153 PROSTAGLANDIN E1 INFUSION FOR DUCTUS DEPENDENT CARDIAC LESIONS

Abstract

Prostaglandin E1 (PGE) infusion (0.1g/kg/min) was used in 15 neonates with ductus dependence of the pulmonary (Group I) or systemic (Group II) blood flow. Group I consisted of 9 patients, 8 with severe right ventricular outflow obstruction and I with transposition of the great arteries with severe pulmonic stenosis. The age at which infusion of PGE was started ranged from 12 hours to 34 days. Duration of infusion was from 10 minutes to 3 days. Improvement in pO2 was seen in 7/9 pts. No increase was seen in 1 infant with hypoplastic pulmonary arteries and 1 infant age 34 days. Two pts developed fever and 1 bradycardia during infusion. In the 5 pts of Group II, 3 had extreme coarctation of the aorta (CA) and 2 interpted aortic arch. The age of infusion ranged from 24 hours to 8 days. Duration of infusion was from 70 minutes to 6 days. Increased pulse pressure in the descending aorta was noted in all 5 pts. Spontaneous correction of metabolic acidosis was preceded by a transient decrease in arterial pH in 3 pts. One infant developed seizures during infusion. One additional infant with pulmonary hypertension secondary to severe mitral insufficiency received PGE because of clinical impression of CA. There was marked improvement in cardiac output. Following surgical intervention PGE was used in 3 Group I and 1 Group II pts because of poor response to the initial surgery. Shunt revision was performed in 3. PGE is effective in ductus dependent right and left heart lesions. Prolonged infusion and effectiveness in the post-operative period is demonstrated.