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Developmental Dynamics : An Official... Mar 2022The ductus arteriosus (DA) is a unique fetal vascular shunt, which allows blood to bypass the developing lungs in utero. After birth, changes in complex signaling... (Review)
Review
The ductus arteriosus (DA) is a unique fetal vascular shunt, which allows blood to bypass the developing lungs in utero. After birth, changes in complex signaling pathways lead to constriction and permanent closure of the DA. The persistent patency of the DA (PDA) is a common disorder in preterm infants, yet the underlying causes of PDA are not fully defined. Although limits on the availability of human DA tissues prevent comprehensive studies on the mechanisms of DA function, mouse models have been developed that reveal critical pathways in DA regulation. Over 20 different transgenic models of PDA in mice have been described, with implications for human DA biology. Similarly, we enumerate 224 human single-gene syndromes that are associated with PDA, including a small subset that consistently feature PDA as a prominent phenotype. Comparison and functional analyses of these genes provide insight into DA development and identify key regulatory pathways that may serve as potential therapeutic targets for the management of PDA.
Topics: Animals; Disease Models, Animal; Ductus Arteriosus; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature; Mice
PubMed: 34350653
DOI: 10.1002/dvdy.408 -
Texas Heart Institute Journal Nov 2022Patent ductus arteriosus is a common cardiac anomaly in infants that, if untreated, is associated with high morbidity and mortality rates. In lower-middle-income...
BACKGROUND
Patent ductus arteriosus is a common cardiac anomaly in infants that, if untreated, is associated with high morbidity and mortality rates. In lower-middle-income countries, such as Nigeria, obtaining cardiovascular surgical care for infants remains difficult. In recent years, especially with the assistance of international voluntary cardiac organizations, efforts have increased to provide cardiac surgical services to this underserved population.
METHODS
In this case series, the authors describe outcomes in 30 infants surgically treated for patent ductus arteriosus between 2013 and 2019 at an emerging cardiac center in Nigeria (9 male [30%] and 21 female [70%]; mean [SD] age, 8.2 [3.01] months; mean [SD] weight, 5.3 [1.52] kg; mean [range] weight deficit, 34.5% [15%-60%]).
RESULTS
All the infants presented with patent ductus arteriosus as the main cardiac lesion, and 4 (13%) were syndromic. The mean (SD) patent ductus arteriosus diameter was 4.73 (1.46) mm. Surgical closure was completed in 29 infants; 1 died before surgery. No procedure-related deaths occurred, but 2 cases of trivial residual patent ductus arteriosus were recorded.
CONCLUSION
Overall, surgical outcomes were excellent, with acceptable mortality rates. Perioperative care will continue to improve as the center is built to a self-sustaining capacity. Findings of this research at this emerging cardiac center in a developing country are a testament to the positive contribution made by international voluntary cardiac missions.
Topics: Infant, Newborn; Infant; Male; Female; Humans; Child; Ductus Arteriosus, Patent; Infant, Premature; Nigeria; Cardiac Surgical Procedures; Treatment Outcome
PubMed: 36511942
DOI: 10.14503/THIJ-21-7633 -
Seminars in Perinatology Mar 2023
Topics: Humans; Infant, Newborn; Ductus Arteriosus, Patent; Indomethacin; Infant, Premature
PubMed: 36894375
DOI: 10.1016/j.semperi.2023.151723 -
Neonatology 2023Milrinone is administered after patent ductus arteriosus (PDA) ligation to prevent and treat postoperative hemodynamic instability (i.e., postligation cardiac syndrome)....
INTRODUCTION
Milrinone is administered after patent ductus arteriosus (PDA) ligation to prevent and treat postoperative hemodynamic instability (i.e., postligation cardiac syndrome). We aimed to explore the effectiveness of milrinone on in-hospital outcomes in infants who underwent PDA ligation using a nationwide inpatient database in Japan.
METHODS
Using the Japanese Diagnosis Procedure Combination database, we identified patients who received milrinone after PDA ligation (n = 428) in neonatal intensive care units between July 2010 and March 2021 and those who did not (n = 3,392). We conducted a 1:4 propensity score-matched analysis with adjustment for background characteristics (e.g., gestational age, birth weight, comorbidities, preoperative treatments, and hospital background) to compare morbidities (bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity), mortality, total hospitalization costs, and other outcomes. For sensitivity analysis, we performed an overlap propensity score-weighted analysis.
