Cases Of Patent Ductus Arteriosus Research Articles

Evaluation of Alacepril Administration in Canine Patent Ductus Arteriosus According to Plasma Chymase Activity.

Chymase in the renin-angiotensin system (RAS) actively contributes to cardiac disease progression. Chymase is activated to produce angiotensin II during tissue injury and is involved in hemodynamics. A recent study demonstrated that plasma chymase activity reflects hemodynamic changes and aids in understanding patent ductus arteriosus (PDA) pathophysiology. The present study examined the relationship between plasma chymase activity and the administration of angiotensin-converting enzyme (ACE) inhibitor. Alacepril was administered to 13 puppies with PDA. Conventional echocardiographic parameters and non-invasive blood pressure were measured before and after medication. Plasma chymase activity was calculated using the colorimetric absorbance method. Plasma chymase activity significantly increased, but blood pressure significantly decreased. We detected an increase in plasma chymase activity due to ACE inhibition in PDA cases treated with alacepril. Plasma chymase activity was affected and altered by alacepril. In veterinary medicine, plasma chymase activity may be a novel method for assessing the pathology of and therapy for cardiac diseases.

Clinical Value of Echocardiographic Screening and Dynamic Observations for Ductus Arteriosus Closure in Newborns

Objective: To explore and analyze the clinical value of echocardiography screening and dynamic observation for ductus arteriosus closure in newborns. Methods: The study was conducted from August 2022 to December 2023. 500 newborns who were admitted to our hospital were selected as research subjects for this study (Kunming Tongren Hospital). All subjects underwent echocardiography to determine the severity of patent ductus arteriosus (PDA). The inner diameter of the pulmonary artery was measured, and the pulmonary artery pressure was estimated through tricuspid regurgitation. If the patient had high pulmonary artery pressure, elective closure surgery was performed. Results: Among the 500 subjects, 448 cases of ductus arteriosus closure and 52 cases of PDA were detected by echocardiography, including 23 cases of simple PDA, 15 cases with patent foramen ovale, 11 cases with atrial septal defect, 1 case with muscular ventricular septal defect, 1 case with tricuspid valve prolapse, and 1 case with tricuspid valve chordae tendineae rupture. After symptomatic treatment and intervention, their echocardiogram results were reviewed and no abnormalities were found. All measurement results of children with PDA combined with pulmonary hypertension were better than before treatment (P < 0.05). Conclusion: Echocardiography is a fast, accurate, and reliable non-invasive imaging examination technology. It can significantly improve congenital heart disease detection rate in infants and young children. Early intervention based on the examination results can dramatically improve the quality of life of infants and young children with PDA.

A Brazilian Neonatal Unit's Experience with Functional Echocardiography and Diagnostic Findings in Congenital Heart Disease

