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PubMed1991

Indomethacin pharmacokinetics in neonates: the value of volume of distribution as a marker of permanent patent ductus arteriosus closure.

Indomethacin (INDO) pharmacokinetics were examined in 18 neonates on 19 occasions, before and after patent ductus arteriosus (PDA) closure. Patients received INDO as an initial dose of 0.25 mg/kg intravenously, and INDO serum concentrations were measured 2 and 8 h after the dose. Subsequent doses were individualized based on clinical response, toxicity, and INDO pharmacokinetics. PDA status was confirmed echocardiographically at the start and end of therapy. INDO pharmacokinetic parameters varied from dose-to-dose within the same patient, and wide interpatient variability was also observed. Pre- and post-PDA closure, only INDO volume of distribution differed significantly (p less than 0.001) with mean values of 0.36 (+/- 0.06) L/kg and 0.26 (+/- 0.08) L/kg. The reason for this occurrence remains unclear. However, a new application for pharmacokinetics as a probe of physiology is demonstrated.

Biomarkers↗
PubMed1991

[Transfemoral plug closure in 45 cases of patent ductus arteriosus].

Forty five consecutive patients with simple patent ductus arteriosus were successfully closed using transfemoral catheter method originally introduced by Porstmann in 1967. However, some improvements of instrumentation and technic were made for achieving much more safety and reliability. The diameter of ductus shown in aortography was from 0.3 to 1.0 cm. Primary success was achieved after the first trial, two trials were necessary only in one case. Emphasis was put on the proper size and shape of plug in order to obtain excellent result. 1-54 months follow-up study after procedure revealed no residual shunt.

Adolescent↗
PubMedDate not supplied

[Silent uncomplicated patent ductus arteriosus in children. Diagnosis with echo-Doppler].

Three cases are presented of patent uncomplicated ductus arteriosus in children, with short systolic murmur, in which the noninvasive diagnosis could not be possible without the echo-Doppler help. Although are cases with small shunts and hemodynamically well tolerated, its diagnosis and surgical treatment are essential in order to prevent the risk of bacterial endocarditis of those patients.

Child↗
PubMedDate not supplied

Development of a new transvenous patent ductus arteriosus occlusion technique using a shape memory polymer.

A novel percutaneous patent ductus arteriosus (PDA) occlusion technique, without the potential problems associated with conventional techniques, has been long awaited. The development of a novel transvenous PDA occlusion technique using a temperature-shape changeable occluder device, and the verification of its in vitro performance, were demonstrated in this study. The principles of this technique are: 1) the bar form device was inserted into the PDA transvenously by a guide wire and a pushing catheter, 2) the device was dashed with hot water through catheters, 3) the device was expanded by hot water in the PDA, and the PDA was occluded. The occluder device, made of a shape memory polymer (polynorbornene), was designed to have the monobloc configuration of a thin disk with a hole for a guide wire in the center and a cone. The barlike device by hot press was fully expanded within 10 sec upon immersion into 45 degrees C water. The mock-circulation test with the "great arteries" and a specially designed "PDA" showed 1) the introduction of hot water (45 degrees C) through the catheters caused expansion of the device which stayed in the "PDA" without any support, 2) the "aortic" pressure and the distal "aortic" flow increased rapidly, and the "pulmonary" flow reduced promptly. This resulted in a drastically reduced shunt ratio at the PDA from 68% to 30%. Thus, the novel PDA occlusion technique developed here functioned well to occlude the PDA in a great arteries model.

Cardiac Catheterization↗
PubMed1990

The effects of indomethacin on renal function and intracranial hemorrhage in infants with patent ductus arteriosus.

The effects of indomethacin on patent ductus arteriosus (PDA) were retrospectively studied by evaluating 1,600 consecutive infants less than 36 weeks gestation from 1983 to 1986. Two hundred thirteen infants were diagnosed with a PDA, and 102 infants received indomethacin. Indomethacin was associated with successful PDA closure in 81 infants (79%), with 59 infants (58%) closing after a single dose. No cases of renal failure were observed after indomethacin. Nine infants were treated despite a creatinine (Cr) value greater than or equal to 1.5 mg/dl. Cr improved in all these infants after therapy. Blood urea nitrogen values were greater than or equal to 30 mg/dl in 22 infants at the time of treatment; 18 infants (82%) improved. An intracranial hemorrhage (ICH) was detected in 23 infants (22%) by cranial ultrasound prior to indomethacin; there was no progression after treatment. Data suggest that indomethacin is highly associated with closure of a PDA, and therapy did not result in prolonged renal dysfunction or worsening ICH.

