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Arteriosus
Kinds of Arteriosus Selected AbstractsRole of natriuretic hormones in the diagnosis of patent ductus arteriosus in newborn infantsACTA PAEDIATRICA, Issue 4 2001E Pesonen Haemodynamically significant patent ductus arteriosus worsens respiratory distress by initiating pulmonary congestion and inactivating of surfactant. Excepting size of the ductus, several factors influence ductal flow. Conclusion: Atrial natriuretic hormones provide clinically useful data, especially in serial follow-up of the patient. [source] Ibuprofen-lysine for closure of patent ductus arteriosusACTA PAEDIATRICA, Issue 4 2001Article first published online: 2 JAN 200 No abstract is available for this article. [source] Patent ductus arteriosus and cystic periventricular leucomalacia in preterm infantsACTA PAEDIATRICA, Issue 3 2001P Pladys Aim: To test the association between early disturbances in hemodynamics induced by left-to-right shunting through the duct and cystic periventricular leucomalacia. Patients: Forty-six preterm infants (27,32 wk) admitted to the neonatal intensive care unit with risk criteria. Methods: Patent ductus arteriosus was evaluated on days 1 and 4, and was significant (sPDA) in cases of absent or reversed end diastolic flow in the subductal aorta. Resistance index was measured in the anterior cerebral artery and in the subductal aorta. Main outcome: Diagnosis of cystic periventricular leucomalacia between day 10 and day 50. Results: The 12 infants who developed cystic periventricular leucomalacia were compared with those who did not. On day 1, sPDA was more frequent (64% vs 26%; p= 0.03) in the cystic periventricular leucomalacia group, left ventricular output was higher (median = 341 vs 279mlkg -1.min -1; p= 0.005), and rescue surfactant was more frequently used (83% vs 47%; p= 0.03). This latter association was confirmed by multivariate analysis. Resistance index in the anterior cerebral artery was increased in cases of significant patent ductus arteriosus (p < 0.01) and was correlated with resistance index in the subductal aorta. Conclusion: On day 1 in this selected population, sPDA has an effect on blood flow velocity waveform in cerebral arteries and is associated with an increase in the emergence of cystic periventricular leucomalacia. This association could be casual rather than causal. [source] Teratogenic effect of bis-diamine on embryonic rat heartCONGENITAL ANOMALIES, Issue 3 2000Masao Nakagawa ABSTRACT, Bis-diamine induces conotruncal anomalies including persistent truncus arteriosus, tetralogy of Fallot, interruption of the aortic arch, and ventricular septal defect in rat embryos when administered to the mother. Bis-diamine also induces extracardiac malformations including thymic hypoplasia, facial dysmorphism, forelimb anomalies and diaphragmatic hernia. However, the teratogenic mechanisms of this chemical in early developing rat hearts have not been fully established. Chimeric studies in chick and quail embryos demonstrated that the cranial neural crest cells reached the cardiac outflow tract, contributing to aorticopulmonary and truncal septation. Since an ablation of the cranial neural crest also produced the conotruncal anomalies, bis-diamine is proposed to disturb the normal migration of cardiac neural crest cells to the heart. Based on our data concerning cardiac anomalies induced by bis-diamine, we reviewed how the cardiac malformations were morphologically established in early developing rat hearts. Our data showed that 1) cardiovascular anomalies induced by bis-diamine are time- and species or strain- dependent. 2) bis-diamine reduces the number of neural crest cells migrating to participate in the conotruncal septation, 3) bis-diamine induces anomalous coronary arteries, thin ventricular walls and epicardial defects, and 4) some embryos cultured in the medium containing bis-diamine had extra-cardiac abnormalities including abnormal location of the otic placodes and delay in mid brain closure. Conclusively, bis-diamine does not appear to merely affect the cardiac development, but rather disturbs normal development of all the organs contributed to by neural crest cells. [source] Percutaneous Closure of a Large PDA in a 35-Year-Old Man with Elevated Pulmonary Vascular ResistanceCONGENITAL HEART DISEASE, Issue 2 2008John S. Hokanson MD ABSTRACT The presence of a large patent ductus arteriosus (PDA) may result in significant pulmonary hypertension, which may not be reversible. We present the case of a 35-year-old man with pulmonary hypertension who had successful percutaneous closure of a large PDA with an Amplatzer muscular ventricular septal defect occluder and resolution of his pulmonary hypertension. The use of prior balloon test occlusion of the PDA suggested that the procedure would be successful, despite the lack of an immediate fall in the pulmonary artery pressure. [source] Abnormal venous and arterial patterning in chordin mutantsDEVELOPMENTAL DYNAMICS, Issue 9 2007Emmanučle C. Délot Abstract Classic dye injection methods yielded amazingly detailed images of normal and pathological development of the cardiovascular system. However, because these methods rely on the beating heart of diffuse the dyes, the vessels visualized have been limited to the arterial tree, and our knowledge of vein development is lagging. In order to solve this problem, we injected pigmented methylsalicylate resins in mouse embryos after they were fixed and made transparent. This new technique allowed us to image the venous system and prompted the discovery of multiple venous anomalies in Chord,/, mutant mice. Genetic inactivation of Chordin, an inhibitor of the Bone Morphogenetic Protein signaling pathway, results in neural crest defects affecting heart and neck organs, as seen in DiGeorge syndrome patients. Injection into the descending aorta of Chrd,/, mutants demonstrated how a very severe early phenotype of the aortic arches develops into persistent truncus arteriosus. In addition, injection into the atrium