scholarly journals Case Report: Persistent Pulmonary Hypertension of the Newborn and Narrowing of the Ductus Arteriosus After Topical Use of Non-Steroidal Anti-Inflammatory During Pregnancy

2021 ◽  
Vol 12 ◽  
Author(s):  
Kévin Le Duc ◽  
Sixtine Gilliot ◽  
Jean Benoit Baudelet ◽  
Sébastien Mur ◽  
Mohamed Riadh Boukhris ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricle ◽  
Ductus Arteriosus ◽  
Persistent Pulmonary Hypertension ◽  
Third Trimester ◽  
Case Presentation ◽  
The Third ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Topical Diclofenac

Background: The use of non-steroidal anti-inflammatory drugs (NSAIDs) during the third trimester of pregnancy can cause premature constriction of the ductus arteriosus. This report describes a case of in utero narrowing of the ductus arteriosus (DA) diagnosed postnatally in a baby with Persistent Pulmonary Hypertension of the Newborn (PPHN), after maternal use of Diclofenac-Epolamine 140 mg patch during the second and third trimester.Case Presentation: A fetal ultrasounds revealed an enlarged hypertrophic right ventricle at 32 weeks of gestation. Detailed questioning of the mother highlighted that topical Diclofenac (FLECTOR®) had been used at 26 and at 31 weeks of gestation. An echocardiography performed 8 h postnatally showed supra-systemic pulmonary hypertension, a restrictive ductus arteriosus and a dilated right ventricle. The newborn was treated by inhaled nitric oxide and oral Sildenafil and was discharged from hospital on day 24. He had a complete normalization of his pulmonary vascular resistance on day 48.Conclusion: This case illustrates the potential fetal and neonatal complications associated with maternal topical Diclofenac medication during pregnancy resulting in antenatal closure of the DA.

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.

scholarly journals Premature Closure of the Ductus Arteriosus in an Otherwise Healthy Fetus

2019 ◽  
Vol 35 (3) ◽  
pp. 235-239
Author(s):  
Michaela Operle ◽  
Sharlette Anderson
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricle ◽  
Fetal Death ◽  
Ductus Arteriosus ◽  
Maternal Exposure ◽  
Premature Closure ◽  
Prostaglandin Synthase ◽  
Inflammatory Drugs ◽  
The Right ◽  
Increased Pressure

Premature closure of the ductus arteriosus is a rare phenomenon. It is thought to be caused by one of three things: abnormal levels of produced and circulating prostaglandin, maternal ingestion of prostaglandin synthase inhibitors, or it can be idiopathic. Idiopathic premature closure of the ductus arteriosus, not caused by maternal exposure to nonsteroidal anti-inflammatory drugs, is an uncommon event that can cause increased pressure on the right ventricle, resulting in pulmonary hypertension. If left untreated, it can result in fetal death.

scholarly journals Use of non-steroidal anti-inflammatory drugs and acetylsalicylic acid in the third trimester of pregnancy

2020 ◽  
Vol 97 ◽  
pp. 8-9
Author(s):  
Annerose E. van der Mijle ◽  
Loes C. de Vries ◽  
Saskia Vorstenbosch ◽  
Eugene P. van Puijenbroek
Keyword(s):  
Acetylsalicylic Acid ◽  
Third Trimester ◽  
The Third ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Critical Ebstein’s anomaly with circular shunt: from successful fetal therapy with non-steroidal anti-inflammatory drugs to biventricular repair using Da Silva cone technique

2021 ◽  
pp. 1-4
Author(s):  
Lilian M. Lopes ◽  
Rodrigo F. Bezerra ◽  
Jose Pedro da Silva ◽  
Luciana da Fonseca da Silva
Keyword(s):  
Single Ventricle ◽  
Ductus Arteriosus ◽  
Ebstein’S Anomaly ◽  
Biventricular Repair ◽  
Fetal Demise ◽  
Ebstein's Anomaly ◽  
Gestational Week ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Single Ventricle Palliation

