Evaluation of echocardiographic markers in dogs with patent ductus arteriosus after ductal closure

AbstractBackgroundVascular obstruction is one of the complications of radiofrequency ablation. Following our previous report on the use of radiofrequency energy for vascular closure in an animal model in this journal, we herein present the first ever in-human report.Patient and methodThe patient was a 3-year-old boy, who received a permanent endocardial pacemaker for congenital complete heart block. He also had a conical patent ductus arteriosus. The ductus was occluded with radiofrequency energy on the arterial side with no complications.ConclusionClosure of patent ductus arteriosus and probably other problematic small vessels could be achieved with radiofrequency energy. Further experience will elucidate the future scope of this novel technique.

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Patent ductus arteriosus in an adult cat with pulmonary hypertension and right-sided congestive heart failure: hemodynamic evaluation and clinical outcome following ductal closure

Journal of Veterinary Cardiology ◽

10.1016/j.jvc.2014.06.001 ◽

2014 ◽

Vol 16 (3) ◽

pp. 197-203 ◽

Cited By ~ 10

Author(s):

José Novo-Matos ◽

Karin Hurter ◽

Rima Bektas ◽

Paula Grest ◽

Tony Glaus

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pulmonary Hypertension ◽

Clinical Outcome ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Hemodynamic Evaluation ◽

Ductal Closure ◽

Adult Cat ◽

Patent Ductus

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A High Ductal Flow Velocity Is Associated with Successful Pharmacological Closure of Patent Ductus Arteriosus in Infants 22–27 Weeks Gestational Age

Critical Care Research and Practice ◽

10.1155/2012/715265 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Karl Wilhelm Olsson ◽

Anders Jonzon ◽

Richard Sindelar

Keyword(s):

Patent Ductus Arteriosus ◽

Flow Velocity ◽

Gestational Age ◽

Pharmacological Treatment ◽

Ductus Arteriosus ◽

Newborn Infants ◽

Cyclooxygenase Inhibitors ◽

Antenatal Steroids ◽

Ductal Closure ◽

Patent Ductus

Objective. To identify factors affecting closure of patent ductus arteriosus (PDA) in newborn infants born at 22–27 weeks gestational age (GA) during pharmacological treatment with cyclooxygenase inhibitors.Method. Infants born at 22–27 weeks of GA between January 2006 and December 2009 who had been treated pharmacologically for PDA were identified retrospectively. Medical records were assessed for clinical, ventilatory, and outcome parameters. Echocardiographic examinations during treatment were reviewed.Results. Fifty-six infants were included in the study. Overall success rate of ductal closure with pharmacological treatment was 52%. Infants whose PDA was successfully closed had a higher GA (25+4weeks versus24+3weeks;P=0.047),and a higher pretreatment left to right maximal ductal flow velocity (1.6 m/s versus 1.1 m/s;P=0.023). Correcting for GA, preeclampsia, antenatal steroids, and age at start of treatment, a higher maximal ductal flow velocity was still associated with successful ductal closure (OR 3.04;P=0.049).Conclusion. Maximal ductal flow velocity was independently associated with success of PDA treatment.

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Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation

BMC Pediatrics ◽

10.1186/s12887-019-1708-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Jonathan L. Slaughter ◽

Clifford L. Cua ◽

Jennifer L. Notestine ◽

Brian K. Rivera ◽

Laura Marzec ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Brain Natriuretic Peptide ◽

Preterm Infants ◽

Prospective Cohort ◽

Ductus Arteriosus ◽

Neurodevelopmental Delay ◽

Ductal Closure ◽

Postmenstrual Age ◽

Patent Ductus

Abstract 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.

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Age-Dependent Closure of the Patent Ductus Arteriosus by Indomethacin

PEDIATRICS ◽

10.1542/peds.62.5.706 ◽

1978 ◽

Vol 62 (5) ◽

pp. 706-712 ◽

Cited By ~ 2

Author(s):

Jeane S. McCarthy ◽

Leonor G. Zies ◽

Henry Gelband

Keyword(s):

Patent Ductus Arteriosus ◽

Premature Infants ◽

Ventricular Hypertrophy ◽

Ductus Arteriosus ◽

Clinical Findings ◽

Age Related ◽

Age Dependent ◽

Ductal Closure ◽

Age Range ◽

Patent Ductus

Indomethacin has been shown to be effective in closing a patent ductus arteriosus (PDA) in small premature infants. However, the age range over which this therapy is effective remains undetermined. Eighteen infants ranging in age from 4 to 45 days were studied. All had auscultatory and clinical findings indicative of PDA. Seventeen had roentgenographic evidence of cardiomegly and/or increased pulmonary vascular markings, and eight had ECG evidence of ventricular hypertrophy. Indomethacin was administered to most patients in two doses of 0.1 to 0.3 mg/kg 24 hours apart. In eight of 12 patients, 3 week of age or younger, the PDA closed after indomethacin therapy. Two patients had a decrease in the intensity of murmur and improvement of congestive heart failure after treatment, but the PDA did not close completely. Only patients 33 weeks of age (actual age) or younger responded to indomethacin therapy with complete ductal closure. The condition of patients 34 to 36 weeks of age improved but there was not complete closure; in patients older than 36 weeks there was no response. The data suggest an age-related mechanism for PDA closure and that treatment with indomethacin before 33 weeks of age is probably required. A role for prostaglandin in ductal patency is postulated.

