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Clinical patent ductus arteriosus in adult genetically epilepsy-prone rats.

Persistent patent ductus arteriosus (PDA) and clinically silent PDAs are relatively common congenital cardiac defects in humans. We report here the occurrence of symptomatic PDA in adults from a colony of genetically epilepsy-prone rats (GEPRs). Affected rats displayed severe ventral edema. Echocardiography revealed PDA in several animals. Necropsy findings included cardiomegaly, hepatic hyperemia and centrilobular necrosis indicative of passive congestion, and vascular changes consistent with pulmonary hypertension. All affected rats were descendants of one of two brother-sister breeding pairs established from a single litter in April 2000. Clinically silent PDAs were also detected in the colony. Histological examination of the ligamentum arteriosus showed normal vascular tissue in asymptomatic GEPR and Sprague-Dawley rats. PDAs are likely to have a genetic component in the GEPR colony and may provide a novel model for the study of pathogenesis and therapy of this condition.

Animals↗

[Gene and gene sequence patenting].

According to the author, the patenting of elements isolated or copied from the human body boils down to the issue of genes and gene sequences. He describes the current situation from the comparative law standpoint (U.S. and Spanish law mainly) and then esamines the biotechnology industry's position.

Base Sequence↗

Patent ductus arteriosus with a left to right shunt in a 64-year-old asymptomatic male.

We report here the unusual case of a 64 year old male, who was incidentally found to have a patent ductus arteriosus (PDA). The patient was asymptomatic. Echocardiography revealed a moderate sized PDA with normal left ventricular function and mild pulmonary hypertension. As the patient was asymptomatic and was not willing for any form of intervention, he was discharged and is currently under close follow-up. To the best of our knowledge this is the oldest reported case of a PDA in Indian literature.

Ductus Arteriosus, Patent↗

Brachydactyly with extrahepatic biliary atresia, patent ductus arteriosus and seizures--a new syndrome?

Brachydactyly is a relatively common congenital anomaly and can be associated with many other malformations. However, brachydactyly in association with biliary atresia is rare. We present a male child with strikingly symmetrical brachydactyly and nail hypoplasia, extrahepatic biliary atresia, patent ductus arteriosus, seizures, developmental delay and cataracts. This combination of features has not previously been described and we suggest that this case represents a new syndrome.

Abnormalities, Multiple↗

Percutaneous treatment of moderate-to-large patent ductus arteriosus with different devices: early and mid-term results.

BACKGROUND: Transcatheter closure is now accepted as the first-choice therapeutic option in patients with patent ductus arteriosus (PDA). However, this procedure is still challenging in large PDA and/or younger patients. This study evaluated feasibility and results of this approach in large, symptomatic PDA using different devices. METHODS: Between April 2000 and July 2004, 57 patients underwent attempt of transcatheter closure of a large PDA at our Institution. Nineteen patients (33.3 %) were on pharmacologic therapy for congestive heart failure. PDA diameter was 3.2+/-1.2 mm (range 1.8-9 mm), resulting in a pulmonary to systemic flow ratio of 2.1+/-1.8 (range 1.4-5). RESULTS: The procedure was successfully performed in 54 patients (94.7%), using the Amplatzer duct occluder (ADO) device (34 patients) or a multiple detachable coil approach (20 patients). Complete PDA occlusion was recorded in 77.8% of patients at 24 hours, 92.6% at 1 month, and 94.4% at last follow-up control (23+/-12 months). PDA morphology and pulmonary to systemic flow ratio did not influence the success rate of the procedure or the residual shunt. A trend toward a higher occlusion rate at any follow-up point was recorded in the ADO group (79.5 vs 75.0% at 24 hours, 97.1 vs 85.0% at 1 month, and 97.1 vs 90% at last follow-up control, p = NS for all comparisons). CONCLUSIONS: Percutaneous closure might be considered effective and safe also in large, clinically significant PDA, by tailoring the device choice to the patient size and ductal morphology. In this setting, the multiple coil option revealed as effective as the ADO device over a mid-term follow-up.

Adolescent↗

Medical innovation and patent gridlock.

Is today's sheer multitude of biological patents (especially on genetics of human beings or human pathogens) killing medical innovation--in addition to generating prohibitive prices for vital medical care?

Drug Costs↗

Therapy of symptomatic patent ductus arteriosus in preterms using mefenemic acid and indomethacin.

Mefenemic acid (MA) was given in three doses of 2 mg/kg/dose at 12 hourly intervals in 16 cases clinically suspected of having symptomatic patent ductus arteriosus (PDA). All babies were 35 weeks gestation (mean 30.1 weeks) and weighed less than or equal to 1700 g at birth (mean 1320 g), the mean age of administration of MA being 16 days. Of the 16 cases, two did not respond to therapy. One non-responder was subsequently shown to have an endocardial cushion defect without PDA on 2-D Echo and Doppler study. The other was 29 days old at the initiation of therapy. In once case, the ductus reopened after an initial closure, however, it closed on repeating a second course of the drug. Thirty preterms (less than or equal to 34 weeks) who were earlier treated with three doses of indomethacin (0.25 mg/kg/dose) formed the comparative study group. The closure rate of PDA on treatment with indomethacin was 70% and that with MA was 93.3% (p greater than 0.05). Two neonates treated with MA and two treated with indomethacin had feeding intolerance and vomiting, perhaps attributable to the drug therapy. We recommend the use of MA for closure of symptomatic PDA in preterms, especially in those cases where indomethacin is not tolerated or when minute titration of its dosage is impracticable.

