Prostaglandin Infusion in Neonate With Severe Coarctation of the Aorta With Closed Ductus Arteriosus—A Case Report and Review of the Literature

2019 ◽  
Vol 11 (4) ◽  
pp. NP239-NP243
Author(s):  
Neha Bansal ◽  
Preetha L. Balakrishnan ◽  
Sanjeev Aggarwal
Keyword(s):  
Surgical Repair ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Dose Dependence ◽  
Spontaneous Closure ◽  
Prostaglandin E ◽  
Review Of The Literature ◽  
Aortic Isthmus ◽  
Ductal Tissue ◽  
Putative Mechanism

We report the case of a premature newborn diagnosed with coarctation of the aorta after spontaneous closure of ductus arteriosus who was successfully managed with prostaglandin E1 infusion until surgical repair could be performed. This case, together with a review of the literature, suggests an important role for prostaglandin in the management of coarctation even in the absence of a patent ductus arteriosus. The putative mechanism for the utility of prostaglandin infusion is that it may relieve the obstruction in neonates with severe coarctation by not only opening of the ductus but, in select cases, relaxing the ductal tissue encircling the aortic isthmus region. We also found a possible dose dependence of the efficacy of the prostaglandin infusion when the ductus is closed.

Coarctation-like Physiology with Cerebral Arteriovenous Fistula

PEDIATRICS ◽  
1969 ◽  
Vol 44 (6) ◽  
pp. 1024-1028
Author(s):  
P. B. Deverall ◽  
J. F. N. Taylor ◽  
G. S. Sturrock ◽  
Eoin Aberdeen
Keyword(s):  
Arteriovenous Fistula ◽  
Aortic Arch ◽  
Cardiac Failure ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Aortic Isthmus ◽  
Obstructive Lesion ◽  
Cerebral Arteriovenous Fistula ◽  
Flow Through ◽  
Reduced Flow

Hemodynamic signs of coarctation of the aorta were present in a neonate dying in cardiac failure. A cerebral arteriovenous fistula was found at autopsy. No obstructive lesion of the aortic arch was present. Development of the aortic isthmus may be impaired if diminished flow through this segment is present. Reduced flow may be present if most of the systemic output is diverted to a fistula proximal to the isthmus, distal systemic flow being maintained by flow from right-to-left through the ductus arteriosus. Spontaneous duct closure after birth may then be followed by a reduction in distal systemic flow, resulting in signs suggestive of coarctation.

scholarly journals Identification of differentially regulated genes in human patent ductus arteriosus

2016 ◽  
Vol 241 (18) ◽  
pp. 2112-2118 ◽  
Author(s):  
Pratik Parikh ◽  
Haiqing Bai ◽  
Michael F Swartz ◽  
George M Alfieris ◽  
David A Dean
Keyword(s):  
Cultured Cells ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Transient Transfection ◽  
Differentially Expressed ◽  
Luciferase Reporter ◽  
Prostaglandin E ◽  
Promoter Regions ◽  
Mrna Quantitation ◽  
Multiple Patients

In order to identify differentially expressed genes that are specific to the ductus arteriosus, 18 candidate genes were evaluated in matched ductus arteriosus and aortic samples from infants with coarctation of the aorta. The cell specificity of the gene's promoters was assessed by performing transient transfection studies in primary cells derived from several patients. Segments of ductus arteriosus and aorta were isolated from infants requiring repair for coarctation of the aorta and used for mRNA quantitation and culturing of cells. Differences in expression were determined by quantitative PCR using the ΔΔCt method. Promoter regions of six of these genes were cloned into luciferase reporter plasmids for transient transfection studies in matched human ductus arteriosus and aorta cells. Transcription factor AP-2b and phospholipase A2 were significantly up-regulated in ductus arteriosus compared to aorta in whole tissues and cultured cells, respectively. In transient transfection experiments, Angiotensin II type 1 receptor and Prostaglandin E receptor 4 promoters consistently gave higher expression in matched ductus arteriosus versus aorta cells from multiple patients. Taken together, these results demonstrate that several genes are differentially expressed in ductus arteriosus and that their promoters may be used to drive ductus arteriosus-enriched transgene expression.

