Premature constriction of the ductus arteriosus that presented persistent pulmonary hypertension of the newborn: case report

Choonpa Igaku ◽  
2015 ◽  
Vol 42 (6) ◽  
pp. 725-730
Author(s):  
Yoshihiro NEMOTO ◽  
Hiroshi ISHIKAWA ◽  
Motoyoshi KAWATAKI
Keyword(s):  
Pulmonary Hypertension ◽  
Case Report ◽  
Ductus Arteriosus ◽  
Persistent Pulmonary Hypertension

scholarly journals Use of sildenafil in an infant with persistent pulmonary hypertension secondary to lung and renal hypoplasia – a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Karen Lavie-Nevo ◽  
Kevin C. Harris ◽  
Joseph Y. Ting
Keyword(s):  
Pulmonary Hypertension ◽  
Case Report ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Ductus Arteriosus ◽  
Hypertensive Crisis ◽  
Pulmonary Arteries ◽  
Right Ventricular Dysfunction ◽  
Persistent Pulmonary Hypertension ◽  
Renal Hypoplasia

Abstract Background Premature preterm rupture of membranes (PPROM) is reported to be associated with high rates of neonatal mortality and morbidity. Sildenafil has been used in infants with persistent pulmonary hypertension of newborn (PPHN) due to congenital diaphragmatic hernia (CDH) and bronchopulmonary dysplasia (BPD). Recently, Sildenafil has been evaluated as an alternative or adjunctive pulmonary vasodilator. This case report illustrates the use of early sildenafil for PPHN and right ventricular dysfunction in an unusual setting of lung and renal hypoplasia. Case presentation A male infant was born at 37 weeks with a birth weight of 2840 g. Rupture of membranes developed at approximately 24 weeks of gestational age (GA). Bilateral small kidneys (< 2 standard deviations below average) were detected on ultrasound (US) examination at 30 weeks of gestation. The baby developed pneumothorax and pulmonary hypertensive crisis towards the end of the first day. An echocardiogram showed a dilated right ventricle, moderate right ventricular systolic dysfunction, hypoplastic pulmonary arteries and a large patent ductus arteriosus with bidirectional flow. The patient was sedated, paralyzed, and inhaled nitric oxide was administered to decrease the pulmonary resistance. In anticipation of persistent pulmonary hypertension due to the hypoplastic lungs and small calibre of pulmonary arteries, sildenafil was started on day of life (DOL) 5 at a dosage of 0.25 mg/kg/dose Q8H and gradually increased to 2 mg/kg/dose Q8H on DOL 9. The patient was finally extubated on DOL 7 and weaned off of non-invasive respiratory support on DOL 26. Sildenafil was gradually weaned beginning on DOL 21 and discontinued on DOL 48. Repeat echocardiogram assessment at 3 months showed complete resolution of PHT and right ventricular dilatation. Conclusions We describe the early use of sildenafil in treating pulmonary hypertension associated with lung and renal hypoplasia in a non-CDH patient. Following this treatment the patient made a full recovery from right ventricular dysfunction.

scholarly journals Fatal neonatal persistent pulmonary hypertension caused by vegetations of infective endocarditis – case report and review of the literature

2020 ◽  
Vol 07 (02) ◽  
pp. 40-45
Author(s):  
Andreea Luciana Avasiloaiei ◽  
Ecaterina Iftime ◽  
Daniela Claudia Scripcaru ◽  
Andrei Petrariu ◽  
Gabriela Ildiko Zonda ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Case Report ◽  
Infective Endocarditis ◽  
Persistent Pulmonary Hypertension ◽  
Review Of The Literature

Elongated Patent Ductus Arteriosus with Intermittent Shunting

PEDIATRICS ◽  
1967 ◽  
Vol 39 (3) ◽  
pp. 446-448
Author(s):  
COLETTE M. KOHLER ◽  
DAN G. MCNAMARA
Keyword(s):  
Pulmonary Hypertension ◽  
Case Report ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Cardiac Defects ◽  
Cardiac Catheterizations ◽  
Delayed Closure ◽  
Patent Ductus

The presence of patent ductus arteriosus without a typical continuous murmur has long been recognized, especially in the presence of pulmonary hypertension, or a small ductus, or with associated cardiac defects; however, there are only a few reports of documented, intermittently disappearing murmurs occurring in individuals over 6 months of age with a substantial shunt in the absence of pulmonary hypertension or associated defects. Danilowicz, et al. have recently reported delayed closure of the ductus anteriosus up to 6 months of age in some premature infants. We present this case report of a 2½-year-old boy with patent ductus arteriosus with cardiac catheterizations during the disappearance and subsequent reappearance of a continuous murmur with documentation of absence of shunting when the murmur was absent and substantial shunting if the murmur was present.

