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Drugs May 2012Persistent patency of the ductus arteriosus is a major cause of morbidity and mortality in premature infants. In infants born prior to 28 weeks of gestation, a...
Persistent patency of the ductus arteriosus is a major cause of morbidity and mortality in premature infants. In infants born prior to 28 weeks of gestation, a haemodynamically significant patent ductus arteriosus (PDA) can cause cardiovascular instability, exacerbate respiratory distress syndrome, prolong the need for assisted ventilation and increase the risk of bronchopulmonary dysplasia, intraventricular haemorrhage, renal dysfunction, cerebral palsy and mortality. We review the pathophysiology, clinical features and assessment of haemodynamic significance, and provide a rigorous appraisal of the quality of evidence to support current medical and surgical management of PDA of prematurity. Cyclo-oxygenase inhibitors such as indomethacin and ibuprofen remain the mainstay of medical therapy for PDA, and can be used both for prophylaxis as well as for rescue therapy to achieve PDA closure. Surgical ligation is also effective and is used in infants who do not respond to medical management. Although both medical and surgical treatment have proven efficacy in closing the ductus, both modalities are associated with significant adverse effects. Because the ductus does undergo spontaneous closure in some premature infants, improved and early identification of infants most likely to develop a symptomatic PDA could help in directing treatment to the at-risk infants and allow others to receive expectant management.
Topics: Cyclooxygenase Inhibitors; Ductus Arteriosus, Patent; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Infant, Premature; Ligation; Risk Factors
PubMed: 22564132
DOI: 10.2165/11632870-000000000-00000 -
Italian Journal of Pediatrics Aug 2019Our aim in this study was to evaluate whether very low birth weight infants (VLBWI) ligated for patent ductus arteriosus (PDA) were associated with worse...
BACKGROUND
Our aim in this study was to evaluate whether very low birth weight infants (VLBWI) ligated for patent ductus arteriosus (PDA) were associated with worse neurodevelopmental outcomes at corrected 2 years. The ligated group was subdivided into ≤2 weeks of life (early) and ligated > 2 weeks of life (late) groups and compared the in-hospital morbidities and long term outcomes.
METHODS
Between Dec 2013 and Dec 2015, VLBWI diagnosed with hs PDA were evaluated.
RESULTS
Of the 191 VLBW infants with hs PDA, 28 (14.7%) infants had surgical ligation for PDA; 11 (39%) infants had EL and 17 (61%) infants had LL. Surgical ligation of hs PDA group had higher morbidities and mortality. Among the142 (83.0%) infants of 171 VLBWI with PDA survived, infants who were ligated had significantly lower scores of Bayley Scales of Infant and Toddler Development III at corrected age of 18 months. However, among the ligated group, there was little evidence of differences between the EL and LL groups. In a multivariable logistic regression analysis, only longer exposure of hs PDA and mechanical ventilation were consistently associated with worse neurodevelopmental outcomes.
CONCLUSION
Our results suggest that surgical ligation for hs PDA may not increase risk for poor neurodevelopmental outcomes at corrected 2 years of age. The early surgical ligation may not be a risk factor.
Topics: Age Factors; Child, Preschool; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant, Newborn; Infant, Very Low Birth Weight; Ligation; Logistic Models; Male; Neurodevelopmental Disorders; Risk Factors; Survival Rate; Treatment Outcome
PubMed: 31443661
DOI: 10.1186/s13052-019-0698-7 -
Proceedings of the Royal Society of... Oct 1952
Topics: Ductus Arteriosus; Ductus Arteriosus, Patent; Humans
PubMed: 13003982
DOI: No ID Found -
Computational and Mathematical Methods... 2022This study was to investigate the value of echocardiographic data in assessing changes in cardiac function before and after transcatheter closure in children and adult...
This study was to investigate the value of echocardiographic data in assessing changes in cardiac function before and after transcatheter closure in children and adult patients with patent ductus arteriosus (PDA). In this study, 150 patients with isolated PDA treated by cardiac catheterization and transcatheter closure were selected as the study sample. Real-time color Doppler echocardiography was used both after and after operation. The results showed that the left ventricle returned to normal in 75 patients one day after operation, with an average age of 10.95 ± 3.27 years; the left ventricle did not return to normal in 10 patients 360 days after operation, with an average age of 64.31 ± 7.05 years. Left ventricular end diastolic volume index (LVEDVI) and left ventricular end systolic volume index (LVESVI) of patients decreased significantly one day after operation and remained at 51.95 ± 9.55 mL/m and 20.36 ± 8.11 mL/m, respectively. In summary, echocardiographic data have a high reference value in assessing cardiac function characteristics in children and adult patients with PDA and are worthy of further promotion.
Topics: Adolescent; Adult; Aged; Cardiovascular Physiological Phenomena; Child; Computational Biology; Ductus Arteriosus, Patent; Echocardiography; Echocardiography, Doppler, Color; Female; Heart Function Tests; Heart Murmurs; Humans; Male; Middle Aged; Vascular Closure Devices; Ventricular Function, Left; Young Adult
PubMed: 35126616
DOI: 10.1155/2022/1310841 -
Clinical Cardiology Sep 2013Widespread use of echocardiography has made earlier diagnosis of patent ductus arteriosus (PDA) possible, but pharmacological or surgical intervention is highly...