Postnatal Development of Obstruction in Coarctation of the Aorta: Role of the Ductus Arteriosus

PEDIATRICS ◽  
1975 ◽  
Vol 56 (4) ◽  
pp. 562-569
Author(s):  
Norman S. Talner ◽  
Michael A. Berman
Keyword(s):  
Ductus Arteriosus ◽  
Systolic Pressure ◽  
Coarctation Of The Aorta ◽  
Descending Aorta ◽  
Aortic Isthmus ◽  
Sequence Of Events ◽  
Hypoplastic Right Ventricle ◽  
Discrete Area ◽  
Aortic Obstruction

The sequence of events leading to the development of acute obstruction in two infants with coarctation has been defined by clinical, hemodynamic, and angiographic studies. One infant had normally related great arteries and an isolated coarctation, while the other infant had transposition with a hypoplastic right ventricle, a ventricular septal defect, narrowing of the aortic isthmus, and a localized site of coarctation. In each instance, a posterior aortic shelf-the basic pathologic lesion in coarctation-could be observed angiographically. Signs of aortic obstruction were absent, however, as long as the ductus arteriosus was widely patent. Following ductal obliteration, femoral pulsations diminished, a peak systolic pressure difference was recorded between the ascending and descending aorta, and a discrete area of juxtaductal coarctation was seen. The basic malformation (posterior aortic curtain) would appear to exist in utero, possibly as an aortic branch point. This lesion is nonobstructive as long as blood can traverse the aortic isthmus through the aortic end of the ductus into the descending aorta. Postnatally, as the ductus arteriosus undergoes goes constriction at its aortic insertion, signs of acute aortic obstruction may become apparent. Normal femoral arterial pulsations during the newborn examination do not definitively exclude coarctation. Pediatricians should recheck at 2 weeks of age if the infant is asymptomatic or sooner if there are signs of cardiac failure to establish the presence or absence of this defect.

P4646Prospective study for antenatal diagnosis of coarctation of the aorta

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Meysonnier Marechal ◽  
S Di Filippo ◽  
N Pangaud ◽  
C Galoin Bertail ◽  
H Joly ◽  
...  
Keyword(s):  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Roc Curves ◽  
Mitral Annulus ◽  
Aortic Annulus ◽  
Fetal Life ◽  
Aortic Isthmus ◽  
Single Center Study ◽  
Great Vessels ◽  
Z Scores

Abstract The objective of this study was to define echocardiographic (ECHO) parameters during fetal life, to predict postnatal aortic coarctation (COA). Material and methods This prospective single-center study from 2010 to 2018 included all fetus diagnosed with isolated ventricular and/ or great vessels asymetry (right heart dominance). Complex CHD were excluded. The cohort was divided in patients with coarctation after birth (COA) and those free from coarctation (noCOA). Left heart, aortic and ductus measurements were collected serially at second trimester (T2), third trimester (T3) ad Z-scores were assessed. COA and noCOA were compared, sensitivity (Se) and specificity (Spec) and ROC curves (cut-off values) were assessed for each parameter. Results 67 cases were included: 34 (50.7%) ranged in group COA and 33 (49.3%) in noCOA. Coarctation occurred more frequently if suspected at T2 (70.6% in COA vs 30.3% in noCOA, p=0.001). Mitral annulus (T3) was 8.6mm in COA vs 10.3mm in noCOA (p=0.002) with cut-off <7.3mm (Se= 50%, Spec= 93.6%, OR= 14.5). Aortic annulus diameter (T3) was 4.8mm in COA vs 6mm in noCOA (p=0.005), with cut-off <5.4mm (Se= 65%, Spec= 77%, OR= 6.3). Aortic isthmus diameter (T3) was 1.4mm in COA vs 2.8mm in noCOA (p=0.003), with cut-off <3mm (Se= 91%, Spec= 65%, OR= 18.9). Ductus arteriosus/ aortic isthmus ratio (T3) was 2.5 in COA vs 1.8 in noCOA (p=0.01) with cut-off >1.57mm (Se= 90.5%, Spec= 62%, OR= 15.4). Conclusion Mitral annulus <7.3mm, aortic annulus <5.4mm, aortic isthmus <3mm and ductus/isthmus ratio >1.57 assessed during 3rd trimester of fetal life may help to predict postnatal coractation of the aorta. These results have to be confirmed by larger prospective studies.

