Patent Ductus Arteriosus In Patients Research Articles

An Observational, Prospective, Multicenter, Registry-Based Cohort Study Comparing Conservative and Medical Management for Patent Ductus Arteriosus

No consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 240/7 and 286/7 weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 ± 1.4 weeks and 926 ± 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (≥Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p > 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01–2.80, p = 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37–0.92, p = 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p = 0.009 and 0.007, respectively). In preterm infants born at <29 weeks of gestation with moderate-to-large PDA, medical treatment did not show any reduction in the rates of open PDA at discharge, surgical or prematurity-related secondary outcomes. In addition to the high incidence of spontaneous closure of PDA in the first week of life, early treatment (<7 days) was associated with higher rates of mortality and BPD/death.

Risk Factors for Necrotizing Enterocolitis in Infants With Patent Arterial Duct. A Retrospective Matched Paired Analysis.

Background: The development of necrotizing enterocolitis (NEC) in neonates with patent ductus arteriosus (PDA) is not well-understood. Our aim was to find risk factors for NEC in children with a significant PDA and to assess differences in mortality and duration of hospital stay between patients with PDA and those with PDA and NEC.Methods: We performed a retrospective single center case control study including infants with PDA scheduled for treatment. We compared multiple patient data between patients with PDA and those with PDA and NEC from 2004 to 2018 using 1:2 and 1:1 matching.Results: We used 1:2 matching with 26 NEC patients (cases) and 52 PDA patients without NEC (controls) and 1:1 matching with 5 NEC patients and 5 PDA patients without NEC. NEC patients had lower Apgar score (1′), more congenital malformations, more suspected sepsis, less hypotension, higher minimum platelet count and higher CRP-values during the week before NEC (P < 0.05, respectively). The mortality was higher in NEC cases [29% (9/31)] compared to the control patients [2% (1/57), P < 0.001]. Lower Apgar score (1′) was correlated with an increased risk of NEC stage III. Hypotension was inversely correlated with the odds of NEC (OR 0.3).Conclusions: NEC increased mortality in infants with PDA. Hypotension did not increase the risk of NEC in infants with PDA. Routine clinical parameters were not able to predict NEC in infants who suffer from PDA.

Echocardiographic Prediction of Left Ventricular Dysfunction After Transcatheter Patent Ductus Arteriosus Closure in Children.

Objectives: To evaluate the change of left ventricular (LV) systolic function after transcatheter patent ductus arteriosus (PDA) closure in children, and to identify whether echocardiography parameters could be the predictors of LV dysfunction post-PDA closure if present.Methods: This study enrolled 191 pediatric PDA patients, and all of them underwent successful transcatheter PDA closure between January 2016 and December 2018. The patent ductus arteriosus diameter (PDAd), aortic root diameter (AOd), left atrial diameter (LAd), right ventricular outflow tract dimension (RVOT), LV end-diastolic dimension (LVEDD), and LV end-systolic dimension (LVESD) were all measured by echocardiography at pre-closure, post-closure (within 24 h after the procedure), and follow-up (3 months after the procedure). The ratio of PDAd to AOd (PDAd/AOd), the ratio of LAd to AOd (LAd/AOd), the left ventricular ejection fraction (LVEF), and the fractional shortening (FS) were calculated.Results: The LAd, LVESD, LVEDD, FS, and LVEF decreased significantly in the 24 h after closure, compared to pre-closure levels. However, all echocardiography parameters recovered to pre-closure levels at 3 months after PDA closure in all patients. Moreover, the pre-closure LAd, LVEF, PDAd/AOd, and LAd/AOd were higher in the patients with post-closure LV systolic dysfunction than in those without post-closure LV systolic dysfunction. Furthermore, the pre-closure LVEF, PDAd/AOd, and LAd/AOd were correlated with the post-closure LVEF, and pre-closure LVEF ≤ 66.5%, PDAd/AOd ≥ 0.28, and LAd/AOd ≥ 1.54 predict the post-closure LV systolic dysfunction.Conclusion: Transcatheter closure of PDA causes a significant deterioration in LV systolic function early after PDA closure, which recovered completely within 3 months of post-closure in children. Pre-closure LVEF, PDAd/AOd, and LAd/AOd can be the predictors of post-closure left ventricular systolic dysfunction.

