Patent Ductus Arteriosus

Assessment and management of neonates with unrepaired congenital heart disease

“…Neonates will respond differently or suboptimally to many inotropes because of their incomplete sympathetic innervation, higher baseline concentration of endogenous catecholamine, and incomplete betaadrenergic receptor maturation as compared with alpha-receptors [7][8][9]. Also, neonatal myocytes have less mitochondria, actin, myosin, ATPase, and are shaped more spherical rather than rectangular as seen in adult myocyte [8]. These myocytes have higher collagen to protein and higher collagen type I-III ratios, which make the neonatal heart less compliant [8,10].…”

“…Also, neonatal myocytes have less mitochondria, actin, myosin, ATPase, and are shaped more spherical rather than rectangular as seen in adult myocyte [8]. These myocytes have higher collagen to protein and higher collagen type I-III ratios, which make the neonatal heart less compliant [8,10]. As can be seen, the treatment options are limited in the neonate and must be appropriately tailored.…”

“…Of the pathophysiologic subtypes of obstructed PBF, one anatomic variant deserves special attention -pulmonary atresia with intact ventricular septum (PA/IVS). Some have reported a 45% rate of coronary artery fistulae with 9% having RVdependent coronary circulation (RVDCC) [8,19]. RVDCC is defined as the presence of coronary fistulae with native coronary obstruction proximal to the fistula such that there is RV perfusion of the myocardium through the fistulous communication rather than antegrade flow through the coronary arteries [20,21].…”

“…Vasoactive medications are often utilized as a treatment but their use in neonates is based on extrapolated pediatric and adult data. Neonates will respond differently or suboptimally to many inotropes because of their incomplete sympathetic innervation, higher baseline concentration of endogenous catecholamine, and incomplete betaadrenergic receptor maturation as compared with alpha-receptors [7][8][9]. Also, neonatal myocytes have less mitochondria, actin, myosin, ATPase, and are shaped more spherical rather than rectangular as seen in adult myocyte [8].…”

Age-Related Prevalence of Open Ductus Arteriosus in Full-Term Newborns

“…Small, hemodynamically insignificant PDAs have been correlated with infective endocarditis, but generally the risk of complications appears to be low [5]. There is no clear definition as to when an open DA should be considered persistent (PDA) [6], i.e., when spontaneous closure cannot be expected, and the estimated prevalence of open DA in term-born neonates and children varies widely depending on the age at examination [7]. Prior research on the topic of DA has largely focused on its prevalence in preterm-born neonates.…”