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PubMed1989

Paralyzed left vocal cord associated with ligation of patent ductus arteriosus.

We reviewed the records of 167 neonates and older children undergoing ligation of a patent ductus arteriosus to determine the prevalence of recurrent laryngeal nerve injury and identify risk factors that might increase the likelihood of injury. Paralysis or paresis of the left vocal cord was identified by fiberoptic laryngoscopy in seven patients. All seven weighted less than 1500 gm at the time of operation and the ductus had been ligated with a metal clip. All had persistent symptoms when observed for 5 to 19 months. Injury to the left recurrent laryngeal nerve occurs infrequently but may have long-term consequences.

Child↗
PubMed1989

Surgical treatment of the aged patient with patent ductus arteriosus.

A 62-year-old woman with massively calcified patent ductus arteriosus (PDA) associated with severe pulmonary hypertension and bilateral hydronephrosis was successfully operated upon. At first, percutaneous nephrostomy was performed under ultrasonographic guidance. Two weeks later, PDA was repaired under cardiopulmonary (CP) bypass, since its division through a left thoracotomy was considered to be fraught with danger. A Foley's balloon catheter was inserted into the aorta through the ductus after a pulmonary arteriotomy under CP bypass. The ductus was closed simpler and safer with a patch mounted on the catheter, because blood flow from the aorta was well controlled by the inflated balloon catheter.

Calcinosis↗
PubMedDate not supplied

Patent ductus arteriosus before and after surgery.

Twenty five patients with patent ductus arteriosus, who had undergone surgical closure were studied retrospectively. Girls were more affected than boys; the sex ratio was 4:1. Associated cardiac lesions were diagnosed in 3 patients, two with ventricular septal defect and one with congenital mitral stenosis. Congestive heart failure was diagnosed in 5 patients before surgery. Typical continuous murmur was heard in most cases (76%), while in the rest only systolic murmur was detected. Electrocardiographic left atrial enlargement, left ventricular hypertrophy and right ventricular hypertrophy were found in 8%, 48% and 40%, respectively. Cardiomegaly with increased pulmonary vascular markings was found in 60% of cases, while ratio of left atrial to aortic root diameter greater than 1.2 was detected in 60% of patients. The PDA could be directly visualized by echocardiography in 15 cases. Cardiac catheterization was performed in 17 cases, 47% with hyperkinetic pulmonary hypertension, 41% with high pulmonary flow without pulmonary hypertension and 12% with mild increased pulmonary flow. The pulmonary-systemic flow ratio (Qp/Qs) was more correlated to pulmonary vascular markings rather than to cardio-thoracic ratio. Division of the ductus was the procedure of choice, but in 16% of cases ductal ligation was performed because of technical reasons. Postoperative catch-up in both weight and height was observed more clearly in children operated at earlier age. Ejection systolic murmur was still detected in 2 patients, in whom hyperkinetic pulmonary hypertension existed prior to surgery. No cardiomegaly was found in patients followed-up 1 year or more after surgery. The mortality was nil.

Child↗
PubMed1987

[Doppler sonographic detection of reduced flow velocity in the celiac trunk of the newborn infant with patent ductus arteriosus Botalli compared to a healthy control group].

Pulsed doppler recordings were obtained in the truncus coeliacus in 12 premature born infants (gestational age 30.3 +/- 2.5 weeks) with the clinical signs of patent ductus arteriosus Botalli (PDA) and compared to a control group of 24 healthy infants (gestational age 40.5 +/- 5.3 weeks). In all children the maximal systolic velocity, the endsystolic and the enddiastolic velocity and the pulsatility-index were measured. The 24 healthy newborns showed the following velocities: Maximal systolic velocity: 77 +/- 16 cm X s-1; endsystolic velocity: 31 +/- 10 cm X s-1; enddiastolic velocity; 18 +/- 9 cm X s-1. The pulsatility-index was 0.75 +/- 0.11. In children with PDA the maximal systolic velocity was 72 +/- 21 cm X s-1, the endsystolic velocity 15 +/- 14 cm X s-1 and the enddiastolic velocity -5 +/- 8 cm X s-1. The pulsatility-index was 1.08 +/- 0.12. All infants with large PDA showed a significant decrease of the endsystolic velocity and enddiastolic velocity, whereas the pulsatility-index was significantly increased. The decrease of the endsystolic and enddiastolic velocity in infants with large PDA in comparison to the healthy control group may lead to hypoxemic-ischemic lesions of the intestinal organs. The increased incidence of necrotizing enterocolitis in premature infants with large PDA may be the result of hypoperfusion of the small bowel.

