scholarly journals Duktus Arteriosus pada Bayi Prematur

2020 ◽  
Vol 1 (2) ◽  
pp. 89-97
Author(s):  
Agus Cahyono
Keyword(s):  
Blood Flow ◽  
Necrotizing Enterocolitis ◽  
Pulmonary Blood Flow ◽  
Ductus Arteriosus ◽  
Prostaglandin Synthesis ◽  
Treatment Modalities ◽  
Organ Blood Flow ◽  
Descending Aorta ◽  
Drug Adverse Event ◽  
Important Structure

Abstract—Ductus arteriosus (DA) is a connecting vessel between proximal descending aorta and pulmonary artery. This important structure normally close after birth. The opened ductus causes increasing of pulmonary blood flow and decreasing of certain organ blood flow (intestine, skin, muscle, and renal) causing complications such as heart failure, metabolic acidosis, necrotizing enterocolitis, and pulmonary edema/bleeding. Prevalence of DA is 0,2/1000 live birth. In under 1500 g babies the proportion of DA is 25%. Surgery and medicine are the treatment modalities of DA closure. Modalities of medicine are indometacine, ibuprofen, and paracetamol. These three modalities work by inhibiting cyclooxygenase enzime causing blockade of prostaglandin synthesis. Drug adverse event can be minimized by carefull in making treatment choice. Keywords: ductus arteriosus, complication, treatment Abstrak—Duktus arteriosus (DA) merupakan pembuluh darah yang menghubungkan aorta desendens proksimal dan arteri pulmonalis. Struktur yang penting pada janin tersebut secara normal menutup setelah lahir. Duktus yang masih terbuka tersebut mengakibatkan peningkatan aliran darah paru dan penurunan aliran darah ke organ usus, kulit, otot, dan ginjal sehingga menyebabkan komplikasi seperti gagal jantung, asidosis metabolik, necrotizing enterocolitis (NEC), serta edema paru/perdarahan. Prevalensi DA yang masih terbuka adalah 0,2 per 1000 kelahiran hidup. Proporsi bayi yang bergejala dengan DA yang masih terbuka kurang lebih 25% bayi dengan berat badan lahir di bawah 1500g. Pilihan terapi penutupan DA adalah cara bedah dan medis. Cara medis memiliki beberapa pilihan yaitu indometasin, ibuprofen, dan parasetamol. Ketiga modalitas terapi tersebut bekerja melalui penghambatan enzim siklooksigenase sehingga sintesis prostaglandin terhambat. Beberapa hal perlu diperhatikan dalam membuat pilihan terapi sehingga komplikasi yang berhubungan dengan efek samping obat dapat dihindari.. Kata kunci: ductus arteriosus, komplikasi, terapi

Abstract 14860: Echocardiographic Assessment of Shunt Fraction in Complex Cyanotic Heart Diseases Palliated With Aortopulmonary Shunts

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Joan K Lee ◽  
briana olson ◽  
Neal Jorgensen ◽  
Matthew D Files
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Heart Diseases ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Ventricular Volume ◽  
Systemic Circulation ◽  
Repeated Measurements ◽  
Observer Agreement ◽  
Shunt Fraction

Introduction: Neonates with complex heart defects with inadequate pulmonary blood flow require aortopulmonary shunts (APS) either as surgical-placed modified Blalock-Taussig shunt or a catheter-based stent implantation into a patent ductus arteriosus. An ideal APS provides equal pulmonary blood flow (Qp) as the systemic blood flow (Qs), which is considered balanced circulation. Pulmonary over-circulation leads to complications from inadequate systemic circulation, such as organ dysfunction, shock, and death. Accurately determining Qp:Qs ratio in these patients relies on catheterization, which is invasive and may falsely lower the Qp due to anesthetic effects. To our knowledge, there has not been any studies on echocardiographic comparisons of balanced versus overcirculated APS. We aim to evaluate echocardiographic Doppler assessment of velocity-time integral (VTI) at the aortic arch isthmus distal to APS origin as a measure of shunt fraction in APS patients. We defined shunt fraction ratio (SFR) as retrograde to prograde flow by VTI. Methods: This is a retrospective pilot study of neonates with APS. We selected two cohorts of patients with appropriately balanced circulation (n=12) and those with excessive Qp (n=5) resulting in end-organ damage. We analyzed serial echocardiograms, with repeated measurements for inter-observer agreement. Results: Mean SFR is lower in balanced cohort compared to the overcirculated cohort (0.45 ± 0.07 vs. 0.55 ± 0.09, p=0.02). For both groups, SFR was positively associated with oxygen saturation (r= 0.57, p=0.01), as well as markers of ventricular volume load, such as the highest brain naturetic peptide during hospitalization (Pearson’s correlation r=0.83, p= 0.04) and as outpatient (r= 0.72, p =0.02). Inter-observer agreement was 0.74, suggesting that this is a reproducible technique. Conclusions: SFR by VTI is a simple echocardiographic technique to estimate the volume of APS flow and appears to have important implications for clinical outcomes. Prompt characterization of pulmonary overcirculation without invasive assessment could improve clinical management. Further prospective studies are needed to validate these findings.

