PRESENT PROBLEMS PERTAINING TO PATENCY OF THE DUCTUS ARTERIOSUS

The incidence of marked retardation of growth in children with patency of the ductus arteriosus was reviewed in an operative series from the New York Hospital and from the literature. Retardation in growth was present in approximately one-third to one-half of the children. Almost all of the patients in the New York Hospital series with serious growth impairment remained retarded following otherwise successful surgery on the ductus at ages 3 to 14 years. Periods of postoperative observation ranged from 1 to 10 years, averaging 4 years. Possible reasons for persistent impairment of growth are considered. This observation is the basis for a recommendation of early operation for patients with patent ductus arteriosus who become retarded in height and weight. It is anticipated that this will afford a better chance of reversibility of the abnormal growth pattern, if the retardation has not persisted too long during the period of most rapid growth.

Download Full-text

Patent Ductus Arteriosus Stenting for All Ductal-Dependent Cyanotic Infants

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009520 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

Kanishka Ratnayaka ◽

Stephen J. Nageotte ◽

John W. Moore ◽

Peter W. Guyon ◽

Krishna Bhandari ◽

...

Keyword(s):

Blood Flow ◽

Length Of Stay ◽

Patent Ductus Arteriosus ◽

Pulmonary Blood Flow ◽

Ductus Arteriosus ◽

Pulmonary Arteries ◽

Practice Change ◽

Almost All ◽

Blalock Taussig Shunt ◽

Patent Ductus

Background: Ductal-dependent cyanotic newborns require a secure source of pulmonary blood flow. There has been a recent migration to selective ductal (patent ductus arteriosus [PDA]) stenting for some of these children. Universal (nonselective) ductal stenting for all infants with ductal-dependent pulmonary blood flow is controversial. We examine outcomes from a single center with this practice change. Methods: We compare outcomes of all ductal-dependent pulmonary blood flow infants (2013–2020 [January–June]) in the following treatment eras: Era 1 (selective PDA stenting; 2013–2017) or Era 2 (universal PDA stenting; 2018–2020 [January–June]). Results: Eighty-eight patients (Blalock-Taussig shunt, n=41; PDA stent, n=47) met inclusion criteria. In Era 1, most received Blalock-Taussig shunt (62% [41/66]). In Era 2, all received PDA stents (100% [22/22]). There were more females in Era 2, but otherwise no demographic differences between eras. There were no differences in mortality, treatment failures, complications, or reinterventions between eras. Postprocedure length of stay was shorter in Era 2 (8 versus 22 days, P =0.02). There were less surgical revisions for PDA stent patients (2% versus 20%, P =0.02). Postprocedure recovery surrogate end points favored Era 2 and PDA stenting. Additional analysis revealed PDA stent (compared with Blalock-Taussig shunt) patients had shorter post-procedure (10 versus 29 days, P ≤0.001) length of stay and more symmetrical branch pulmonary arteries (0.9 versus 0.7, P =0.001) at subsequent surgery. Conclusions: PDA stenting for almost all ductal dependent cyanotic newborns can be safe and effective and may have lower morbidity than selective PDA stenting.

Download Full-text

Prostaglandin E2 and patent ductus arteriosus in premature infants

Paediatrica Indonesiana ◽

10.14238/pi56.1.2016.8-14 ◽

2016 ◽

Vol 56 (1) ◽

pp. 8

Author(s):

Mochammading Mochammading ◽

Risma Kerina Kaban ◽

Piprim Basarah Yanuarso ◽

Mulyadi Djer

Keyword(s):

Patent Ductus Arteriosus ◽

Prostaglandin E2 ◽

Premature Infants ◽

Ductus Arteriosus ◽

Maximum Flow ◽

Repeated Measurements ◽

Strong Positive Correlation ◽

Pge2 Level ◽

Almost All ◽

Patent Ductus

Background Patent ductus arteriosus (PDA) is a congenital heart disease most commonly occurring in premature infants. Spontaneous ductus arteriosus (DA) closure in premature infants has been suggested to be associated with duct lumen maturity and the DA sensitivity to prostaglandin E2 (PGE2).Objective To assess for a possible correlation between serum PGE2 levels and PDA size in premature infants.Methods This observational study using repeated measurements on premature infants with PDA detected at days 2-3 of life was undertaken in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, from April to May 2014. The PDA was diagnosed using 2-D echocardiography and PGE2 levels were measured by immunoassay. Pearson’s correlation test was used to evaluate a possible correlation between PGE2 level and DA diameter.Results Thirty-three premature infants of median gestational age 31 (range 28-32) weeks and median birth weight 1,360 (range 1,000-1,500) grams were enrolled. Almost two-thirds of the subjects were male. Almost all (30/33) subjects had spontaneous DA closure before the age of 10 days. Subjects’ mean DA diameter was 2.9 (SD 0.5) mm with maximum flow velocity of 0.2 (SD 0.06) cm/sec, and left atrial-to-aortic root ratio (LA/Ao) of 1.5 (SD 0.2). Their mean PGE2 levels at the ages of 2-3, 5-7, and after 10 days were 5,238.6 (SD 1,225.2), 4,178.2 (SD 1,534.5), and 915.2 (SD 151.6) pg/mL, respectively. The PGE2 level at days 2-3 was significantly correlated with DA diameter (r = 0.667; P < 0.001), but not at days 5-7 (r = 0.292; P = 0.105) or at day 10 (r = 0.041; P = 0.941).Conclusion There is a strong, positive correlation between the PGE2 level and DA diameter in preterm infants at 2-3 days of age. However, there is no significant correlation between PGE2 level and persistence of PDA.

Download Full-text