Patent Ductus Arteriosus: Investigations, and Treatment

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Published: 2021-12-13

Page: 84-97


Omar Elsaka *

Department of Cardiology, Mansoura University, Faculty of Medicine, Mansoura Manchester Medical Program (MMMP), Mansoura, Egypt.

*Author to whom correspondence should be addressed.


Abstract

Background: Managing persistent patent ductus arteriosus (PDA) is still a difficult task. During the previous 20 years, the attitude regarding PDA has evolved in the other way, from pushing for an aggressive and early closure to a demand for careful observation. While persistent PDA can complicate preterm neonatal medical management due to fluid overload, pulmonary edema or hemorrhage, hypotension, and decreased tissue perfusion, it can also contribute to long-term neonatal morbidities such as bronchopulmonary dysplasia (BPD). It is now apparent that the majority of PDA cases close spontaneously and do not require treatment, as long as conservative management is used. However, there has been little consensus on what defines a hemodynamically significant PDA and when, if ever, it should be treated. With growing worry about the potential risks of PDA ligation, a new method for transcatheter PDA closure is gaining traction. We describe current knowledge of the pathogenesis, diagnosis, and therapy of PDA in preterm newborns in this review, and give some evidence-based recommendations.

Conclusion: Fluid restriction and diuretics (where clinically appropriate), medicinal intervention, and surgical ligation are the three current therapy options for PDA.

Keywords: Cyclooxygenase inhibitors, ibuprofen lysine, indomethacin, non-steroidal anti-inflammatory drugs, patent ductus arteriosus, prostaglandins


How to Cite

Elsaka, O. (2021). Patent Ductus Arteriosus: Investigations, and Treatment. Asian Journal of Research in Medicine and Medical Science, 3(1), 84–97. Retrieved from https://globalpresshub.com/index.php/AJRMMS/article/view/1376

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References

Kaemmerer H, Meisner H, Hess J, Perloff JK. Surgical treatment of patent ductus arteriosus: a new historical perspective. Am J Cardiol. 2004;94(9):1153-4.

Cassels DE, Bharati S, Lev M. The natural history of the ductus arteriosus in association with other congenital heart defects. Perspect Biol Med. Summer. 1975; 18(4):541-72.

Condo M, Evans N, Bellu R, Kluckow M. Echocardiographic assessment of ductal significance: retrospective comparison of two methods. Arch Dis Child Fetal Neonatal Ed. 2012;97(1):F35-8.

Vanhaesebrouck S, Zonnenberg I, Vandervoort P, et al. Conservative treatment for patent ductus arteriosus in the preterm. Arch Dis Child Fetal Neonatal Ed. 2007;92(4):F244-7.

Attridge JT, Kaufman DA, Lim DS. B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed. 2009; 94(3):F178-82.

Nuntnarumit P, Chongkongkiat P, Khositseth A. N-terminal-pro-brain natriuretic peptide: A guide for early targeted indomethacin therapy for patent ductus arteriosus in preterm Infants. Acta Paediatr. 2011;100(9):1217-21.

Takami T, Yoda H, Kawakami T, et al. Usefulness of indomethacin for patent ductus arteriosus in full-term infants. Pediatr Cardiol. 2007;28(1):46-50.

McCarthy JS, Zies LG, Gelband H. Age-dependent closure of the patent ductus arteriosus by indomethacin. Pediatrics. 1978;62(5):706-12.

Watanabe K, Tomita H, Ono Y, Yamada O, Kurosaki K, Echigo S. Intravenous indomethacin therapy in infants with a patent ductus arteriosus complicating other congenital heart defects. Circ J. 2003; 67(9):750-2.

Richards J, Johnson A, Fox G, Campbell M. A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants. Pediatrics. 2009;124(2):e287-93.

Jones LJ, Craven PD, Attia J, Thakkinstian A, Wright I. Network meta-analysis of indomethacin versus ibuprofen versus placebo for PDA in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2011; 96(1):F45-52.

Lin CC, Hsieh KS, Huang TC, Weng KP. Closure of large patent ductus arteriosus in infants. Am J Cardiol. 2009;103(6):857-61.

Rapacciuolo A, Losi MA, Borgia F, et al. Transcatheter closure of patent ductus arteriosus reverses left ventricular dysfunction in a septuagenarian. J Cardiovasc Med (Hagerstown). 2009; 10(4):344-8.

Chen Z, Chen L, Wu L. Transcatheter amplatzer occlusion and surgical closure of patent ductus arteriosus: comparison of effectiveness and costs in a low-income country. Pediatr Cardiol. 2009;30(6):781-5.

Tomita H, Uemura S, Haneda N, et al. Coil occlusion of PDA in patients younger than 1 year: risk factors for adverse events. J Cardiol. 2009;53(2):208-13.

Hoellering AB, Cooke L. The management of patent ductus arteriosus in Australia and New Zealand. J Paediatr Child Health. 2009;45(4):204-9.

Agnetti A, Carano N, Tchana B, et al. Transcatheter closure of patent ductus arteriosus: experience with a new device. Clin Cardiol. 2009;32(11):E71-4.

Vida VL, Lago P, Salvatori S, et al. Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants?. Ann Thorac Surg. 2009;87(5): 1509-15.

Weisz DE, More K, McNamara PJ, et al. PDA ligation and health outcomes: a meta-analysis. Pediatrics. 2014;133(4):e1024-46.

Terlemez S, Isık O, Sahin S, Akcan AB, Kaynak Turkmen M. A rare complication of patent ductus arteriosus ligation: inadvertent ligation of the left pulmonary artery. Heart Surg Forum. 2017;20(6): E266-E268.

Heuchan AM, Hunter L, Young D. Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland. Arch Dis Child Fetal Neonatal Ed. 2012;97(1):F39-44.

Allegaert K, Rayyan M, Anderson BJ. Impact of ibuprofen administration on renal drug clearance in the first weeks of life. Methods Find Exp Clin Pharmacol. 2006; 28(8):519-22.

Burney K, Thayur N, Husain SA, Martin RP, Wilde P. Imaging of implants on chest radiographs: a radiological perspective. Clin Radiol. 2007;62(3):204-12.

Campbell DC, Hood RH Jr, Dooley BN. Patent ductus arteriosus. Review of literature and experience with surgical corrections. J Lancet. 1967;87(10):415- 8.

Castaneda A. Congenital heart disease: a surgical-historical perspective. Ann Thorac Surg. 2005;79(6):S2217-20.

Mandhan PL, Samarakkody U, Brown S, et al. Comparison of suture ligation and clip application for the treatment of patent ductus arteriosus in preterm neonates. J Thorac Cardiovasc Surg. 2006;132(3):672-4.

Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation. 2006;114(17):1873-82.

Zupancic JA, Richardson DK, O'Brien BJ, et al. Retrospective economic evaluation of a controlled trial of indomethacin prophylaxis for patent ductus arteriosus in premature infants. Early Hum Dev. 2006; 82(2):97-103.

de Albuquerque Botura C, da Rocha BA, Balensiefer T, et al. Oral pharmacological treatment for patent ductus arteriosus in premature neonates with hemodynamic repercussions. Asian Pac J Trop Med. 2017;10(11):1080-3.

Agrawal H, Waller BR 3rd, Surendan S, Sathanandam S. New patent ductus arteriosus closure devices and techniques. Interv Cardiol Clin. 2019;8(1):23-32.