Responsiveness of the ductus arteriosus to prostaglandin E1 assessed by combined cross sectional and pulsed Doppler echocardiography.

Abstract

Cross sectional echocardiography combined with Doppler echocardiography was used to record either ductal morphology or the flow profile within the ductus arteriosus before and after infusion of prostaglandin E1 in 25 newborn infants with cyanotic and acyanotic congenital heart disease with ductus dependent blood flow. The ultrasound results were compared with changes in arterial oxygen tension and the overall clinical response to prostaglandin E1 seen during the same period in 24 of the 25 patients in whom the degree of ductal narrowing could be determined with the ultrasound method. At the time of the study, the ductus was widely patent or slightly narrowed in 12 patients and was closed in two patients. These patients did not respond to prostaglandin E1. There was prominent localised narrowing of the ductus in seven patients and generalised narrowing in three. After the infusion of prostaglandin E1 there was no ductal narrowing in these patients, except for one patient who had slight residual localised narrowing. There was also a considerable change in the ductal flow profiles in each patient. In these 10 patients infusion of prostaglandin E1 resulted in an increase in arterial oxygen tension, clinical improvement, or both. The present study indicates that prostaglandin E1 is effective in patients with prominent narrowing of the ductus but is not in patients in whom the ductus is widely patent or closed. Cross sectional echocardiography combined with Doppler echocardiography was useful for predicting the responsiveness of the ductus arteriosus to the infusion.

Regional Blood Flow Distribution and Left Ventricular Output during Early Neonatal Life: A Quantitative Ultrasonographic Assessment

“…Ductus arteriosus. The inner diameter and the blood flow pattern of the ductus arteriosus were also determined at the time of the other hemodynamic measurements (1,18,19). Ductus arteriosus size was determined from the inner diameter on two-dimensional color echocardiographic images, with the inner diameter being measured at the narrowest portion of the ductal lumen in the parasternal long-axis plane.…”

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][13][14][15][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.…”

“…Images were obtained through a high parasternal imaging window, using a direct inferior or slightly superior position by effecting a counterclockwise rotation in the left second to third intercostal space. Images were acquired by effecting a clockwise or counterclockwise rotation while visualising the aortic arch along its long axis – left or right, according to the direction of the aortic arch – alternatively over the right or left clavicle, over the bifurcation of the main and left pulmonary arteries 14 . Ductal morphology was defined by minimal and maximal intraluminal diameter measurements by two-dimensional echocardiography.…”

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

“…The maximal and minimal intraluminal diameters of the ductus arteriosus were measured using the long axial view, as previously reported. 9,10 We used two indices to evaluate the ductal morphology, minimal intraluminal diameter and minimal plus maximal intraluminal diameters, because we have previously determined that localized narrowing within the ductus occurs as early evidence of ductal constriction, subsequently leading to closure along the whole length. 11…”

“…Arterial oxygen tension was measured by peripheral oxygen saturation. Ductal closure was defined as the presence of echocardiographically determined signs, 9 as well as when the above clinical parameters were seen. 9…”