneous closure of the PDA in children, using interventional radiology, is a simple and reproducible technique. It is now the treatment of choice in most pediatric cardiac centers worldwide.
The treatment of very large patent ductus arteriosus (PDA) was thought to be solely surgical. There is not enough experience in transcatheter closure of large hypertensive PDA. In this report, successful catheter closure of a large and hypertensive ductus using the Amplatzer Muscular VSD Occluder and a literature review are presented.
Patents can help attract funding as well as create additional revenue streams.
Interpleural analgesia for postoperative pain with bupivacaine 0.25%, 0.375% and 0.5% at dosage of 1.5 mg/kg was evaluated in three randomized groups (A, B and C) of 22 children having triple ligation for patent ductus arteriosus (PDA). Complete pain relief was obtained within 30 min irrespective of the concentration of bupivacaine. The duration of pain relief significantly varied with the concentrations of the drug used, respectively 5.02 +/- 0.4 h, 6.88 +/- 0.7 h and 8.24 +/- 1.08 h (mean +/- SD) for 0.25%, 0.375% and 0.5% bupivacaine (p less than 0.05). No side effects were observed and no other supplemented narcotics were given. We concluded that 0.5% bupivacaine at the dose of 1.5 mg/kg was effective in postoperative pain relief after thoracotomy in patients undergoing PDA ligation surgery.
Some patients with patent ductus arteriosus (PDA) may develop new aortic regurgitation (AR) after coil occlusion. This study evaluated the risk factors for the development of AR after coil occlusion of PDA. A total of 23 patients with PDA were managed with coil embolization over a three-and-a-half-year period. Three patients with pre-embolization AR were excluded. A post-occlusion transthoracic echocardiogram was performed within 24 hours after the procedure. Ten patients developed AR and 10 did not. Gender, age, weight, body surface area (BSA), pulmonary artery pressure, and pulmonary vascular resistance did not differ significantly between the 2 groups. Both larger PDA size (either corrected for weight or BSA, p = 0.008 and 0.002, respectively) and a higher ratio of pulmonary to systemic flow (Qp/Qs) [p = 0.013] were significant risk factors for the development of AR after coil occlusion. Re-evaluation of the patients at 3 and 6 months after the procedure revealed 7 patients still had a regurgitant jet. The results of this study suggest that the larger the PDA and larger the shunt, the greater the likelihood of developing AR after coil occlusion.
Patent ductus arteriosus, a common congenital cardio-vascular disease, needs surgery for correction. Three methods are described: 1. transsection and suturing of the ductus ends; 2. dissection of the ductus itself and occlusion by double ligation (classical method), 3. modified double ligation described by Jackson and Henderson. A modification of the technique is described, based on the previous methods of double ligation.
73-year-old female with mitral and tricuspid valve regurgitation due to patent ductus arteriosus (PDA) with atrial fibrillation (AF) was reported. The patient was admitted for dyspnea on effort. She was diagnosed as mitral and tricuspid valve regurgitation due to PDA with AF by transthoracic echocardiography. She underwent mitral valve plasty (quadrangular resection of prolapsed posterior leaflet and annuloplasty with Duran flexible-ring 25 mm), tricuspid annuloplasty (De Vega annuloplasty), PDA direct closure and radiofrequency modified maze procedure. Postoperative echocardiogram showed good mitral and tricuspid valve function. He recovered well after the operation and was discharged in stable sinus rhythm.
UNLABELLED: The costs of transcatheter closure of patent ductus arteriosus in relation to the surgical closure still a controvertial issue in our hospitals. The aim of the study was compared the costs of both treatments. METHODS: We included 57 patients treated with transcatheter occlusion and 26 underwent surgery. Information about laboratory tests, average in hospital days of stay, anesthesia type and duration, operating and hemodinamic room costs, was gather. A database containing the costs from the institution unitary costs system in force was designed. RESULTS: sociodemographyc characteristics were similar in both groups. Ductus size was larger in patients treated with surgery (p<0.05). In hospital stay, as well as, the number of complications after the procedure were less in the patients treated with transcatheter occlusion (p<0.05). The closure with Amplatzer device was more expensive than the surgical one, and both were more expensive than coil. With surgical treatment, 86.5% of the costs are due to in hospital stay, with the Amplatzer this issues represented a 36%, however, the cost of the devices by itself represents a 40% of the total treatment cost. CONCLUSIONS: Even though total charges of Amplatzer devices are more expensive than surgery, transcatheter occlusion represents advantages in relation to less in hospital stay, resources used and number of complications, which allows hospital resources optimization.
The surgical management of a case of right aortic arch with isolation of the left subclavian artery and bilateral patent ductus arterioses is described. A review of the 39 cases of isolation of the left subclavian artery reported in the literature revealed only one single case which on autopsy was found to have associated bilateral ductus arterioses. The case we report is the first in which the diagnosis was made during life and successful surgical correction was carried out.