Prolonged Prostaglandin E1 Infusion in an Infant With Cyanotic Congenital Heart Disease

PEDIATRICS ◽  
1978 ◽  
Vol 61 (4) ◽  
pp. 534-536
Author(s):  
Alan B. Lewis ◽  
Paul R. Lurie
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pulmonary Blood Flow ◽  
Congenital Heart ◽  
Prostaglandin E1 ◽  
Ductus Arteriosus ◽  
Cyanotic Congenital Heart Disease

A small-for-gestational-age premature infant with severe tetralogy of Fallot was treated with prostaglandin E1 to dialate the ductus arteriosus and increase pulmonary blood flow. The infusion was continued for 29 days without complication at which time surgery was performed.

Ductus Arteriosus Dilatation by Prostaglandin E1 in Infants With Pulmonary Atresia

PEDIATRICS ◽  
1977 ◽  
Vol 59 (3) ◽  
pp. 325-329 ◽  
Author(s):  
Michael A. Heymann ◽  
Abraham M. Rudolph
Keyword(s):  
Central Nervous System ◽  
Pulmonary Blood Flow ◽  
Prostaglandin E1 ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Postnatal Period ◽  
Descending Aorta ◽  
Arterial Blood ◽  
Surgical Palliation ◽  
The Central Nervous System

Infants with pulmonary atresia depend on patency of the ductus arteriosus for survival in the immediate postnatal period. Despite continuing hypoxemia after birth the ductus arteriosus usually constricts, thus reducing pulmonary blood flow. This often occurs while awaiting surgical palliation or correction, leading either to marked deterioration in the infant's condition, or death. In ten infants with pulmonary atresia, we infused prostaglandin E1 (PGE1) at a rate of 0.1µg/kg/min in six and 0.05µg/kg/min in four into the descending aorta at the orifice of the ductus arteriosus. The ductus arteriosus was effectively dilated: at the narrowest point the diameter, measured in eight infants, almost doubled. In all ten infants arterial blood PO2 increased, averaging 24.6 mm Hg before and 43.7 mm Hg after the infusion was started. Infusion of PGE1 directly into the aorta adjacent to the ductus arteriosus avoided the complications of pyrexia, muscular twitching, and excitability which may be related to the effects of prostaglandins on the central nervous system.

scholarly journals Bidirectional Ductal Shunting and Preductal to Postductal Oxygenation Gradient in Persistent Pulmonary Hypertension of the Newborn

Children ◽  
2020 ◽  
Vol 7 (9) ◽  
pp. 137
Author(s):  
Amy Lesneski ◽  
Morgan Hardie ◽  
William Ferrier ◽  
Satyan Lakshminrusimha ◽  
Payam Vali
Keyword(s):  
Blood Flow ◽  
Pulmonary Hypertension ◽  
Pulmonary Blood Flow ◽  
Ductus Arteriosus ◽  
Arterial Oxygen Tension ◽  
Persistent Pulmonary Hypertension ◽  
Arterial Oxygen ◽  
Meconium Aspiration ◽  
Arterial Blood Gas ◽  
Arterial Blood

Background: The aim was to evaluate the relationship between the direction of the patent ductus arteriosus (PDA) shunt and the pre- and postductal gradient for arterial blood gas (ABG) parameters in a lamb model of meconium aspiration syndrome (MAS) with persistent pulmonary hypertension of the newborn (PPHN). Methods: PPHN was induced by intermittent umbilical cord occlusion and the aspiration of meconium through the tracheal tube. After delivery, 13 lambs were ventilated and simultaneous 129 pairs of pre- and postductal ABG were drawn (right carotid and umbilical artery, respectively) while recording the PDA and the carotid and pulmonary blood flow. Results: Meconium aspiration resulted in hypoxemia. The bidirectional ductal shunt had a lower postductal partial arterial oxygen tension ([PaO2] with lower PaO2/FiO2 ratio—97 ± 36 vs. 130 ± 65 mmHg) and left pulmonary flow (81 ± 52 vs. 133 ± 82 mL/kg/min). However, 56% of the samples with a bidirectional shunt had a pre- and postductal saturation gradient of < 3%. Conclusions: The presence of a bidirectional ductal shunt is associated with hypoxemia and low pulmonary blood flow. The absence of a pre- and postductal saturation difference is frequently observed with bidirectional right-to-left shunting through the PDA, and does not exclude a diagnosis of PPHN in this model.