Characteristics and transcatheter closure of patent ductus arteriosus in patients living at moderate-to-high altitude in Eastern Anatolia

The incidence of patent ductus arteriosus (PDA) is greater among patients living at high altitude. In this po-pulation, the ductal diameter is often larger and pulmonary hypertension is more frequent. The aim of this study was to evaluate the hemodynamic and morphological features of PDA and transcatheter closure procedures performed with various devices in a group of patients living at high altitude in Turkey. The data of 327 patients who lived at an altitude of at least 1600 m above sea level and who had undergone cardiac catheterization for isolated PDA between May 2010 and July 2018 were retrospectively analyzed. The mean age was 7.33±7.67 years, and 62.4% of the patients were female. The mean ductal diameter was 3.74±2.14 mm. Pulmonary hypertension was present in 57.8%. Transcatheter closure was performed in 322 patients, with a 97.3% success rate. The Amplatzer duct occluder I (ADO I) was used most often, as well as off-label use of the Amplatzer vascular plug II (AVP) and the Amplatzer muscular ventricular septal defect occluder (AMVSDO). Pulmonary artery pressure decreased immediately in the vast majority after percutaneous closure. Transient left ventricular systolic dysfunction after ductal closure was seen only rarely. Follow-up was uneventful. Transcatheter PDA closure can be performed with high success rate in highlanders. Off-label devices may be required for these procedures. Pulmonary hypertension is frequent but regresses after ductal closure. Transient left ventricular dysfunction after transcatheter closure is rarely seen in these patients and resolves without any medication.

NT-proBNP level and left ventricle diameters before and after transcatheter closure of PDA and VSD

Background Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels before and after transcatheter closure may correlate with changes in left ventricular internal diameter end diastole (LVIDd) and end systole (LVIDs). Patent ductus arteriosus (PDA) and ventricular septal defect (VSD) are structural abnormalities which effects cardiac hypertrophy. Cardiac muscle stretching decreases after closure, followed by reduced left ventricle diameters and decreased NT-proBNP levels.&#x0D; Objective To analyze for possible correlations between NT-proBNP levels and left ventricle diameters before and after transcatheter closure.&#x0D; Methods Subjects were PDA and VSD patients who underwent transcatheter closure in the Pediatrics Department of dr. Moh Hoesin Hospital, Palembang, South Sumatera, from May 2016 to March 2017. Measurement of NT-proBNP levels and echocardiography were performed before closure, as well as one and three months after closure.&#x0D; Results There were 34 subjects (15 girls) with median age of 91.5 months. Median NT-proBNP levels were significantly reduced after closure: before closure 111.7pg/mL, one month after closure 62pg/mL, and three months after closure 39 pg/mL (P&lt;0.05). Median LVIDd and LVIDs were also significantly reduced after closure [LVIDd: 39.5mm before, 34.5mm one mo after, and 32.5mm 3 mo after (P&lt;0.05); LVIDs: 23.9mm before, 20.5mm 1 mo after, and 20.0mm 3 mo after (P&lt;0.05)]. At one month after closure, there was a moderate positive correlation between NT-proBNP levels and LVIDd (r=0.432; P=0.011), but no correlation with LVIDs (r=0.287; P=0.100). At three months after closure, there was a significant moderate positive correlation between changes of NT-proBNP levels and changes of LVIDd (r=0.459; P=0.006), as well as LVIDs (r=0.563; P=0.001).&#x0D; Conclusion In pediatric PDA and VSD patients, NT-proBNP levels have a significant positive correlation with diastolic and systolic left ventricle diameters at three months after closure. Decreased NT-proBNP levels may be considered as a marker of closure effectiveness.

Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults

BackgroundCatheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. MethodsThis single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. ResultsOf 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77mmHg to 33mmHg;P=0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. ConclusionsIn contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients.

Normal Left Ventricular Size in Premature Newborns by the Echocardiographic Bullet Method.