revealed several patterning defects of the anterior cardinal veins and their tributaries, including absence of segments, looping and midline defects. The signals that govern the development of the individual cephalic veins are unknown, but our results show that the Bone Morphogenetic Protein pathway is necessary for the process. Developmental Dynamics 236:2586,2593, 2007. © 2007 Wiley-Liss, Inc. [source] Subcutaneous fat necrosis of the newborn associated with ventricular septal defect and patent ductus arteriosusINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2009Jae Hwan Kim MD No abstract is available for this article. [source] Purification of Matrix Gla Protein From a Marine Teleost Fish, Argyrosomus regius: Calcified Cartilage and Not Bone as the Primary Site of MGP Accumulation in Fish,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 2 2003DC Simes Abstract Matrix Gla protein (MGP) belongs to the family of vitamin K-dependent, Gla-containing proteins, and in mammals, birds, and Xenopus, its mRNA was previously detected in extracts of bone, cartilage, and soft tissues (mainly heart and kidney), whereas the protein was found to accumulate mainly in bone. However, at that time, it was not evaluated if this accumulation originated from protein synthesized in cartilage or in bone cells because both coexist in skeletal structures of higher vertebrates and Xenopus. Later reports showed that MGP also accumulated in costal calcified cartilage as well as at sites of heart valves and arterial calcification. Interestingly, MGP was also found to accumulate in vertebra of shark, a cartilaginous fish. However, to date, no information is available on sites of MGP expression or accumulation in teleost fishes, the ancestors of terrestrial vertebrates, who have in their skeleton mineralized structures with both bone and calcified cartilage. To analyze MGP structure and function in bony fish, MGP was acid-extracted from the mineralized matrix of either bone tissue (vertebra) or calcified cartilage (branchial arches) from the bony fish, Argyrosomus regius,, separated from the mineral phase by dialysis, and purified by Sephacryl S-100 chromatography. No MGP was recovered from bone tissue, whereas a protein peak corresponding to the MGP position in this type of gel filtration was obtained from an extract of branchial arches, rich in calcified cartilage. MGP was identified by N-terminal amino acid sequence analysis, and the resulting protein sequence was used to design specific oligonucleotides suitable to amplify the corresponding DNA by a mixture of reverse transcription-polymerase chain reaction (RT-PCR) and 5,rapid amplification of cDNA (RACE)-PCR. In parallel, ArBGP (bone Gla protein, osteocalcin) was also identified in the same fish, and its complementary DNA cloned by an identical procedure. Tissue distribution/accumulation was analyzed by Northern blot, in situ hybridization, and immunohistochemistry. In mineralized tissues, the MGP gene was predominantly expressed in cartilage from branchial arches, with no expression detected in the different types of bone analyzed, whereas BGP mRNA was located in bone tissue as expected. Accordingly, the MGP protein was found to accumulate, by immunohistochemical analysis, mainly in the extracellular matrix of calcified cartilage. In soft tissues, MGP mRNA was mainly expressed in heart but in situ hybridization, indicated that cells expressing the MGP gene were located in the bulbus arteriosus and aortic wall, rich in smooth muscle and endothelial cells, whereas no expression was detected in the striated muscle myocardial fibers of the ventricle. These results show that in marine teleost fish, as in mammals, the MGP gene is expressed in cartilage, heart, and kidney tissues, but in contrast with results obtained in Xenopus and higher vertebrates, the protein does not accumulate in vertebra of non-osteocytic teleost fish, but only in calcified cartilage. In addition, our results also indicate that the presence of MGP mRNA in heart tissue is due, at least in fish, to the expression of the MGP gene in only two specific cell types, smooth muscle and endothelial cells, whereas no expression was found in the striated muscle fibers of the ventricle. In light of these results and recent information on expression of MGP gene in these same cell types in mammalian aorta, it is likely that the levels of MGP mRNA previously detected in Xenopus, birds, and mammalian heart tissue may be restricted toregions rich in smooth muscle and endothelial cells. Our results also emphasize the need to re-evaluate which cell types are involved in MGP gene expression in other soft tissues and bring further evidence that fish are a valuable model system to study MGP gene expression and regulation. [source] Total Arch Replacement with Open Stent-Grafting for Aneurysm of Ductus Arteriosus After Surgery for Patent Ductus ArteriosusJOURNAL OF CARDIAC SURGERY, Issue 5 2010Kosaku Nishigawa M.D. An enhanced computed tomography of the chest revealed a saccular aneurysm measuring a maximum diameter of 28 mm in the lesser curvature of the distal aortic arch; she was diagnosed with an aneurysm of ductus arteriosus after surgery for PDA. We performed total aortic arch replacement with open stent-grafting through median sternotomy. This approach enabled us to avoid the risk of dissecting adhesions around the aneurysm and clamping the aorta distal to the aneurysm.,(J Card Surg 2010;25:557-559) [source] Etiology and Management of Chylothorax Following Pediatric Heart SurgeryJOURNAL OF CARDIAC SURGERY, Issue 4 2009Michael Milonakis M.D. The purpose of this study was to review our experience with the management of chylothorax following congenital heart surgery. Methods: Between September 1997 and August 2006, of 1341 pediatric patients undergoing correction of congenital heart disease in our institution, 18 (1.3%) developed chylothorax postoperatively. Surgical procedures included tetralogy of Fallot repair in 10 patients, ventricular septal defect closure (one), atrial septal