Blood Flow Velocity↗
PubMed1988

The effect of surfactant replacement therapy on conditions associated with respiratory distress syndrome: patent ductus arteriosus, intraventricular hemorrhage, and bronchopulmonary dysplasia.

In assessing the current experience with SRT, both considering its effects on respiratory function and on associated problems, there are strong suggestions that this therapy has the potential to have a major impact on the morbidity and mortality of premature infants. The studies to date have not disclosed any serious adverse reactions, and there are strong trends toward improvements in short-term respiratory function and in long-term outcomes. In particular, SRT does not seem to adversely effect cardiopulmonary circulatory status and worsen the effects of the patent ductus arteriosus. There are no adverse effects on intraventricular hemorrhage and some possibility that it may lead to a reduction in hemorrhages. The use of SRT will likely have its biggest effect on reducing the incidence and severity of bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMedDate not supplied

Surgical ligation of patent ductus arteriosus in a neonatal intensive care setting is safe and cost effective.

The physiological and biochemical status of two groups of neonates with patent ductus arteriosus (PDA) requiring surgical ligation were compared. One group (n = 14) had ductus ligation in the operating room (OR) and the other group (n = 14) had the same operation in an isolation room in the Neonatal Intensive Care Unit (NICU). The groups were closely matched in terms of gestational age and weight. Nursing time and disposable equipment savings were significantly different. We have confirmed that PDA ligation can be done safely in the NICU and is more cost efficient than ligation in the OR.

Cost-Benefit Analysis↗
PubMed1985

[Pulsed Doppler and bidimensional echocardiography in patent ductus arteriosus].

The classical form of patent ductus arteriosus (PDA) does not usually pose any difficulty in diagnosing. When the auscultatory signs are atypical, for example in the newborn or in cases with pulmonary hypertension, pulsed Doppler echocardiography may be a useful diagnostic aid. This study reports the results of pulsed Doppler examination in PDA. Twenty-four children with a suspected PDA underwent pulsed Doppler examination during 2D echocardiography. This population was divided into 2 groups; Group I: children who underwent catheterisation, and group II: in which catheterisation was not performed. The mean age in Group I was 7 years compared to 50 days in Group II, which mainly comprised newborn and premature babies. Direct visualisation of PDA by 2D echo was attempted in all cases. The search for a PDA by pulsed Doppler was made by positioning the sample volume at the bifurcation of the main pulmonary artery. PDA is associated with turbulent systolo-diastolic flow away from the transducer. Suprasternal and subcostal views were also used. In Group I (13 cases) PDA was directly visualised by 2D echo in 7 children (53 p. 100). By comparison, pulsed Doppler examination diagnosed all 13 cases of PDA; these results were confirmed at catheterisation or surgery. In Group II (11 cases) direct visualisation of PDA was successful in 6 cases (54 p. 100). Pulsed Doppler was non-specific, showing typical flow disturbances in 8 cases and systolic turbulence in 3 cases at the level of bifurcation.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1987

[Non-invasive assessment of the peak pressure gradient between the aorta and pulmonary artery in patent ductus arteriosus].

The validity of continuous wave Doppler ultrasound estimation of the peak pressure gradient between the aorta (Ao) and pulmonary artery (PA) in patients with patent ductus arteriosus (PDA) was evaluated. Ten patients, all without other anomalies, underwent cardiac catheterization and cine-angiography, and the peak pressure gradient between the Ao and PA (dP(C)) was measured during catheterization. In all cases the mean PA pressure was less than 35 mmHg. According to the angiographic findings, the patients were categorized as Group A, consisting of seven patients whose features of the ductus were wedge- or tube-like in configuration; Group B, consisting of two patients whose features were termed "orifice-like" stenosis including one with abrupt narrowing on the PA side of the ductus and the other with a short segmental ductus. Group C consisted of one patient who had a long curved segmental ductus. The maximum velocity of ductus flow was measured by continuous wave Doppler ultrasonography, and the estimated peak pressure gradient between the Ao and PA by Doppler (dP(D] was calculated using the simplified Bernoulli equation (dP = 4V2). In group A, dP(D) was overestimated compared to dP(C) in all patients by 19 to 51 mmHg (mean 34 mmHg). However, in group B, the difference between dP(D) and dP(C) was small, 5 mmHg and 7 mmHg, respectively. In group C, dP(D) was underestimated as opposed to dP(C). Thus, in the limited cases, the simplified Bernoulli equation could be used in estimating the peak pressure gradient between the Ao and PA. However, this equation leads to overestimation in many cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗
PubMed1988

