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Cardiology in the Young Jan 2024
Topics: Child; Female; Humans; Adolescent; Infant; Cardiac Catheterization; Treatment Outcome; Premature Birth; Ductus Arteriosus, Patent; Septal Occluder Device
PubMed: 37350355
DOI: 10.1017/S1047951123001749 -
World Journal For Pediatric &... Jul 2018The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities.... (Observational Study)
Observational Study
OBJECTIVE
The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as "rescue" therapy. The objective of this study was to review our institutions' outcomes of surgical PDA ligation.
METHODS
All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality.
RESULTS
One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively.
CONCLUSION
In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.
Topics: Ductus Arteriosus, Patent; Female; Follow-Up Studies; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Ligation; Male; Retrospective Studies; Treatment Outcome
PubMed: 29945507
DOI: 10.1177/2150135118766454 -
Congenital Heart Disease Jan 2019Clinically significant patent ductus arteriosus (PDA) has been associated with significant morbidity in extremely low birth weight (ELBW) infants. Current management of... (Review)
Review
Clinically significant patent ductus arteriosus (PDA) has been associated with significant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a comprehensive review of this emerging procedure.
Topics: Cardiac Catheterization; Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Septal Occluder Device
PubMed: 30811790
DOI: 10.1111/chd.12712 -
Journal of Perinatology : Official... Nov 2019The optimal management approach of the patent ductus arteriosus (PDA) in premature infants remains uncertain owing the lack of evidence for long-term benefits and the... (Review)
Review
The optimal management approach of the patent ductus arteriosus (PDA) in premature infants remains uncertain owing the lack of evidence for long-term benefits and the limited analyses of the complications of medical and surgical interventions to date. In recent years, devices suitable to plug the PDA of premature infants (including extremely low birthweight, <1000 g) have become available and several trials have demonstrated successful and safe transcatheter PDA closure (TCPC) in this population. Whether TCPC represents a paradigm shift in PDA management that will result in improved short- and long-term outcomes, less bronchopulmonary dysplasia, improved neurodevelopment, or better long term renal function remains to be seen. Careful rigorous study of the potential benefits of TCPC in this highly vulnerable population in the context of well-designed adequately powered trials is needed prior to widespread adoption of this approach.
Topics: Cardiac Catheterization; Disease Management; Ductus Arteriosus, Patent; Echocardiography; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Ligation; Septal Occluder Device
PubMed: 31562396
DOI: 10.1038/s41372-019-0506-7 -
American Journal of Perinatology Jul 2017Patent ductus arteriosus (PDA) is a common complication of prematurity and a risk factor for poor outcome. Infants undergoing surgical PDA ligation are at highest... (Observational Study)
Observational Study
Patent ductus arteriosus (PDA) is a common complication of prematurity and a risk factor for poor outcome. Infants undergoing surgical PDA ligation are at highest risk for neurodevelopmental injury. Autonomic dysfunction has been described in premature infants with PDA. To interrogate the autonomic nervous system by analysis of advanced heart rate variability (HRV) metrics before and after surgical closure of the PDA. Prospective, observational study. Twenty-seven infants born before 28 weeks' gestation were included in this study. Continuous electrocardiogram data were sampled at a rate of 125 Hz for a total of 6 hours before and 6 hours after 30 hours of surgical closure. HRV was determined by detrended fluctuation analysis to calculate the short and long root mean square (RMS and RMS) and α components at two time scales (long and short). Gestational age (GA) was positively associated with RMS, RMS, and α and was negatively associated with α. There was no difference between RMS, RMS, α, or α before and after surgery; however, median heart rate was lower after surgery ( < 0.01). Advancing GA is highly associated with increasing HRV; however, surgical ligation does not affect HRV in the postoperative period.
Topics: Autonomic Nervous System; Ductus Arteriosus, Patent; Echocardiography; Electrocardiography; Female; Gestational Age; Heart Rate; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Ligation; Male; Prospective Studies
PubMed: 28282664
DOI: 10.1055/s-0037-1600127 -
Fetal and Pediatric Pathology 2006Exposure of the fetus to indomethacin by administration of the drug to the mother may cause many side effects, including premature closure of the ductus arteriosus....