defect with pulmonary stenosis repair (one), Fontan procedure (three), coarctation of the aorta repair (one), aortopulmonary shunt (one), and ligation of patent ductus arteriosus in one patient. All patients followed a therapeutic protocol including complete drainage of chyle collection and controlled nutrition. Somatostatin was used adjunctively in six (33.3%) patients. Surgical intervention was reserved for persistent lymph leak despite maximal therapy. Following resolution of chylothorax, a medium-chain triglyceride diet was implemented for six weeks. Results: There were no deaths. Fifteen patients (83.3%) responded to conservative therapy. Lymph leak ranged from 2.5 to 14.7 mL/kg per day for 8 to 42 days. Three patients with persistent drainage required thoracotomy with pleurodesis to achieve resolution, in two of which previously attempted chemical pleurodesis with doxycycline proved ineffective. Duration of lymph leak in this subgroup ranged from 15 to 47 days with 5.1 to 7.4 mL/kg per day output. Conclusions: Postoperative chylothorax is an infrequent complication of surgery for congenital heart disease and can occur even after median sternotomy in the absence of pathologically elevated venous pressure or Fontan circulation. Although hospitalization can be prolonged, conservative therapy is effective in most cases, while surgical pleurodesis proved successful in the refractory cases. [source] Patent Ductus Arteriosus ClosureJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2006RICHARD A. KRASUSKI M.D. Patent ductus arteriosus is a common clinical lesion which increases the risk of endocarditis and may lead to heart failure and pulmonary hypertension. Devices and techniques have advanced to the point that in most patients percutaneous closure should be the procedure of choice. Devices are best selected by fully examining the anatomy of the defect. In general coils are best suited for smaller defects and the Amplatzer Duct Occluder excels in moderate to large defects. Follow-up should include echocardiography to ensure complete closure. [source] Advances in Transcatheter Patch Occlusion of Heart DefectsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2003E. B. SIDERIS M.D. The transcatheter patch device consists of the following components: a sleeve type polyurethane patch, a double balloon support catheter and a retrieval thread. It has been applied in a variety of heart defects, including various types of atrial septal defects, ventricular septal defects and patent ductus arteriosus. New advances include an accelerated release time for many applications and better immobilization. Using accelerated fibrin formation principles, transcatheter path release time has been decreased to less than 24 hours for patent ductus arteriosus and some ventricular septal defects; in contrast 48 hours are required for patch release in large atrial septal defects. The device is also unlikely to move away from the septum using the new immobilization methods. Since the patch is inflatable, only three sizes are required for the occlusion of all defect types and sizes. Conclusion: In conclusion the transcatheter patch is applicable in a variety of heart defects; the procedure is safer and faster, becoming outpatient, for many applications. Furthermore, it is cost effective. (J Interven Cardiol 2003;16:419,424) [source] Catheter Closure of Coronary Artery FistulasJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2001SHAKEEL A. QURESHI F.R.C.P. Coronary artery fistulas are rare and vary widely in their morphological appearance and presentation. This paper presents experience of catheter closure of coronary artery fistulas in 40 patients. Catheter closure was performed with a variety of techniques, including detachable balloons, stainless steel coils, controlled-release coils, controlled-release patent ductus arteriosus (PDA) coils, and Amplatzer PDA plug. The vast majority of the fistulas were occluded with coils and in particular, controlled-release coils. Successful occlusion of the fistula was achieved in 39 (97%) of 40 patients. In one patient, the detachable balloon deflated prematurely and the patient underwent elective surgery. One 4-month-old infant died approximately 6 hours after the procedure. Immediate occlusion of the coronary artery fistula occurred in 33 (82%) of patients and late occlusion in 4 patients. Thus overall, total occlusion was achieved in 37 (97%) of 39 patients. The main complication was embolization of the occlusion device, which occurred in 6 (17%) of cases. In one of these cases, a detachable balloon deflated prematurely, and in five patients, coils embolized and were retrieved. In one of the patients, all six coils embolized 24 hours after the procedure but were retrieved, and further coils were implanted successfully. Controlled-release coils have made an important contribution to the technique of catheter closure of coronary artery fistulas. Catheter closure of these fistulas is an acceptable alternative to the standard surgical treatment. [source] Outcome and hospital cost for infants weighing less than 500 grams: A tertiary centre experience in TaiwanJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007Wu-Shiun Hsieh Aim: To determine the outcome and hospital cost for infants weighing ,500 g at a tertiary centre in Taiwan. Methods: We retrospectively reviewed the medical records of infants who were born alive with birthweight ,500 g at the National Taiwan University Hospital from 1997 to 2004. Their outcome and hospital cost were analysed. Results: A total of 168 infants were included for analysis that 146 of them died after compassionate care in the delivery room and 22 received postnatal resuscitation. The infants who received resuscitation were more likely to have higher birthweights, older gestational ages and multiple births compared with those who received compassionate care. After resuscitation, five of the infants died and 17 were admitted to neonatal intensive care unit (NICU) for further management. Subsequently, 12 infants