RESULTS
In-hospital morbidity, bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis occurred in 58%, 48%, 9.5%, and 7.1% of patients, respectively; the in-hospital mortality was 5.4%. After 1:4 propensity score matching, no significant difference was observed regarding mortality (7.1 vs. 5.7%), in-hospital morbidity (55 vs. 50%), bronchopulmonary dysplasia (44 vs. 41%), intraventricular hemorrhage (7.8 vs. 9.1%), necrotizing enterocolitis (8.5 vs. 8.9%), retinopathy of prematurity (21 vs. 22%), or total hospitalization costs (median: approximately 86,000 vs. 82,000 US dollars) between milrinone users (n = 425) and nonusers (n = 1,698). Sensitivity analyses yielded consistent results.
CONCLUSIONS
Milrinone use after PDA ligation was not associated with improved in-hospital outcomes, such as mortality and morbidity.
Topics: Infant; Infant, Newborn; Humans; Ductus Arteriosus, Patent; Milrinone; Retrospective Studies; Enterocolitis, Necrotizing; Bronchopulmonary Dysplasia; Retinopathy of Prematurity; Infant, Premature; Cerebral Hemorrhage; Ligation
PubMed: 37757762
DOI: 10.1159/000533958 -
Respiratory Care May 2022A persistent patent ductus arteriosus (PDA) can have significant clinical consequences in preterm infants, depending on the degree of left-to-right shunting, its impact... (Review)
Review
A persistent patent ductus arteriosus (PDA) can have significant clinical consequences in preterm infants, depending on the degree of left-to-right shunting, its impact on cardiac performance, and associated perinatal risk factors that can mitigate or exacerbate the shunt. Although the best management strategy remains contentious, PDAs that have contraindications to, or have failed medical management have historically undergone surgical ligation. Recently smaller occluder devices and delivery systems have allowed for minimally invasive closure in the catheterization laboratory even in extremely premature infants. The present review summarizes the pathophysiologic manifestations, treatment options and management of hemodynamically significant PDA in preterm infants. Additionally, we review the available literature surrounding the respiratory support and outcomes of preterm infants following definitive PDA closure.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Risk Factors
PubMed: 35473850
DOI: 10.4187/respcare.09489 -
Seminars in Perinatology Jun 2018Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids'... (Review)
Review
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.
Topics: Cerebral Intraventricular Hemorrhage; Cross-Sectional Studies; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Female; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Very Low Birth Weight; Ligation; Male; Practice Patterns, Physicians'; Retrospective Studies; Treatment Outcome; United States; Vocal Cord Paralysis
PubMed: 29954594
DOI: 10.1053/j.semperi.2018.05.008 -
Pediatric Research Jul 2018In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but... (Review)
Review
In many preterm infants, the ductus arteriosus remains patent beyond the first few days of life. This prolonged patency is associated with numerous adverse outcomes, but the extent to which these adverse outcomes are attributable to the hemodynamic consequences of ductal patency, if at all, has not been established. Different treatment strategies have failed to improve short-term outcomes, with a paucity of data on the correct diagnostic and pathophysiological assessment of the patent ductus arteriosus (PDA) in association with long-term outcomes. Echocardiography is the selected method of choice for detecting a PDA, assessing the impact on the preterm circulation and monitoring treatment response. PDA in a preterm infant can result in pulmonary overcirculation and systemic hypoperfusion, Therefore, echocardiographic assessment should include evaluation of PDA characteristics, indices of pulmonary overcirculation with left heart loading conditions, and indices of systemic hypoperfusion. In this review, we provide an evidence-based overview of the current and emerging ultrasound measurements available to identify and monitor a PDA in the preterm infant. We offer indications and limitations for using Neonatologist Performed Echocardiography to optimize the management of a neonate with a PDA.
Topics: Arrhythmias, Cardiac; Cardiomyopathies; Ductus Arteriosus; Ductus Arteriosus, Patent; Echocardiography; Hemodynamics; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Myocarditis; Neonatologists; Neonatology; Persistent Fetal Circulation Syndrome; Phenotype; Prognosis; Risk
PubMed: 30072803
DOI: 10.1038/s41390-018-0077-x -
European Journal of Pediatrics Mar 2022Monitoring patent ductus arteriosus (PDA) in premature infants is currently performed intermittently using echocardiography which requires considerable expertise. The...