scholarly journals Prostaglandin E2 in a preterm infant with coarctation of the aorta

2019 ◽  
Vol 12 (9) ◽  
pp. e230910 ◽  
Author(s):  
Bernadette Khodaghalian ◽  
Nimish V Subhedar ◽  
Ashish Chikermane
Keyword(s):  
Surgical Intervention ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Preterm Neonates ◽  
Term Therapy ◽  
Prostaglandin E ◽  
Aortic Blood Flow ◽  
Aortic Constriction ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Prostaglandins are widely used in aortic coarctation to maintain ductal patency and preserve systemic perfusion until surgical intervention can be performed. Although the short-term use of prostaglandins to ameliorate aortic narrowing in neonates with a closed ductus has been reported, it has not been described as a longer term therapy in extremely preterm neonates. A 27-week gestation baby weighing 560 g presented at 40 days of age with coarctation and a closed ductus arteriosus. He was successfully treated with a 7-week course of prostaglandin E2 therapy because surgical intervention was not deemed feasible in view of his size. Treatment resulted in a relaxation of the aortic constriction and improvement in aortic blood flow velocity profile, highlighting the value of long-term prostaglandin therapy in this population and supporting the hypothesis that the presence of ductal tissue contributes to the development of juxtaductal aortic constriction in some extremely preterm infants.

Vascular ring associated with d-transposition of the great arteries: when should we suspect aortic arch anomalies?

2018 ◽  
Vol 28 (12) ◽  
pp. 1489-1490
Author(s):  
Katsutoshi Nakano ◽  
Taiyu Hayashi ◽  
Hiroshi Ono
Keyword(s):  
Aortic Arch ◽  
Ductus Arteriosus ◽  
Vascular Ring ◽  
Coarctation Of The Aorta ◽  
Aortic Arch Anomalies ◽  
Aortic Isthmus ◽  
Diagnostic Clue ◽  
Male Neonate

AbstractA male neonate with d-transposition of the great arteries was diagnosed with the concomitant anomaly of left circumflex aortic arch and right-sided ductus arteriosus, which formed a vascular ring. Initial postnatal echocardiography had demonstrated an obscured aortic isthmus mimicking coarctation of the aorta, which could be a diagnostic clue to circumflex aortic arch.

Effectiveness of Prostaglandin E 1 in Relieving Obstruction in Coarctation of the Aorta Without Opening the Ductus Arteriosus

2004 ◽  
Vol 25 (1) ◽  
pp. 49-52 ◽  
Author(s):  
L. Liberman ◽  
W. M. Gersony ◽  
P. A. Flynn ◽  
J. J. Lamberti ◽  
R. S. Cooper ◽  
...  
Keyword(s):  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Prostaglandin E

A cardiopulmonary bypass strategy to support a patient with vein of Galen malformation

Perfusion ◽  
2021 ◽  
pp. 026765912110015
Author(s):  
Alex Robertson ◽  
Nagarajan Muthialu ◽  
Mike Broadhead
Keyword(s):  
Cardiopulmonary Bypass ◽  
Surgical Repair ◽  
Circulatory Arrest ◽  
Ductus Arteriosus ◽  
Venous Drainage ◽  
Deep Hypothermic Circulatory Arrest ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Neurological Sequelae ◽  
Ph Stat

We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation. Several strategies were employed to attenuate the cerebral shunt including pH-stat, high cardiac index, restrictive venous drainage, continuous ventilation and deep hypothermic circulatory arrest. The patient recovered from surgery with no apparent neurological sequelae.

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