died and five infants survived to discharge. Two infants were discharged against advice and died within days. After exclusion of those receiving compassionate care, the NICU survival rate was 22.7% and the long-term survival rate was 13.6%. The most common early morbidities were respiratory distress syndrome, intraventricular haemorrhage and patent ductus arteriosus, whereas the late morbidities included cholestatic jaundice, retinopathy of prematurity and chronic lung disease. The average total hospital costs for the NICU survivors with birthweight ,500 g was US$ 42 411 and the average hospital cost per day was US$ 350. Conclusion: Exclusive compassionate care was given to the majority of the infants weighing ,500 g in Taiwan. The survival rate remained low in these marginally viable infants. [source] Review of left-to-right shunting patent ductus arteriosus and short term outcome in 98 dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 9 2002N. Van Israël The case records of 98 dogs with a left-to-right shunting patent ductus arteriosus (PDA) were reviewed. There were 35 breeds represented, with a female to male ratio of 3:1. Forty per cent of the dogs were older than one year at initial presentation and 31 per cent had clinical signs attributable to PDA. A left heart base continuous murmur of grade IV/VI or higher was noted in 90 per cent of the dogs. On electrocardiography, the most common abnormalities were tall R waves (63 per cent) and deep QII waves (62 per cent). The radiographic triad of dilation of the descending aorta with enlargement of the main pulmonary artery segment and left atrium, typical of PDA, was noted in only 26 per cent of cases. Two-dimensional (2D) and M-mode echocardiography detected left atrial enlargement (35 per cent) and an increased left ventricular diameter in diastole (82 per cent) and systole (84 per cent) as the most common abnormalities. Doppler echocardiography demonstrated increased aortic outflow velocities in 66 per cent of cases. The overall short-term successful outcome in this study was 95 per cent. There was no significant difference between surgical ductal ligation using a standard technique or the Jackson-Henderson technique in terms of survival, occurrence of haemorrhage or residual shunting. The number of interventional procedures used in this study was too low for statistical comparison, but there appeared to be a trend towards a higher rate of residual shunting and a lower fatality rate using a coil occlusion technique. [source] Immediate and Late Outcomes of Transarterial Coil Occlusion of Patent Ductus Arteriosus in DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2006F.E. Campbell Records from dogs (n = 125) that underwent attempted transarterial coil occlusion of patent ductus arteriosus (PDA) at the University of California, Davis, between 1998 and 2003, were reviewed, and a subset of these dogs (n = 31) in which the procedure was performed at least 12 months earlier were reexamined to determine long-term outcome. Coil implantation was achieved in 108 dogs (86%). Despite immediate complete ductal closure in only 34% of dogs, the procedure was hemodynamically successful as evidenced by a reduction in indexed left ventricular internal diameter in diastole (LVIDd; P < .0001), fractional shortening (P < .0001), and left atrial to aortic ratio (LA: Ao; P = .022) within 24 hours. Complete ductal closure was documented in 61% of dogs examined 12 to 63 months after coil occlusion. Long-standing residual ductal flow in the other 39% of dogs was not associated with increased indexed LVIDd or LA: Ao and was not hemodynamically relevant. Repeat intervention was deemed advisable in only 4 dogs with persistent (n = 1) or recurrent (n = 3) ductal flow. Complications included aberrant embolization (n = 27), death (n = 3), ductal reopening (n = 3), transient hemoglobinuria (n = 2), hemorrhage (n = 1), aberrant coil placement (n = 1), pulmonary hypertension (n = 1), and skin abscessation (n = 1). Serious infectious complications did not occur despite antibiotic administration to only 40% of these dogs. Transarterial coil occlusion was not possible in 14 dogs (11%) because of coil instability in the PDA and was associated with increased indexed minimum ductal diameter (P= .03), LVIDd (P= .0002), LVIDs (P= 0.001), and congestive left heart failure (P= .03) reflecting a relatively large shunt volume. [source] Transarterial Coil Embolization of Patent Ductus Arteriosus in Small Dogs with 0.025-Inch Vascular Occlusion Coils: 10 CasesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2004Daniel F. Hogan Patent ductus arteriosus (PDA) is the most common congenital cardiac disease in the dog and generally leads to severe clinical signs, including left-sided congestive heart failure. Historically, definitive treatment consisted of surgical ligation; however, the use of vascular occlusion devices by minimally invasive techniques has gained popularity in veterinary medicine during the past decade. Adequate vascular access is a major limiting factor for these minimally invasive techniques, precluding their use in very small dogs. The clinical management of PDA with 0.025-in vascular occlusion coils in a minimally invasive transarterial technique in 10 dogs is described. The dogs were small (1.38 ± 0.22 kg), were generally young (6.70 ± 5.74 months), and had small minimal ductal diameters (1.72 ± 0.81 mm from angiography). Vascular access was achieved, and coil deployment was attempted in all dogs with a 3F catheter uncontrolled release system. Successful occlusion, defined as no angiographic residual flow, was accomplished in 8 of 10 (80%) dogs. Successful occlusion was not achieved in 2 dogs (20%), and both dogs experienced embolization of coils into the pulmonary arterial tree. One of these dogs died during the procedure, whereas the other dog underwent a successful surgical correction. We conclude that transarterial PDA occlusion in very small dogs is possible with 0.025-in vascular occlusion coils by means of a 3F catheter system