Introduction: The diagnosis of congenital heart diseases is a challenge for pediatricians due to the diversity of clinical presentations and symptoms, just like several other diseases prevalent in the neonatal period. Often the diagnosis is established during the gestation period, sometimes the hypothesis is formulated by neonatal screening. However, several cases will require clinical suspicion from the pediatrician. Given the possibility of this diagnosis, the evaluation of the infant cardiologist is essential. Unfortunately, this professional is not always readily available. In the intensive care units, health professionals use heart rate, blood pressure, capillary refill, urinary output and acid-base balance for hemodynamic analysis. These data are significant, but nonspecific. Thus, functional echocardiography can improve hemodynamic evaluation with positive impact on diagnosis. Our objective was to conduct a retrospective analysis of hospitalizations in a Brazilian neonatal unit, with the goal of identifying the diagnoses of congenital heart diseases made by a researcher using functional echocardiography, from July 2015 to September 2017, having as inclusion criteria; clinical manifestations of distress or respiratory failure, characterized by tachypnea, signs of dyspnea, need for oxygen therapy or ventilatory support and/or hemodynamic instability, characterized by tachycardia, cyanosis, cold extremities, prolonged capillary filling time, fine pulses and/or hypotension, low urinary output. Results: During the 26 months of the study, 362 neonates were hospitalized. Of these, 223 were included in the research for presenting cardiorespiratory manifestations. We observed three cases of obstructive shock related to cardiac tamponade, 18 cases of congenital heart disease, five cases of hypertrophic myocardiopathy, seven cases of myocardial dysfunction not related to structural heart disease, 46 cases of neonatal persistent pulmonary hypertension and 27 cases of patent ductus arteriosus (six with hemodynamics repercussion). Conclusions: The results showed functional and/or anatomical changes in 105 patients analyzed (46.7%), identified a diversity of structural cardiopathies, improved hemodynamic evaluation with impact on the therapeutic approach. While using functional echocardiography in neonates, clinicians should be aware that undiagnosed critical congenital heart defects can present during this period. They should acknowledge the limitations of skills, and it should not be used as a screening tool for diagnosing or excluding congenital heart defects. A patient with a suspected critical congenital heart defect should be quickly referred to a pediatric cardiologist, even if this implies out-of-hospital patient’s transportation. We assume that the systematic implementation of this technology by the medical team can improve diagnostic accuracy, which can positively impact the therapy used. Keywords: Critical care, neonatology, ultrasonography, echocardiography, point-of-care systems, cardiac tamponade, hypertension pulmonary, heart defectal congenits.

Cardiac Hypertrophy in Neonates Born to Diabetic Mothers at Farhat Hached of Sousse University Hospital

<i>Introduction:</i> The association between cardiac hypertrophy and hyperinsulinism is mainly observed in the newborn, although the onset in older infants has also been described. The aim of our study is to research a cardiac hypertrophy in newborns of diabetic mothers. <i>Methodology</i>: This was a cross-sectional study, involving one hundred and twenty (120) newborns of diabetic mothers from August 1^stto November 30, 2020. These newborns of diabetic mothers had received an echocardiographic examination at the laboratory of the FARHAT HACHED University Hospital in Sousse (Tunisia) regardless of the associated cardiac or extracardiac pathology, during the study period, to detect cardiac hypertrophy. <i>Results:</i> The sex ratio was in favor of the female gender at 0.90. The average weight was 3554.04 g, with extremes ranging from 1,600 g to 5,200 g. Twelve (12) newborns had a weight greater than or equal to 4,000 g (10.00% of macrosomes). Among mothers, there were 03 types of diabetes: type 1 diabetes (2.65%), type 2 diabetes (0.88%) and gestational diabetes (96.46%). Echocardiography was normal in 91 neonates (75.83%) and abnormal in 29 neonates (24.17%). The prevalence of cardiac hypertrophy was 09.17% and that of other associated cardiac abnormalities was 21.66%. There were 11 cases of patent foramen ovale, 11 cases of patent ductus arteriosus, 02 cases of ostium secundum atrial septal defect, 01 case of interrupted aortic arch, 01 case of pulmonary stenosis. These abnormalities were associated on the one hand with the septal hypertrophy and on the other hand, associated with each other in the same newborn. Left ventricular ejection function was normal in all neonates with an average of 66% and extremes between 59% and 76%. <i>Conclusion:</i> Cardiac hypertrophy described in the newborn of diabetic mother is characterized by hypertrophy of the ventricular walls more often predominating over the septum. Transthoracic echocardiography is the reference (non-invasive) technique for diagnosing and monitoring these hypertrophies.