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Abnormal Cerebral Hemodynamics in Preterm Infants with Patent Ductus Arteriosus

PEDIATRICS ◽

10.1542/peds.69.6.778 ◽

1982 ◽

Vol 69 (6) ◽

pp. 778-781

Author(s):

Brian Lipman ◽

Gerald A. Serwer ◽

Jane E. Brazy

Keyword(s):

Blood Flow ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Cerebral Arteries ◽

Flow Patterns ◽

Cerebral Hemodynamics ◽

Ductal Closure ◽

Blood Flow Patterns ◽

Patent Ductus

Blood flow patterns in the anterior cerebral arteries were studied in eight preterm infants with patent ductus arteriosus and left-to-right shunts. A noninvasive Doppler technique was used to obtain the blood flow patterns and to calculate a pulsatility index. Advancing diastolic blood flow was decreased in all eight infants, and two demonstrated retrograde anterior cerebral artery flow during diastole. Following ductal closure, the diastolic flow in the anterior cerebral arteries increased significantly, reaching levels seen in normal infants. These observations demonstrate that infants with patent ductus arteriosus and left-to-right shunts may have abnormal cerebral hemodynamics which return to normal following ductal closure.

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Ductal Closure With Paracetamol: A Surprising New Approach to Patent Ductus Arteriosus Treatment

PEDIATRICS ◽

10.1542/peds.2011-0359 ◽

2011 ◽

Vol 128 (6) ◽

pp. e1618-e1621 ◽

Cited By ~ 124

Author(s):

C. Hammerman ◽

A. Bin-Nun ◽

E. Markovitch ◽

M. S. Schimmel ◽

M. Kaplan ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

New Approach ◽

Ductal Closure ◽

Patent Ductus

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Using benchmarking to identify inter-centre differences in persistent ductus arteriosus treatment: can we improve outcome?

Cardiology in the Young ◽

10.1017/s104795111700052x ◽

2017 ◽

Vol 27 (8) ◽

pp. 1488-1496 ◽

Cited By ~ 3

Author(s):

Esther J. S. Jansen ◽

Koen P. Dijkman ◽

Richard A. van Lingen ◽

Willem B. de Vries ◽

Daniel C. Vijlbrief ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Standard Procedure ◽

Ductus Arteriosus ◽

Short Term ◽

Surgical Ligation ◽

Persistent Ductus Arteriosus ◽

Ductal Closure ◽

Neonatal Icu ◽

Patent Ductus

AbstractObjectiveThe aim of this study was to identify inter-centre differences in persistent ductus arteriosus treatment and their related outcomes.Materials and methodsWe carried out a retrospective, multicentre study including infants between 24+0 and 27+6 weeks of gestation in the period between 2010 and 2011. In all centres, echocardiography was used as the standard procedure to diagnose a patent ductus arteriosus and to document ductal closure.ResultsIn total, 367 preterm infants were included. All four participating neonatal ICU had a comparable number of preterm infants; however, differences were observed in the incidence of treatment (33–63%), choice and dosing of medication (ibuprofen or indomethacin), number of pharmacological courses (1–4), and the need for surgical ligation after failure of pharmacological treatment (8–52%). Despite the differences in treatment, we found no difference in short-term morbidity between the centres. Adjusted mortality showed independent risk contribution of gestational age, birth weight, ductal ligation, and perinatal centre.ConclusionsUsing benchmarking as a tool identified inter-centre differences. In these four perinatal centres, the factors that explained the differences in patent ductus arteriosus treatment are quite complex. Timing, choice of medication, and dosing are probably important determinants for successful patent ductus arteriosus closure.

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The Role of Paracetamol for Closing Patent Ductus Arteriosus. A Challenging Alternative for Ductal Closure?

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2016.05.013 ◽

2016 ◽

Vol 69 (11) ◽

pp. 1103-1104 ◽

Cited By ~ 1

Author(s):

Inés Tofé Valera ◽

María Pilar Jaraba Caballero ◽

María Dolores Ruiz González ◽

María Victoria Rodríguez Benítez ◽

María José Parraga Quiles

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Ductal Closure ◽

Patent Ductus

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Use of combination therapy with acetaminophen and ibuprofen for closure of the patent ductus arteriosus in preterm neonates

Paediatrics & Child Health ◽

10.1093/pch/pxaa057 ◽

2020 ◽

Author(s):

Susan Kimani ◽

Aimann Surak ◽

Michael Miller ◽

Soume Bhattacharya

Keyword(s):

Adverse Effects ◽

Combination Therapy ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care ◽

Ductus Arteriosus ◽

Combination Group ◽

Preterm Neonates ◽

Primary Therapy ◽

Ductal Closure ◽

Patent Ductus

Abstract Objective To compare effectiveness and safety of combination therapy (acetaminophen and ibuprofen) to monotherapy (ibuprofen, indomethacin, or acetaminophen alone) in treatment of the patent ductus arteriosus (PDA) in premature neonates. Methods This was a retrospective cohort study of neonates admitted to a tertiary-level neonatal intensive care unit. Included neonates were born at <32 weeks gestation and received pharmacotherapy for PDA closure. Based on the primary therapy received, our cohort was divided into the following four groups: indomethacin alone, ibuprofen alone, acetaminophen alone, and ibuprofen and acetaminophen (in combination). Baseline characteristics, effectiveness, safety, neonatal mortality, and morbidities rates between these groups were compared. Results One hundred and forty neonates were analyzed; 17 received combination therapy, and 123 neonates received monotherapy: 22 (17.9%) ibuprofen, 29 (23.6%) acetaminophen, and 72 (58.5%) indomethacin. The PDA closure rates were 41.7% for indomethacin, 41.2% for combination therapy, 37.9% for acetaminophen, and 31.8% for ibuprofen (P=0.100). Rates of adverse effects were comparable between the groups. Conclusion The rate of ductal closure was not different between combination therapy and monotherapy. The study did not demonstrate any increased adverse effects in the combination group. Future well-designed prospective clinical trials are needed to guide clinical practice.

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