Objective To define the normal range for a novel parameter of left ventricular (LV) size in premature neonates. Study Design We retrospectively analyzed echocardiographic imaging data to produce percentile nomograms and tabular data for Z-score calculation for LV end-diastolic volume (LVEDV) in premature neonates. The utility of LVEDV was compared with the current standard for LV size in patients who were treated for a patent ductus arteriosus (PDA). Results The mean gestational age and weight for the normal (n = 85) and PDA (n = 19) cohorts was 33 ± 5 weeks and 1.96 ± 1.0 kg and 25 ± 2 weeks and 0.87 ± 0.3 kg, respectively. The mean LVEDV of the PDA group (97.7 ± 22.2 mL/m^2.76) was significantly larger than that of reference group (63.0 ± 11.2 mL/m^2.76), p = 0.002. The sensitivity of LVEDV was better (68 vs. 11%) compared with LV dimension (the current standard) in detecting a large LV in the PDA patients. The LVEDV for our reference cohort (63.0 ± 11.2 mL/m^2.76) was smaller than the published normals (70.4 ± 9.1 mL/m^2.76, p &lt; 0.001) for infants. Conclusion Echocardiographic LVEDV can now be utilized to determine the LV size in premature neonates. In patients with a PDA, an elevated LVEDV &gt; +2 Z-scores can serve as objective data to aid in clinical trials and/or management decisions.

Successful Transcatheter Closure of Patent Ductus Arteriosus in Isolated Levocardia with Situs Inversus

Isolated levocardia with situs inversus is an extremely rare type of situs anomaly with an estimated incidence of 1 per 22,000 in the general population. This autosomal recessive situs anomaly has been described as normal levo position of the heart with dextro position of the abdominal viscera. In this case report, we describe accidental diagnosis of isolated levocardia with situs inversus in pediatric patient while evaluating for heart murmur. Systematic examination of the patient identified the presence of patent ductus arteriosus, anomalous course of inferior vena cava and bovine aortic arch. We shared our experience of successful transcatheter closure of patent ductus arteriosus. This case report is worth reporting both, for demonstrating the possibility of the percutaneous device closure of the patent ductus arteriosus in patient with this unusual situs anomaly to interventional cardiologists and because of scanty of literature.

ASSA14-14-04 Transcatheter Closure of Patent Ductus Arteriosus in Children with Body Weight ≤ 8 kg

Background To explore the interventional experience and safety, efficiency of transcatheter closure of patent ductus arteriosus (PDA) in children with body weight ≤8 kg. Methods From May 2001 to August 2013,102 children with body weight ≤8 kg were diagnosed PDA. All patients were underwent transcatheter closure and aorta descendens angiography 6 min after the closure. To observe the therapeutic efficacy, we examed X-ray, ECG and echocardiography 24 h, 1 month, 3 month and 6 month after operation. Results In 102 patients, male 27, female 75, aged from 3 months to 2 years(0.9 ± 0.5 years), body weight from 5 to 8 kg (7.2 ± 0.9) kg.In 102 patients, there were funnel PDA 58, tubular PDA 39, window PDA 1 and irregular PDA 4. The narrowest PDA diameter of pulmonary artery side was 2∼10 (4.8 ± 1.6) mm by aortography. 25 patients used Amplatzer company PDA mushroom occluders, 5 patients used new type Amplatzer ADO-II occluders and 1 patient used Amplatzer Plug. 69 patients used domestic-made PDA mushroom occluders, 2 patients used domestic-made VSD occluders. The mushroom occluders waist diameter was from 6 to 16 mm. 87 patients mean pulmonary pressure were ≥25 mmHg and 43 patients mean pulmonary pressure were ≥50 mmHg before occlusion. The mean pulmonary pressure decreased with different extent after occlusion, which were consistent with dynamic pulmonary artery hypertention. 102 patients were all cured successfully and the closure achievement ratio was 100%. Conclusions PDA patients with low body weight had their own specificness. Interventional therapy has its risk. However, it is still a safe methods to treat PDA if we performed the procedure with cautiousness, selected occluder appropriately and prevent the complication.