Computed tomography jellyfish angiography in pediatric endovascular interventions

Contrast pooling (CP) reconstruction is widely used in computed tomography (CT) studies of congenital heart diseases. However, endovascular devices are usually obscured in CP. To improve visualization of the vascular lumen, we developed jellyfish angiography (JFA), a semitransparent blood pool inversion technique. Ten CT studies of patent ductus arteriosus (PDA) or coarctation of the aorta (CoA) were selected retrospectively for reconstruction using both CP and JFA. Four of the studies were conducted before the endovascular intervention, and six were conducted after the intervention. Radiology residents and pediatric cardiologists completed questionnaires regarding the reconstruction models. For radiology residents, JFA was superior to CP in postintervention PDA diagnosis, device evaluation, and overall satisfaction. For pediatric cardiologists, JFA outperformed CP in both PDA and CoA postintervention cases. Our findings show that JFA overcomes the disadvantages of CP and can improve the visualization of intraluminal devices which is essential for endovascular treatment evaluation.

The effects of intravenous paracetamol use on blood parameters in the treatment of patent ductus arteriosus

Aim: Patent ductus arteriosus (PDA), a cause of significant hemodynamic imbalance in newborn babies, can be treated using pharmacological or surgical methods. The purpose of this study was to compare intravenous (IV) paracetamol in newborns with hemodynamically significant PDA, with indomethacin and ibuprofen in terms of changes caused in blood parameters.Methods: Intravenous paracetamol was used for 3-6 days at 4x15 mg/kg/dose in cases diagnosed with PDA and admitted for follow-up between November 2014 and December 2015, and unable to receive oral medication or with contraindications for indomethacin-ibuprofen use. These cases were investigated retrospectively in terms of changes in pre and post-treatment AST (aspartate aminotransferase), ALT (alanine aminotransferase), urea, creatinine, platelet, and neutrophil values.Results: Intravenous paracetamol was administered to 10 cases of PDA, diagnosed between November 2014 and December 2015. Prior to paracetamol therapy, an increase in urea values was present in one case, increased AST in two, and decreased platelet values in two. Post-treatment values returned to normal ranges in all cases, and hemodynamic improvement was observed after the closure of the ductus arteriosus.Conclusion: Our analysis of its effect on PDA closure and its potential side-effect profile in patient blood parameters compared to other known therapeutic agents indicates that intravenous paracetamol, which is easily available and accessible in Turkey, may be an important option for the treatment of PDA.

Plasma Chymase Activity Reflects the Change in Hemodynamics Observed after the Surgical Treatment of Patent Ductus Arteriosus in Dogs.

Chymase is a protease stored in mast cell granules that produces angiotensin II (ANG II) from angiotensin I (ANG I) and is associated with tissue injury, inflammation, and remodeling, especially involving the cardiovascular system. As cardiovascular events occur, chymase is activated by degranulation to the extracellular matrix. Although chymase has been suggested to be associated with cardiovascular disease progression, there are not enough reports in veterinary medicine. Patent ductus arteriosus (PDA) is a common congenital cardiac disease in veterinary medicine. Almost all cases of PDA can be treated surgically to prevent the development of congestive heart disease and/or pulmonary hypertension. The aims of the present study were to measure chymase activity before and after PDA occlusions, and to investigate the relationships between the congestive and hemodynamic states of PDA and chymase activity. In the present study, 17 puppies diagnosed with PDA were included and all puppies completely recovered to the level of healthy dogs. Chymase activity significantly decreased at 2 months after the operation, along with the echocardiography parameters of congestion. Therefore, plasma chymase activity may be useful as a novel predictor for understanding the hemodynamics of PDA in veterinary medicine.

Adult Congenital Heart Disease and Percutaneous Interventions : Analysis of Cases over five years in a Bangladeshi Center

