A Framework for AI-Assisted Detection of Patent Ductus Arteriosus from Neonatal Phonocardiogram

The current diagnosis of Congenital Heart Disease (CHD) in neonates relies on echocardiography. Its limited availability requires alternative screening procedures to prioritise newborns awaiting ultrasound. The routine screening for CHD is performed using a multidimensional clinical examination including (but not limited to) auscultation and pulse oximetry. While auscultation might be subjective with some heart abnormalities not always audible it increases the ability to detect heart defects. This work aims at developing an objective clinical decision support tool based on machine learning (ML) to facilitate differentiation of sounds with signatures of Patent Ductus Arteriosus (PDA)/CHDs, in clinical settings. The heart sounds are pre-processed and segmented, followed by feature extraction. The features are fed into a boosted decision tree classifier to estimate the probability of PDA or CHDs. Several mechanisms to combine information from different auscultation points, as well as consecutive sound cycles, are presented. The system is evaluated on a large clinical dataset of heart sounds from 265 term and late-preterm newborns recorded within the first six days of life. The developed system reaches an area under the curve (AUC) of 78% at detecting CHD and 77% at detecting PDA. The obtained results for PDA detection compare favourably with the level of accuracy achieved by an experienced neonatologist when assessed on the same cohort.

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Patent Ductus Arteriosus: An Overview

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-12.3.138 ◽

2007 ◽

Vol 12 (3) ◽

pp. 138-146 ◽

Cited By ~ 7

Author(s):

James E. Dice ◽

Jatinder Bhatia

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Congenital Heart ◽

Heart Defects ◽

Ductus Arteriosus ◽

Clinical Signs ◽

Medical Intervention ◽

Fluid Restriction ◽

Term Infants ◽

Patent Ductus

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects, accounting for 5%–10% of all congenital heart disease in term infants. The occurrence of PDA is inversely related to gestational age and weight, with an even greater incidence in preterm infants. The maintenance of ductal patency is essential for the normal development of the fetus. In the neonate, however, persistent patency of the ductus arteriosus (DA) is associated with significant morbidity and mortality. Normally, at birth, the DA constricts, resulting in intraluminal ischemic hypoxia, which eventually leads to closure and remodeling of the ductus. PDA in term infants is usually associated with a functional defect, whereas in preterm infants it is associated with immaturity. Normal physiologic mechanisms contributing to closure - oxygen tension and decreased prostaglandins—are altered in prematurity. Clinical signs of ductal patency include murmur, tachycardia, bounding peripheral pulses, and congestive heart failure and associated symptoms. Symptoms are not always present; therefore, diagnostic imaging is critical if a PDA is suspected on clinical grounds. Three management strategies are currently available for PDA: fluid restriction and diuretics (as clinically appropriate), medical intervention, and surgical ligation. Pharmacologic closure can be achieved via administration of intravenous indomethacin or ibuprofen lysine. While both agents have shown similar efficacy, ibuprofen lysine has demonstrated an improved safety profile, particularly in terms of renal effects, compared to indomethacin.

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A Mystery of Patent Ductus Arteriosus and Serum Osmolality in Preterm Infants

American Journal of Perinatology ◽

10.1055/s-0038-1673397 ◽

2018 ◽

Vol 36 (06) ◽

pp. 641-646 ◽

Cited By ~ 5

Author(s):

Ufuk Cakir ◽

Cuneyt Tayman

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Area Under The Curve ◽

Clinical Problem ◽

Serum Osmolality ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Important Clinical Problem ◽

Patent Ductus

Objective Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants. Study Design Our study was conducted between January 2013 and December 2017. Premature infants with birth weight <1,500 g and gestational age <32 weeks were included in the study. Serum osmolality was compared between infants with hemodynamically significant PDA (hsPDA) and non-hsPDA. Results During the study period, 799 patients were evaluated. Mean serum osmolality levels were higher in the “hsPDA” group (297 ± 10.9 vs. 292 ± 8.3 mOsm/L) (p = 0.001). The area under the curve for osmolality was 0.582 (p = 0.0006, 95% confidence interval: 0.541–0.622) at the time of diagnosis for predicting hsPDA, with a cutoff value for osmolality of 300 mOsm/L. Conclusion Serum osmolality may be recognized as an important contributing factor for ductal patency especially among extremely preterm infants who are most likely to have hsPDA in the early days of life.