BACKGROUND
Widespread use of echocardiography has made earlier diagnosis of patent ductus arteriosus (PDA) possible, but pharmacological or surgical intervention is highly variable. Herein, we investigate the prevalence of PDA and its management in a routine care system.
METHODS
A 15-year retrospective dataset (1996-2010) was analyzed. Selection criteria included age ≤17 years, enrollees in South Carolina State Medicaid, and diagnosed as having PDA on 1 or more service visits to a pediatrician or pediatric cardiologist.
RESULTS
The 15-year treated prevalence rate of PDA was 0.25/1000 pediatric cases of congenital heart disease (CHD). PDA was more prevalent in non-African American patients (adjusted odds ratio [aOR]: 1.12), but not in females after controlling for all other CHDs diagnosed in the cohort. Associated CHDs were present in 57.6% of the cases, primarily atrial or ventricular septal defects, and fewer patients (5.5%) developed pulmonary hypertension. Of 3627 PDA cases examined, 70.0% received no medications or PDA repair. Therapeutic ibuprofen was used for closure in 24.4% of the cases, and a PDA repair was performed in 7.8%. Younger children (aOR: 0.82), those who received an atrial septal defect closure (aOR: 5.18), and those who were treated with digoxin (aOR: 1.86) or with diuretics or preload/afterload reducing agents (ie, calcium channel blockers or angiotensin-converting enzyme inhibitors) (aOR: 5.72) were significantly more likely to have a PDA repair procedure.
CONCLUSIONS
The majority of diagnosed PDA cases did not require pharmacological or surgical intervention. Those receiving pharmacological or surgical intervention were treated conservatively in relation to the presence of distress symptoms or concomitant CHDs requiring intervention.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Cardiac Surgical Procedures; Ductus Arteriosus, Patent; Echocardiography; Female; Follow-Up Studies; Humans; Ibuprofen; Infant; Male; Medicaid; Prevalence; Retrospective Studies; Time Factors; United States
PubMed: 23720302
DOI: 10.1002/clc.22150 -
Seminars in Perinatology Apr 2012Although a moderate-sized patent ductus arteriosus (PDA) needs to be closed by the time a child is 1-2 years old, there is great uncertainty about whether it needs to be... (Review)
Review
Although a moderate-sized patent ductus arteriosus (PDA) needs to be closed by the time a child is 1-2 years old, there is great uncertainty about whether it needs to be closed during the neonatal period. Although 95% of neonatologists believe that a moderate-sized PDA should be closed if it persists in infants (born before 28 weeks) who still require mechanical ventilation, the number of neonatologists who treat a PDA when it occurs in infants who do not require mechanical ventilation varies widely. Both the high likelihood of spontaneous ductus closure and the absence of randomized controlled trials, specifically addressing the risks and benefits of neonatal ductus closure, add to the current uncertainty. New information suggests that early pharmacologic treatment has several important short-term benefits for the preterm newborn. By contrast, ductus ligation, while eliminating the detrimental effects of a PDA on lung development, may create its own set of morbidities that counteract many of the benefits derived from ductus closure.
Topics: Cardiovascular Agents; Ductus Arteriosus, Patent; Female; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ligation; Male; Pregnancy; Respiration, Artificial; Unnecessary Procedures
PubMed: 22414883
DOI: 10.1053/j.semperi.2011.09.022 -
Pediatrics and Neonatology Jul 2021Identifying preterm infants with a higher likelihood of spontaneous patent ductus arteriosus (PDA) closure would be desirable. This study aimed to examine daily PDA...
BACKGROUND
Identifying preterm infants with a higher likelihood of spontaneous patent ductus arteriosus (PDA) closure would be desirable. This study aimed to examine daily PDA status during the first week of life for very low birthweight (VLBW, <1500 g) preterm infants and to develop a scoring system to predict spontaneous PDA closure.
METHODS
We enrolled VLBW infants admitted between January 2016 and January 2017 and performed daily echocardiographic screening for PDA existence. Oxygen index (OI, mean airway pressure × fraction of inspired oxygen/partial pressure of arterial oxygen) was applied to represent the respiratory condition.
RESULTS
A total of 215 VLBW infants were enrolled, and the accumulative incidence of spontaneous PDA closure by age 1 week was 80%, 70%, and 34% for infants born of gestational age (GA) ≥30, 28-29, and ≤27 weeks, respectively. Of these 215 infants, 184 infants entered the second phase to establish the scoring system. Infants with spontaneous PDA closure were more mature (GA 29.2 ± 2.3 vs. 26.9 ± 2.3 weeks, p < 0.001), had lower OI (2.8 ± 2.2 vs. 5.6 ± 5.3, p < 0.001) and were less likely to need endotracheal intubation (23% vs. 68%, p < 0.001). Using the receiver operating characteristics curve, OI <2.5 was determined favoring higher PDA closure incidence. The score was calculated based on the odds ratio generated in multiple regression: 4, 3 and 1 points for GA ≥30, 28-29 and ≤27 weeks, 2 and 1 points for OI <2.5 and ≥2.5, and 3 and 1 points for without and with endotracheal intubation. Using score ≥6 to predict PDA closure, the sensitivity and specificity were 0.77 and 0.72.