Background: In recent year ‘s considerable progress has been made in the early diagnosis and treatment of congenital heart disease (CHD) and a significant number of children are expected to survive into adulthood after completion of treatment. This has created a scope of a substantial population of patients with adult congenital heart disease. In Bangladesh, milder or simple from of congenital heart diseases are prevalent among populations but palliated and treated cases of CHD are gradually increasing the load of work for adult congenital heart disease (ACHD) professionals. Many of these cases can be treated by transcatheter intervention with excellent outcome. Methods: This is a retrospective study conducted in a tertiary level cardiac hospitals of Bangladesh from January 2015 to December 2020. All cases aging 18 years and above were included who had undergone cardiac catheterization or percutaneous interventions. Data were collected from Echocardiography department, Catheterization Laboratory and indoor department. Follow up data were collected from echocardiography and outpatient department. Results: Total Two hundred Ninety-four cases were enrolled for cardiac catheterization. Two hundred eighteen cases had various types of intervention. Most of the cases were in 18-25 years age group. Among shunt lesions, 165 cases (56.12%) had atrial septal defect (ASD), 48(22.02%) had ventricular septal defect (VSD), 32 (14.67%) had patent ductus arteriosus (PDA), and 4(1.83%) had patent foramen ovale (PFO). Device closure was performed in 120(55.04%) cases of ASD, 13(5.96%) cases of VSD, 30 (13.76%) cases of PDA and in 4(1.83%) cases of PFO. Nineteen (8.72%) had valvuloplasty for pulmonary stenosis (PS), 2 (0.68%) had valvuloplasty for aortic stenosis (AS), 2(0.068%) had coarctoplasty for coarctation of the aorta (CoA), 4 (1.83%) had percutaneous pulmonary valve implantation (PPVI). Seventeen (7.79%) cases had double intervention of ASD device closure and pulmonary stenosis, 5 (2,29%) cases had ASD and PDA device closure and 2 (0.92%) cases had PDA device closure and balloon coarctoplasty. ASD device was embolized in 4 cases. There were no other complications. Conclusion: Outcome of intervention in ACHD was found safe and effective and no significant short or long-term complications were noticed. Cardiovasc j 2022; 14(2): 121-127

Echocardiographic assessment of intimal thickness growth of patent ductus arteriosus in neonates and analysis of influencing factors

The spontaneous closure rate of patent ductus arteriosus (PDA) is high, and the necessity of early intervention is debated. Quantitative echocardiographic assessment of the intima in PDA has not been reported. This study evaluated intimal thickness growth in neonatal cases of PDA via echocardiography and investigated its correlation with clinical factors. Seventy-three neonates were enrolled, and echocardiography was performed three times: within 24 h post-birth (first echo), 48 h after the first echo (second echo), and before discharge (third echo). According to PDA outcome, the neonates were divided into the PDA-open group (n = 18 cases), PDA-closure at second echo group (n = 32 cases), and non-PDA at first echo group (n = 23 cases). We measured the intimal thickness (IT1 and IT2 at first and second echo, respectively), lumen diameter of ductus arteriosus (D1 and D2 at first and second echo, respectively), IT1/D1 ratio, and intimal thickness growth rate (V). Correlations between echocardiographic indicators, perinatal factors, and clinical treatment were analyzed. On first echo, the PDA-open group showed a significantly lower IT1/D1 than the combined PDA-closure group (P < 0.05). On second echo, the PDA-open group showed a significantly lower IT2 and V than the PDA-closure group as well as a significantly higher D2 (P < 0.05). Smaller gestational age correlated with a larger D2 but smaller IT2 and V (P < 0.05) and a higher level of respiratory support within 72 h post-birth correlated with a larger D2 and smaller IT 2 (P < 0.05). Increasing oxygen demand within 72 h of birth correlated with a larger D1 and D2 (P < 0.05). Echocardiographic assessment of intimal thickness growth in PDA may provide an approach for predicting spontaneous PDA closure, thereby guiding decision-making regarding early intervention.

The Antenatal and Postnatal Consequences of Antenatal Exposure to Prolonged Low Dose Indomethacin.

