digoxin and Ductus-Arteriosus--Patent

To review the literature on the physiologic changes created by neonatal patent ductus arteriosus (PDA) and the potential impact on drug disposition in these infants.. An Index Medicus and bibliographic search of the English-language literature pertaining to neonatal PDA and drug usage in newborns.. PDA in premature infants is associated with a variety of physiologic changes that could alter drug disposition. Perfusion of drug-elimination organs (i.e., liver and kidney) may be diminished, resulting in decreased drug elimination. Further, the general fluid overload state associated with PDA may result in larger volumes of distribution (Vd), and dilutional effects for many drugs. Drug absorption, Vd, tissue penetration, and clearance may be affected by the physiologic changes incurred by a PDA. Although the pharmacokinetics of several categories of therapeutic agents may be affected by a PDA, disposition changes with the aminoglycosides and indomethacin have been the best documented. The most reliable pharmacokinetic change appears to be related to drug Vd. The interpretation of many of these studies is confounded by a potential drug interaction with the concurrent administration of indomethacin for PDA closure.. Close therapeutic drug monitoring is indicated in newborns with PDAs as abrupt changes in drug disposition can occur with PDA closure. PDA-induced changes in specific pharmacokinetic parameters of agents such as the aminoglycosides, indomethacin, and perhaps vancomycin may prove to be a valuable diagnostic adjunct for the identification of babies with undiagnosed PDA. More research into this pharmacophysiologic aspect of pharmacokinetics is warranted.

Topics: Absorption; Anti-Bacterial Agents; Digoxin; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Pharmacokinetics

The incidence, pathophysiology, and clinical findings of symptomatic patent ductus arteriosus (PDA) are reviewed, and the pharmacologic management of symptomatic PDA is discussed. Spontaneous closure of the ductus arteriosus (DA) usually occurs within four days after birth in most premature and full-term infants. The incidence of PDA is related to birth weight in premature infants and has been shown to decrease with an increase in birth weight. Clinical findings are reviewed. Prophylactic treatment in the first few hours after birth may not be needed in most premature infants. Treatment should be considered only if the ductus becomes symptomatic. Medical management consists of respiratory support, fluid restriction, diuretics, digoxin, and indomethacin. Respiratory support, fluid restriction, and diuretics are used as first-line treatment of symptomatic PDA. Digoxin cannot be recommended as part of first-line therapy, since its risks seem to outweigh the benefits in preterm infants. Indomethacin should be used only if other standard measures including fluid restriction and diuretic treatment fail. The mechanism of action, pharmacokinetics, adverse effects, and drug interactions of indomethacin are discussed. Symptomatic PDA can increase morbidity and mortality, especially in very low birth weight infants. Treatment of symptomatic PDA may decrease the morbidity associated with this condition.

Topics: Digoxin; Diuretics; Ductus Arteriosus, Patent; Fluid Therapy; Humans; Indomethacin; Infant, Newborn

Recently there has been a significant reappraisal of the role of PDA in the context of neonatal cardiopulmonary disease. This article reviews surgical intervention, pharmacologic treatment, and assessment of ductal patency in the neonate.

Topics: Alprostadil; Blood Circulation; Clinical Trials as Topic; Digoxin; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Function Tests; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ligation; Persistent Fetal Circulation Syndrome; Prostaglandin Antagonists; Random Allocation; Respiratory Distress Syndrome, Newborn

Considerations for the use of the principal inotropic agents (digoxin and dopamine) in the newborn are discussed. The role of Prostaglandin-E in retaining the patency of the ductus arteriosus in the initial treatment of anomalous vessel formation is outlined. Conversely, chemotherapeutic possibilities for inhibiting prostaglandin production and thus encouraging closure of the ducts prior to surgical intervention are described.