Abstract We report an innovative treatment strategy for fetal Ebstein’s anomaly with a circular shunt. We used transplacental non-steroidal anti-inflammatory drugs, at the 29th gestational week, to constrict the ductus arteriosus avoiding fetal demise. We addressed the critical neonate with an urgent Starnes procedure. Finally, instead of following the usual single-ventricle palliation pathway after the Starnes procedure, we achieved successful two-ventricle repair with the cone technique at 5 month old.

scholarly journals Glucocorticoids for treating paediatric pulmonary hypertension: a novel use for a common medication

2017 ◽  
Vol 27 (7) ◽  
pp. 1410-1412 ◽  
Author(s):  
Manish Aggarwal ◽  
Ronald Mark Grady
Keyword(s):  
Pulmonary Hypertension ◽  
Potential Utility ◽  
Inflammatory Drugs ◽  
Laboratory Investigations ◽  
Anti Inflammatory

AbstractLaboratory investigations have shown the role of inflammation in the pathogenesis of pulmonary hypertension and improvement after anti-inflammatory drugs. Despite these observations, reports on the use of steroids to treat pulmonary hypertension in humans are absent from the literature. In this article, we report the use of glucocorticoids in the treatment of two children with pulmonary hypertension, demonstrating its potential utility.

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.

Non-steroid anti-inflammatory drugs in the treatment of patent ductus arteriosus in European newborns

2009 ◽  
Vol 22 (sup3) ◽  
pp. 77-80 ◽  
Author(s):  
Hercília Guimarães ◽  
Gustavo Rocha ◽  
Teresa Tomé ◽  
Fani Anatolitou ◽  
Kosmas Sarafidis ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Patent Ductus

The effect of milrinone on right and left ventricular function when used as a rescue therapy for term infants with pulmonary hypertension

2015 ◽  
Vol 26 (1) ◽  
pp. 90-99 ◽  
Author(s):  
Adam T. James ◽  
John D. Corcoran ◽  
Patrick J. McNamara ◽  
Orla Franklin ◽  
Afif F. El-Khuffash
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Right Ventricle ◽  
Left Ventricular Function ◽  
Strain Rate ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Inhaled Nitric Oxide ◽  
Persistent Pulmonary Hypertension ◽  
Myocardial Performance

AbstractIntroductionMilrinone may be an appropriate adjuvant therapy for infants with persistent pulmonary hypertension of the newborn. We aimed to describe the effect of milrinone administration on right and left ventricular function in infants with persistent pulmonary hypertension not responding to inhaled nitric oxide after 4 hours of administration.Materials and methodsThis is a retrospective review of infants born after or at 34 weeks of gestation with persistent pulmonary hypertension who received milrinone treatment. The primary endpoint was the effect of milrinone on myocardial performance and haemodynamics, including right and left ventricular outputs, tissue Doppler velocities, right ventricle and septal strain, and strain rate. Secondary endpoints examined included duration of inhaled nitric oxide and oxygen support.ResultsA total of 17 infants with a mean (standard deviation) gestation and birth weight of 39.8 (2.0) weeks and 3.45 (0.39) kilograms, respectively, were included in the study. The first echocardiogram was performed 15 hours after the commencement of nitric oxide inhalation. Milrinone treatment was started at a median time of 1 hour after the echocardiogram and was associated with an increase in left ventricular output (p=0.04), right ventricular output (p=0.004), right ventricle strain (p=0.01) and strain rate (p=0.002), and left ventricle s` (p<0.001) and a` (p=0.02) waves. There was a reduction in nitric oxide dose and oxygen requirement over the subsequent 72 hours (all p<0.05).ConclusionThe use of milrinone as an adjunct to nitric oxide is worth further exploration, with preliminary evidence suggesting an improvement in both oxygenation and myocardial performance in this group of infants.

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