Despite its many clinical applications, indomethacin is seldom used in pregnancy, principally because of concerns regarding the potential for constriction of the arterial duct. The aim of this study was to document adverse antenatal effects and postnatal outcomes after in utero exposure to low-dose indomethacin. We studied a retrospective cohort of pregnancies between 2005 and 2016 at the John Radcliffe Hospital, Oxford, UK, in which mothers at extremely high risk of preterm birth were treated as prophylaxis with indomethacin 25 mg, 12 hourly, before 29 weeks. Antenatal effects on the arterial duct and postnatal outcomes were analysed. Overall, 198 fetuses had in utero follow-up, and 13 (6.6%) had ductal constriction, all within 9 days of starting treatment. No ductal constriction was seen in pregnancies when therapy was started before 20 weeks, and all effects were reversed after cessation of therapy. An analysis of postnatal complications was possible in 181 neonates. There were eight (4.4%) neonatal deaths, all but one associated with extreme preterm birth. Seven (5%) patent ductus arteriosus cases occurred in the 140 neonates delivered after 28 weeks who were alive at discharge. Postnatal complications were not more common in neonates in whom antenatal ductal constriction had been demonstrated. In conclusion, fetuses exposed to prolonged low dose indomethacin have a low incidence of in utero complications; these complications can be diagnosed with ultrasound and are reversible. Adverse postnatal events are related to gestation at birth and do not appear more common.

Telemedicine usage via WeChat for children with congenital heart disease preoperatively during COVID-19 pandemic: a retrospective analysis.

ObjectiveDuring the COVID-19 pandemic, parents of infants having medical problem face challenges of insufficient medical resources at home. The purpose of this study was to investigate the effect of WeChat-based telehealth services on the preoperative follow-up of infants with congenital heart disease (CHD) during the COVID-19 pandemic.MethodsThis study retrospectively analyzed the medical records of 190 infants with CHD who underwent remote follow-up via WeChat from December 2019 to May 2020 in Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University. In addition, the psychological benefits of WeChat on the parents of these infants were analyzed.ResultsIn total, 190 infants were involved in this study, including 72 cases of ventricular septal defects, 42 cases of patent ductus arteriosus, 55 cases of atrial septal defects, 3 cases of tetralogy of Fallot, 2 cases of endocardial cushion defects, 12 cases of pulmonary stenosis, 2 cases of total anomalous pulmonary venous connection and 2 cases of aortic arch constriction. During the follow-up period, 48 infants who received surgical indications were hospitalized in time for surgical treatment. It was recommended that 10 infants with respiratory tract infections be treated in local hospitals through the WeChat platform. We provided feeding guidance to 28 infants with dysplasia through the WeChat platform. The psychological evaluation results of parents showed that the median score and range of Self-Rating Depression Scale scores were 42 and 32–58, respectively. Nine parents (4.7%) were clinically depressed, while the majority had mild depression. The median score and range of Self-Rating Anxiety Scale scores were 44 and 31–59, respectively. Twenty parents (10.5%) had clinical anxiety, while the rest had mild anxiety.ConclusionDuring the COVID-19 pandemic, follow-up management and health services for infants with CHD prior to surgery through the WeChat platform were useful in identifying the state of an infant’s condition as well as in identifying and relieving care pressure, anxiety and depression in the parents.

Abstract 12971: Oxidative Stress in Children With Left to Right Shunt Congenital Heart Disease

