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Seminars in Perinatology Apr 2013A persistent left-to-right shunt through a patent ductus arteriosus (PDA) increases the rate of hydrostatic fluid filtration into the lung's interstitium, impairs... (Review)
Review
A persistent left-to-right shunt through a patent ductus arteriosus (PDA) increases the rate of hydrostatic fluid filtration into the lung's interstitium, impairs pulmonary mechanics, and prolongs the need for mechanical ventilation. In preclinical trials, pharmacologic PDA closure leads to improved alveolarization and minimizes the impaired postnatal alveolar development that is the pathologic hallmark of the "new bronchopulmonary dysplasia (BPD)". Although early pharmacologic closure of the PDA decreases the incidence of pulmonary hemorrhage, intraventricular hemorrhage, and the need for PDA ligation, there is little evidence from controlled, clinical trials to support or refute a causal role for the PDA in the development of BPD. However, evidence from epidemiologic, preclinical, and randomized controlled clinical trials demonstrate that early ductus ligation is an independent risk factor for the development of BPD and may directly contribute to the neonatal morbidities it is trying to prevent.
Topics: Animals; Bronchopulmonary Dysplasia; Cyclooxygenase Inhibitors; Disease Models, Animal; Ductus Arteriosus, Patent; Humans; Ibuprofen; Infant, Newborn; Infant, Premature; Pulmonary Circulation; Respiration, Artificial
PubMed: 23582964
DOI: 10.1053/j.semperi.2013.01.006 -
Congenital Heart Disease Jan 2019Regulation of the ductus arteriosus, an essential fetal vessel connecting the pulmonary artery and aorta, is complex. Failure of this vessel to close after birth may... (Review)
Review
Regulation of the ductus arteriosus, an essential fetal vessel connecting the pulmonary artery and aorta, is complex. Failure of this vessel to close after birth may result in a persistent left-to-right shunt through the patent ductus arteriosus, a condition associated with significant morbidities. Numerous factors contribute to the shift from fetal ductus patency to postnatal closure, requiring precise coordination of molecular cues with biomechanical forces and underlying genetic influences. Despite significant advances, questions remain regarding signaling dynamics and the natural time course of ductus closure, particularly in preterm neonates. This review highlights the contributions of early investigators and more recent clinician scientists to our understanding of the molecular and mechanical factors that mediate ductus patency and closure.
Topics: Cardiac Surgical Procedures; Ductus Arteriosus; Ductus Arteriosus, Patent; Hemodynamics; Humans; Infant, Newborn; Oxidative Stress
PubMed: 30468303
DOI: 10.1111/chd.12714 -
Neonatology 2019The natural history and optimal management of a patent ductus arteriosus (PDA) among infants with established severe bronchopulmonary dysplasia (sBPD) remains uncertain. (Comparative Study)
Comparative Study
BACKGROUND
The natural history and optimal management of a patent ductus arteriosus (PDA) among infants with established severe bronchopulmonary dysplasia (sBPD) remains uncertain.
OBJECTIVES
To describe the characteristics of PDA present at ≥36 weeks' postmenstrual age (PMA) and the effects of late surgical PDA closure in a referral cohort of very preterm infants with sBPD.
STUDY DESIGN
This retrospective cohort study was performed in a tertiary neonatal intensive care unit. Study infants were born at <32 weeks' gestation between 2010 and 2016, diagnosed with sBPD, and had an echocardiographic PDA at ≥36 weeks' PMA. We reviewed echocardiograms performed closest to 3 time points (≥36 weeks' PMA, hospital discharge, and 1 year of age) and assessed clinical outcomes among infants with versus without late PDA treatment.
RESULTS
Among 329 infants with sBPD, 59 had a PDA at ≥36 weeks' PMA. Most PDAs were small (n = 33) and shunted left to right (n = 53). The PDA closed spontaneously prior to discharge in 5 of 21 infants who did not undergo surgical closure and decreased in size in 3. The PDA spontaneously closed by 1 year of age in 6 out of 12 infants with an open duct at discharge. PDA surgery (n = 23) at ≥36 weeks' PMA was not associated with increased risk for the composite outcome of tracheostomy, systemic vasodilator at discharge, or death after adjusting for potential confounders (OR 3.2, 95% CI 0.81-13.0).
CONCLUSIONS
The majority of conservatively treated late PDAs closed spontaneously or decreased in size.PDA surgery was not associated with severe adverse clinical outcomes.
