Echocardiographic evaluation of the ductal morphology in patients with refractoriness to lipo‐prostaglandin E₁ therapy

Abstract

Patients with refractoriness to lipo-PGE1 therapy could not be predicted from initial intraluminal diameters of the ductus using echocardiography. Therefore, serial echocardiographic examinations are important to detect early findings of ductal closure. In addition, PGE1-CD is still useful as back-up therapy in such patients.

Efficacy of very low-dose prostaglandin E1 in duct-dependent congenital heart disease

“…Prostaglandin E1 for maintaining ductal patency in duct-dependent congenital heart disease has been widely in use for several years and it is the subject of many studies 1 2 , 12 – 16 Freed et al have published the report of a 56-centre study of prostaglandin E1 administration to 492 neonates with either cyanotic or acyanotic congenital heart disease 8 . Prostaglandin E1 was administered intra-arterially or intravenously, at a dose schedule for cyanotic congenital heart disease starting at 0.1 mcg/kg/minute, which could be lowered to 0.002 mcg/kg/minute in 27% of the patients, while the dose was increased again to the starting level in 3% and 11% of patients received various doses.…”

“…8,9 Given the need for mechanically assisted ventilation and neonatal intensive care that arose with prostaglandin E1 treatment, different studies explored prostaglandin E1 treatment at a dose lower than the proposed standard, to reduce adverse effects without loss of efficacy. [10][11][12][13] It is yet unclear, however, how low the dose can be while continuing to keep the patency of the ductus arteriosus, or how low it should be to be devoid of side effects. The objective of the present study was to determine the lowest effective prostaglandin E1 dose that can be given without adverse effects while ensuring ductus arteriosus patency.…”

Transposition of the great arteries

“…Lipo-prostaglandin is effective at lower dosages and has less side effects than prostaglandin E 1 -cyclodextrin; however, some patients may develop refractoriness to lipo-prostaglandin E 1 [15]. Standard dosage For spontaneously breathing infants, 5 to 15 ng/kg/min; for ventilated infants (if necessary), 50 ng/kg/min intravenous infusion made up in 5% dextrose solution.…”