Patent Ductus Arteriosus In Infants Research Articles

Ibuprofen Preferable to Indomethacin for Closure of PDA in Infants

Patent ductus arteriosus (PDA) occurs commonly in premature infants with respiratory distress syndrome. Although indomethacin is the standard

Evaluation of Gianturco Coils for Closure of Large (≥3.5 mm) Patent Ductus Arteriosus

Objectives. This report evaluates the use of Gianturco coils to close large patent ductus arteriosus (PDAs) (≥3.5 mm) and describes transvenous delivery of 0.052-in. (0.132-cm) Gianturco coils.Background. Coil closure of PDAs has become increasingly popular. However, the technique has significant limitations when used to close large PDAs. This report evaluates patient characteristics, PDA anatomy, hemodynamic variables, delivery technique and coil geometry to determine predictors of success.Methods. Between January 1995 and January 1997, 16 of 118 patients undergoing catheterization for PDA closure were found to have large PDAs. Their median age and weight were 14 months (range 3 months to 43 years) and 8.5 kg (range 3.5 to 73), respectively. The mean PDA diameter was 4.3 mm (range 3.5 to 5.9). Closure of PDAs was attempted using transcatheter delivery of 0.038-in. (0.096-cm) and 0.052-in. coils. Differences in clinical, anatomic, hemodynamic and technical variables between successes and failures were compared.Results. Eleven (69%) of 16 patients had successful closure of their PDA. Failures occurred only in patients <8 months of age with an indexed PDA diameter >7 mm/m and a pulmonary/systemic flow ratio ≥2.8:1. Use of 0.052-in. coils tended to reduce the incidence of embolization and the number of coils needed for closure.Conclusions. Patients >8 months of age can have successful closure of large PDAs with currently available Gianturco coils. The 0.052-in. Gianturco coils can be used safely to close large PDAs in infants as small as 6 kg. Increased experience and improved coil design may improve closure rates of large PDAs in infants.

Transcatheter closure with single or multiple Gianturco coils of patent ductus arteriosus in infants weighing ≤8 kg: Retrograde versus antegrade approach

Experience with transcatheter closure (TCC) of patent ductus arteriosus (PDA) in small infants is limited. Our goals were to evaluate the immediate and short-term results of TCC of PDA in small infants (≤8 kg) as attempted with single or multiple Gianturco coils and to compare results for PDA ≤2.5 mm versus PDA >2.5 mm. Twenty-four infants underwent an attempt at TCC of PDA at a median age of 0.7 years (range 2 weeks to 1.5 years) and median weight of 6.5 kg (range 2.3 to 8 kg). Coils were placed by the transvenous route in 14 patients and by the transarterial route in 10 patients. The median PDA diameter was 2.7 mm (range 0.4 to 5.2 mm). Ten patients had PDA diameters <2.5 mm and all had complete closure, 9 with a single coil and 1 with two coils. Fourteen patients had PDA diameters ≥2.5 mm; closure was complete in 10 patients, 9 of whom required multiple coils. There was a trend toward improved results with multiple coils delivered transvenously. There was immediate complete closure of the PDA with a diameter as large as 5.2 mm that persisted at a median follow-up period of 1.2 year. Closure was unsuccessful in 4 patients, each of whom required multiple coils. The median fluoroscopy time was 19 minutes. Complications included transient loss of femoral pulse in 2 infants, mild left pulmonary artery obstruction in 2, and nonretrievable coil migration to the right lung in one. We conclude that TCC is effective therapy for small infants with a PDA of diameter ≤5.2 mm by the single- or multiple-coil technique on an outpatient basis and that TCC can be performed in neonates as small as 2.3 kg.

A new video-assisted thoracoscopic surgical technique for interruption of patent ductus arteriosus in infants and children: F. Laborde, P. Noirhomme, J. Karam, et al. J Thorac Cardiovasc Surg 105:278–280, (February), 1993

A new video-assisted thoracoscopic surgical technique for interruption of patent ductus arteriosus in infants and children: F. Laborde, P. Noirhomme, J. Karam, et al. J Thorac Cardiovasc Surg 105:278–280, (February), 1993

A new video-assisted thoracoscopic surgical technique for interruption of patent ductus arteriosus in infants and children