Topics: Bronchopulmonary Dysplasia; Cardiac Surgical Procedures; Conservative Treatment; Ductus Arteriosus, Patent; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Male; Netherlands; Premature Birth; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Time-to-Treatment; Treatment Outcome
PubMed: 31269508
DOI: 10.1159/000500269 -
Annals of Cardiac Anaesthesia 2021
Topics: Cardiomyopathy, Hypertrophic; Ductus Arteriosus, Patent; Humans
PubMed: 34747769
DOI: 10.4103/aca.ACA_53_20 -
Kardiologia Polska 2021
Topics: Abnormalities, Multiple; Aortic Valve; Bicuspid Aortic Valve Disease; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Septal Defects, Atrial; Humans; Lower Extremity Deformities, Congenital; Upper Extremity Deformities, Congenital
PubMed: 34599494
DOI: 10.33963/KP.a2021.0118 -
Pediatrics Apr 2017To examine yearly trends of patent ductus arteriosus (PDA) diagnosis and treatment in very low birth weight infants.
OBJECTIVE
To examine yearly trends of patent ductus arteriosus (PDA) diagnosis and treatment in very low birth weight infants.
METHODS
In this retrospective cohort study of very low birth weight infants (<1500 g) between 2008 and 2014 across 134 California hospitals, we evaluated PDA diagnosis and treatment by year of birth. Infants were either inborn or transferred in within 2 days after delivery and had no congenital abnormalities. Intervention levels for treatment administered to achieve ductal closure were categorized as none, pharmacologic (indomethacin or ibuprofen), both pharmacologic intervention and surgical ligation, or ligation only. Multivariable logistic regression was used to assess risk factors for PDA diagnosis and treatment.
RESULTS
PDA was diagnosed in 42.8% (12 002/28 025) of infants, with a decrease in incidence from 49.2% of 4205 infants born in 2008 to 38.5% of 4001 infants born in 2014. Pharmacologic and/or surgical treatment was given to 30.5% of patients. Between 2008 and 2014, the annual rate of infants who received pharmacologic intervention (30.5% vs 15.7%) or both pharmacologic intervention and surgical ligation (6.9% vs 2.9%) decreased whereas infants who were not treated (60.5% vs 78.3%) or received primary ligation (2.2% vs 3.0%) increased.
CONCLUSIONS
There is an increasing trend toward not treating patients diagnosed with PDA compared with more intensive treatments: pharmacologic intervention or both pharmacologic intervention and surgical ligation. Possible directions for future study include the impact of these trends on hospital-based and long-term outcomes.
Topics: California; Cohort Studies; Cyclooxygenase Inhibitors; Ductus Arteriosus, Patent; Female; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Infant, Very Low Birth Weight; Ligation; Logistic Models; Male; Retrospective Studies
PubMed: 28562302
DOI: 10.1542/peds.2016-2390 -
Medical Ultrasonography Jun 2010Patent ductus arteriosus (PDA) is a congenital disorder in heart, wherein the ductus arteriosus fails to close after birth. This leads to the generation of a...
Patent ductus arteriosus (PDA) is a congenital disorder in heart, wherein the ductus arteriosus fails to close after birth. This leads to the generation of a left-to-right shunt, leading to pulmonary hypertension. Color Doppler echocardiography is essential for the diagnosis. The identification of a diastolic flow oriented in the opposite direction in the pulmonary artery finalizes the diagnosis. We present the case of a 4 year old patient with systolic and diastolic left parasternal lift, echographically diagnosed with patent ductus arteriosus. The typical echographic aspects for this cardiac malformation are thoroughly detailed.
Topics: Child, Preschool; Diagnosis, Differential; Ductus Arteriosus, Patent; Echocardiography; Humans; Male
PubMed: 21173945
DOI: No ID Found -
Archives of Cardiovascular Diseases Mar 2022Transcatheter closure of a patent ductus arteriosus in children is widely performed to reduce symptoms and decrease the risk of endocarditis. Most arterial ducts are... (Observational Study)
Observational Study
BACKGROUND
Transcatheter closure of a patent ductus arteriosus in children is widely performed to reduce symptoms and decrease the risk of endocarditis. Most arterial ducts are closed successfully with dedicated devices. However, in a tubular or "type C" patent ductus arteriosus with congestive heart failure, the occlusion is more challenging with these devices, with a higher risk of complications, such as aortic or left pulmonary stenosis and device embolization.
AIM
To report our experience with muscular ventricular septal defect devices for patent ductus arteriosus occlusion in small children.