Ductus Arteriosus, Patent↗

Patent ductus arteriosus (PDA) in adults evaluated in echocardiography and multi-slice computed tomography (MSCT).

The authors presented three cases of patent ductus arteriosus (PDA) diagnosed in adulthood as an solated defect in patients without clinical signs using echocardiography and MSCT. The paper discusses extensively the techniques of both examinations, the use of various reconstructive algorithms in MSCT and possible visualization of the arterial duct as well as concomitant changes in the vessels and heart. SCT, although not used in PDA diagnosis to date, was found to be a valuable non-invasive diagnostic method of detecting this defect in patients in whom echocardiography failed or in examinations conducted due to non-cardiological clinical indications.

Adult↗

Patent ductus arteriosus in a 9-day-old Grant's zebra.

A 9-day old Grant's zebra with a 3-day history of lethargy, weight loss, inappetance, and diarrhea was treated with ampicillin, vitamin E and selenium, and tetanus antitoxin without effect in 24 h. On transfer to the local veterinary clinic, a grade IV/VI continuous heart murmur was detected and a patent ductus arteriosus found at necropsy.

Animals↗

[A follow-up study on transcatheter closure of patent ductus arteriosus with Amplatzer duct occluder in children].

OBJECTIVE: To document the five-year follow-up results of transcatheter Amplatzer duct occluder (ADO) occlusion of patent ductus arteriosus (PDA) in children and to assess the safety and effectiveness of this method for PDA closure. METHODS: A retrospective cohort study was completed in patients with PDA underwent transcatheter closure by the ADO in Guangdong Cardiovascular Institute from April 1998 to December 2003. RESULTS: Transcatheter closure of PDA with ADO was attempted in 250 children patients. The median age was 5.3 years and median weight was 15.1 kg. The PDAs were from 1.8 mm to 11.0 mm (median 4.2 mm) in the narrowest diameter, of which 52 were larger than 5 mm (20.0%). All PDAs were occluded with 4 approximately 14 mm ADO through 6F (n = 205) or 7F (n = 45) sheaths. Devices were successfully implanted in 245 patients (98.0%). The Qp/Qs decreased from 1.90 +/- 0.60 to 1.03 +/- 0.21 (P < 0.05). All shapes of the PDA could be closed. Late complication occurred in five patients, including hemolysis in three patients and the los of the pulse of femoral artery in two patients. Follow-up after device implantation was accomplished in 205 patients (82.0%). The incidence of residual shunt at follow-up periods of 1 d, 1 m, 6 m, 12 m, 24 m, 36 m, 48m and 60 m after device occlusion was 9.2%, 2.8%, 1.2%, 0.8%, 0, 0, 0 and 0, respectively. Five patients (2.0%) required re-intervention to treat residual shunt with or without hemolysis. Event-free rates were 98.0% at one year and five years. CONCLUSION: This long-term follow-up result confirmed the safety and effectiveness of ADO closure of PDAs in children.

Adolescent↗

Severe intravascular hemolysis after transcatheter coil occlusion of patent ductus arteriosus.

Severe intravascular hemolysis is a rare complication of transcatheter closure of patent ductus arteriosus (PDA). It is thought to be secondary to red blood cell damage from a high-velocity jet from a residual shunt. However, only a small minority of patients with a residual shunt develop this complication. We report a case of intravascular hemolysis after partial coil occlusion of a PDA in which the Dacron strands were stripped off the coils during bioptome-assisted deployment. The exposure of the blood flow jet to bare metallic coils may have contributed to the occurrence of the severe hemolysis.

Cardiac Catheterization↗

[Can we expect decreasing the incidence of patent ductus arteriosus (PDA) in the population of premature neonates who had received antenatal steroid therapy?].