Association of aortic stiffness to brain natriuretic peptide in children before and after device closure of patent ductus arteriosus

ObjectivesWe evaluated the influence of device closure for patent ductus arteriosus (PDA) on the aortic stiffness index (ASI) and brain natriuretic peptide (BNP) and their association with cardiac function. Patients and methodsASI and echocardiography assessment before and after treatment (16±9months) in 48 children with PDA (mean age 10±4.5) and 52 control children (mean age 9.7±4.6). BNP level was measured pre-closure for all children, and was measured six months after closure only for children with PDA. ResultsASI was higher in PDA patients than in controls (P<0.001). ASI correlated with age (P<0.05), LVEF% (P<0.01), E/E′ (<0.03), pulmonary artery pressure (P<0.001), and BNP (P<0.001). ASI and BNP significantly decreased after closure (P<0.001). ASI and BNP were independent predictors for post-closure systolic dysfunction (P<0.001and <0.005, respectively). Receiver operating curve (ROC) analysis showed that ASI⩾13.5, BNP level ⩾75pg/ml and basal mean pulmonary artery pressure (PAP)⩾23 were powerful predictors for post-closure systolic function. ConclusionASI is significantly associated with BNP and basal PAP in children with PDA. After device closure, aortic distensibility improved significantly and was associated with significant improvement in both systolic and diastolic functions. ASI can be used for monitoring the course of patients with PDA, and may give opportunities for early intervention.

Surgical treatment of interrupted aortic arch associated with ventricular septal defect and patent ductus arteriosus in patients over one year of age

Background Interrupted aortic arch (IAA) is a rare congenital anomaly affecting 1.5% of infants with congenital heart disease. Neonatal repair of IAA is required to avoid irreversible pulmonary vascular lesion. However, in China, patients with IAA associated with ventricular septal defect (VSD) and patent ductus arteriosus (PDA) over one year of age are common. So we investigated the outcome of surgical treatment of IAA with VSD and PDA in patients over one year of age. Methods From January 2009 to December 2012, 19 patients with IAA have undergone complete single–stage repair. The patients’ mean age was 4.4 years, ranging 1 to 15 years; and their mean weight was 12.8 kg, ranging 4.2 to 36.0 kg. Fifteen IAA were type A, four were type B. Preoperative cardiac catheterization data were available from all patients. Mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) were measured. The measurements of postoperative pulmonary artery pressure were taken in the operating room at the end of the case. All patients underwent echocardiographic examinations before discharged from the hospital. In addition, cardiac catheterization and echocardiographic examinations were performed during follow–up. Selective brain perfusion through the innominate artery during aortic arch reconstruction was used in all patients. Mean follow–up was (1.6±0.8) years. Results There were two hospital deaths (2/19, 11%). One patient died of pulmonary hypertension crisis, and another died of postoperative low cardiac output. Five cases had other main postoperative complications but no postoperative neurologic complications. Seventeen survivors were followed up, and there were no late deaths or reoperation. Mean cross–clamp duration was (85±22) minutes and selective brain perfusion duration was (34±11) minutes. Two patients required delayed sternal closure at two days postoperatively. Intensive care unit and hospital stays were (9±8) days and (47±24) days, respectively. Pressure gradients across the anastomosis at most recent follow up were less than 22 mmHg. mPAP regressed significantly from preoperative (62.1±8.1) mmHg to postoperative (37.3±11.3) mmHg (P &lt;0.001) and (24.2±6.0) mmHg at six months after discharged from the hospital (P &lt;0.001). The pulmonary vascular resistance also regressed significantly from preoperative (1 501.4±335.7) dyn·s·cm–5 to (485.0±215.1) dyn·s·cm–5 at six months after discharged from the hospital (P &lt;0.001). The majority of the seventeen patients (89%) were in New York Heart Association (NYHA) class I, and 11% remained in NYHA class II. Conclusions Single–stage repair of patients with IAA, VSD and PDA over one year of age can have good surgical results and functional outcomes. Assessment and treatment of pulmonary artery pressure pre–operatively and postoperatively was crucial. mPAP and pulmonary vascular resistance may have regress significantly compared to preoperative values.