Background: Oxidative stress has recently been noted as a factor involved in myocardial remodeling and has been reported to be a predictor of heart failure severity and cardiac death in adults. However, its relevance in the pediatric field is unclear. Objective: This study aimed to investigate the reference range of oxidative stress dynamics and evaluate the role of oxidative stress in children with left to right shunt congenital heart disease (CHD). Methods: The subjects consisted of 40 patients (CHD group) with left to right shunt CHD who underwent cardiac catheterization at Hamamatsu University Hospital and 105 healthy children. The oxidative stress markers were measured in blood derivatives of reactive oxygen metabolites (ROM; adult reference value 250-300 U. CARR). We examined the dynamics of ROM in healthy children and then compared the various parameters, including ROM, in 40 age- and sex-matched healthy controls (control group). Results: The median age of the CHD group (21 boys and 19 girls) was 9.5 months (interquartile range: 2.8-32.0 months). CHD consisted of 27 cases of ventricular septal defect, 8 cases of atrial septal defect, 4 cases of patent ductus arteriosus, and 1 case of atrioventricular septal defect. In the healthy children, ROM showed a significant positive correlation with age (r = 0.482, p &lt;0.001). The blood ROM of the CHD group (292 ± 84 U.CARR) was significantly higher (p &lt;0.001) than that in the control group (199 ± 82 U.CARR), and the ROM showed a significant positive correlation with the pulmonary-to-systemic blood flow ratio (r = 0.333, p = 0.022), the percentage of left ventricular end diastolic volume (r = 0.503, p &lt;0.001), and the percentage of right ventricular end diastolic volume (r = 0.771, p &lt;0.001). The area under ROC curve of ROM for pulmonary-to-systemic-blood-flow ratio &gt; 1.5 was 0.741 (95% CI: 0.576-0.906, p=0.026), with a cut-off value of 293 U.CARR. Conclusions: ROM, an indicator of oxidative stress, showed a gradual upward trend with age in childhood, and this transition was confirmed to differ from that of NT-proBNP, which decreases to a steady state after marked elevation in the early neonatal period. These findings suggest that ROM is a biological marker reflecting at least the volume load in left to right shunt CHD.

Thrombocytopenia associated with transcatheter closure of giant patent ductus arteriosus.

Thrombocytopenia occasionally occurs following the closure of some giant patent ductus arteriosus cases. Unfortunately, there is no associated research describing the associated risk factors for thrombocytopenia post-procedure. We reviewed all patients who received occluders with sizes ≥10/12 mm between January 2013 and June 2019. All the data and information on the characteristics of the patients and their follow-up were recorded. Univariate analysis, receiver operating characteristic curves, and linear regression were used to analyse the risk factors for thrombocytopenia and the predictors of hospitalisation stay. Finally, 32 patients (17.5%) suffered from thrombocytopenia. Univariate analysis revealed the ratio between occluder disc size (mm) and body weight (kg) (1.71 ± 0.51 versus 1.35 ± 0.53) as an independent predictive factor for thrombocytopenia, and the area under the curve of the ratio of occluder size and body weight for predicting thrombocytopenia post-closure was 0.691 (95% confidence interval: 0.589-0.792, p = 0.001). The best cut-off value for the ratio of occluder size and weight was 1.5895, with a sensitivity and specificity of 68.8 and 66.9%, respectively. Each unit of the ratio of occluder size and body weight predicted an average hospitalisation stay of 2.856 days (95% confidence interval: 1.380-4.332). Treatment with medication did not reduce the hospitalisation stay or benefit platelet restoration. Once the ratio of occluder size and body weight is greater than 1.6, thrombocytopenia always exists. Every unit of the ratio of occluder size and body weight represents an additional 3 days of hospitalisation. Treatment does not reduce the duration of hospitalisation.

Device closure of patent ductus arteriosus: analysis of cases in a Bangladeshi centre

Background: Transcatheter closure of Patent ductus arteriosus (PDA) has become the first-choice therapy for closure in patients of any age group. Authors reviewed the outcome of device closure in all age groups starting from neonate to adult.Methods: From December 2014 to December 2019, 440 cases underwent transcatheter closure in a catheterization laboratory of a tertiary level cardiac hospital. Selection criteria were isolated PDA or PDA with associated conditions which can be managed in the same setting by an intervention. Exclusion criteria were proven Eisenmenger syndrome. A retrospective review of outcome and complications were recorded from computerized data records.Results: Age of the patient varied from 10 days to 65 years. The median age was 3 years. Most of the patients were female (63%), weight varied from 1.8 kg to 75 kg. the median weight was 7.5 kg. Isolated PDA cases were 74.77 %. Among syndromes, congenital rubella syndrome was common (7.5%), followed by Down Syndrome (6.36%). The narrowest PDA diameter varied for 1.8 mm - 14 mm with a median of 5 mm. Among duct occluders, 8x6 mm CeraTM was the commonest one used in the study population. Complete occlusion was observed in 99.55% of cases.Conclusions: Transcatheter closure of PDA is considered safe and efficacious in all age groups. It is the gold standard now and replaced surgical option in most of the places.

