Effects of prostaglandin E1 infusion in the pre-operative management of critical congenital heart disease.

Abstract

Prostaglandin E1(PGE1) was administered to 27 infants in whom pulmonary or systemic blood flow was entirely or significantly dependent upon the patency of the ductus arteriosus. In 12 patients with pulmonary atresia or severe pulmonary stenosis, PGE1 infusion was followed by an improvement in hypoxemia and acidemia (group I). In 2 patients with left ventricular outflow-tract obstruction, PGE1 infusion was followed by an improvement in arterial blood pressure, peripheral perfusion and urine output (group II). In 5 patients with d-transposition of the great arteries and intact ventricular septum who had persistent severe hypoxemia after creation of an interatrial communication, PGE1 infusion improved the arterial oxygenation with dilatation of the ductus arteriosus (group III). Seven patients (3 of group I, 2 of group II and 2 of group III) failed to respond to PGE1. There were no fatal side effects. It is concluded that PGE1 therapy is highly effective in stabilizing pre-operative conditions of infants with ductus-dependent congenital heaat disease. prostaglandin E1 i ductus-dependent congenital heart disease ; pre-operative management Adequate pulmonary or systemic blood flow is dependent upon the patency of the ductus arteriosus in some of the critically ill infants with congenital heart disease. Partial or complete closure of the ductus after birth results in hypoxemia or severe heart failure with the progressive development of acidemia. Although palliative or corrective surgical procedures were available, mortality in these infants was high, because of their deteriorated pre-operative conditions and of the difficulties of the surgical techniques. Elliott et al. (1975) and Olley et al. (19Th, 1976) reported that administration of prostaglandins E1 (POE1) and E2 (PGE2) to such infants improved the deteriorated conditions. Following their reports, several authors have recongn-

Do Predictors Exist for a Successful Withdrawal of Preoperative Prostaglandin E1 from Neonates with d-Transposition of the Great Arteries and Intact Ventricular Septum?

“…Our incidence of apnea was within the range of other reports [7][8][9]11], and mechanical ventilation for prolonged apnea was not necessary for any of our patients. One-fourth of all neonates to whom PGE 1 is administered will experience apnea, highlighting the need for close cardiopulmonary monitoring of these patients in an intensive care, intermediate care, or neonatal unit.…”

“…In the study of Lewis et al [7], central nervous system events were observed more often in acidotic patients and in those with a longer duration of PGE 1 infusion. The highest incidence of seizure-like activities was noted in the study of Ohara et al [9], but it is not obvious from this study whether these patients had additional risk factors such as asphyxia or prematurity.…”

“…In our study population, severe side effects (i.e., seizure-like episodes and necrotizing enterocolitis) were not observed. When various studies of PGE 1 side effects are compared, the findings seem to indicate that serious adverse events are limited to at-risk populations and to patients who require high maintenance doses of PGE [8,9]. Our study did not include patients with additional risk factors, and the maintenance dose of PGE 1 was kept low.…”

Mortality From Congenital Cardiovascular Malformations in Japan, 1968 Through 1997.

“…Prostaglandin E1 was introduced in the late 1970s 10 and widely used in the 1980s in Japan, 11 contributing to better management of neonates with ductaldependent critical CCVM. At the same time, 2-dimensional echocardiography was introduced and widely used in 1980s in Japan, 12 dramatically changing non-invasive diagnostic accuracy, especially for neonatal CCVM.…”

Pre‐ and Postoperative Quantitation of Right Ventricular Tissue Doppler Velocities in Infants with Hypoplastic Left Heart Syndrome

“…2 It is assumed that with ductal reopening, clinical signs improve and RV function normalizes. [3][4][5] This improvement in RV function has not been prospectively quantitated in patients with HLHS. Likewise, the impact of initial surgical palliation on RV function in this patient population has not been measured.…”