Acute Kidney Injury↗
PubMed1990

Results of ligation of patent ductus arteriosus in dogs: 201 cases (1969-1988).

Surgical treatment of 201 dogs with patent ductus arteriosus at the College of Veterinary Medicine, The Ohio State University was evaluated retrospectively to determine risk factors for development of surgical complications. During surgery, 15 dogs (7%) died because of hemorrhage associated with ductus dissection (n = 8), pulmonary edema (n = 4), ventricular fibrillation (n = 1), hemorrhage not associated with ductus dissection (n = 1), and cardiac arrest immediately after ductus ligation (n = 1). An additional 8 dogs (4%) died less than 1 month after surgery (total mortality before, during, and immediately after surgery, 11%). Nineteen dogs (9.5%) developed hemorrhage during surgery. Sixteen dogs developed complications other than hemorrhage (pulmonary edema [n = 4], cardiac arrest [n = 4], iatrogenic lung trauma [n = 3], ventricular fibrillation [n = 2], septicemia [n = 2], and recanalized ductus [n = 2]). Correlation was not found between age, sex, body weight, surgical technique (Jackson method vs standard method of dissection), or surgeon level of training and development of hemorrhage during surgery, other complications, or survival less than 5 days. Positive correlation (P less than 0.05) was found between hemorrhage and death within 5 days after surgery. Positive correlation (P less than 0.05) was also found between other complications and death within 5 days after surgery. Nineteen dogs survived surgery, but later died of unrelated causes (mean life span, 57 months); 63 of the dogs were still alive and doing well as of January 1990 (mean life span, 47 months after surgery). Contrary to previous reports, age, body weight, and surgical technique did not affect results.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1990

Single lung transplantation and closure of patent ductus arteriosus for Eisenmenger's syndrome. Toronto Lung Transplant Group.

A case report of the first single lung transplantation and closure of a patent ductus arteriosus for Eisenmenger's syndrome is presented. The operation was performed on Sept. 28, 1988. The patient was extubated on postoperative day 8, discharged from the intensive care unit on postoperative day 13, and discharged from the hospital on postoperative day 43, free of symptoms and without supplementary oxygen. Subsequent symptoms of dyspnea, presyncope, and fatigue recurred in association with subvalvular right ventricular outflow tract obstruction. Symptomatic improvement occurred gradually in association with reduction of the outflow tract obstruction. The patient is in New York Heart Association class I-II 12 months after the operation. The rationale, methods, and management of this patient are discussed, as well as the potential for application of this operation in similar settings.

Adult↗
PubMed1989

Reocclusion for persistent shunting after catheter placement of the Rashkind patent ductus arteriosus occluder.

Between February 1986 and January 1989, 105 percutaneous catheter occlusions of patent ductus arteriosus were undertaken, with six patients having residual left-to-right shunting confirmed by colour-flow Doppler nine months to years after initial occlusion. Five of six had successful reocclusion by placement of a second 12 mm Rashkind device. All successful reocclusions had continuous murmurs. Colour-flow Doppler characterized residual shunting as a discrete jet coursing superior to the device in five and through the pods in one. No left pulmonary artery obstruction was detected following placement of the second device. All patients were discharged the day of or the day following reocclusion.

Angioplasty, Balloon↗
PubMedDate not supplied

[Balloon occlusion descending aorta angiography in patients with patent ductus arteriosus].