Topics: Digoxin; Dopamine; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Humans; Indomethacin; Infant, Newborn; Prostaglandins E

Topics: Aortography; Carbon Dioxide; Digoxin; Diuretics; Ductus Arteriosus, Patent; Echocardiography; Electrocardiography; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Postoperative Complications; Respiration Disorders

Topics: Acute Kidney Injury; Airway Obstruction; Anemia, Hemolytic; Arteriovenous Fistula; Asphyxia Neonatorum; Cardiac Output; Digoxin; Ductus Arteriosus, Patent; Female; Heart Failure; Humans; Hyperthyroidism; Hypoglycemia; Infant; Infant, Newborn; Isoproterenol; Medical History Taking; Pregnancy; Pulmonary Edema; Pulmonary Valve; Sepsis; Streptococcal Infections; Tachycardia, Paroxysmal; Tricuspid Valve Insufficiency

Topics: Cardiac Catheterization; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Electrocardiography; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases

Recently there has been a significant reappraisal of the role of PDA in the context of neonatal cardiopulmonary disease. This article reviews surgical intervention, pharmacologic treatment, and assessment of ductal patency in the neonate.

Topics: Alprostadil; Blood Circulation; Clinical Trials as Topic; Digoxin; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Function Tests; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Ligation; Persistent Fetal Circulation Syndrome; Prostaglandin Antagonists; Random Allocation; Respiratory Distress Syndrome, Newborn

As a result of randomized assignment, 15 preterm infants weighing 1,500 gm or less at birth and who had a symptomatic PDA were treated according to a medical management protocol, and ten according to an early surgical closure protocol. All infants required mechanical ventilation at the time of study entry, which was one week after birth. Birth weight, gestational age, age at onset of congestive failure, age at study entry, and the initial morbidity of members of the two groups were similar. The nine surviving infants managed according to the surgical closure protocol were weaned from mechanical ventilation sooner, had a decreased need for digoxin and furosemide, achieved gastrointestinal function sooner, and had a smaller hospital bill than the 12 survivors of the medical management group. These results indicate that infants with a symptomatic PDA still requiring mechanical ventilation at one week after birth will benefit from surgical closure of the ductus at that time.

Topics: Digoxin; Ductus Arteriosus, Patent; Economics, Medical; Furosemide; Humans; Infant, Newborn; Infant, Small for Gestational Age; Length of Stay

In infants with respiratory distress syndrome (RDS) hypoxemia inhibits closure of the patent ductus arteriosus (PDA), resulting in increased pulmonary blood flow with subsequent increased hypoxemia. In an attempt to interrupt this cycle 42 consecutive premature infants with RDS and PDA, weighing between 550 and 2,000 gm (average, 1,383 gm) and with an average gestational age of 31 weeks, were arbitrarily treated either medically (13 patients) or by interruption of the PDA (20 patients). Eleven patients who were initially treated medically could not be weaned from the respirator and later underwent operation. There were no operative or anesthetic deaths; late survival was 65% (20 patients). The last 31 patients were randomly divided into operative and nonoperative groups. Preliminary results revealed no significant differences in late survival between the two groups. Since the operative risk is minimal, further investigative efforts are indicated to settle this issue.

Topics: Digoxin; Ductus Arteriosus, Patent; Humans; Hypoxia; Infant, Newborn; Radiography, Thoracic; Respiratory Distress Syndrome, Newborn

Given its narrow therapeutic range, digoxin's pharmacokinetic parameters in infants are difficult to predict due to variation in birth weight and gestational age, especially for critically ill newborns. There is limited evidence to support the safety and dosage requirements of digoxin, let alone to predict its concentrations in infants. This study aimed to compare the concentrations of digoxin predicted by traditional regression modeling and artificial neural network (ANN) modeling for newborn infants given digoxin for clinically significant patent ductus arteriosus (PDA).. A retrospective chart review was conducted to obtain data on digoxin use for clinically significant PDA in a neonatal intensive care unit. Newborn infants who were given digoxin and had digoxin concentration(s) within the acceptable range were identified as subjects in the training model and validation datasets, accordingly. Their demographics, disease, and medication information, which were potentially associated with heart failure, were used for model training and analysis of digoxin concentration prediction. The models were generated using backward standard multivariable linear regressions (MLRs) and a standard backpropagation algorithm of ANN, respectively. The common goodness-of-fit estimates, receiver operating characteristic curves, and classification of sensitivity and specificity of the toxic concentrations in the validation dataset obtained from MLR or ANN models were compared to identify the final better predictive model.. Given the weakness of correlations between actual observed digoxin concentrations and pre-specified variables in newborn infants, the performance of all ANN models was better than that of MLR models for digoxin concentration prediction. In particular, the nine-parameter ANN model has better forecasting accuracy and differentiation ability for toxic concentrations.. The nine-parameter ANN model is the best alternative than the other models to predict serum digoxin concentrations whenever therapeutic drug monitoring is not available. Further cross-validations using diverse samples from different hospitals for newborn infants are needed.