OBJECTIVES: The efficacy of antenatal steroid therapy (ANS--use with the recommendation from 1999; therapy repeated every 7-10 days; dexamethasone was used) on the incidence of RDS in neonates born before 34 weeks of gestation has been well documented in several studies. However, we know very little about the influence of ANS on patent ductus arteriosus (PDA). DESIGN: The purpose of this study was to assess the influence of ANS on the incidence of PDA in neonates born before 35 weeks of gestation. MATERIALS AND METHODS: The analysed population consisted of 425 newborns delivered at Research Institute Polish Mother's Memorial Hospital between 1996-1998. Patients were enrolled in three groups according to mode of ANS: Group I--complete ANS; Group II--partial ANS; Group III--without ANS (reference group, OR = 1). The complete ANS consisted of at least 24 mg of dexamethasone with a first dose given not earlier then 24 hours before delivery. The analysis was based on retrospective evaluation of patient's medical records. PDA was diagnosed during echocardiographic examination or during autopsy. The incidence and risk of significant PDA in enrolled groups were estimated. RESULTS: Use of complete ANS has no influence of the incidence of PDA. In the partial ANS group the risk of PDA (OR 1,89; p = 0,052 vs group III) was increased. Risk of PDA was also higher in patients born before 29 weeks of gestation, especially from the partial ANS group. CONCLUSIONS: The antenatal steroid therapy has influence of the incidence of PDA. We observed higher risk of PDA in the group of neonates born before 29 weeks of gestation and in the partial ANS group.

Adult↗

Single therapeutic catheterization for treatment of native coarctation of aorta and large patent ductus arteriosus using a covered stent.

A 20-year-old girl was diagnosed to have severe coarctation of the aorta, large patent ductus arteriosus and severe pulmonary artery hypertension. She underwent single therapeutic catheterization for the treatment of native coarctation of aorta and closure of ductus arteriosus using 39 mm long Cheatham-Platinum covered stent. The procedure was done successfully under local anesthesia without any complication. This appears to be a safe strategy while dealing with an adolescent or an adult with this combination of lesions.

Abnormalities, Multiple↗

Management of patent ductus arteriosus in preterm infants.

OBJECTIVE: To evaluate the incidence of symptomatic patent ductus arteriosus (PDA) in preterm infants, and the results of the intravenous indomethacine treatment and surgery. METHODS: Among 394 preterm infants (<37 weeks), symptomatic PDA was diagnosed by echocardiography in 51 babies and they were examined retrospectively. All infants were managed conservatively and then IV indomethacine was given to non-responders (n=30). Surgical closure was performed in 12 babies. RESULTS: The incidence of symptomatic PDA in preterm infants was 12.9%: median age: 3 days, mean birth weight: 1434+/-540 g (540-2900g) and mean gestational age (GA) 30.9+/-3.3 weeks (23-37 weeks). With indomethacine, ductal closure was achieved in 70% infants. Early clinical improvement was observed in all cases that underwent surgery and most of them had a low birth weight (<1500 g) and an early gestational age (<32 weeks). None of them died due to operation. CONCLUSION: The incidence of symptomatic PDA is high in preterm infants. Treatment with indomethacine improves ductal closure and is associated with few reversible adverse effects. In the other hand, early clinical improvement and high success rate were achieved after surgery. If indomethacine fails to achieve ductal closure, decision of surgery must be made immediately.

Cardiovascular Agents↗

[Postoperative management for severe pulmonary hypertension in a patient with congenital mitral stenosis and patent ductus arteriosus].

A 1-year and 11-month-old girl with congenital mitral stenosis (MS) and patent ductus arteriosus (PDA) underwent mitral valve replacement (CarboMedics 16 mm) and ligation of PDA. Though she had suffered from severe postoperative pulmonary hypertension crisis, the inhalation of nitric oxygen (NO) with intravenous use of phosphodiesterase (PDE) III inhibitor and prostaglandin I2 (PGI2) was useful for the postoperative management. Severe pulmonary hypertension is the one of critical postoperative complications for congenital MS with PDA cases. Therefore adequate treatments, such as the combination of NO, PDE Ill inhibitor and PGI2, should be important for those cases. In our case, cardiac catetherization revealed a remaining of pulmonary hypertension under medication of beraprost sodium. Further observation should be necessary for the patient including new medicine, such as sildenafil citrate.

3',5'-Cyclic-AMP Phosphodiesterases↗

[Patent ductus arteriosus closure with a Nit-Occlud device. Experience with 13 cases].

We report our experience with the percutaneous closure of patent ductus arteriosus with a Nit-Occlud device made of Nitinol (Nickel-Titanium alloy) in 13 patients; 10 women and 3 men, average age of 23.2 +/- 21.1 years. Average diameters were 3.8 +/- 0.8 mm and the morphologies, according to Krichenko's classification, were 10 type A, 2 type E, and 1 type C. The device was selected according to the aortic ampule and the narrowest part of the ductus. We implanted 8 occluders of 11 x 6 mm, 4 of 9 x 6 mm, and 1 of 7 x 6 mm. In three patients (25%) total occlusion was observed 15 minutes after implantation, in seven (54%) a trivial leak was observed, and in only two patients (16.6%) was the leak moderate to severe. In on patient, the occluder migrate to the pulmonary artery trunk and was successfully removed percutaneously; the patient was subjected then to surgical closure. Echocardiography follow-up 24 h later showed total occlusion in nine patients (69%). Six months after the procedure, two patient presented trivial leak (15%). One patient developed an endocarditic infection and died. We concluded that this occluder might be useful for this pathology, but further studies must be done.

Adolescent↗