Twenty-seven patients, aged 2 months to 3 years, underwent thoracic aorta angiography with balloon inflation during right heart catheterization and cineangiography. The balloon-tipped catheter was manipulated either from the right ventricle to main pulmonary artery and then through patent ductus arteriosus (PDA) or from the right ventricle through ventricular septal defect (VSD) to ascending aorta and to mid-thoracic aorta where the balloon was fully inflated with carbon dioxide. After satisfactory positioning of the inflated balloon, contrast medium was administrated via power injector with a volume of 1.5 ml/kg and a flow rate of 10 ml/sec. Cineangiograms of left lateral projection were obtained. The blood was seen clearly from the thoracic aorta to aortic arch, and also through the PDA to pulmonary vessels. On the late films, left heart chambers were also opacified. Areas of anatomic interest were well visualized in 20 cases of isolated PDA, three of PDA with VSD, two of infantile coarctation of aorta with PDA and VSD, two of tetralogy of Fallot with severe pulmonic stenosis and PDA. This procedure is simple and effective in visualizing the PDA and also, in many occasions, other associated cardiac anomalies. Conventional left heart catheterization and cineangiography could thus be omitted in some cases of congenital heart diseases. There were no untoward complications observed during and after the procedure. This technique is useful especially in critically ill infants.

Aorta, Thoracic↗
PubMed1989

Pharmacologic management of patent ductus arteriosus.

The incidence, pathophysiology, and clinical findings of symptomatic patent ductus arteriosus (PDA) are reviewed, and the pharmacologic management of symptomatic PDA is discussed. Spontaneous closure of the ductus arteriosus (DA) usually occurs within four days after birth in most premature and full-term infants. The incidence of PDA is related to birth weight in premature infants and has been shown to decrease with an increase in birth weight. Clinical findings are reviewed. Prophylactic treatment in the first few hours after birth may not be needed in most premature infants. Treatment should be considered only if the ductus becomes symptomatic. Medical management consists of respiratory support, fluid restriction, diuretics, digoxin, and indomethacin. Respiratory support, fluid restriction, and diuretics are used as first-line treatment of symptomatic PDA. Digoxin cannot be recommended as part of first-line therapy, since its risks seem to outweigh the benefits in preterm infants. Indomethacin should be used only if other standard measures including fluid restriction and diuretic treatment fail. The mechanism of action, pharmacokinetics, adverse effects, and drug interactions of indomethacin are discussed. Symptomatic PDA can increase morbidity and mortality, especially in very low birth weight infants. Treatment of symptomatic PDA may decrease the morbidity associated with this condition.

Digoxin↗
PubMedDate not supplied

Pulsatile flow changes in the anterior cerebral arteries in infants with patent ductus arteriosus: measured with Doppler technique.

Cerebral hemodynamics were measured, using the Doppler ultrasound technique (directed toward anterior cerebral artery through the anterior fontanel), in 6 patent ductus arteriosus (PDA) patients with large left to right shunt and in 32 neonates before and just following functional closure of ductus arteriosus. PDA was confirmed by color echocardiogram and Doppler flow study. All 6 sick babies had prominent retrograde flow in the descending aorta during diastole. The value of pulsatility index (PI) derived from the components of peak systolic and end--diastolic frequency, was calculated. An obvious higher PI with simultaneous decrease in diastolic Doppler frequency in sick babies (PI = 0.89 +/- 0.05) were detected. On the contrary, the PI valves in the presence of opening of the ductus (PI = 0.65 +/- 0.07) in normal newborn infants didn't differ significantly with those just following functional closure (PI = 0.63 +/- 0.05). These data suggested that PDA might result in the physiologic consequence of ischemic cerebral injury if large left to right shunt occurred.

Cerebral Arteries↗
PubMed1989

Surgical management of patent ductus arteriosus. A review of 413 cases.

Ligation under controlled hypotension is a simple, quick and effective surgical management of patent ductus arteriosus. In this study 413 cases are reviewed: clinical presentations, cardiac catheterization and operative findings are studied in relation to the surgical procedures. Ligation of the ductus was the treatment of choice in 357 cases irrespective of the age and size of the ductus with only four instances of recanalization which needed religation. Other procedures included division and suture, patch aortoplasty, transaortic patch and transpulmonary closure under profound hypothermia and arrest. There were two deaths and only five major types of morbidities described.

Adolescent↗
PubMed1989

[Report of a case of an atypical huge patent ductus arteriosus].