Topics: Digoxin; Ductus Arteriosus, Patent; Female; Forecasting; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Linear Models; Male; Neural Networks, Computer; Retrospective Studies

Fetal tachyarrhythmia may cause fetal hydrops and lead to fetal morbidity and mortality. Supraventricular tachycardia and atrial flutter have been the most diagnosed. We present a case of fetal atrial flutter diagnosed during the second trimester treated with digoxin and sotalol and delivered at term.. A 30-year-old primigravid woman was diagnosed with fetal atrial flutter at the gestational age of 25 weeks with atrial rates of 480-520 bpm and ventricular rates of 200-250 bpm. Initially, she was treated with digoxin then with a combination of digoxin and sotalol. The fetal heart beat slowed after sotalol treatment but did not return to sinus rhythm. The fetus was delivered vaginally. Neonatal echocardiography showed a small apical ventricular septal defect and small patent ductus arteriosus. Electrocardiography also revealed atrial flutter with occasional atrial fibrillation.. The efficacy of antiarrhythmic drug therapy for fetal atrial flutter has not been well established. In our case, we used sotalol combined with digoxin and the fetal heart beat slowed after therapy. Sotalol may be considered the drug of choice for fetal atrial flutter. If the fetal atrial flutter is resistant to these therapies, a combination of other congenital cardiac diseases or organic abnormalities should be considered.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Delivery, Obstetric; Digoxin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Ductus Arteriosus, Patent; Echocardiography; Female; Fetal Diseases; Heart Rate, Fetal; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Pregnancy; Sotalol

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Child; Cranial Nerve Neoplasms; Digoxin; Down Syndrome; Ductus Arteriosus, Patent; Facial Nerve; Facial Paralysis; Female; Heart Defects, Congenital; Heart Septal Defects, Atrial; Humans; Hypothyroidism; Infant, Newborn; Male; Neurilemmoma; Transposition of Great Vessels

Digoxin was administered to an 18-day-old infant who showed evidence of cardiac failure. When a Doppler echogram revealed a patent ductus, indomethacin was administered for medical management. Therapeutic digoxin doses then resulted in toxic serum concentrations of 8.2 ng/ml. Serum creatinine rose accordingly. Although this patient did not manifest signs of digoxin toxicity, practitioners should be alerted to the potential complications of these commonly used agents.

Topics: Creatinine; Digoxin; Drug Interactions; Ductus Arteriosus, Patent; Female; Heart Failure; Humans; Indomethacin; Infant, Newborn

The clinical pharmacology of ibuprofen (Motrin, Upjohn) in relation to the pathophysiologic aspects of various diseases is explained. An understanding of prostaglandin's numerous effects can help the clinician to expand the use of ibuprofen (as in Barttern's syndrome) and to exercise caution as warranted, as when treating patients with renal disease. Knowledge of ibuprofen's clinical pharmacology may also enable practitioners to prescribe the drug rationally in situations not well represented in the literature, as in the elderly or in individuals with bleeding diatheses or severe liver disease. The use of ibuprofen in multiple-drug therapy with aspirin, warfarin, phenytoin, digoxin, or lithium is explored. Perusal of the literature enables the clinician to gain an awareness of patient subpopulations warranting careful use of medication, including the elderly or individuals with systemic lupus erythematosus, mixed connective tissue disease, or aspirin-induced asthma.