The Current Role of Surgery in Treating Adult Patients with Patent Ductus Arteriosus

Surgical closure of patent ductus arteriosus (PDA) is still required in selected adult patients. We analyzed the morphology of the anomaly and coexisting pathological findings in adult patients who were recently referred to our institute for surgical PDA repair. Six adult PDA patients who were not considered candidates for percutaneous closure underwent surgical PDA correction. In three patients with isolated PDA, computed tomographic scan revealed short, wide, and distorted ductus. In the remainder three patients, concomitant heart or aortic disease was found. Transpulmonary approach under total cardiopulmonary bypass or hypothermic circulatory arrest was performed. In all patients, a Dacron patch was used to close the duct. The balloon occlusion technique with normothermic cardiopulmonary bypass was performed in four patients. In one of these patients, the balloon occlusion was not feasible because of unfavorable ductal anatomy, and PDA was closed in short hypothermic circulatory arrest. In two patients with aortic aneurysm, PDA closure and aortic reconstruction were performed in deep hypothermic circulatory arrest. No significant complications occurred during postoperative course. After the mean follow-up period of 48 months, neither ductal reopening nor aneurysmal degeneration of remnant ductal tissue was found. Surgical PDA closure in adults remains the treatment of choice in wide, deformed PDAs unsuitable for percutaneous closure and PDAs associated with surgical aortic or heart disease.

Correlation Between Methyltetrahydrofolate Reductase (MTHFR) Polymorphisms and Isolated Patent Ductus Arteriosus in Taiwan

Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C gene polymorphisms are associated with the risk of patent ductus arteriosus (PDA) congenital heart defects. This study aimed to determine the association of these polymorphisms in patients with isolated PDA and in non-PDA patients group without congenital heart disease. This retrospective case-controlled study was undertaken in 17 patients with isolated PDA and a control non-PDA group consisting of 34 subjects without congenital heart disease. MTHFR gene polymorphisms were analysed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In addition, the genotype distribution of the MTHFR gene was compared among different ethnicities using the HapMap database. In contrast to the MTHFR C677T polymorphism, differences in the MTHFR A1298C genotype were observed between the two groups (P=0.002); a greater proportion of the PDA patients had the MTHFR 1298CC and 1298AA genotypes as compared to the non-PDA control group. After merging the data obtained from the Taiwanese participants with that from the HapMap database, genetic diversity of the MTHFR 1298AA genotype was observed. Thus, the MTHFR A1298C polymorphism is associated with isolated PDA in Taiwan. Larger studies are necessary to evaluate the prognostic value of determining MTHFR polymorphism in PDA.

Catheterization Therapy vs Surgical Closure in Pediatric Patients With Patent Ductus Arteriosus: A Meta‐Analysis

Patent ductus arteriosus (PDA) remains a common congenital heart disease in pediatric patients, and the new trend of catheterization therapy is still associated with some potential risks and complications. Compared with surgical closure, the clinical effect of catheterization therapy in pediatric PDA patients requires meta-analysis. A systematic literature search of PubMed, Cochrane Library, Embase, Science Citation Index, Web of Science, and the Chinese Biomedicine literature database was conducted. Eligible studies included controlled trials of pediatric PDA patients receiving catheterization therapy vs surgical closure. Relative risks (RRs), standard mean differences, and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I(2) test. Seven studies with a total of 810 patients met the inclusion criteria. Catheterization therapy neither significantly increased the primary success rate (RR: 0.92, 95% CI: 0.82-1.03, P = 0.16) nor reduced the total postprocedure complications (RR: 0.74, 95% CI: 0.44-1.25, P = 0.26) and blood transfusion (RR: 1.10, 95% CI: 0.16-7.67, P = 0.93). Catheterization was associated with a statistically significant increase in residual shunts (RR: 5.19, 95% CI: 1.41-19.20, P = 0.01) and reduction in length of hospital stay (standard mean difference: -1.66, 95% CI: -2.65 to -0.67, P = 0.001). Catheterization therapy in pediatric PDA patients did not show a significant advantage in primary success rate, total complications, or blood transfusion, but it was associated with increase in residual shunts and reduction in length of hospital stay.