and that it represents a viable alternative to surgical ligation. The risk of pulmonary arterial embolization is higher with this uncontrolled release system, but this risk may decrease with experience. [source] Transvenous Embolization of Small Patent Ductus Arteriosus with Single Detachable Coils in DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2001Matthias Schneider Transvenous embolization of small patent ductus arteriosus (PDA; , 4 mm) with a single detachable coil was attempted in 24 dogs (median age 5.7 months, range, 2.6,65.5 months; median body weight 5.5 kg, range, 1.5,30.0 kg). Angiographic imaging of the duct and pressure measurements were made before and after embolization. The minimal ductal diameter was 2.7 ± 0.7 mm. In all dogs, a single coil was employed regardless of residual shunting. Ten dogs (PDA minimal diameter range, 1.5-2.2 mm) received a 5-mm coil, and 14 dogs (PDA minimal diameter range, 2.9-3.6 mm) received a 8-mm coil. After coil embolization the angiographic shunt grade decreased significantly (n = 20, P < .001). Residual shunts were assessed by angiography 15 minutes after and by Doppler echocardiography 1,3 days and 3 months after the intervention. In the dogs treated with the 5-mm coils the residual shunt rate was low (0%, 10%, and 0% for angiography and Doppler echocardiography at 1,3 days and 3 months, respectively), in contrast to the dogs treated with the 8-mm coils (91%, 79%, and 67% for angiography and Doppler echocardiography at 1,3 days and 3 months, respectively). After 3 months, no residual murmur was found in dogs treated with the 5-mm coils (0/7), in contrast to murmurs in 5 of 12 (42%) dogs treated with the 8-mm coils. Despite incomplete closure in these dogs, volume loading of the left heart decreased in all dogs. Pulmonic or aortic coil embolism did not occur. Analysis of initial results shows that single detachable coil embolization is possible in all dogs with a small PDA (, 4 mm), but only very small PDA (s 2.5) could be treated effectively, and for the moderate PDA (2.6-4.0 mm) longer coils or multiple coils may be necessary to achieve complete occlusion. [source] Transcatheter Closure of Patent Ductus Arteriosus Using Occluding Spring CoilsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2000A. A. Stokhof The purpose of this study is to report our initial experience with the use of spring coils to close the patent ductus arteriosus in the dog. There are few large-patient series reported in the veterinary literature. Coil closure was attempted in 15 dogs (median weight, 6.5 kg; range, 1.2 to 38.7 kg) presenting with a patent ductus arteriosus between May 1997 and May 1999. Arterial catheterization followed by angiography was used to decide if coil placement was adequate. A 5- or 8-mm embolization coil, depending on the angiographic diameter of the ductus, was delivered, with 1 loop in the pulmonary arterial side and the remainder of the coil in the aortic side of the duct. Additional coils were used if a residual shunt was present, and closure was confirmed by aortography. Patients were discharged the day after the procedure. Successful coil closure, without residual shunt on angiography, was achieved in 11 of 13 dogs in which coils were released. In 6 dogs, a coil embolized to the pulmonary artery. Four of these dogs had successful closure with multiple coils, and 2 others had surgery. None of these dogs experienced adverse effects. In 2 dogs with conical patent ductus arteriosus >5 mm in minimal diameter, coil closure was not done. We conclude that the patent ductus arteriosus size and anatomical shape are crucial in deciding whether coil closure is the method of choice. In selected cases, coil closure represents an elegant alternative to surgical ligation. Although pulmonary embolism occurred commonly, it did not cause any obvious clinical problem. [source] Fetal hydrops associated with spontaneous premature closure of ductus arteriosusPATHOLOGY INTERNATIONAL, Issue 9 2006Takeshi Kondo A 36-year-old woman presenting with fetal growth restriction in the 25th week of gestation was referred to Kobe University Hospital where hydrops fetalis was detected. A stillborn fetus, 2012 g in weight and 40 cm in height, was delivered in the 33rd week of gestation. The mother had no past history of non-steroidal anti-inflammatory drug (NSAID) use during the pregnancy. The male fetus showed maceration without macroscopic anomalies, but it was markedly edematous with bilateral pleural effusion and massive ascites. The autopsy revealed an enlarged heart and aortic coarctation in the region of the ductus arteriosus. A mild form of aortic coarctation and premature closure of the ductus arteriosus with fibrous thickening of the wall were observed. The lungs were atelectatic with vascular dilatation and congestion. This is the first documented case of hydrops fetalis caused by spontaneous premature closure of the ductus arteriosus concomitant with aortic coarctation. The findings suggest that some form of idiopathic, or spontaneous, closure of the ductus arteriosus can be one of the causes of chronic fetal heart failure, coarctation of the aorta, and fetal hydrops. [source] High levels of CXCL8 in tracheal aspirate samples taken at birth are associated with adverse respiratory outcome only in preterm infants younger than 28 weeks gestationPEDIATRIC PULMONOLOGY, Issue 3 2007Jozef De Dooy PhD Abstract We investigated the relation between perinatal endotracheal colonization, the associated cytokine response and respiratory outcome in ventilated preterm neonates. Between September 1999 and March 2002, a cohort of 141 neonates with a gestational age <31 weeks requiring ventilation directly after birth, were followed prospectively. All were admitted to the Neonatal Intensive Care Unit, University Hospital of Antwerp, Belgium. A tracheal aspirate (TA) sample was collected soon after birth and was processed for microbiological examination, leukocyte count, and cytokine analysis (interleukines [IL] IL-1,, IL-6, CXCL8 (formerly