Topics: Arthritis, Rheumatoid; Aspirin; Bartter Syndrome; Cyclooxygenase Inhibitors; Digoxin; Drug Hypersensitivity; Drug Interactions; Ductus Arteriosus, Patent; Humans; Ibuprofen; Indomethacin; Kidney; Kinetics; Lithium; Liver; Lupus Erythematosus, Systemic; Mixed Connective Tissue Disease; Phenytoin; Platelet Aggregation; Prostaglandins E; Warfarin

Topics: Digoxin; Ductus Arteriosus, Patent; Echocardiography; Furosemide; Humans; Infant, Newborn; Infant, Premature, Diseases

Topics: Digoxin; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases

The maturation of the lung is one of the greatest challenges the premature infant must face after birth. Premature infants have been observed to have a higher prevalence of patency of the ductus arterious, presenting the physician with a dilemma and a challenge. This article discusses the clinical and pathophysiologic manifestations and the management of patent ductus arteriosus in the premature infant.

Topics: Blood Transfusion; Cardiac Catheterization; Digoxin; Diuresis; Ductus Arteriosus, Patent; Echocardiography; Heart Murmurs; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases

Indomethacin is commonly coadministered with digoxin for the treatment of patent ductus arteriosus (PDA) in preterm infants. The combination of digoxin that is eliminated almost exclusively by the kidney and indomethacin, which tends to reduce renal function, has potential hazards. We report 11 preterm infants (gestational age 25-33 week) treated with digoxin for PDA in whom a standard indomethacin therapy (mean of total dose = 0.32 mg/kg) resulted in a significant elevation of serum digoxin to potentially toxic levels (from 2.2 +/- 0.7 ng/ml to 3.2 +/- 0.7) (P less than 0.001). This phenomenon correlated well with decreased urine output (from 86 +/- 34 ml to 43 +/- 24 per 24 hour) (P less than 0.001) following indomethacin. No significant change was found in serum creatinine concentration pre- and post-indomethacin. Digoxin half-life was significantly prolonged (mean 97 +/- 17 hour) following indomethacin therapy as compared with an age matched control group (mean half-life 43 +/- 19 hour) (P less than 0.05). Our data suggest that when indomethacin is added to digoxin therapy, the digoxin dosage should be reduced by 50% until urine output and digoxin serum levels can be better assessed.

Topics: Digoxin; Drug Therapy, Combination; Ductus Arteriosus, Patent; Half-Life; Humans; Indomethacin; Infant, Newborn; Infant, Premature; Kinetics

Topics: Digoxin; Ductus Arteriosus, Patent; Humans; Infant

Eleven LBW infants were studied to assess the predictability of individual digoxin dosage requirement from a single serum digoxin concentration (SDC) at various times within the first dosing interval. The mean and SD of gestational age, weight and postnatal age were 31.6 +/- 3.5 wk, 1.51 +/- 0.47 kg and 3.7 +/- 2.1 days, respectively. Total body digoxin clearance (TBDC) in each infant was calculated from the computer-fitted biexponential equation describing each first-dose blood level curve. There was no correlation between the TBDC (99.5 +/- 37.0 ml/kg/hr) and the 6-hr SDCs (3.1 +/- 0.6 ng/ml) after the first dose (P greater than 0.20). Significant correlation of both 12- and 24-hr SDCs (2.8 +/- 0.6 and 2.3 +/- 0.5 ng/ml) after first dose with TBDC was found (r = -0.53, P less than 0.05 and r = -0.87, P less than 0.005, respectively). Good correlation (r = 0.88) of 1/dose (where dose = mg/kg/day to achieve a mean steady-state level of 2 ng/ml) with the 24-hr SDCs was also observed (P less than 0.005).

Topics: Computers; Digoxin; Ductus Arteriosus, Patent; Humans; Infant, Low Birth Weight; Infant, Newborn; Metabolic Clearance Rate

Left ventricular systolic time intervals were assessed in 16 preterm infants with symptomatic left-to-right ductal shunts, before, during and after digoxin therapy. An intravenous loading dose of digoxin, 20 micrograms/kg, resulted in a serum digoxin concentration of 1.94 +/- 0.44 nmol/l (mean +/- 1 SD) but in no significant change in heart rate or systolic time intervals. Digoxin maintenance, 2.5 micrograms/kg/12 h, led 3-7 days later to serum concentrations of 2.57 +/- 1.06 nmol/l with an associated shortening of left ventricular ejection time (p less than 0.05) which probably reflected a reduced ductal shunt. Digoxin therapy was withdrawn after ductal closure. The terminal serum half-life was 87 +/- 17 h. Decreasing digoxin concentrations were associated with prolongation of left ventricular ejection time (p less than 0.01). Digoxin therapy did not seem to influence left ventricular systolic time intervals while ductal patency persisted. This may be attributed to limitations of the method or the left ventricle already working at its maximum.