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Thrombocytopenia associated with transcatheter closure of giant patent ductus arteriosus

Cardiology in the Young ◽

10.1017/s1047951120003169 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1896-1901

Author(s):

Lei Liu ◽

Peng Yue ◽

Xiaolan Zheng ◽

Hongyu Liao ◽

Jiawen Li ◽

...

Keyword(s):

Risk Factors ◽

Body Weight ◽

Confidence Interval ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Univariate Analysis ◽

Area Under The Curve ◽

Independent Predictive Factor ◽

Associated Risk Factors ◽

Patent Ductus

AbstractIntroduction:Thrombocytopenia occasionally occurs following the closure of some giant patent ductus arteriosus cases. Unfortunately, there is no associated research describing the associated risk factors for thrombocytopenia post-procedure.Methods:We reviewed all patients who received occluders with sizes ≥10/12 mm between January 2013 and June 2019. All the data and information on the characteristics of the patients and their follow-up were recorded. Univariate analysis, receiver operating characteristic curves, and linear regression were used to analyse the risk factors for thrombocytopenia and the predictors of hospitalisation stay.Results:Finally, 32 patients (17.5%) suffered from thrombocytopenia. Univariate analysis revealed the ratio between occluder disc size (mm) and body weight (kg) (1.71 ± 0.51 versus 1.35 ± 0.53) as an independent predictive factor for thrombocytopenia, and the area under the curve of the ratio of occluder size and body weight for predicting thrombocytopenia post-closure was 0.691 (95% confidence interval: 0.589–0.792, p = 0.001). The best cut-off value for the ratio of occluder size and weight was 1.5895, with a sensitivity and specificity of 68.8 and 66.9%, respectively. Each unit of the ratio of occluder size and body weight predicted an average hospitalisation stay of 2.856 days (95% confidence interval: 1.380–4.332). Treatment with medication did not reduce the hospitalisation stay or benefit platelet restoration.Conclusion:Once the ratio of occluder size and body weight is greater than 1.6, thrombocytopenia always exists. Every unit of the ratio of occluder size and body weight represents an additional 3 days of hospitalisation. Treatment does not reduce the duration of hospitalisation.

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An Overview of Aortopulmonary Window

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i46a32854 ◽

2021 ◽

pp. 169-174

Author(s):

Dhanvijay Roshani ◽

Raut Arti ◽

Dhobe Sonal ◽

Dighikar Vrushali

Keyword(s):

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Heart Defects ◽

Ductus Arteriosus ◽

Pulmonary Atresia ◽

Abnormal Development ◽

Aortopulmonary Window ◽

Autopsy Study ◽

Associated Lesions ◽

Patent Ductus

Aortopulmonary (AP) window is exactly a rare congenital anomaly that represents approximately 0.2 and 0.5% of all congenital heart abnormalities. It consists of communication between the aorta and the pulmonary artery or its branches. Although closely related to AP window, the pulmonary artery origin from the ascending aorta (also termed “hemitruncus”) is classified as a separate defect. AP window was first described by Elliotson in 1830 in an autopsy study. In 1948, Robert Gross successfully ligated an AP window in a patient undergoing a thoracotomy for closure of a patent ductus arteriosus (PDA). In 1957, Cooley and associates described the first successful repair of AP window using cardiopulmonary bypass. Aortopulmonary window occurs due to the abnormal development of the heart’s major blood vessels during early fetal growth. In most cases, this heart defect occurs by chance, with no clear reason. This condition can occur on its own or with other heart defects such as: 1. Tetralogy of Fallot, 2. Pulmonary atresia, 3. Truncus arteriosus, 4. Atrial septal defect, 5. Patent ductus arteriosus, 6. Interrupted aortic arch. Treatment for aortopulmonary window involves surgery to close the hole between the aorta and the pulmonary artery with a patch or device. This surgery is normally done as soon as possible after the diagnosis is made, usually when the child is a newborn. Associated lesions are usually repaired during the same surgery. Associated lesions are usually repaired during the same surgery. More complex repairs and myocardial protection strategies are required in patients with associated lesions, increasing the morbidity and mortality associated with the operation.