CONCLUSION
A score made up of GA, OI and need for intubation was proposed to predict spontaneous PDA closure by age 1 week, which could be helpful to clinicians in the management of PDA in preterm infants.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Persistent Fetal Circulation Syndrome; Protective Factors
PubMed: 33931344
DOI: 10.1016/j.pedneo.2021.03.014 -
Colombia Medica (Cali, Colombia) 2015An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique...
An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.
Topics: Adult; Anemia, Hemolytic; Anti-Bacterial Agents; Blood Sedimentation; Ductus Arteriosus, Patent; Echocardiography; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Treatment Outcome
PubMed: 26309344
DOI: No ID Found -
Medical Science Monitor : International... Dec 2014Hemodynamically significant patent ductus arteriosus (hsPDA) leads to injury in tissues/organs by reducing perfusion of organs and causing oxidative stress. The purpose...
BACKGROUND
Hemodynamically significant patent ductus arteriosus (hsPDA) leads to injury in tissues/organs by reducing perfusion of organs and causing oxidative stress. The purpose of this study was to evaluate the oxidant/antioxidant status in preterm infants with hsPDA by measuring the total antioxidant capacity and total oxidant status and to assess neuronal damage due to oxidant stress related to hsPDA.
MATERIAL AND METHODS
This prospective study included 37 low-birth-weight infants with echocardiographically diagnosed hsPDA treated with oral ibuprofen and a control group of 40 infants without PDA. Blood samples were taken from all infants, and than the total antioxidant capacity (TAC), total oxidant status (TOS), and S-100B protein levels were assessed and oxidative stress index was calculated before and after therapy.
RESULTS
The mean pre-therapy TOS level and oxidative stress index (OSI) value of the patients with hsPDA were significantly higher, but TAC level was lower than in the control group. There were no statistically significant differences in the mean post-therapy values of TOS, TAC, OSI, and S-100B protein between the two groups.
CONCLUSIONS
hsPDA may cause cellular injury by increasing oxidative stress and damaging tissue perfusion; however the brain can compensate for oxidative stress and impaired tissue perfusion through well-developed autoregulation systems to decrease tissue injury.
Topics: Antioxidants; Case-Control Studies; Ductus Arteriosus, Patent; Female; Humans; Ibuprofen; Infant, Newborn; Infant, Premature; Male; Oxidative Stress; S100 Calcium Binding Protein beta Subunit
PubMed: 25542161
DOI: 10.12659/MSM.892166 -
Journal of Veterinary Internal Medicine Mar 2021Studies describing the clinical progression of animals with reverse patent ductus arteriosus (PDA) are lacking.
BACKGROUND
Studies describing the clinical progression of animals with reverse patent ductus arteriosus (PDA) are lacking.
OBJECTIVES
To describe the signalment, presenting signs, echocardiographic features, and survival in a group of dogs and cats with bidirectional and continuous right-to-left PDA.
ANIMALS
Forty-six client-owned animals included, comprising 43 dogs and 3 cats with bidirectional or continuous right-to-left PDA.
METHODS
Retrospective multicenter study. Medical records and echocardiographic findings reviewed from animals diagnosed with bidirectional or continuous right-to-left PDA. Impact of ductal morphology, spectral Doppler flow profile, PCV, sildenafil treatment at presentation, sildenafil dose, severity of pulmonary hypertension, general anesthesia with or without surgery and the presence of right-sided congestive heart failure (R-CHF) on crude mortality rate were evaluated via Mantel-Cox log rank comparison of Kaplan-Meier survival curves. Univariable and multivariable Cox proportional hazards analysis was performed, and hazard ratio (HR) (95% confidence intervals [CI]) was presented.
RESULTS
Hindlimb collapse was the most common presenting sign in dogs (n = 16). Clinical signs in cats were variable. Median survival time was 626 days in dogs (range 1-3628 days). Dogs with R-CHF had a shorter median survival time (58 days vs 1839 days, P = .03). Dogs treated with sildenafil at initial presentation survived longer (1839 days vs 302 days, P = .03), which was the only independent predictor of survival (HR 0.35, CI 0.15-0.86, P = 0.021).
CONCLUSIONS AND CLINICAL IMPORTANCE
Dogs and cats with reverse PDA have a variable clinical presentation and prognosis. Survival time was longer in animals prescribed sildenafil at diagnosis. Dogs with R-CHF at presentation have a worse overall outcome.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Ductus Arteriosus, Patent; Echocardiography; Retrospective Studies
PubMed: 33634497
DOI: 10.1111/jvim.16072