Topics: Digoxin; Ductus Arteriosus, Patent; Heart Rate; Humans; Infant, Newborn; Infant, Premature, Diseases; Prospective Studies; Systole

Eighteen infants, each weighing less than 1,500 gm, were treated with low dose digoxin therapy for patent ductus arteriosus and signs of circulatory congestion. Nine of the 18 developed one or more signs of clinical deterioration felt to be related to digoxin therapy: eight infants experienced frequent episodes of bradycardia, six had cardiac arrhythmias, and six experienced feeding difficulties. All signs disappeared when digoxin therapy was discontinued. Digoxin, even in relatively low dosages, can have deleterious complications in seriously ill low-birth-weight infants. Alternatives to digoxin in this patient population should be considered before institution of digoxin therapy.

Topics: Arrhythmias, Cardiac; Bradycardia; Digoxin; Ductus Arteriosus, Patent; Feeding Behavior; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases

A retrospective study is made on the results of the treatment of 38 preterm infants with symptomatic PDA; they represented an incidence of 4% of all the admissions to our Unit from June 1978 to March 1980. 30 of the 38 infants (79%) had PDA associated with RDS. Conservative medical treatment failed in 42% of the patients, requiring the administration of indomethacin for pharmacologic closure of their PDA. The different responses to the drug in each of the established groups are commented, being the group with a birth weight less than 1,500 g who presented the highest percentage of re-openings (62.5%) and of therapeutic failures (50%). An early closure of the PDA can contribute to decrease the morbidity and mortality of these infants, specially those with lower birth weight.

Topics: Digoxin; Ductus Arteriosus, Patent; Female; Furosemide; Humans; Indomethacin; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Male; Respiratory Distress Syndrome, Newborn; Retrospective Studies

An infant with Ebstein's malformation of the tricuspid valve and severe pulmonic stenosis underwent a 39-day course of prostaglandin E1 infusion, and a histologic study of the ductus arteriosus was undertaken after autopsy. There were marked alterations in the ductal and juxtaductal structures following this prolonged infusion of prostaglandin E1. The internal elastic lamella of the ductus was disrupted in many areas. The media showed widespread areas of disruption with cavity formation. The adventitia adjacent to the junction of the ductus with the pulmonary artery was thickened and infiltrated with mononuclear cells. The nerve trunks in the adventitia were markedly infiltrated with mononuclear cells and showed cavitation as well as considerable surrounding edema. Mucopolysaccharides were increased throughout the ductus. These changes produced increased fragility of the ductal and juxtaductal structures, thus increasing the likelihood of spontaneous aneurysms and rupture, or of tearing or rupture at the aortic and pulmonary junctions at the time of surgical closure of the ductus. Unusual fragility of the ductus, pulmonary artery, and aorta has been observed during ligation of the ductus following prostaglandin E infusions lasting seven and ten days. Additionally, another patient who had received prostaglandin E infusion for six days demonstrated aneurysmal fullness to the ductus arteriosus at autopsy. The histologic findings and intraoperative experience in this study suggest that there may be a real danger of spontaneous or surgically related rupture of the ductus arteriosus after prolonged infusion of prostaglandins.