Study of Multiple Systemic-to-Pulmonary Shunts in Single Ventricle Hearts

2012 ◽  
Author(s):  
Mahdi Esmaily Moghadam ◽  
Tain-Yen Hsia ◽  
Bari Murtuza ◽  
Alison Marsden
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Ductus Arteriosus ◽  
Adverse Outcomes ◽  
Flow Dynamics ◽  
Single Institution ◽  
Shunt Occlusion ◽  
Flow Competition ◽  
Blalock Taussig Shunt

For newborns diagnosed with single ventricle hearts and insufficient blood flow to the lungs, their lack of oxygen in the blood can be remedied with a modified Blalock-Taussig shunt (BTshunt) between the innominate and pulmonary artery. However, some surgeons prefer to have two systemic-to-pulmonary shunts, by either leaving the ductus arteriosus open or construct a second BT shunt, to provide additional pulmonary blood flow. There have been clinical reports of premature shunt occlusion when more than one shunt is employed, and a recent audit of shunt operations at a single institution has revealed increased mortality. There are speculation that these adverse outcomes can be due to flow competition between the two shunts, and/or having too much pulmonary blood flow. The flow dynamics and cardiopulmonary physiology in single ventricle circulations where pulmonary blood flow is supplied by more than one shunt has not been studied previously. In this study, we adopted CFD-based multi-domain simulations to compare a range of shunt configurations to examine the issue of flow competition and pulmonary overcirulation.

The Effects of Meclofenamate, Captopril and Phentolamine on Organ Blood Flow in the Conscious Rabbit

1981 ◽  
Vol 61 (1) ◽  
pp. 97-105 ◽  
Author(s):  
R. A. Banks ◽  
L. J. Beilin
Keyword(s):  
Blood Flow ◽  
Arterial Pressure ◽  
Hepatic Artery ◽  
Peripheral Resistance ◽  
Prostaglandin Synthesis ◽  
Organ Blood Flow ◽  
Inhibit Prostaglandin Synthesis ◽  
Conscious Rabbits ◽  
Artery Flow ◽  
Intravenous Sodium

1. Systemic and regional vascular changes were measured in conscious rabbits after intravenous sodium meclofenamate, captopril and phentolamine. These drugs were used respectively to inhibit prostaglandin synthesis and angiotensin-converting enzyme, and to block α-adrenoceptors. 2. Meclofenamate reduced renal and adrenal blood flow by 11 and 28% respectively, and doubled hepatic artery flow. The effect on renal and adrenal flow persisted in the presence of phentolamine. 3. Captopril decreased estimated peripheral resistance and increased cardiac output without changing arterial pressure. Kidney and adrenal flow increased by 70 and 21% respectively. 4. Phentolamine reduced arterial pressure and doubled flow to skeletal muscle and increased hepatic artery flow to the liver. 5. Splenic blood flow was unaffected by meclofenamate, captopril or phentolamine alone. Meclofenamate given after captopril caused a halving of splenic flow and a rise in arterial pressure; these effects were prevented by phentolamine. 6. The results point to a continuing effect of prostaglandin synthesis in maintaining blood flow to the kidney and adrenal gland independent of α-adrenoceptor activation in resting conscious rabbits. An important modulating effect of prostaglandins on sympathetic vascular tone in the spleen is suggested.

Differential effect of recruitment maneuvres on pulmonary blood flow and oxygenation during HFOV in preterm lambs

2008 ◽  
Vol 105 (2) ◽  
pp. 603-610 ◽  
Author(s):  
Graeme R. Polglase ◽  
Timothy J. M. Moss ◽  
Ilias Nitsos ◽  
Beth J. Allison ◽  
J. Jane Pillow ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lung Volume ◽  
Airway Pressure ◽  
Pulmonary Blood Flow ◽  
Ductus Arteriosus ◽  
Oxygenation Index ◽  
Preterm Neonates ◽  
Mean Airway Pressure ◽  
Lung Volume Recruitment ◽  
High Frequency Oscillatory

The effects of lung volume recruitment manouvres on pulmonary blood flow (PBF) during high-frequency oscillatory ventilation (HFOV) in preterm neonates are unknown. Since increased airway pressure adversely affects PBF, we compared the effects of two HFOV recruitment strategies on PBF and oxygenation index (OI). Preterm lambs (128 ± 1 day gestation; term ∼150 days) were anesthetized and ventilated using HFOV (10 Hz, 33% tI) with a mean airway pressure (Pao) of 15 cmH2O. Lung volume was recruited by either increasing Pao to 25 cmH2O for 1 min, repeated five times at 5-min intervals (Sigh group; n = 5) or stepwise (5 cmH2O) changes in Pao at 5-min intervals incrementing up to 30 cmH2O then decrementing back to 15 cmH2O (Ramp group; n = 6). Controls ( n = 5) received constant HFOV at 15 cmH2O. PBF progressively decreased (by 45 ± 4%) and OI increased (by 15 ± 6%, indicating reduced oxygenation) in controls during HFOV, which was similar to the changes observed in the Sigh group of lambs. In the Ramp group, PBF fell (by 54 ± 10%) as airway pressure increased ( r2 = 0.99), although the PBF did not increase again as the Pao was subsequently reduced. The OI decreased (by 47 ± 9%), reflecting improved oxygenation at high Pao levels during HFOV in the Ramp group. However, high Pao restored retrograde PBF during diastole in four of six lambs, indicating the restoration of right-to-left shunting through the ductus arteriosus. Thus the choice of volume recruitment maneuvre influences the magnitude of change in OI and PBF that occurs during HFOV. Despite significantly improving OI, the ramp recruitment approach causes sustained changes in PBF.

Sign in / Sign up

Export Citation Format

Share Document