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Feasibility and Safety of Percutaneous Cardiac Interventions for Congenital and Acquired Heart Defects in Infants ≤1000 g

Children ◽

10.3390/children8090826 ◽

2021 ◽

Vol 8 (9) ◽

pp. 826

Author(s):

Ranjit Philip ◽

Jeffrey Towbin ◽

Neil Tailor ◽

Vijaya Joshi ◽

Jason N. Johnson ◽

...

Keyword(s):

Adverse Event ◽

Patent Ductus Arteriosus ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Transcatheter Closure ◽

Heart Defects ◽

Ductus Arteriosus ◽

Major Adverse Event ◽

Procedural Success ◽

Patent Ductus

The transcatheter closure of patent ductus arteriosus (TCPC) has been demonstrated to be feasible even in infants weighing ≤1000 g. However, other percutaneous cardiac interventions (PCI) for such small infants born with congenital heart defects (CHD) or acquired heart defects (AHD) have not been well described. The purpose of this study was to describe the feasibility and safety of PCI in infants ≤1000 g. A retrospective review was conducted between June 2015 and May 2021, looking at 148 consecutive PCIs performed on infants weighing ≤1000 g at the time of the procedure. The procedural success rate was 100%. The major adverse event (AE) rate for TCPC was 3%, while there were no major AEs for other PCI. It is feasible to perform PCIs in infants weighing ≤1000 g with CHD and AHD using currently available technologies.

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Anesthesia Management in VP Shunt Surgery in Neonates with Hypoplastic Left Heart Syndrome (HLHS) and Dandy Walker Syndrome

Solo Journal of Anesthesi, Pain and Critical Care (SOJA) ◽

10.20961/soja.v1i1.49476 ◽

2021 ◽

Vol 1 (1) ◽

pp. 7

Author(s):

Purwoko Purwoko ◽

Fandi Ahmad Muttaqin

Keyword(s):

Patent Ductus Arteriosus ◽

Hypoplastic Left Heart Syndrome ◽

Vascular Resistance ◽

Ductus Arteriosus ◽

Clinical Manifestations ◽

Heart Sounds ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Left Heart Syndrome ◽

Patent Ductus

Introduction: Hypoplastic left heart syndrome (HLHS) is defined as the incomplete development of the left heart structures, including the mitral valve, left ventricle, aortic valve, and aortic arch. The clinical presentation of HLHS depends on the patency of the ductus arteriosus and the degree of restriction of the atrial septum. Common clinical manifestations include cyanosis, respiratory distress, and hemodynamic instability within hours of delivery. Delays in diagnosis and delay in intervention will increase the morbidity of neonates with HLHS.Purpose: To understand the mechanism of HLHS along with the principles of anesthesia in neuroaesthetics procedures in pediatrics in order to obtain a good outcome.Case Illustration: A 9-day old baby girl, weight 2522 grams with HLHS (aortic atresia) with patent ductus arteriosus (PDA), type II atrial septal defect (ASD) with a left to right shunt, and dandy walker syndrome. From the physical examination, the patient's condition is stable, with GCS E4V5M6, pulse 130-135 beats/minute, breath rate 48x / minute, and SpO2 94-98%. The patient's head was enlarged from birth, no heart sounds were found, regular I-II heart sounds. Blood laboratory tests showed a total bilirubin value of 11.7 mg / dL, direct bilirubin 0.64 mg / dL, indirect bilirubin 10.43 mg / dL, hemoglobin 20.1 g%, hematocrit 55%, with leukocytes 19.9x103 / L, platelets 216 x 103 / L, serum Na 122 mmol / L, K 7.8 mmol / L, Cl 101 mmol / L.Discussion: The anesthetic approach in HLHS is to maintain preoperative hemodynamic stability by maintaining heart rate, preload, and PGE1, balancing systemic vascular resistance and pulmonary vascular resistance, preventing too high PaO2, and administering inotropic agents to increase cardiac output and keep the patent ductus arteriosus open. The balance of systemic and pulmonary blood flow is a key principle in the management of HLHS anesthesia. Conclusion: The main goal of HLHS anesthesia is to minimize hemodynamic changes to prevent compromised hemodynamics in both circulations and maintaining stability is essential in preventing morbidity, complications, and increasing good outcomes in surgery..