Topics: Cardiac Catheterization; Digoxin; Ductus Arteriosus; Ductus Arteriosus, Patent; Ebstein Anomaly; Female; Furosemide; Humans; Infant, Newborn; Infusions, Intra-Arterial; Pregnancy; Prostaglandins E

Serum digoxin (DIG) levels, timed urine and M-mode echocardiograms were performed in 9 low birth weight infants with left-to-right shunting due to patent ductus arteriosus treated with DIG (40 micrograms/kg in 3 and 20 micrograms/kg in 6). Half the DIG was given initially and a quarter at 8-hourly intervals. Serum DIG levels at 24 h (1.8-7.0 ng/ml) were similar in both dose groups. One infant in the 40 micrograms/kg dose group developed Wenckebach phenomenon. Left atrial to aortic root ratio fell within 30 min and remained reduced during the ensuing 24 h (p less than 0.025). There were no significant changes in the other echocardiographic measurements. Half-life of distribution and elimination of DIG were 1.04 +/- 0.46 and 15.25 +/- 0.36 h. The alpha-phase volumes of distribution (VD) differed between the 40 and 20 micrograms/kg dose groups (2.28 +/- 0.05 vs. 1.33 +/- 0.66 liters/kg, p less than 0.025). The beta-phase VD (4.25 +/- 0.61 and 2.76 +/- 0.99, respectively) were similar. Mean urinary DIG clearance was 13.1 +/- 3.2 ml/min/1.73(2).

Topics: Digoxin; Ductus Arteriosus, Patent; Echocardiography; Half-Life; Heart; Humans; Infant, Low Birth Weight; Infant, Newborn; Kinetics

Topics: Creatinine; Digoxin; Ductus Arteriosus, Patent; Heart Failure; Humans; Indomethacin; Infant, Newborn; Kidney; Male

During 1975, 38 of 44 infants with a birth weight of less than or equal to 1,500 gm who developed pulmonary edema and congestive heart failure due to a patent ductus arteriosus were managed medically until the ductus closed spontaneously days or weeks later. Overall survival was 71%, and there were no deaths among 11 infants weighing more than 1,250 gm. Pulmonary complications were prevalent and were attributed to the extensive use of mechanical ventilation required to control pulmonary edema. The results of this study document the results to be expected when small preterm infants with a symptomatic patent ductus arteriosus are managed without surgical or pharmacologic intervention and provide a basis for the rational design of clinical trials evaluating other management approaches.

Topics: Blood Transfusion; Digoxin; Ductus Arteriosus, Patent; Furosemide; Heart Failure; Hematocrit; Humans; Infant, Newborn; Infant, Premature; Pulmonary Edema

Digoxin therapy was evaluated retrospectively in a group of 30, and prospectively in a group of 16 low-birth-weight, premature infants with cardiorespiratory symptoms due to persistent patency of the ductus arteriosus. The response to decongestive therapy was equivocal. Digoxin levels in serum varied between 1.5 and 13 ng/ml. Digoxin half-life in serum exceeded three days in four patients. Fourteen of the combined group of 46 infants had signs of toxicity of digoxin. High dosage, inadvertent overadministration, and variable clearance of digoxin, as well as special characteristics of the patients studied, are postulated as explanations for the high incidence of toxicity. This study suggests that digoxin therapy in low-birth-weight, premature infants with patent ductus arteriosus is not without risk.

Topics: Digoxin; Ductus Arteriosus, Patent; Female; Half-Life; Heart Block; Heart Failure; Heart Rate; Humans; Infant, Low Birth Weight; Infant, Newborn; Male; Prospective Studies; Retrospective Studies

A prospective 2 1/2 year study of 50 infants with combined respiratory distress syndrome (RDS) and patent ductus arteriosus (PDA) was undertaken to determine whether echocardiographic measurements combined with clinical assessment could be used to select those infants who needed cardiac treatment. From a pilot study, criteria were adopted to use digoxin in the treatment of infants with evidence of congestive cardiac failure and/or a left atrial dimension 1.5 times normal size, and to ligate the PDA in those with unremitting congestive cardiac failure and a left atrial dimension persistently twice normal. Left atrial, left ventricular, and aortic dimensions, left atrial to aortic ratio, and mean Vcf were echocardiographically determined. Forty-six per cent of the 50 infants with PDA required digoxin administration, and 18 per cent of the total group was operated. The long-term mortality for the total group was 12 per cent (6 of 50) and mortality was 33 per cent (3 of 9) for the operated group. Results showed that absolute left atrial dimension, particularly if recorded in two dimensions, most accurately predicted those infants who would develop congestive cardiac failure or failure that would become medically unmanageable.

