Palliative Therapies for Congenital Heart Disease with Ductus Dependent Pulmonary Circulation

2017 ◽  
Vol 221 (06) ◽  
pp. 272-275
Author(s):  
Shi-Min Yuan
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Circulation ◽  
Congenital Heart ◽  
Prostaglandin E ◽  
Blalock Taussig Shunt

AbstractIn neonates, the management of ductus dependent pulmonary circulation is challenging. There have been three palliative therapies for this lesion: the modified Blalock-Taussig shunt, ductal stenting and prostaglandin E infusions, for maintaining the ductal patency before definite operations. Debates remain with regard to the indications and disadvantages of three palliative therapies. The aim of this article is to give a brief review of these three palliative therapies.

scholarly journals Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at A Tertiary Neonatal Intensive Care Unit

2016 ◽  
Vol 2 (4) ◽  
pp. 185-191 ◽  
Author(s):  
Manuela Cucerea ◽  
Marta Simon ◽  
Elena Moldovan ◽  
Marcela Ungureanu ◽  
Raluca Marian ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Side Effects ◽  
Pulmonary Circulation ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Ductus Arteriosus ◽  
Prostaglandin E ◽  
Critical Congenital Heart Disease ◽  
The Mean

AbstractIntroduction: Congenital heart diseases (CHD) have been reported to be responsible for 30 to 50% of infant mortality caused by congenital disabilities. In critical cases, survival of newborns with CHD depends on the patency of the ductus arteriosus (PDA), for maintaining the systemic or pulmonary circulation. The aim of the study was to assess the efficacy and side effects of PGE (prostaglandin E) administration in newborns with critical congenital heart disease requiring maintenance of the ductus arteriosus.Material and method: All clinical and paraclinical data of 66 infants admitted to one referral tertiary level academic center and treated with Alprostadil were analyzed. Patients were divided into three groups: Group 1: PDA dependent pulmonary circulation (n=11) Group 2: PDA dependent systemic circulation (n=31) Group 3: PDA depending mixed circulation (n=24)Results: The mean age of starting PGE1 treatment was 2.06 days, 1.91 (+/−1.44) days for PDA depending pulmonary flow, 2.39 (+/−1.62) days for PDA depending systemic flow and 1.71 (+/1.12) for PDA depending mixing circulation. PEG1 initiation was commenced 48 hours after admission for 72%, between 48-72 hours for 6%, and after 72 to 120 hours for 21% of newborns detected with PDA dependent circulation. Before PEG1 initiation the mean initial SpO2 was 77.89 (+/− 9.2)% and mean initial oxygen pressure (PaO2) was 26.96(+/−6.45) mmHg. At the point when stable wide open PDA was achieved their mean SpO2increased to 89.73 (+/−8.4)%, and PaO2 rose to 49 (+/−7.2) mmHg. During PGE1 treatment, eleven infants (16.7%) had apnea attacks, five children (7.5%) had convulsions, 33 (50%) had fever, 47 (71.2%) had leukocytosis, 52 (78.8%) had edema, 25.8% had gastrointestinal intolerance, 45.5% had hypokalemia, and 63.6% had irritability.Conclusions: For those infants with severe cyanosis or shock caused by PDA dependent heart lesions, the initiation and maintenance of PGE1 infusion is imperative. The side effects of this beneficial therapy were transient and treatable.

Arterial Duct Stenting in Congenital Heart Disease with Duct-Dependent Pulmonary Circulation

2010 ◽  
Vol 6 (3) ◽  
pp. 183-191
Author(s):  
Giuseppe Santoro ◽  
Biagio Castaldi ◽  
Gianpiero Gaio ◽  
Maria Teresa Palladino ◽  
Carola Iacono ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Circulation ◽  
Congenital Heart ◽  
Arterial Duct

Fifteen-minute consultation: Assessing the child with a Blalock-Taussig shunt who is unwell in a district general hospital