called IL-8), IL-10, IL-12p70 and tumor necrosis factor alpha [TNF-,]). Together with the prospectively registered patient's comorbidities and severity of disease, these inflammatory parameters were analyzed in a multivariate Cox proportional hazards model with time of extubation and duration of oxygen therapy as main outcome measures. Of the 141 patients included, 31 (22%) died before discharge from the unit and 37 (26%) had a positive TA culture. Independent predictors of duration of mechanical ventilation were: gestational age <28 weeks, degree of respiratory distress syndrome (RDS) at birth, significant patent ductus arteriosus (PDA), the SNAP-score, and high levels of CXCL8 (>4,153 pg/ml) in TA only in neonates with a gestational age <28 weeks. Variables associated with extended duration of oxygen therapy were gestational age <28 weeks, birth weight <1,000 g, degree of RDS at birth, and duration of mechanical ventilation. Pediatr Pulmonol. 2007; 42:193,203. © 2007 Wiley-Liss, Inc. [source] Patent ductus arteriosus flow patterns in the treatment of congenital diaphragmatic herniaPEDIATRICS INTERNATIONAL, Issue 4 2009Shinya Okamoto Abstract Background:, Congenital diaphragmatic hernia (CDH) mortality still remains high, due to lung hypoplasia and persistent pulmonary hypertension of the neonate (PPHN). Effective management of PPHN and time of operation are quite important to the improvement of CDH treatment. In order to determine the optimal time for operation, we monitored PPHN with cardiac ultrasound. Methods:, PPHN was assessed with three parameters: patent ductus arteriosus flow patterns (PDAFP), %left ventricular diameter at diastole, and left ventricular fraction of shortening (LVFS). Four patients with an antenatal diagnosis were treated under this protocol. Diaphragm repair was performed when PDAFP became left to right shunt dominant and the pre- and postoperative course was analyzed with regular chart reviews. Results:, The alveolar-arterial oxygen difference levels of four patients were 590, 335, 613 and 530 mmHg, and operations were carried out when the patients were 2, 2, 3 and 2 days old, respectively. In three of the four patients (all except case 3) the PDAFP changed from right to left shunt dominant or bidirectional (BD), to left to right shunt dominant within 48 h. The %left ventricular diameter at diastole was relatively stable around the time of operation. The LVFS of all patients decreased after the operation. Only the LVFS of case 3 decreased temporarily to less than 30% (which indicates poor left ventricular function) but recovered. No patients needed extracorporeal membrane oxygenation support. All patients survived the procedure and were extubated. Case 3, who took 10 days to become left to right shunt dominant after the operation, needed home oxygenation therapy for 10 months. Conclusions:, PDAFP was a reliable marker of PPHN on a high-frequency oscillatory ventilator to determine the optimal time for the operation for CDH. The optimal time for operation is supposed to be the time when PDAFP become left to right shunt dominant. [source] Surgical closure of patent ductus arteriosus reduces the cerebral tissue oxygenation index in preterm infants: a near-infrared spectroscopy and Doppler studyPEDIATRICS INTERNATIONAL, Issue 3 2006PATRIZIA ZARAMELLA Abstract Background: The aim of this study was to investigate the effects of patent ductus arteriosus (PDA) ligature on cerebral oxygen saturation, cerebral blood volume (CBV) and cerebral blood flow velocity by means of near-infrared spectroscopy (NIRS) and transcranial Doppler simultaneous examinations. Methods: This is an observational study considering 16 babies of gestational age 24,34 weeks diagnosed with PDA who underwent surgical ligation. The cerebral oxygen saturation, CBV and blood gases values were obtained 35 min before ligation, so also around the 14th and 27th min after the clip's insertion. Results: Cerebral oxygen saturation, measured as tissue oxygenation index (TOI), decreased significantly after PDA ligation from a basal value of 61.1 (3.8) before surgery to 56.6 (3.3) and 55.8 (2.6)%, for the 14th and 27th min, respectively (P < 0.04). CBV before and after clipping was unvaried. A negative correlation was found between ,pH and ,CBV after ligation (R = 0.52, P = 0.03), whilst a positive correlation was found between ,CBV and ,PaCO2 (R = 0.62, P = 0.009). pH increased at the 27th min post-ligation. Conclusions: NIRS is a tool for obtaining information on cerebral oxygen saturation and CBV changes during surgical PDA ligation at the bedside. A fall in TOI suggests an increased oxygen extraction during PDA surgery. The lack of increase in ,CBV or in diastolic flow velocity show that the PDA before the clipping did not limit cerebral blood flow, the drop in TOI suggests increased oxygen consumption over the clip and the need for accurate monitoring of oxygen utilization after the surgical treatment. [source] Cardiocirculatory effects of patent ductus arteriosus in extremely low-birth-weight infants with respiratory distress syndromePEDIATRICS INTERNATIONAL, Issue 3 2003Senji Shimada Abstract Background:,Cardiocirculatory effects of hemodynamically significant patent ductus arteriosus (hsPDA) have not been systematically studied in extremely low-birth-weight (ELBW) infants with respiratory distress syndrome (RDS). The objective of the present study was to evaluate the effects of hsPDA on the left ventricular output (LVO) and organ blood flows in ELBW infants with RDS. Methods:,Extremely low-birth-weight infants (birth-weight <1000 g) treated with surfactant for RDS were studied by serial Doppler flow examinations. Doppler flow variables in 19 infants in whom hsPDA developed (hsPDA group) were compared with those in 19 infants without hsPDA matched for gestational age, birth-weight, and postnatal age (non-hsPDA group). All infants in the hsPDA group had pharmacologic closure of ductus arteriosus when hsPDA developed. Results:,Before pharmacological closure of PDA, the hsPDA group had