Möbius syndrome associated with acyanotic congenital heart disease in a neonate

The Mobius syndrome is rare and the cause is still unclear. We present here a case of a newborn baby with the Mobius syndrome, showing unilateral facial nerve palsy with asymmetrical facial expression, poor sucking, dysphagia, and ear abnormality. Though cardiac anomalies are very rare our case had atrial septal defect and a tiny patent ductus arteriosus in patient of Mobius syndrome.

Heart size, heart function, and plasma B-type natriuretic peptide levels after transcatheter closure of patent ductus arteriosus

Background Patent ductus arteriosus (PDA) is a commoncongenital heart disease causing some blood in the aorta to flowinto the pulmonary artery (PA), resulting in dilatation of the leftatrium (IA) and left ventricle (LY), increased B-type natriureticpeptide (BNP) level, and the development of h eart failure.Objectives To evaluate the clinical course, changes in heart sizeand function, and BNP level after transcatheter closure of PDAusing the Amplatzer® duct occluder (ADO).Methods This quasi-experimental study used a one-group, pretestposttestdesign, and was done on PDA patients who underwenttranscatheter closure using ADO. The outcomes measurementswere performed four times, namely, before the procedure andat one, three, and six months after the procedure. Results werecompared using a serial time analysis. Outcomes measured wereheart failure scores, chest x-ray (CXR) and echocardiographyfindings, and plasma BNP level.Results There were 23 PDA patients enrolled, of which 12 werefemales. Subjects' median bodyweight was 11 (range 6.6 to 55) kg.Prior to PDA closure, 12 subjects had mild heart fa ilure (class II)and 7 had moderate heart failure (class III). On follow-up at onemonth after the procedure, all subjects had improved heart failurescores (P&lt;0.0001), and no heart failure was found on furtherfollow up. Likewise, there was a decreased mean cardiothoracicratio (CTR) from 58 to 55% at 1-month (P = 0.001), and alsofrom 55 to 52% at3-month follow up (P&lt;0.0001), but no furtherdecrease was found afterwards (P = 0.798). The left atrium/aorta(LA/Ao) ratio measured by echocardiography also showed astatistically significant decrease from 1.6 prior to the procedureto 1.3 (P&lt;0.0001) in the first month, but it remained stableafterwards. Diastolic function, represented by peak E and A wavesalso significantly decreased from 127 and 91 cm/sec, before theprocedure, to 90 and 68 cm/sec, respectively, at 1 month follow-up(P &lt;0.0001 and P &lt; 0.0001, respectively) . However, there were nostatistically significant changes in E/ A ratio, ejection fract ion andfractional shortening. Plasma BNP level significantly decreasedfrom 58 pg/mL before the procedure to 28 pg/mL at 1 monthfollow-up (P= 0 .001), but no further significant decrease wasobserved afterwards.Conclusion After PDA closure with ADO, we observe significantimprovements in heart failure scores, heart size, diastolic function,and BNP level of our subjects especially in the first month afterthe procedure.

Anesthetic management of a patient with hypertrophic cardiomyopathy and patent ductus arteriosus

Anesthetic management of a patient with hypertrophic cardiomyopathy and patent ductus arteriosus

Influence of Patent Ductus Arteriosus and Its Treatment on Retinopathy of Prematurity

Purpose: This study investigated the influence of patent ductus arteriosus (PDA) and its treatment on incidence and progression of retinopathy of prematurity (ROP). Methods: The authors retrospectively reviewed the medical records of 408 infants who underwent screening examinations for ROP at the Neonatal Intensive Care Unit of our hospital. Results: The total incidence of ROP was 23.5% (96 out of 408) and the patients that needed treatment were 7.4% (30 out of 408). The mean birth weight and gestational age was 1406.1 grams and 30.67 weeks in patients without ROP, and 979.8 grams and 27.46 weeks in patients with ROP, respectively. In both total and very low birth weight (VLBW) patients, the incidence of ROP was higher in the PDA group than the non-PDA group, but the PDA group was an independent risk factor only in the VLBW group (p = 0.033). The incidence of threshold disease was not significantly different between the PDA and control groups (p = 0.757). There was no significant difference of incidence of ROP and threshold disease among the 3 treatment groups for PDA. Conclusions: In VLBW patients, the presence of PDA increased the risk of ROP and its progression, thus more attention is needed for PDA patients. However, there was no significant difference in ROP incidence and progression according to different PDA treatment methods.

