scholarly journals SURGICAL TREATMENT OF OPEN DUCTUS ARTERIOSUS IN PREMATURE INFANTS

2018 ◽  
Vol 22 (6) ◽  
pp. 301-305
Author(s):  
V. V. Aleksi-Meskhishvili ◽  
Yury A. Kozlov
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Ductus Arteriosus ◽  
Cyclooxygenase Inhibitors ◽  
Recurrent Nerve ◽  
Low Birth Weight Infants ◽  
Leading Role ◽  
Lymphatic Duct ◽  
Great Vessels ◽  
Prophylactic Use

The choice of tactics for the treatment of open arterial duct (OAD) in newborns is one of the most controversial and debatable topics in neonatal medicine. There are several approaches in the treatment of OAD in small infants: 1) the prophylactic use of cyclooxygenase inhibitors; 2) treatment on the background of maintenance therapy without the medical and surgical intervention; 3) drug stimulation of the closure of the AOA; 4) surgical intervention. Surgical treatment, which can be done with the aid of the open surgery and thoracoscopy, still plays a leading role. Complications associated directly with the operation are minimal. In this study, we present a review of the literature, including current information on the most frequent complications arising from the surgical treatment of OAD in newborns - damage to the lungs with the development of pneumothorax, damage to the great vessels with circulatory disorders, wound to the left phrenic nerve followed by paresis of the left diaphragm dome, damage to the recurrent nerve with impaired function of the left vocal cords, damage to the thoracic lymphatic duct with the development of chylothorax, damage to the muscles with development of functional scoliosis. Special attention is paid to the prognosis of the course of the disease and the survival rate of low birth weight infants.

scholarly journals Molecular Mechanisms Underlying Remodeling of Ductus Arteriosus: Looking beyond the Prostaglandin Pathway

2021 ◽  
Vol 22 (6) ◽  
pp. 3238
Author(s):  
Ho-Wei Hsu ◽  
Ting-Yi Lin ◽  
Yi-Ching Liu ◽  
Jwu-Lai Yeh ◽  
Jong-Hau Hsu
Keyword(s):  
Adverse Effect ◽  
Clinical Management ◽  
Vascular Remodeling ◽  
Molecular Mechanisms ◽  
Surgical Intervention ◽  
Ductus Arteriosus ◽  
Clinical Problem ◽  
Cyclooxygenase Inhibitors ◽  
Medical Patients ◽  
Fetal Circulation

The ductus arteriosus (DA) is a physiologic vessel crucial for fetal circulation. As a major regulating factor, the prostaglandin pathway has long been the target for DA patency maintenance or closure. However, the adverse effect of prostaglandins and their inhibitors has been a major unsolved clinical problem. Furthermore, a significant portion of patients with patent DA fail to respond to cyclooxygenase inhibitors that target the prostaglandin pathway. These unresponsive medical patients ultimately require surgical intervention and highlight the importance of exploring pathways independent from this well-recognized prostaglandin pathway. The clinical limitations of prostaglandin-targeting therapeutics prompted us to investigate molecules beyond the prostaglandin pathway. Thus, this article introduces molecules independent from the prostaglandin pathway based on their correlating mechanisms contributing to vascular remodeling. These molecules may serve as potential targets for future DA patency clinical management.

Prophylactic intravenous paracetamol use in extremely premature infants for patent ductus arteriosus

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Musa Silahli ◽  
Zeynel Gokmen ◽  
Mehmet Tekin
Keyword(s):  
Patent Ductus Arteriosus ◽  
Retinopathy Of Prematurity ◽  
Ductus Arteriosus ◽  
Hemodynamic Instability ◽  
Extremely Low Birth Weight ◽  
Control Group ◽  
Low Birth Weight Infants ◽  
Intravenous Paracetamol ◽  
Prophylactic Use ◽  
Patent Ductus

AbstractObjectivesPatency of ductus arteriosus (PDA) is a very common problem among extremely low birth weight infants (ELBW). Hemodynamic instability caused by PDA is associated with important morbidities. This study aims to evaluate the effects of prophylactic intravenous paracetamol on the hemodynamically significant patent ductus arteriosus (hsPDA).MethodsA total of 75 infants of <28 week-gestational age were enrolled into the study which was retrospective. Prophylactic paracetamol as the experimental group and none-prophylaxis group as the control group were compared in the study.ResultsThere were 35 subjects in the prophylactic paracetamol group (PPG), and 40 in the control group. Primary outcome measures were ductal closure, ductal diameter, grade 3–4 IVH, and repeated ibuprofen need for the treatment of hsPDA. At the time of the evaluation by echo, hsPDA, and the diameter of the ductus higher than 1 mm were found significantly lower in the PPG (p=0.004 and p=0.013). Additionally, the repeated course of ibuprofen was significantly lower in the PPG (p=0.025). Secondary outcomes were the other perinatal morbidities. According to the results of the study, the male gender is 6.6, and the paracetamol use is 5.5 times more likely to suffer from ROP.ConclusionsThe results of the study indicated that prophylactic paracetamol use in ELBW infants decreases the likelihood of hsPDA. The repeated course of ibuprofen for the treatment of hsPDA can be reduced. Furthermore, it can be understood that while prophylactic use of paracetamol is preventive for intraventricular hemorrhage, it does not function in the same way for retinopathy of prematurity or bronchopulmonary dysplasia. It might even worse the retinopathy of prematurity. Further prospective randomized controlled and larger sample-sized studies are needed.