Classic surgical interruption of patent ductus arteriosus was partially replaced by transcatheter endovascular closure in 1971. We describe a new technique for ductus closure by video-assisted thoracoscopic surgical interruption, derived from video-assisted endoscopic surgery. With the patient under general anesthesia and intubated, two 5 mm holes were made through the left thoracic wall. A video camera and specially devised surgical tools were introduced; such as scissors, dissectors, and clip appliers. The ductus was dissected, and two titanium clips were applied, completely interrupting the ductus. Thirty-eight patients were operated on from April 1991 to April 1992. Mean age was 23.3 months (range 1.5 to 90 months) and mean weight was 9.5 kg (range 2.4 to 25 kg). Six had associated lesions not necessitating immediate surgical treatment. All had successful closure of the patent ductus with the video-assisted technique, but two needed two such procedures, one because of incomplete immediate ductus closure and one because of partial opening of the clip after 24 hours. One patient had recurrent laryngeal nerve injury and four had pneumothorax on the left side. The usual hospital stay was 2 or 3 days. There were no other complications and no deaths. Video-assisted thoracoscopic surgical interruption was a rapid, safe, and successful technique for closure of the patent ductus arteriosus. Better dissection of the ductus decreased the risk of recurrent laryngeal nerve injury and that of clip opening. In the last 26 patients, in whom a 2 mm multiperforated catheter was used for chest drainage during the first hours, no pneumothoraces occurred. Video-assisted thoracoscopic interruption of the patent ductus arteriosus is feasible in low-weight infants, whereas transcatheter endovascular closure of the ductus usually is not possible. The technique will be applied to premature infants with new instruments designed for the size of these patients.

Prophylactic Indomethacin for Prevention of Intraventricular Hemorrhage in Premature Infants

The impact of early prophylactic use of intravenous indomethacin on the incidence and severity of periventricular-intraventricular hemorrhage and patent ductus arteriosus in 199 oxygen-requiring premature infants (less than or equal to 1300 g birth weight) was prospectively investigated. The trial was controlled, the infants were randomized, and the investigators were unaware of the group assignments. Patients with minimal (grade I) or no periventricular-intraventricular hemorrhage determined by prestudy echoencephalography were randomized within two birth weight subgroups (500 to 899 and 900 to 1300 g) to receive either prophylactic indomethacin (n = 99) or an equal volume of saline-vehicle placebo (n = 100). The first dose (0.2 mg/kg) was given within 12 hours of delivery and two subsequent doses (0.1 mg/kg) were administered at 12 hourly intervals. Prophylactic indomethacin significantly reduced the incidence of grades II to IV periventricular-intraventricular hemorrhage. Intraventricular hemorrhage was half as common in infants given prophylactic indomethacin as in control infants (23% v 46%, P less than .002). The reduction was manifested in both birth weight subgroups. Results of this study also confirmed a lower incidence of clinically significant patent ductus arteriosus in infants who received prophylactic indomethacin in contrast to those who received placebo (11% v 42%, P less than .001). No significant differences were found between treatment and control groups in the duration of oxygen therapy, mechanical ventilation, or hospitalization or in the incidence of pneumothorax, chronic lung disease, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Early prophylactic indomethacin initiated within 12 hours of delivery is effective in reducing the incidence of intraventricular hemorrhage as well as clinically significant patent ductus arteriosus in very low birth weight premature infants.

Flow in the Aorta and Patent Ductus Arteriosus in Infants with Aortic Atresia or Aortic Stenosis: A Pulsed Doppler Ultrasound Study

We used pulsed Doppler ultrasound to determine the flow dynamics of the aorta and patent ductus arteriosus (PDA) in 21 infants (ages 1 to 16 days) with PDA and aortic atresia (n = 15) or aortic stenosis (n = 6). The flow within the PDA was recorded in 19, and was right-to-left during systole in all. There was a diastolic left-to-right PDA shunt in 11 patients with aortic atresia and in three with aortic stenosis, and the shunt was associated with large (3 to 11 mm in diameter) interatrial communications. In two patients with aortic atresia and three with aortic stenosis, however, the diastolic PDA shunt was from right to left, and the interatrial communications were small (0 to 2 mm in diameter). The right-to-left diastolic PDA shunting may be best explained by the relative pulmonary (high with left-sided inflow obstruction and a small interatrial communication) and systemic resistances. All patients with aortic atresia and three with aortic stenosis had retrograde systolic flow in the transverse aortic a...

Real-time Doppler color flow mapping for detection of patent ductus arteriosus

In this study, ultrasound Doppler color flow mapping systems were utilized to examine flow in the pulmonary artery in 31 premature and term infants (aged 4 hours to 9 months) with patent ductus arteriosus accompanying respiratory distress syndrome, as an isolated lesion, or with patent ductus in association with other cyanotic or acyanotic congenital heart disorders. The flow mapping patterns were compared with those of a control population of 15 infants who did not have patent ductus arteriosus. In unconstricted ductus arteriosus, the flow from the aorta into the pulmonary artery was detected in late systole and early diastole and was distributed along the superior leftward lateral wall of the main pulmonary artery from the origin of the left pulmonary artery back in a proximal direction toward the pulmonary valve. In constricted patent ductus arteriosus, or especially in a ductus in association with cyanotic heart disease, the position of the ductal shunt in the pulmonary artery was more variable, often directed centrally or medially. Waveform spectral Doppler sampling could be performed in specific positions guided by the Doppler flow map to verify the phasic characteristics of the ductal shunt on spectral and audio outputs. Shunts through a very small patent ductus arteriosus were routinely detected in this group of infants, and right to left ductal shunts could also be verified by the Doppler flow mapping technique. This study suggests substantial promise for real-time two-dimensional Doppler echocardiographic flow mapping for evaluation of patent ductus arteriosus in infants.