Exposure of the fetus to indomethacin by administration of the drug to the mother may cause many side effects, including premature closure of the ductus arteriosus. Hypoxia is a predisposing factor for premature ductal closure and often occurs after maternal indomethacin therapy. We present two sets of monozygotic twins with twin-to-twin transfusion, where in utero ductal closure occurred in the donor twin while the recipient twin appeared unaffected. This selective closure of the ductus arteriosus suggests that the affected twin was predisposed to hypoxia and thus was more susceptible to ductal closure in response to indomethacin exposure.
Topics: Adult; Congenital Abnormalities; Ductus Arteriosus; Fatal Outcome; Female; Fetofetal Transfusion; Genetic Predisposition to Disease; Humans; Hypoxia; Indomethacin; Infant, Newborn; Polyhydramnios; Pregnancy; Premature Birth; Tocolytic Agents; Twins, Monozygotic
PubMed: 17060191
DOI: 10.1080/15513810600908354 -
Pediatric Cardiology Aug 2021Transcatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed... (Review)
Review
Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants.
Transcatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed with an implant success rate of 97%. Major procedural complications related to transcatheter PDA closure in extremely low birth weight (ELBW) infants are relatively infrequent (< 3%) ,but may be associated with a fatality if not optimally managed. Operators performing transcatheter PDA closures should be knowledgeable about these potential complications and management options. Prompt recognition and treatment are often necessary to avoid serious consequences. With strict guidelines on operator training, proctoring requirements, and technical refinements, transcatheter PDA closure in ELBW infants can be performed safely with low complication rates. This article summarizes the consensus guidelines put forward by a panel of physicians for the prevention and management of periprocedural complications of transcatheter PDA closure with the Amplatzer Piccolo Occluder in ELBW infants.
Topics: Consensus; Ductus Arteriosus, Patent; Humans; Infant; Infant, Extremely Low Birth Weight; Postoperative Complications; Practice Guidelines as Topic; Septal Occluder Device
PubMed: 34195869
DOI: 10.1007/s00246-021-02665-3 -
Journal of Comparative Pathology May 1997Hypervitaminosis A and D is a potential cause of "hyena disease" in cattle, which results from premature growth-plate closure in long bones of calves. This study showed...
Hypervitaminosis A and D is a potential cause of "hyena disease" in cattle, which results from premature growth-plate closure in long bones of calves. This study showed that vitamin A induced growth-plate closure if calves were given an intramuscular injection of vitamins A and D (2,000,000 IU and 300,000 IU, respectively) on the first day after birth and, in addition, vitamin A (30,000 IU/kg body weight) in a water dispersible form was added to the milk substitute daily. Gross lesions were observed in the proximal tibial growth plates of each of seven calves after 3 weeks of vitamin-A treatment. Microscopical examination showed commencing premature growth-plate closure in the proximal tibia at 2 weeks. After one week, the growth plate showed focal thinning, and there was premature endochondral ossification of columnar cartilage. Longitudinal bone growth was dramatically reduced before growth plate closure at one week (25 microns/day in a treated animal versus 136 microns/day in a control). Liver concentrations of retinol and retinyl palmitate became strikingly elevated at on week, and thereafter increased slowly until the third week. Elevation of plasma retinol and retinyl palmitate was rapid, reaching a maximum on day 10. Plasma all-trans-retinoic acid was undetectable in many samples from treated animals, but plasma concentrations of derivatives of retinoic acid (9-cis-retinoic acid, 13-cis-retinoic acid, 13-cis-4-oxoretinoic acid, and 9, 13 dicis-retinoic acid) were elevated. The vitamin-A intake required to induce growth-plate closure in calves was found to be exceedingly high. Vitamin-A toxicity must be considered as a potential cause of hyena disease, but it would seem likely that other factors also play a role.