Surgical Ligation of Patent Ductus Arteriosus Using the Descending Aortic Approach in Two Dogs

Surgical ligation is the treatment of the choice in patients with patent ductus arteriosus (PDA). This case series presents two cases of PDA, one with and one without persistent left cranial vena cava (PLCVC), treated with surgical ligation through the descending aortic approach with mini-thoracotomy. There were no specific complications during the surgical procedures. The descending aortic approach would be an alternative method for dissection of the PDA.

Incidental detection of patent ductus arteriosus during cardiac surgery in adult patients: A case series

Patent ductus arteriosus (PDA) is an inborn heart defect in which the ductus arteriosus (i.e., a vascular structure between the pulmonary artery and aorta that usually closes shortly after birth) remains open. Because most patients with PDA are diagnosed and treated when they are infants, this is a relatively rare congenital heart defect among adults. Herein, we present the cases of PDA in adults, which were detected during cardiac surgery.

Patent Ductus Arteriosus (P.D.A.) (An analysis of 37 surgically proved cases)

An analysis of the clinical picture on 37 cases of patent ductus arteriosus proved by operation is presented, including the chest X-ray and electrocardiographic findings.&#x0D; In 13 cases preoperative hemodynamic studies were necessary to establish the diagnosis, although in most of the cases it could be based on clinical findings only.&#x0D; During the years 1968 to 1973, 37 patients were operated upon for patent ductus arteriosus (PDA) at the Cardiologic Center, Dr. Cipto Mangunkusumo Hospital, Medical School University of Indonesia, Jakarta.&#x0D; This paper is meant to analyze the clinical picture and in some instances, the hemodynamic findings of those 37 patients.

KATP channels in ductus arteriosus function and pathophysiology: mechanism of action and therapeutic potential