Flow in the aorta and patent ductus arteriosus in infants with aortic atresia or aortic stenosis: a pulsed Doppler ultrasound study.

We used pulsed Doppler ultrasound to determine the flow dynamics of the aorta and patent ductus arteriosus (PDA) in 21 infants (ages 1 to 16 days) with PDA and aortic atresia (n = 15) or aortic stenosis (n = 6). The flow within the PDA was recorded in 19, and was right-to-left during systole in all. There was a diastolic left-to-right PDA shunt in 11 patients with aortic atresia and in three with aortic stenosis, and the shunt was associated with large (3 to 11 mm in diameter) interatrial communications. In two patients with aortic atresia and three with aortic stenosis, however, the diastolic PDA shunt was from right to left, and the interatrial communications were small (0 to 2 mm in diameter). The right-to-left diastolic PDA shunting may be best explained by the relative pulmonary (high with left-sided inflow obstruction and a small interatrial communication) and systemic resistances. All patients with aortic atresia and three with aortic stenosis had retrograde systolic flow in the transverse aortic arch, probably resulting from inadequate left ventricular output. Antegrade diastolic flow in the transverse aortic arch toward the PDA was observed in all infants with aortic atresia and a left-to-right PDA shunt. Ascending aortic flow was recorded in 11 patients with aortic atresia, and was retrograde during diastole in each, the result of coronary perfusion. Application of pulsed Doppler ultrasound can lead to a better understanding of the hemodynamics and physiology of patients with congenital cardiovascular disease.

Patent ductus arteriosus in hyaline membrane disease: chest radiography.

Sequential chest radiographs of 45 consecutive neonates with respiratory distress were reviewed prospectively. Nineteen had hyaline membrane disease, 16 had infiltrates of other etiology, three had transient tachypnea of the newborn, and seven had no pulmonary pathology on chest radiography. Ten of the 19 infants with hyaline membrane disease and one of the 16 with pulmonary infiltrates had clinical and radiologic evidence of a patient arteriosus; there was echocardiographic confirmation in seven. Radiologic evidence of the patent ductus arteriosus was detected in all cases with no false positives. The radiographic criterion of the patent ductus was the appearance in sequential frontal chest films of pulmonary plethora, that is, pulmonary vascular engorgement and perihilar edema "haze." The radiographic appearance of the patent ductus arteriosus was detected prior to the clinical signs in seven of 11 cases and simultaneously with the clinical picture in three cases. In one the radiographic abnormally occurred later. Chest radiography is a valuable adjunct in the early diagnosis of a patent ductus arteriosus in infants with hyaline membrane disease.

Pharmacological closure of ductus arteriosus in preterm infants using indomethacin.

Patent ductus arteriosus (PDA) was diagnosed in 27 (21%) of 129 infants weighing [unk] 1500 g at birth presenting over 1½ years. The incidence of PDA in infants with pulmonary disease, particularly hyaline membrane disease, was higher than that in infants without such disease (31% compared with 16%). 16 (59%) infants with PDA developed congestive cardiac failure (CCF), of whom 12 were [unk] 1000 g at birth. Eight of these infants had persistent CCF despite aggressive antifailure treatment, and 8 were ventilator-dependent although stable on medical management. Pharmacological ductal closure with indomethacin was attempted in these 16 infants according to clinical and echocardiographic criteria. Complete or partial ductal closure with clinical and echocardiographic improvement was achieved in 75% of infants. Treatment with indomethacin failed in 4 infants all of whom were [unk] 1000 g at birth and had gestational ages [unk] 26 weeks. Two of these infants had surgical ligation of the PDA and recovered. No morbidity was attributed to indomethacin except for transient oliguria. Overall survival was 76%; this ranged from 50% in infants weighing 501-750 g, to 91% in infants weighing 1251-1500 g. Results suggest that (1) extremely preterm infants are less likely to respond to indomethacin, (2) success is more likely in the first 10 days of life, (3) a total dose greater than 0·6 mg/kg will not increase the success rate, (4) selective morbidity from indomethacin is unlikely if the contraindications of bleeding tendency, hyperbilirubinaemia, and renal dysfunction are followed, although urinary output must be monitored carefully, (5) indomethacin is a useful alternative to surgical ligation although long-term prognosis from clinical trials has yet to be established.