2019 ◽  
Vol 105 (3) ◽  
pp. 142-146 ◽  
Author(s):  
Steven McVea ◽  
Anne McGettrick
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
General Hospital ◽  
Congenital Heart ◽  
District General Hospital ◽  
Univentricular Heart ◽  
Pulmonary Shunt ◽  
Intercurrent Illness ◽  
General Paediatrician ◽  
Blalock Taussig Shunt

Univentricular heart disease accounts for ~1.25% of all congenital heart disease. Such cases remain among the most challenging to manage, typically requiring a three-staged palliation. The first stage involves placement of a systemic to pulmonary shunt. While a variety of shunt types, including ductal stenting, can be used to manage univentricular conditions, the archetype remains the Blalock-Taussig (BT) shunt. While waiting future palliative intervention at home, intercurrent illness may necessitate presentation to a district general hospital where subspecialist advice and assessment is remote. This review aims to present the general paediatrician with a straightforward BT shunt physiology overview highlighting unique complications which may complicate intercurrent illness.

Stent Implantation to Maintain Patency of a Stenosed Blalock Taussig Shunt

2005 ◽  
Vol 13 (3) ◽  
pp. 274-276 ◽  
Author(s):  
Amjad Kouatli ◽  
Jameel Al-Ata ◽  
M Omar Galal ◽  
Muhammed A Amin ◽  
Arif Hussain
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Oxygen Saturation ◽  
Stent Implantation ◽  
Congenital Heart ◽  
Balloon Dilation ◽  
Complex Congenital Heart Disease ◽  
Blalock Taussig Shunt

A 14-year-old female with complex congenital heart disease underwent a left-sided classical Blalock Taussig (BT) shunt 15 days after birth. Ten years after the operation her oxygen saturation had decreased significantly. An angiography revealed a severely stenosed BT shunt. Balloon dilation including implantation of a 6 × 13 mm stent was performed successfully. Immediately after intervention, oxygen saturation rose from 55% to 80 84% in room air. Follow-up at a year and a half later showed the classical BT shunt was still patent.

Shear Stress Exposure Measurements on the Motionless Fluid Diode Valve in the Pulmonary Position

2010 ◽  
Author(s):  
Tiffany Camp ◽  
Richard S. Figliola ◽  
Timothy A. Conover ◽  
T.-Y. Hsia
Keyword(s):  
Congenital Heart Disease ◽  
Shear Stress ◽  
Heart Disease ◽  
Pressure Gradient ◽  
Pulmonary Circulation ◽  
Congenital Heart ◽  
Pulmonary Insufficiency ◽  
Stress Exposure ◽  
Exposure Measurements

Pulmonary insufficiency is one of the consequences of congenital heart disease, and currently no permanent solution exists. The concept of a motionless diode valve to regulate the pulmonary circulation has been proposed and previously studied. The diode valve has shown the ability to regulate flow with levels of regurgitation and pressure gradient that are acceptable within the pulmonary circulation [1].

Prostaglandins in congenital heart disease—potential for confusion

1995 ◽  
Vol 5 (2) ◽  
pp. 202-203 ◽  
Author(s):  
R. John Madar ◽  
Tim J.D. Donaldson ◽  
Stewart Hunter
Keyword(s):  
Congenital Heart Disease ◽  
United Kingdom ◽  
Heart Disease ◽  
Congenital Heart ◽  
Prostaglandin E ◽  
The United Kingdom ◽  
Arterial Duct

the use of prostaglandians in maintaining the patency of the arterial duct in congenital heart disease is well established. Intravenous1-3 and ora12–4 administration has been used, although for acute use intravenous and possibly intraosseous5 routes are favored. Both prostaglandin E1 (alprostadil—ProstinVR: Upjohn)1,4 and prostaglandin E2 (dinoprostone—Prostin E2: Upjohn)2,3 are used for this purpose, although only prostaglandin E1 is licensed for this indication in the United Kingdom. Prostaglandin E1 costs approximately 8 times more than prostaglandin E2 (£56.96 versus £7.43 per vial).

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