Right-to-left patent ductus arteriosus with dysplastic left ventricle in a dog.

A 6-week-old Siberian Husky pup had an unusual group of congenital heart anomalies that included a right-to-left patent ductus arteriosus, a small left ventricular chamber and ascending aorta, and a dysplastic mitral valve that may have been stenotic. Anomalies were diagnosed, using cardiac catheterization, angiocardiography, and blood gas determinations. Findings were confirmed by postmortem examination.

Angiocardiography↗
PubMed1987

Transfemoral plug closure of patent ductus arteriosus.

A patent ductus arteriosus should be closed because of its hemodynamic significance and/or the risk of infective endocarditis. Mortality of surgery is low. In adults, however, technical problems can arise due to calcification of the ductus walls. Using the transfemoral plug technique, developed by Porstmann, we attempted a ductus closure without surgery on 35 patients. The youngest was an 11-year-old girl, the oldest a 63-year-old woman (mean age of all patients: 37 years). The pressure in the pulmonary artery ranged from 15/5 to 70/27 mmHg, the diameter of the ductus from 2 to 9 mm (mean: 4.4 mm). According to the size and shape of the ductus, a plug of polyvinyl alcohol (Ivalon) with an inner steel wire frame was prepared. Threaded over a long arterio-transductal venous track wire, the plug was introduced into the femoral artery and advanced into the ductus by a pushing catheter. After removal of the track wire the plug remained wedged in the ductus. In all 35 patients, transfemoral ductus closure was possible. Patients with complaints improved remarkably within some days. Heart size and pulmonary congestion decreased considerably. All patients were followed for a period of 1-46 months. In two of them, the ivalon plug embolized into a side branch of the left pulmonary artery 7 and 2 weeks after the procedure, but without serious consequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Isolated pulmonary valve endocarditis with patent ductus arteriosus. A report of a case.

A case of pulmonary valve endocarditis in a patient with patent ductus arteriosus is reported. The diagnosis was made by echocardiographic examination. The M mode echocardiogram showed "shaggy" echoes on the pulmonic valve and the two dimensional echocardiogram disclosed a big vegetation in the right outflow tract. The patient underwent surgery with complete cardiopulmonary bypass. The ductus arteriosus was closed by endopulmonary approach and the pulmonic vegetation was removed.

Adolescent↗
PubMed1986

Systolic time intervals in patent ductus arteriosus before and after corrective surgery.

Systolic time intervals (STI) were analyzed in 11 patients with isolated patent ductus arteriosus (PDA) and unidirectional left-to-right shunt, before, shortly after (within 2 months) and a long time (at least 10 years) after the corrective surgery. The measurements were obtained from simultaneous high speed photographic recordings of electrocardiogram, external carotid pulse and phonocardiogram. Before the operation, the left ventricular ejection time (LVET) was significantly prolonged (p less than 0.01) and this abnormality was correlated with Qp/Qs (r = 0.74, p less than 0.01). Shortly after the operation, the LVET was shorter than normal, and became normal only a long time after. It is concluded that the most likely explanation for these abnormalities is: 1) before the operation, the increased stroke volume of the left ventricle secondary to the shunt, and 2) after corrective surgery, the depressed contractility of the left ventricle secondary to the long-standing volume overload which tends to persist after the corrective surgery.

Adolescent↗
PubMed1985

Fentanyl pharmacokinetics and hemodynamic effects in preterm infants during ligation of patent ductus arteriosus.