Real-time cross-sectional echocardiographic imaging and measurement of the patent ductus arteriosus in infants and children.

While echocardiography has been used to noninvasively document indirect effects on the heart of left-to-right shunting through a patent ductus arteriosus, no noninvasive technique has been developed to image the duct itself. In this study, 35 sequential studies were performed on 28 patients with a mechanical sector scanner to image the distal pulmonary artery and its bifurcation by scanning along the axis of the right ventricular outflow tract. Cross-sectional imaging, just superior to the take-off of the right pulmonary artery, provided visualization of the patent ductus as a distal continuation of the pulmonary artery connecting to the descending aorta. Ductal visualization by cross-sectional echo was validated by saline echo contrast observations of right-to-left and left-to-right shunting through the duct in 14 patients, by surgical observations in 11, angiographic observations in 13 and autopsy observations in three. Angiographic size of the ductus arteriosus, whether constricted or widely patent, tortuous or straight, was predicted correctly and echo/angiographic correlations for smallest inner ductal dimension were excellent (r = 0.97). This study provides a method for and validates the direct imaging of the ductus arteriosus and suggests that cross-sectional echocardiography can accurately predict ductal contour and quantitative ductal cross-sectional size noninvasively.

Chest film diagnosis of patent ductus arteriosus in infants with hyaline membrane disease

Patent ductus arteriosus in an infant with hyaline membrane disease is usually a serious complication. To evaluate the diagnostic role of chest radiography in these infants, a double-blind study comparing patients with both hyaline membrane disease and patent ductus arteriosus and matched controls was undertaken. Three pediatric radiologists acted as observers. In no instance were they more reliable than chance in predicting the presence of a patent ductus arteriosus. Analysis according to various clinical criteria (e.g., severity of illness, PAO2) also failed to show any subgroup in which the observers were accurate. From these data it is concluded that chest radiography does not play a significant role in the diagnosis of patent ductus arteriosus in infants with hyaline membrane disease.

Chloroquine, quinine, procaine, quinidine and clomipramine are prostaglandin agonists and antagonists

Chloroquine, quinine, procaine, quinidine and clomipramine behave as prostaglandin (PG) antagonists in a rat mesenteric vascular bed preparation. The ID50 concentrations were within the range of therapeutically effective human plasma levels in each case. Antagonism to PGE2 was studied in detail and seemed to be at least in part competitive. The drugs also antagonized the effects of PGs A1, A2, F2α and E1. Each drug also had weak prostaglandin agonist activity but only over a very narrow range of concentrations. It is possible that some of the clinical actions of these drugs may depend on blockade or imitation of natural PG effects. The findings suggest new approaches to the search for PG antagonists, a new screening technique for anti-inflammatory drugs and possible new uses for these established drugs. A preliminary study suggests that chloroquine may be successful in closing a patent ductus arteriosus in infants.

Patent ductus arteriosus in infants and children. A review of 936 operations (1946–1969): Ph. G. Panagopoulos, C. J. Tatooles, E. Aberdeen, D. J. Waterston, and R. E. Bonham Carter. Thorax 26: 137–144 (March) 1971

Patent ductus arteriosus in infants and children. A review of 936 operations (1946–1969): Ph. G. Panagopoulos, C. J. Tatooles, E. Aberdeen, D. J. Waterston, and R. E. Bonham Carter. Thorax 26: 137–144 (March) 1971

Patent ductus arteriosus in infants and children. A review of 936 operations (1946-69).

Nine hundred and thirty-six consecutive cases of closure of a patent ductus arteriosus in infants and children are reported. Among 789 without any other cardiac anomalies there were 11 deaths, seven of these with severe congenital anomalies other than cardiovascular. There was one incomplete closure. The deaths in this series were mostly associated with additional congenital cardiac anomalies. Forty-eight of the 59 who died had additional cardiac anomalies. Forty-seven of the deaths were in infants. For 691 patients over the age of 1 year the hospital mortality rate was less than 0·5%. Ligation of the ductus using two ligatures of thick plaited silk (1·2 mm diameter) was the technique used in 99% of these cases. There were four cases of recanalization or inadequate ligation but all four survived. This technique seems an acceptable one for the closure of a patent ductus arteriosus.

Cardiac failure and patency of the ductus arteriosus in early infancy

Patent ductus arteriosus in infants under 1 year of age can lead to cardiac failure in the presence or in the absence of a high pulmonary vascular resistance, as exemplified by the findings in 2 infants 8 weeks and 5 months of age. Possible reasons for the development of pulmonary hypertension in one of these infants are discussed. It is suggested that chronic anoxia, resulting from postmaturity with associated placental dysfunction, might be an important etiologic factor in producing alterations of the pulmonary vessels.