The ductus arteriosus (DA) is an essential fetal vessel connecting the pulmonary artery and aorta. In utero, the DA diverts blood flow away from the developing lungs, shunting it to the systemic circulation where gas exchange occurs within the placenta. After birth, the DA must close to allow adequate perfusion of the newly inflated lungs. Failure of the postnatal DA to constrict results in PDA (patent ductus arteriosus), one of the most common congenital cardiovascular disorders that is associated with significant morbidities and increased infant mortality. PDA disproportionately affects the most critically ill premature neonates, affecting 60–80% of infants weighing <1000g. The only drugs currently available to promote DA closure (indomethacin, ibuprofen, acetaminophen) non-specifically target the prostaglandin pathway, are associated with severe adverse side-effects, and are ineffective in ~30% of patients. Consequently, there is a significant need to identify novel DA-specific regulators of vascular tone in order to develop additional PDA therapeutic options. To this end, we demonstrated that vascular ATP-regulated potassium (KATP) channels, comprised of pore-forming Kir6.1 and regulatory SUR2B subunits, are developmentally regulated and significantly enriched in the mouse and human DA compared to other blood vessels. Of note, gain-of-function mutations in Kir6.1/SUR2B channels underlie Cantu syndrome, an autosomal dominant disorder in which 50% of patients have symptomatic PDA. Using isolated human and mouse DA myography assays and in vivo mouse models, we found that glibenclamide (a non-specific KATP channel inhibitor traditionally used to treat diabetes) induced DA constriction, while having relatively no effect on other vessel types. Moreover, inhibiting KATP channels made DAs more sensitive to ibuprofen-induced constriction, highlighting the potential of KATP channel inhibitors as adjuvant PDA therapies. Importantly, exposure to glibenclamide made human DAs more sensitive to oxygen-induced constriction, a finding of particular importance for cases of PDA in preterm infants who often have substantially lower pO2. Ongoing and future studies are focused on using high-throughput screening assays and medicinal chemistry to identify and optimize vascular-specific (Kir6.1/SUR2B) KATP channel inhibitors with the ultimate goal of developing novel DA-selective PDA therapies that are safer and more effective than those currently available. Support or Funding Information This work was supported by R21HL132805 and AHA15SDG25280015 awarded to ELS, R01DK082884 awarded to JSD, and R35HL140024 awarded to CGN (A) Pressure myography was used to measure changes in lumen diameter in dose response studies of the KATP channel inhibitor, glibenclamide. Vessels were isolated from preterm (day 15 of gestation) and term (day 19 of gestation) mice and mounted on glass pipette tips in microvessel perfusion chambers. (B) DAs are significantly more sensitive to glibenclamide-induced constriction compared to ascending aortas (aAO), descending aortas (dAO), and mesenteric arteries. (A) Neonatal human DA ring suspended in an organ bath for use in wire myography assay. (B) Quantification of results from 7 vessels. Increased tension corresponds to vasoconstriction, while decreased tension corresponds to vasodilation. Pinacidi (KATP channel activator) relaxes the human DA, while glibenclamide (KATP channel inhibitor) used in combination with oxygen makes vessels more sensitive to O2-induced constriction. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Congenital heart disease management problems in the hospitalo-university center of Oran Algeria

Congenital heart disease (CHD) is extremely diverse, ranging from the simple abnormality allowing the growth of the child without any problem until the serious malformation, incompatible with the survival of the newborn. Their incidences and frequencies are clearly increasing in our country. To have data on the frequency of CHD and the care of children hospitalized in our unit with CHD. Retrospective study of 164 files, hospitalized during the period from January 2014 to December 2015, the diagnosis was done by echocardiography coupled with Doppler. Frequency of hospitalization of CHD was 80%, with extremes 2 days to 15 years, sex-ratio = 0.9. Left-to-right shunts are the most frequent 99 cases, (60 ventricular septal defect, 17 atrioventricular canal, 5 cases of patent ductus arteriosus, 8 atrial septal defect). The most frequent cyanogenic congenital heart (18 tetralogy of Fallop, 7 transposition of the great arteries). The obstacles on the aorta (5 coarctation), obstacles on the pulmonary artery (5 pulmonary atresia with ventricular septal defect, 3 pulmonary atresia with intact septum) and 27 cases of complex heart disease. Only 31 patients were operated, 27 died, 20 complicated by Eisenmenger syndrom due to a lack of technical platform and to a diagnostic delay, due to lack of cardio-pediatrician training associated with surgery delay. Congenital heart disease presents a problem of diagnostic and therapeutic management in particular surgical. This study gives a reflection on the congenital cardiopathy in Algeria should help to attract the attention of the country's public authorities on the need to set up a national program for the management of this type of heart disease.

Patent DuctusArteriosus Treatment: Size does Matter

Patent Ductus Arteriosus ( PDA ) is one of the commonest acyanotic congenital heart disease.Surgical or device closure is done when medical management fails.Choice of management depends on size of PDA. A study was conducted to assess the type of surgical technique to be followed either direct ligation or division and suturing.10 Cases of PDA were studied from May 2012 to May 2017 ages ranged from 12 days to five years with youngest weighing 650 grams.There were no postoperative complications and death.In two patients division suturing done and in other eight ligation was done.Repeat 2 D echo after three months did not show recanalization in either group.Conclusion was both techniques are equally effective but division suturing was more difficult than ligation. DOI: 10.21276/AWCH.1803