Monitoring patent ductus arteriosus (PDA) in premature infants is currently performed intermittently using echocardiography which requires considerable expertise. The aim of this pilot study was to investigate whether PDA status could be assessed from standard neonatal intensive care monitoring. Electrocardiography (ECG) and blood pressure (BP) waveforms were acquired from extremely preterm infants using standard neonatal monitors. We developed software using MATLAB to analyse ECG and BP waveforms and their interrelationships in terms of pulse transit time (PTT) and pulse wave velocity (PWV). The times from peak systolic BP to diastolic trough (BPFt) and from the diastolic trough to peak systolic BP (BPRt) were also calculated. PTT, BPFt and BPRt were normalised for heart rate (HR) termed NPTT, NBPFt and NBPRt, respectively. ECG, invasive aortic BP monitoring and echocardiography were performed in 14 preterm infants < 29 weeks' gestation in the first 3 days after birth. The median (range) birth weight of the infants was 0.90 (0.48-1.31) kg, gestation 26.6 (24.0-28.7) weeks, PDA diameter 1.6 (0.8-3.6) mm and mean BP 32 (16-40) mmHg. We found a significant positive correlation between PDA diameter and NPTT (r = 0.69, P = 0.007) as well as NBPFt (r = 0.65, P = 0.012) and NBPRt (r = 0.71, P = 0.005). No relationship was found between PDA diameter and pulse pressure.Conclusions: Interrelationships between ECG and BP traces as well as BP waveform time analysis are straightforward to measure and associated with PDA diameter. The results of this pilot study suggest that this approach may help provide biomarkers for continuous monitoring PDA diameter and function. What is Known: • Patent ductus arteriosus (PDA) in premature infants is associated with increased risk of developing chronic lung disease, necrotising enterocolitis and cerebral injury. • Currently PDA is assessed intermittently using echocardiography which requires considerable expertise and sometimes is not well tolerated by critically ill preterm infants. What is New: • Blood pressure (BP) and ECG waveform interrelation and BP trace time analysis, taking account of heart rate, relate to PDA diameter. • ECG and BP waveform phase difference as well as BP waveform time analysis may be useful in the continuous assessment of PDA function.
Topics: Ductus Arteriosus, Patent; Humans; Ibuprofen; Infant; Infant, Extremely Premature; Infant, Newborn; Intensive Care, Neonatal; Pilot Projects; Pulse Wave Analysis
PubMed: 34748081
DOI: 10.1007/s00431-021-04311-9 -
La Tunisie MedicaleDespite the operational experience in the percutaneous closure of Patent ductus arteriosus (PDA), complications can arise during the procedure. To overcome these...
UNLABELLED
Despite the operational experience in the percutaneous closure of Patent ductus arteriosus (PDA), complications can arise during the procedure. To overcome these complications the choice of the device must be adapted to each patient.
AIM
To report the experience of the cardiology department in the transcatheter device closure of PDA and to determine the influencing factors of choice of the device.
METHODS
Our study included patients with patent ductus arteriosus that are admitted for transcatheter closure, between September 2003 and June 2016.
RESULT
One hundred and fifty-three patients were included in our study. Transcatheter closure was not done in 9 cases. The transcatheter closure was successful in 140 patients. The complications were observed in 11 patients that includes device embolization in 3 cases, aortic protrusion in four cases pulmonary protrusion in three cases and inguinal hematoma in one another. Three predictive factors of complications were: age < 2 years, tubular PDA type C and ratio duct diameter/weight > 0.95. A mild residual shunt was observed at the end of the procedure in 22.85 % of the patients. The risk of residual shunt was significantly increased when the age < 2 years, the large PDA, the presence of pulmonary hypertension and the tubular C PDA.
CONCLUSION
The choice of the device depends essentially on age, the weight and the duct anatomy.
Topics: Cardiac Catheterization; Catheters; Child, Preschool; Ductus Arteriosus, Patent; Humans; Treatment Outcome
PubMed: 35288912
DOI: No ID Found -
The Journal of Thoracic and... Aug 2016
Topics: Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature; Ligation; Persistent Fetal Circulation Syndrome
PubMed: 27157919
DOI: 10.1016/j.jtcvs.2016.04.013