METHODS
Retrospective observational series of patients weighing<10kg, with a tubular patent ductus arteriosus (typeC) and congestive heart failure, who underwent transcatheter closure with a muscular ventricular septal defect device between 2017 and 2019.
RESULTS
Eight patients were included. The mean age and weight at closure were 6.3 months (range 1-18 months) and 5.3kg (range 2.4-8.2kg), respectively. All patent ductus arteriosus were occluded successfully using Occlutech® (N=3) or Amplatzer® (N=5) muscular ventricular septal defect devices. In four cases, the muscular ventricular septal defect device was used after failure to close the patent ductus arteriosus with a dedicated patent ductus arteriosus device. Two patients had mild left pulmonary artery stenosis, with a maximum velocity on continuous Doppler of 3m/s and 2.7m/s, respectively. After a mean follow-up of 28 months (range 14-41 months), all patients were asymptomatic with excellent results. The mild pulmonary stenosis improved, with a maximum velocity of 2.3m/s in both patients.
CONCLUSIONS
Closure of tubular patent ductus arteriosus in small children with congestive heart failure using a muscular ventricular septal defect device is safe in this preliminary experience. Further studies with more patients are warranted.
Topics: Cardiac Catheterization; Child; Ductus Arteriosus, Patent; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Pulmonary Valve Stenosis; Retrospective Studies; Septal Occluder Device; Treatment Outcome
PubMed: 35249850
DOI: 10.1016/j.acvd.2022.01.003 -
European Journal of Pediatrics Jun 2022To gain insight in the availability of guidelines, diagnostic criteria, and treatment strategies and whether clinical equipoise regarding optimal treatment for patent...
To gain insight in the availability of guidelines, diagnostic criteria, and treatment strategies and whether clinical equipoise regarding optimal treatment for patent ductus arteriosus (PDA) in prematurity is present. We hypothesized that (co-)authors of PDA-related papers were more likely to screen for a PDA and would treat earlier and more aggressively. An international internet-based survey between September 2019 and March 2020 in which we collected (1) baseline characteristics; (2) availability of guidelines; (3) screening strategy for PDA; (4) diagnostic criteria for hemodynamic significance; (5) treatment strategy; and (6) metrics of treatment efficacy. Finally, ten clinical equipoise statements were posed on a Likert scale. In total, 144 surveys were sent, of which 71/144 (49%) surveys could be analyzed with 56/71 (79%) fully completed surveys. The respondents, mainly neonatologists in a level III neonatal intensive care unit, of whom 36/71 (51%) had (co-)authored a publication on the PDA, highlighted a lack of national guidelines, heterogeneous approach to screening strategies, and marked variability in diagnostic criteria to assess hemodynamic significance, treatment strategies and effect measurement. No major significant differences were observed between respondents who did or did not (co-)author a publication on the PDA. Respondents who screened for PDA scored significantly higher on the need for screening, early and aggressive treatment. Remarkably, the scores of all statements regarding clinical equipoise varied widely. Conclusions: Our survey highlights the lack of guidelines and enormous heterogeneity in current practice. Current evidence is not robust enough to harmonize current treatment strategies into (inter)national guidelines. What is Known: • Patent ductus arteriosus (PDA) incidence is inversely related to gestational age. • Although early pharmacological treatment induces PDA closure, optimal treatment is debated due to the lack of beneficial effects on outcome. What is New: • In the absence of (inter)national guidelines, diagnostic and treatment strategies are heterogeneous and contradictory, even in a selected hemodynamically- interested group. • Different PDA screening strategies did, while PDA publication status did not, show significant differences in treatment strategy and responses to equipoise statements.
Topics: Consensus; Ductus Arteriosus, Patent; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Infant, Premature; Surveys and Questionnaires
PubMed: 35305143
DOI: 10.1007/s00431-022-04441-8 -
BMC Pediatrics Sep 2019Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term...
BACKGROUND
Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm.
METHODS
Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort.
DISCUSSION
The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in "high-risk" infants most likely to receive benefit.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03782610. Registered 20 December 2018.
Topics: Biomarkers; Data Collection; Ductus Arteriosus, Patent; Echocardiography, Doppler; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Neurodevelopmental Disorders; Outcome Assessment, Health Care; Patient Selection; Prospective Studies; Remission, Spontaneous; Respiration Disorders; Severity of Illness Index; Time Factors; United States
PubMed: 31519154
DOI: 10.1186/s12887-019-1708-z