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.

Oxidant stress from uncoupled nitric oxide synthase impairs vasodilation in fetal lambs with persistent pulmonary hypertension

2007 ◽  
Vol 292 (4) ◽  
pp. H1812-H1820 ◽  
Author(s):  
Girija G. Konduri ◽  
Ivane Bakhutashvili ◽  
Annie Eis ◽  
Kirkwood Pritchard
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Nitric Oxide Synthase ◽  
Pulmonary Artery ◽  
Ductus Arteriosus ◽  
Oxidant Stress ◽  
Pulmonary Arteries ◽  
Persistent Pulmonary Hypertension ◽  
Pulmonary Vasodilation ◽  
Oxide Synthase

Persistent pulmonary hypertension of newborn (PPHN) is associated with decreased NO release and impaired pulmonary vasodilation. We investigated the hypothesis that increased superoxide (O2•−) release by an uncoupled endothelial nitric oxide synthase (eNOS) contributes to impaired pulmonary vasodilation in PPHN. We investigated the response of isolated pulmonary arteries to the NOS agonist ATP and the NO donor S-nitroso- N-acetylpenicillamine (SNAP) in fetal lambs with PPHN induced by prenatal ligation of ductus arteriosus and in sham-ligated controls in the presence or absence of the NOS antagonist nitro-l-arginine methyl ester (l-NAME) or the O2•− scavenger 4,5-dihydroxy-1,3-benzenedisulfonate (Tiron). ATP caused dose-dependent relaxation of pulmonary artery rings in control lambs but induced constriction of the rings in PPHN lambs. l-NAME, the NO precursor l-arginine, and Tiron restored the relaxation response of pulmonary artery rings to ATP in PPHN. Relaxation to NO was attenuated in arteries from PPHN lambs, and the response was improved by l-NAME and by Tiron. We also investigated the alteration in heat shock protein (HSP)90-eNOS interactions and release of NO and O2•− in response to ATP in the pulmonary artery endothelial cells (PAEC) from these lambs. Cultured PAEC and endothelium of freshly isolated pulmonary arteries from PPHN lambs released O2•− in response to ATP, and this was attenuated by the NOS antagonist l-NAME and superoxide dismutase (SOD). ATP stimulated HSP90-eNOS interactions in PAEC from control but not PPHN lambs. HSP90 immunoprecipitated from PPHN pulmonary arteries had increased nitrotyrosine signal. Oxidant stress from uncoupled eNOS contributes to impaired pulmonary vasodilation in PPHN induced by ductal ligation in fetal lambs.

Complete closure of the ductus arteriosus in the foetus with transposition of the great arteries

2020 ◽  
Vol 30 (4) ◽  
pp. 588-590
Author(s):  
Agnieszka Grzyb ◽  
Adam Koleśnik ◽  
Dariusz Gruszfeld ◽  
Joanna Szymkiewicz-Dangel
Keyword(s):  
Pulmonary Hypertension ◽  
Organ Failure ◽  
Ductus Arteriosus ◽  
Persistent Pulmonary Hypertension ◽  
Multi Organ Failure ◽  
Complete Closure ◽  
Other Substances ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

AbstractPrenatal restriction of the ductus arteriosus can manifest as persistent pulmonary hypertension in the newborn, especially dangerous with the transposition of the great arteries. Its aetiology has long been related to maternal intake of non-steroidal anti-inflammatory drugs; however, some other substances, including polyphenols, may have similar properties. We describe a case of complete prenatal closure of the ductus arteriosus in the foetus with transposition of the great arteries. The newborn presented with pulmonary hypertension unresponsive to pharmacotherapy and died of multi-organ failure.

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