scholarly journals Surgical ligation of patent ductus arteriosus in very low birth weight infants: A 9-year single center experience

2020 ◽  
Author(s):  
Jun Ho Lee ◽  
Hyun Ju Lee ◽  
Hyun-Kyung Park ◽  
Ja-Hye Ahn ◽  
Hee Sun Kim ◽  
...  
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Low Birth Weight Infants ◽  
Surgical Ligation ◽  
Patent Ductus

Abstract Background We analyzed the feasibility and outcomes of early surgical ligation in very low birth weight infants (VLBWIs) with hemodynamically significant patent ductus arteriosus (HSPDA) and investigated predictors for surgical treatment after unsuccessful medical management. Methods Medical records from the neonatal intensive care unit of Hanyang University Seoul Hospital from January 2010 to December 2018 were retrospectively reviewed. 233 VLBWIs with HSPDA were enrolled in our study. Of these infants, 134 underwent surgical ligation and were subdivided into the early ligation group (n = 49; within 10 days of age) and the late ligation group (n = 85; after 10 days of age). Results The mean gestational age and birth weight were significantly lower in the patent ductus arteriosus (PDA) ligation group than in the Non-ligation group (p < 0.001). PDA ductal diameter > 2.0 mm (p < 0.001), low Apgar score at 5 minutes (p = 0.033), and chorioamnionitis (p = 0.037) were the predictors for receiving surgical treatment for PDA. Early ligation was significantly associated with a low incidence of culture-proven sepsis (p = 0.004), mechanical ventilator time > 4 weeks (p = 0.007), necrotizing enterocolitis stage (NEC) ≥ III (p = 0.022), and intraventricular hemorrhage (IVH) grade ≥ III (p = 0.035). Conclusions Early surgical ligation minimizes adverse effects of HSPDA in predicted infants who subsequently require surgical treatment for PDA. We suggest that predicted VLBWIs with HSPDA that is unresponsive to medical treatment should avoid delayed ductal closure to reduce severe NEC, severe IVH, culture-proven sepsis, and facilitate earlier endotracheal extubation.

scholarly journals Long-term Results of Two Different Surgical Techniques Used in Carpal Tunnel Syndrome

2021 ◽  
Author(s):  
Serdar Ercan ◽  
Zeki Serdar Ataizi
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Intervention ◽  
Long Term Results ◽  
Recurrent Nerve ◽  
Transverse Incision ◽  
Longitudinal Incision ◽  
Tunnel Syndrome

Abstract Objective Carpal tunnel syndrome (CTS), the compression of the median nerve under the carpal ligament, is the most common peripheral nerve entrapment of the upper extremity. While conservative treatment is used for patients with mild and moderate symptoms, surgical treatment is preferred for severe symptoms. The aim of the study is to evaluate the difference between transverse and longitudinal incision by comparing postoperative pain and recurrence rates. Methods The patients were divided into two groups according to the surgical incision type. Surgical intervention was applied to patients in group T (transverse incision) and group L (longitudinal incision) by the same two surgeons in each group. All patients were followed-up with electromyography (EMG) and performance scale before and after surgical treatment. If the postoperative EMG result was similar to the preoperative EMG result, it was accepted as recurrent CTS. Results A total of 418 patients were included to the study. Six patients in the group T with transverse incision, and 18 patients in the group L with longitudinal incision, were reoperated for an average of 6 ± 2 months after the primary surgery. Conclusion Complications are less, and recurrent nerve compression is less in longitudinal approach, since surgical intervention is performed by seeing the median nerve directly.

Ligation of left pulmonary artery instead of patent ductus arteriosus

2020 ◽  
Vol 30 (12) ◽  
pp. 1943-1945
Author(s):  
Semih Murat Yucel ◽  
Irfan Oguz Sahin
Keyword(s):  
Surgical Treatment ◽  
Pulmonary Artery ◽  
Patent Ductus Arteriosus ◽  
Surgical Complication ◽  
Ductus Arteriosus ◽  
Left Pulmonary Artery ◽  
Artery Ligation ◽  
Surgical Closure ◽  
Post Operative Period ◽  
Patent Ductus

AbstractDuctus arteriosus is an essential component of fetal circulation. Due to occurring changes in the cardiopulmonary system physiology after birth, ductus arteriosus closes. Patent ductus arteriosus can be closed by medical or invasive (percutaneous or surgical) treatment methods. Percutaneous or surgical closure of patent ductus arteriosus can be performed for the cases that medical closure failed. Surgical treatment is often preferred method for closure of patent ductus arteriosus in the neonatal period. The most common surgical complications are pneumothorax, recurrent laryngeal nerve injury, bleeding, and recanalisation. A very rare surgical complication is left pulmonary artery ligation that has been presented in a few cases in the literature. Echocardiography control should be performed in the early post-operative period, especially in patients with clinical suspicion. If reoperation is required, it should never be delayed. We report a newborn patient whose left pulmonary artery ligated accidentally during patent ductus arteriosus closure surgery and surgical correction of this complication at the early post-operative period.

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