An atypical huge patent ductus arteriosus (PDA) associated with extreme pulmonary hypertension in a 6-month old female infant was reported. The left 3rd intercostal thoracotomy revealed huge PDA which has an appearance of pulmonary-ductus-descending aorta-trunk (PDDT) on the left side. The right side of the ductus continued to the aortic arch without demarcation between the ductus and the aorta. The median sternotomy clarified the ascending aorta, normal aortic arch, and main pulmonary artery. However, the top of the main pulmonary artery seemed to be fused with the aortic arch. The diagnosis of distal type of aortopulmonary window with wide communication was made and the total circulatory arrest with deep hypothermia and the intracavitary patching for separation of systemic and pulmonary blood flow seemed to be required for the complete repair. Total repair was decided to be postponed one week later and the chest was closed. The patient died of multi-organ failure originating from acute respiratory failure 23 days after exploratory thoracotomy without being repaired. Postmortem examination revealed a huge PDA freely communicating with the ascending aorta and the aortic arch. This is a report of an atypical huge PDA rarely seen and the conventional division or ligation is unfeasible. The circulatory arrest with deep hypothermia and intracavitary patching are obligatory for the surgical repair.

Ductus Arteriosus, Patent↗
PubMed1989

The size of the orifices of the pulmonary trunk and aorta in atrial septal defect, ventricular septal defect, patent ductus arteriosus and tetralogy of Fallot.

To estimate the influence of the pulmonary (Qp) and systemic (Qs) blood flow on the size of the orifices of the pulmonary trunk (PT) and aorta (AO), the early systolic diameters of the orifices of both great vessels were measured from the cineangiocardiograms in 33 children with ventricular septal defect (VSD), 30 with atrial septal defect of the secundum type (ASD), 24 with patent ductus arteriosus (PDA), and 29 with tetralogy of Fallot (TF). They were compared to 35 normal children (N). An excellent linear correlation between the ratio of squared diameters of PT and AO orifices (PT2/AO2) and Qp/Qs was found in patients with ASD (r = 0.80, P less than 0.001), good in VSD group (r = 0.57, P less than 0.001), weak in TF (r = 0.36, P less than 0.028) and no correlation in the PDA group. PT2/AO2 was significantly greater in ASD (2.38:1 +/- 0.56) and VSD (1.76:1 +/- 0.44), and smaller in TF (0.20:1 +/- 0.10) (P less than 0.005). There were no significant differences between PDA (1.33:1 +/- 0.25) and N group (1.22:1 +/- 0.17) (P greater than 0.05). The size of PT2 per 100 cm of body height was increased in ASD, VSD and PDA, and decreased in TF (P less than 0.005). The corresponding value for AO2 was increased in PDA and TF (P less than 0.005).

Aorta↗
PubMed1989

[Successful surgical treatment of patent ductus arteriosus with severe pulmonary hypertension using temporary long external bypass in an adult].

A 22-year-old man with patent ductus arteriosus with severe pulmonary hypertension was operated upon successfully. The operation, trans-aortic direct closure of ductus, was done using temporary long external bypass. Postoperative course was uneventful, and the patient is now well 6 years and 8 months after operation. Postoperative cardiac catheterization revealed decreased pressure of pulmonary artery from 116 to 44 mmHg. The details of the operative procedure and postoperative course were described and a brief review of literatures was also done.

Adult↗
PubMed1989

[Axillary vertical incision thoracotomy sparing pectoralis major muscle and latissimus dorsi muscle: an approach for patent ductus arteriosus].

The technique of an axillary vertical incision thoracotomy sparing pectoralis major muscle and latissimus dorsi muscle for a closure of patent ductus arteriosus is presented. After an mid-axillary vertical incision, serratus anterior muscle is incised on the third intercostal space between pectoralis major muscle and latissimus dorsi muscle. The space between serratus anterior muscle and rib cage (Spatium intermusc. thoracale) is dissected with a finger, through this space the 3rd intercostal thoracotomy is performed in the axillary and dorsal portion. The ventral part of intercostal muscle is incised from inside of the thoracic cavity for sparing the pectoralis major muscle. We performed this technique in two patients aged 1 year, and secured equally good operative fields as could be secured by the original axillary vertical incision thoracotomy described by Browne.

Axilla↗