Topics: Animals; Bone Diseases, Developmental; Cattle; Cattle Diseases; Growth Plate; Hypervitaminosis A; Injections, Intramuscular; Liver; Male; Tibia; Vitamin A; Vitamin D
PubMed: 9179748
DOI: 10.1016/s0021-9975(97)80052-7 -
AJR. American Journal of Roentgenology Jan 1999Our objective was to use gray-scale, color-flow, and duplex Doppler sonography to study the anatomy, flow pattern, and time of closure of the ductus venosus in healthy...
OBJECTIVE
Our objective was to use gray-scale, color-flow, and duplex Doppler sonography to study the anatomy, flow pattern, and time of closure of the ductus venosus in healthy premature infants.
SUBJECTS AND METHODS
We prospectively examined the ductus venosus in 130 premature infants whom we divided into two groups: Group I comprised 27 neonates of gestational age 28-32 weeks, and group II comprised 103 neonates of gestational age 33-36 weeks. Neonates who had undergone umbilical vessel manipulation were excluded from the study. All examinations included gray-scale, color-flow, and duplex Doppler sonography. Patency, length, color flow, and Doppler characteristics of the ductus venosus were recorded. Neonates were examined 1-2 days after birth, 6-7 days after birth, and subsequently every 3-4 days until ductus closure was observed. The time of closure of the ductus for the two groups was compared using the chi-square test.
RESULTS
The ductus venosus was patent during the initial examination in 128 of the 130 neonates. Doppler waveform was venous with little variation in velocity. Ductus length slightly exceeded 1 cm in both groups. We found a statistically significant difference in the percentage of infants having a patent ductus venosus after the initial examination: At 1 week after birth, ductus patency was shown in 85% of the infants in group I and in 56% of the infants in group II; at 2 weeks, the respective percentages were 42% and 14%; and at 3 weeks, 27% and 0%.
CONCLUSION
The ductus venosus is patent 1-2 days after birth in virtually all premature infants. From 6 days after birth and onward, a significantly greater percentage of smaller premature infants (i.e., 28-32 weeks' gestational age) have a patent ductus venosus than do larger premature infants (i.e., 33-36 weeks' gestational age).
Topics: Blood Flow Velocity; Fetus; Humans; Infant, Newborn; Infant, Premature; Prospective Studies; Time Factors; Ultrasonography, Doppler; Umbilical Veins; Vascular Patency
PubMed: 9888772
DOI: 10.2214/ajr.172.1.9888772 -
The Annals of Thoracic Surgery Mar 1995During a 30-month period, 34 premature infants underwent surgical closure of a patent ductus arteriosus. The mean gestational age at birth was 25 +/- 0.3 weeks and the... (Clinical Trial)
Clinical Trial
During a 30-month period, 34 premature infants underwent surgical closure of a patent ductus arteriosus. The mean gestational age at birth was 25 +/- 0.3 weeks and the mean age at the time of operation was 3 +/- 0.3 weeks (mean weight, 829 +/- 54 g). Indomethacin therapy had failed in 32 patients, and 2 had contraindications to its use. The initial 8 patients had parascapular incision and ligation of the patent ductus arteriosus; the last 26 patients had a short transaxillary incision and clipping. The average duration of the operation from the time of incision to skin closure was 36 +/- 2 minutes (range, 15 to 65 minutes). One patient (3%) needed chest tube insertion intraoperatively because of visceral pleura disruption. Two patients (5.8%) had a "small pneumothorax" (< 10% of the lung field) that resolved within 24 hours. There was no morbidity or mortality directly related to the operative procedure, although 3 patients (8.8%) ultimately died from problems related to their severe prematurity. We conclude that surgical closure of patent ductus arteriosus without chest tube drainage can be accomplished safely in premature infants. Postoperative nursing care is simplified and the cost is reduced because the need for the chest tube and drainage system is eliminated and the number of chest radiograms needed postoperatively is reduced.
Topics: Blood Loss, Surgical; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Ligation; Male; Postoperative Complications; Surgical Procedures, Operative; Time Factors; Treatment Outcome
PubMed: 7887709
DOI: 10.1016/0003-4975(94)00996-1