A bolus of 30 micrograms X kg-1 fentanyl was given to nine preterm infants (gestational age 31.8 +/- 4.7 weeks, weight 1100 +/- 309 g) for induction of anesthesia for ligation of a patent ductus arteriosus. Thirty minutes after the injection, fentanyl plasma concentrations were between 7.7 and 13.6 ng X ml-1. Elimination half-life was 6-32 hr (mean +/- SD, 17.7 +/- 9.3). Systolic blood pressure remained stable throughout surgery. There was a gradual increase in heart rate from 159 +/- 12 min-1 at the time of skin incision to 173 +/- 15 min-1 at the time of skin closure (P less than 0.05). Fentanyl plasma concentrations remained virtually unchanged between 30 min (10.6 +/- 1.9 ng X ml-1) and 120 min (9.6 +/- 1.6 ng X ml-1); whereas at the end of surgery most infants moved and breathed spontaneously. This phenomenon can be explained by redistribution of fentanyl from brain into pharmacodynamically inert tissues.

Anesthesia, Intravenous↗
PubMed1985

Decreased plasma glucose following indomethacin therapy in premature infants with patent ductus arteriosus.

The effect of indomethacin on carbohydrate metabolism was studied in six premature infants with significant patent ductus arteriosus (mean +/- S.D., birth weight 1,066 +/- 244 gm, gestational age 30 +/- 1.6 weeks). All infants were in a glucose steady state between 50 and 100 mg/dl over a 2-hour period before indomethacin administration. There was a significant fall in plasma glucose at 1, 6, 12, and 24 hours following intravenous indomethacin infusion. Since there was no significant change in insulin levels from the baseline, the mechanism of indomethacin-mediated lack of prostaglandin inhibition of insulin release was not substantiated. Based on this study, plasma glucose levels should be followed closely in the first 24 hours following intravenous indomethacin administration.

Birth Weight↗
PubMed1985

Angiosonography of patent ductus arteriosus in neonates.

A diagnosis of patent ductus arterious (PDA) in neonates is occasionally difficult. With an umbilical artery catheter in the descending thoracic aorta, agitated saline or dextrose solutions can be used as a sonographic contrast agent during real-time ultrasound monitoring of the origins of the great arteries. Videorecording is performed during rapid injection of 1-2 ml of sonographic contrast. Detection of echoes in the pulmonary artery signifies a PDA. Angiosonography is a clinically useful bedside procedure performed in the neonatal intensive care unit without the use of ionizing radiation, iodinated contrast or extensive catheter manipulation.

Alprostadil↗
PubMed1985

[Patent ductus arteriosus in premature infants with respiratory distress syndrome].

Since April 1983 10 premature infants suffering from patent ductus arteriosus combined with respiratory distress syndrome have been seen at our dept. for being treated surgically. One infant came to death due to bronchopulmonary dysplasia. The first 6 cases of this series were dealt with in detail. The possibility of conservative treatment (Indomethazin) or ligature of the duct are discussed.

Birth Weight↗
PubMed1985

[Regional myocardial perfusion abnormality detected by digital subtraction angiography in a case of patent ductus arteriosus with coronary arterial fistulae].

A 19-year-old woman with patent ductus arteriosus and increasingly severe chest pain received various examinations including exercise stress radionuclide test, which revealed hypokinesis and decreased myocardial perfusion in the apex and left ventricular dilatation. Conventional selective coronary arteriography and newly-developed ECG synchronized digital subtraction angiography (DSA) were performed to identify the genesis of her myocardial ischemia. Selective coronary arteriography revealed congenital coronary arterial fistulae in the right and left coronary arteries. The largest fistula was observed around the obtuse marginal artery terminating in the left ventricle. Although stenosis of the left circumflex and left anterior descending arteries (LAD) were not observed, the LAD appeared to be hypoplastic. Hypoplasia of the LAD and the steal phenomenon by arterial fistula could have been responsible for the myocardial ischemia in the apex, but this method did not clearly reveal the area and the degree of myocardial ischemia in the apex. Sequentially subtracted images during the arterial and capillary phases were obtained by utilizing ECG-synchronized DSA for selective coronary arteriography. For these images, densitometric analysis was adapted to the myocardial region, i.e. circumferential densitometry using 21 segments around the left ventricular wall. Decreased myocardial perfusion was clearly demonstrated in the apex in capillary phase images. Moreover, circumferential analysis provided detailed information about the area and the degree of impaired peripheral circulation in the myocardium. This analysis by DSA may prove useful for evaluating myocardial perfusion abnormalities.

Adult↗