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Successful Surgical Outcome of Coarctation of Aorta in an adult male

University Heart Journal ◽

10.3329/uhj.v8i1.11671 ◽

2012 ◽

Vol 8 (1) ◽

pp. 62-64

Author(s):

Md Mostafizur Rahman ◽

M A Hossain ◽

MAQ Chowdhury ◽

OS Khan ◽

SR Sarker ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Heart Defects ◽

Ductus Arteriosus ◽

Coarctation Of The Aorta ◽

Uncontrolled Hypertension ◽

Coarctation Of Aorta ◽

Older Children ◽

Exertional Dyspnea ◽

High Index Of Suspicion ◽

Patent Ductus

Coarctation of the aorta is a relatively common defect that accounts for 5-8% of all congenital heart defects. Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most commonly patent ductus arteriosus, bicuspid aortic valve and ventricular septal defect. The diagnosis of coarctation of the aorta may be missed or delayed unless there is a high index of suspicion and the presentation may be congestive heart failure in infant or hypertension in older children and adult. A case of coarctation of the aorta associated with patent ductus arteriosus having features of headache, exertional dyspnea and uncontrolled hypertension is being presented here. PTFE patch aortoplasty and ligation with transfixation of PDA was done. Post-operative period was uneventful and patient was discharged on 7th post-operative day. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11671 University Heart Journal Vol. 8, No. 1, January 2012

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Prostaglandin E[1] treatment in patent ductus arteriosus dependent congenital heart defects

Journal of Perinatal Medicine ◽

10.1515/jpm.2004.069 ◽

2004 ◽

Vol 32 (4) ◽

Cited By ~ 22

Author(s):

G. Tálosi ◽

M. Katona ◽

K. Rácz ◽

E. Kertész ◽

B. Onozó ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Ductus Arteriosus ◽

Prostaglandin E ◽

Patent Ductus

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Whole-exome Sequencing Identify Rare Variants in Novel Candidate Genes with Non-syndromic Patent Ductus Arteriosus

10.21203/rs.3.rs-142511/v1 ◽

2021 ◽

Author(s):

Ying Gao ◽

Ying Liu ◽

Jiaoyu Li ◽

Yinghui Chen ◽

Qi Zhang ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Exome Sequencing ◽

Candidate Genes ◽

Whole Exome Sequencing ◽

Heart Development ◽

Heart Defects ◽

Ductus Arteriosus ◽

Human Embryos ◽

Whole Exome ◽

Patent Ductus

Abstract Background Patent Ductus Arteriosus (PDA) is one of the most common congenital heart defects that can cause pulmonary hypertension, heart failure, and even death. Prior studies have suggested a role for genetics in determining spontaneous ductal closure, however the clinical characteristics and genetic cause underlying PDA remain unclear. Results Therefore, to further explore genetic etiology of PDA, we applied Whole-exome Sequencing (WES) in 39unrelated isolated, non-syndromic PDApatientsand 100 healthy controls. Through a series of bio-information filtering strategies, the candidate genes are prioritized by comprehensively considering factors such as genefunctional enrichment, expression pattern and mutation burden during heart development. 18 rare damage variants of 6 total novel genes (SOX8, NES, CDH2, ANK3, EIF4G1, HIPK1)were identified for the first time and these pathogenic candidates are also highly expressed in the heart of human embryos. Conclusions WES is an efficient diagnostic tool for identifying PDA related genes. The finding of our study contributes new insights into the molecular basis of PDA and may inform further studies on genetic risk factors for this congenital birth defect.

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