significantly higher LVO, lower blood flow volume of the abdominal aorta, and lower mean blood flow velocities in the celiac artery, superior mesenteric artery, and renal artery than the non-hsPDA group. These alterations in the hsPDA group reverted to the levels in the non-hsPDA group after the closure of PDA and had no deleterious effects on the cardiorespiratory status. No significant differences between the groups were found in mean blood flow velocities of the anterior cerebral artery throughout the study period. Conclusion:,These results indicate that although LVO is increased, the splanchnic and renal blood flows are decreased when hsPDA develops in ELBW infants with RDS. The effects of these alterations of LVO and organ blood flows on the cardiorespiratory course seem to be minor when early pharmacologic closure of PDA is done. [source] Catheter closure of moderate to large sized patent ductus arteriosus using the simultaneous double or triple coil techniquePEDIATRICS INTERNATIONAL, Issue 5 2001Teiji Akagi AbstractBackground: Although the clinical experience with transcatheter closure of the patent ductus arteriosus using the coils has grown rapidly, one important complication of this procedure using the conventional Gianturco coil was the migration of coils into peripheral vessels. This is especially for patients with a relatively larger size ductus and the risk for such complications could be increased. In this situation, the detachable coil may have some technical benefits to perform coil occlusion and reduce the incidence of complications. Methods: We describe the clinical efficacy of a simultaneous double or triple coil occlusion technique using the Cook detachable coil or bioptome delivered 0.052 inch Gianturco coil to close the ductus arteriosus. This was performed in patients whose ductus diameter was greater than 3.0 mm. Results: From February 1995 to December 2000, 118 patients with patent ductus arteriosus were treated by coil occlusion using Cook detachable coils, of whom 58 patients whose minimum diameter of ductus , 3.0 mm were reviewed. All patients had successful placement of coils. According to the evaluation by color flow mapping, a trivial shunt was observed in 17 patients (29%) within 24 h after the procedure. In 11 out of 17 patients, a residual shunt was not detected 1 month after the procedure. At 6 months after the procedure, the residual shunt was detected only in three patients. Conclusions: Although this study did not calculate the statistical significance between detachable and non-detachable coils in term of occlusion rate, our institutional experience suggests that the simultaneous double or triple coil technique using the detachable or 0.052 inch Gianturco coils can reduce the prevalence of coil migration or complications. [source] Clinical implication of isolated right dominant heart in the fetusPRENATAL DIAGNOSIS, Issue 8 2007Eui Jung Abstract Objective To evaluate the clinical implication of isolated right dominant heart (RDH) in fetal echocardiography. Study design We reviewed the medical records of pregnant women diagnosed with fetal RDH at Asan Medical Center from December 1999 to December 2005. The criteria of RDH were the ratio of right-to-left atrial and ventricular width and the ratio of the diameter of pulmonary artery-to-aorta were greater than 1.5. Fetuses with congenital heart disease, including coarctation of the aorta (CoA), noncardiac anomalies or chromosomal abnormalities were excluded. Results RDH was identified in 44 fetuses. Twenty-nine (66%) were confirmed to have normal heart and 15 (34%) had cardiac anomalies by postnatal echocardiogrphy; 11 CoA, 1 interruption of aortic arch, 1 patent ductus arteriosus, and 2 ventricular septal defect. Mean gestational age at presentation with RDH was later in normal fetuses as compared to fetuses with CoA (p < 0.005). Only 26% (4/15) of fetuses presenting with RDH during the second-trimester were found to have normal heart postnatally, compared with 86% (25/29) of those diagnosed in the third-trimester. Conclusion RDH in the fetus is a risk factor for postnatal CoA particularly when diagnosed in the second-trimester, and should be an indication for neonatal echocardiography. Copyright © 2007 John Wiley & Sons, Ltd. [source] Prenatal diagnosis of mosaic ring chromosome 22 associated with cardiovascular abnormalities and intrauterine growth restrictionPRENATAL DIAGNOSIS, Issue 1 2003Chih-Ping Chen Abstract Objectives To present the prenatal diagnosis and perinatal findings of mosaic ring chromosome 22. Case Amniocentesis was performed at 18 gestational weeks because of an advanced maternal age. Cytogenetic analysis of the cultured amniotic fluid cells revealed mosaicism for ring chromosome 22, 45,XX,-22[6]/46,XX,r(22)(p13q13.31)[15]. Abnormal fetal sonographic findings included small for gestational age, a ventricular septal defect, and truncus arteriosus. The pregnancy was terminated. Additional phenotypic findings included hypertelorism, epicanthal folds, and abnormal ears. Cytogenetic analysis of the cord blood lymphocytes revealed a complex mosaic karyotype, 45,XX,-22[7]/46,XX,r(22)(p13q13.31)[82]/46,XX,idic r(22)(p13q13.31;p13q13.31)[11]. Cytogenetic analysis of the hepatocytes also revealed mosaic r(22) with mosaicism for idic r(22) and monosomy 22. The deletion of distal 22q and the duplication of 22q11.2 on idic r(22), and the distal 22q deletion on r(22) were demonstrated by fluorescent in situ hybridization (FISH) analysis using 22q terminal probes at 22q13 and a DiGeorge syndrome critical region probe at 22q11.2. The breakpoint on distal 22q13 and the extent of the duplication of 22q on idic r(22) was determined by examining polymorphic markers specific for chromosome 22 using quantitative fluorescent polymerase chain reaction assays. The chromosomal aberration was of maternal origin. Conclusion Molecular and FISH studies allow a better delineation of some prenatally detected aneuploidy syndromes and help elucidate the genetic pathogenesis. Fetuses having mosaic