Topics: Aorta; Birth Weight; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Atria; Heart Failure; Heart Ventricles; Humans; Infant, Newborn; Prospective Studies; Respiratory Distress Syndrome, Newborn

Diagnostic separation of infants with signs of cardiac failure (hypoglycemia, sepsis, myocarditis, hypoxemia) but no congenital cardiocirculatory malformation from those with a large left to right shunt is crucial in newborn management. Echocardiographic studies of 218 infants and children allowed group separation and distinction from normal by the assessment of mean velocity of circumferential fiber shortening (Vcf) and the ratio of left atrial to aortic root diameter at end-systole (LA/Ao). In normal premature and full-term infants, Vcf (1.51 +/- 0.04 [mean +/- standard error]) was significantly lower than in infants with a large shunt (2.12 +/- 0.08, P less than 0.01) and higher than in infants with nonstructural heart disease (1.18 +/- 0.06, P less than 0.001). LA/Ao ratios were comparable in the groups with a large shunt and nonstructural heart disease (1.14 +/- 0.1 and 1.26 +/- 0.2, respectively) and were significantly higher in both groups than in normal subjects (0.77 +/- 0.01, P less than 0.001). Similar echocardiographic distinctions could be made when 10 older children (aged 2 to 10 years) with cardiomyopathy were compared with 45 normal older children. Serial determination of these variables was of major assistance in patient management.

Topics: Cardiomyopathies; Child; Child, Preschool; Diagnosis, Differential; Digoxin; Ductus Arteriosus, Patent; Echocardiography; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Myocardial Contraction; Myocarditis

The successful simultaneous closure of a persistent ductus arteriosus and mitral valve replacement in a 65-year-old woman with pulmonary hypertension is reported. The approach through a left thoracotomy gave good exposure and momentary cessation of cardiopulmonary bypass made ligation of the calcified ductus possible. Although this seems to be a rare association, when mitral valve disease is significant the simultaneous closure of the duct and mitral valve surgery is the treatment of choice.

Topics: Aged; Blood Pressure; Cardiac Catheterization; Cardiopulmonary Bypass; Cineangiography; Digoxin; Ductus Arteriosus, Patent; Female; Heart Rate; Humans; Hypertension, Pulmonary; Ligation; Methods; Mitral Valve; Mitral Valve Insufficiency; Practolol

Topics: Aorta; Aortic Arch Syndromes; Aortic Valve; Autopsy; Birth Weight; Chlorothiazide; Digoxin; Ductus Arteriosus, Patent; Electrocardiography; Heart Auscultation; Heart Defects, Congenital; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Male; Mitral Valve; Oxygen; Pulmonary Artery; Pulse

Topics: Asphyxia Neonatorum; Body Weight; Digoxin; Ductus Arteriosus, Patent; Female; Gestational Age; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male; Organomercury Compounds; Respiratory Distress Syndrome, Newborn; Sex Factors

Topics: Birth Weight; Cataract; Cesarean Section; Chloramphenicol; Digoxin; Drug-Related Side Effects and Adverse Reactions; Ductus Arteriosus, Patent; Female; Humans; Infant; Infant, Newborn; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Rubella virus

In 28 infants and children with complete transposition of the great vessels, atrial septal defects were created utilizing an open technique with inflow caval occlusion and moderate hypothermia. Of the 12 infants for whom operation was necessary during the first two weeks of life only two survived, suggesting that this technique is not adequate for infants at this age. Only four of the 16 children operated on between the ages of two weeks and three years failed to survive. Two of these died because of pre-existing non-cardiac conditions. Seven children with associated systemic-to-pulmonary shunts survived; the open technique may be preferable in this particular group. Despite the initial improvement afforded by this procedure, three sudden late deaths occurred. For this reason, and because of the danger of early development of pulmonary vascular disease, total operative correction of the malformation should be performed early.

Topics: Angiocardiography; Cardiac Surgical Procedures; Child; Digoxin; Diuretics; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Septal Defects; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Hypothermia; Hypothermia, Induced; Infant; Infant, Newborn; Organomercury Compounds; Thoracic Surgery; Transposition of Great Vessels