Increased Incidence of Coronary Artery Origin Anomalies Associated With Isolated Patent Ductus Arteriosus

Coronary artery anomalies may increase the risk of sudden death. Despite awareness of this association with certain congenital heart anomalies such as tetralogy of Fallot and transposition of the great arteries, it is thought to be an infrequent finding in cases of isolated patent ductus arteriosus (PDA). The authors report their experience with coronary anomalies in PDA patients. This study aimed to estimate the incidence of coronary artery anomalies in patients with PDA. The study reviewed 206 angiograms of PDA patients obtained between 1999 and 2011 to determine the origin of the coronary arteries. In 102 angiograms (49.5 %), the origin of the coronary arteries could be adequately visualized. An anomalous origin of coronary arteries was detected in 11 of the 102 patients (10.8 %). Seven of these patients had a single common coronary artery origin (6.8 %). One patient had an aberrant origin of the left coronary artery from the noncoronary sinus, and three patients had an aberrant origin of the right coronary artery: two from the left coronary sinus and one from the noncoronary sinus. These findings suggest that the incidence of coronary artery anomalies in association with an isolated PDA may be considerably higher than expected and previously reported. In view of the increased risk for sudden death with coronary anomalies, a reasonable approach is to determine the coronary artery origin and pathway after the diagnosis of an isolated PDA.

Abstract 171: Plasma Hypoosmolarity After Birth Promotes Closure of the Ductus Arteriosus

Background: Changes in environmental conditions after birth, such as increased oxygen tension, are known to regulate the closure of the ductus arteriosus (DA). We previously found that plasma osmolarity was significantly decreased early after birth in rats, and that Transient Receptor Potential Melastatin (TRPM) 3, a hypoosmolarity sensor, was highly expressed in the rat DA compared to the aorta. We assessed the hypothesis that plasma hypoosmolarity regulated tension of the DA via TRPM3. Methods: Fura-2 assay was used to evaluate the change in intracellular calcium [Ca 2+ ] i in vascular smooth muscle cells (SMCs). Tension of vascular rings was measured by a wire myograph system. Rapid whole-body freezing method was used to examine vasoconstriction in rat in vivo . Plasma osmolarity of human preterm infants was analyzed by freezing point depression osmometry. Results: We found that [Ca 2+ ] i was increased by hypoosmolarity (270mOsm/kg) in SMCs isolated from the rat DA (DASMCs) compared to aortic SMCs (31.3% vs. 8.5% of basal 340/390 ratio P &lt;0.01, n=6). When DASMCs were treated with siTRPM3, hypoosmolarity-induced [Ca 2+ ] i elevation was attenuated by 48.7% ( P &lt;0.01, n=6). Hypoosmolarity (270 and 250mOsm/kg) increased the tension of rat DA (17.4% and 29.8% of 120mM of KCl, respectively, P &lt;0.01, n=8). Moreover, a TRPM3 activator pregnenolone sulfate (200μ M) induced contraction of the rat DA (39.4% of KCl P &lt;0.001, n=6). Conversely, when plasma osmolarity was kept higher to 322mOsm/kg by intra-peritoneal injection of 5.4% hypersaline, the DA closure was partially inhibited by 13% compared to 0.9% saline injection in vivo ( P &lt;0.05, n=11). Plasma osmolarity was decreased 2 h after birth in late preterm infants (28-35weeks’ gestation) (3.2±0.8 % reduction of cord blood, P &lt;0.001, n=35), but not in early preterm infants (24-27weeks’ gestation) (1.1±1.3 % reduction of cord blood, NS , n=17). Furthermore, plasma osmolarity of patent DA (PDA) patients recovered to the adult level by the 2nd day of life while it still remained low in non PDA patients. Conclusions: These results suggest that plasma hypoosmolarity after birth promotes DA closure via TRPM3 and that keeping the plasma osmolarity within proper levels during early neonatal period would be important for DA closure.