r(22) with a low level mosaicism for r(22) duplication/deletion may present cardiovascular abnormalities and intrauterine growth restriction on prenatal ultrasound. Copyright © 2002 John Wiley & Sons, Ltd. [source] Structural and Histochemical Studies on the Teleostean Bulbus ArteriosusANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 6 2009I. L. Leknes Summary The structure and histochemical properties of the bulbus arteriosus in two species from an evolutionary old teleost family, Characidae, and in three modern teleosts, family Cichlidae, are described. The bulbar wall was composed of an outer layer, a middle layer and a strongly folded inner layer covered by a thick, granule-rich endothelial cell layer towards the lumen. One of the cichlid species (Thorichthys meeki) was injected intraperitoneally with horse ferritin; the endothelial cell layer of the heart atrium and ventricle displayed high ability to endocytose ferritin particles from the blood stream, but the corresponding layer in the bulbus arteriosus displayed no such uptake. This finding suggests that the bulbar endothelial cell layer plays no scavenger or immunological blood cleansing roles in this species. The bulbar endothelial cell granules were strongly coloured by periodic acid,Schiff (PAS) in the present cichlids, but weakly coloured by PAS in the present characids. These cell layers were uncoloured by alkaline carmine in ethanol in both cichlids and characids. The negative carmine test combined with a positive PAS test for the bulbar endothelial cell layer in the present cichlids indicates that these cells contain only small amounts of polysaccharides. The weak PAS-colouring for the bulbar endothelial cell layer in characids indicates a very low content of sugars in these cells. These findings together with the fact that this cell layer in the present cichlids and characids was nearly uncoloured when treated with orcein, Heidenhain's Azan or Schmorl's solutions for elastic materials suggest that the bulbar endothelial granules do not play any role in the blood cleansing or in the rebuilding or maintenance of the ground substance or elastic material in the bulbar wall. Probably, the granules in the bulbar endothelial cell layer in the present species contain mainly proteins, connected to some PAS-positive polysaccharides to enhance their solubility. [source] An update on cardiovascular malformations in congenital rubella syndrome,BIRTH DEFECTS RESEARCH, Issue 1 2010Matthew E. Oster Abstract BACKGROUND: Congenital rubella syndrome (CRS) has long been characterized by the triad of deafness, cataract, and cardiovascular malformations (CVMs). While initial reports identified patent ductus arteriosus (PDA) as the primary CVM in CRS, the exact nature of the CVMs found in CRS has not been well established. METHODS: We searched the English literature from 1941 through 2008 to identify studies that used cardiac catheterization or echocardiography to evaluate the CVMs in CRS. RESULTS: Of the 121 patients in the 10 studies with catheterization data, 78% had branch pulmonary artery stenosis, and 62% had a PDA. In 49% of cases, both branch pulmonary artery stenosis and PDA were present, whereas isolated branch pulmonary artery stenosis and isolated PDA were found in 29 and 13% of cases, respectively. Of the 12 patients in the 10 studies with echocardiographic data, PDA was more common than branch pulmonary artery stenosis, but this finding is greatly limited by the small numbers of patients and limitations of echocardiography. Although published studies of CVMs in CRS have in general reported PDA as the CVM phenotype most commonly associated with CRS, among CRS cases evaluated by catheterization, branch pulmonary artery stenosis was actually more common than PDA. Moreover, although the combination of branch pulmonary artery stenosis and PDA was more common than either branch pulmonary artery stenosis or PDA alone, isolated branch pulmonary artery stenosis was twice as common as isolated PDA. CONCLUSION: Among children with suspected CRS, clinical evaluations for the presence of CVMs should include examinations for both branch pulmonary artery stenosis and PDA. Birth Defects Research (Part A), 2010. © 2009 Wiley-Liss, Inc. [source] Angioarchitecture of the venous and capillary system in heart defects induced by retinoic acid in mice,BIRTH DEFECTS RESEARCH, Issue 7 2009Anna Ratajska Abstract BACKGROUND: Corrosion casting and immunohistochemical staining with anti-alpha smooth muscle actin and anti-CD34 was utilized to demonstrate the capillary plexus and venous system in control and malformed mouse hearts. METHODS: Outflow tract malformations (e.g., double outlet right ventricle, transposition of the great arteries, and common truncus arteriosus) were induced in progeny of pregnant mice by retinoic acid administration at day 8.5 of pregnancy. RESULTS: Although control hearts exhibited areas in which capillaries tended to be oriented in parallel arrays, the orientation of capillaries in the respective areas of malformed hearts was chaotic and disorganized. The major branch of a conal vein in control hearts runs usually from the left side of the conus to its right side at the root of the pulmonary trunk and opens to the right atrium below the right auricle; thus, it has a curved course. On the other hand, a conal vein in malformed hearts courses from the left side or from the anterior side of the conus and tends to traverse straight upwards along the dextroposed aorta or along the aortopulmonary groove with its proximal part located outside of the heart. Other cardiac veins in outflow tract malformations are positioned in the same locations as in control hearts. CONCLUSIONS: We postulate that the changed location of the conal vein and disorganized capillary plexus result from malformed morphogenesis of the outflow tract and/or a disturbed regulation of angiogenic growth factor release from the adjacent environment. Birth Defects Research (Part A), 2009. © 2009 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||