Functional Critical Aortic Stenosis with Transient Retrograde Flow in a Neonate with Left Diaphragmatic Hernia

We report a neonate with left congenital diaphragmatic hernia and severe left ventricular dysfunction, in whom the blood flow in the transverse arch and its branches was supported in a retrograde fashion by patent ductus arteriosus. There was only minimal antegrade flow across the aortic valve and hemodynamic physiology resembled critical aortic stenosis, necessitating the immediate use of prostaglandin E1 infusion to maintain the patent ductus arteriosus.     

长疗程消炎痛治疗早产儿动脉导管未闭疗效和血浆6-酮-前列腺素F_1α变化的研究

目的探讨长疗程和常规疗程（短疗程）消炎痛关闭早产儿动脉导管的疗效、安全性及治疗前后前列腺素水平的变化。方法设计前瞻性双盲随机对照试验。体重≥1250g的动脉导管未闭（PDA）早产儿随机分为短疗程组（对照组）[0.2mg/（kg.次）,确诊后即刻、12、36h各用1次]和长疗程组（试验组）[0.15mg/（kg.次）,确诊后即刻、12、36、48h各用1次]。在治疗前后监测血浆6-酮-前列腺素F1α水平,评估临床症状和心脏彩超改变,主要观察指标为动脉导管的关闭情况及不良反应。结果一个疗程消炎痛治疗后试验组动脉导管关闭率高于对照组（75.0%比64.3%,RR1.17,95%CI0.823～1.654）,少尿发生率低于对照组（7.1%比32.0%,RR0.22,95%CI0.053～0.938）。两组患儿血浆6-酮-前列腺素F1α在消炎痛治疗后较治疗前明显降低（280ng/L比295ng/L,P〈0.001）,但两组差异无统计学意义。结论长疗程消炎痛治疗早产儿PDA的疗效与短疗程相当,且降低了少尿的发生率,并未增加坏死性小肠结肠炎发生率。血浆6-酮-前列腺素F1α在应用消炎痛后降低。     

妊娠晚期胎儿心功能-Tei指数与静脉导管指数相关性研究

目的 探讨胎儿左、右心室Tei指数与静脉导管指数的相关性.方法 应用多普勒超声心动图测量55名孕龄在28～40周的胎儿左、右心室多普勒时间间期,获得左、右心室Tei指数,应用多普勒获得静脉导管频谱,获得前负荷指数、峰值流速指数,分析Tei指数与静脉导管指数的相关性.结果 左、右心室Tei指数与静脉导管前负荷指数、峰值流速指数之间无相关性.结论 静脉导管频谱不能反映Tei指数的细微变化,不能取代Tei指数评估胎儿心功能的变化程度.     

Two-dimensional and Doppler echocardiographic assessment of variably shaped ductus arteriosus by the parasternal approach

Summary Parasternal two-dimensional and Doppler echocardiography were compared with angiographic, surgical, and postmortem data in 213 patients with various forms of congenital heart disease for its accuracy in determining patency and anatomy of the ductus arteriosus (DA). The age range of the examined patients was from 1 day to 4 years (mean, 7.4 months). Echocardiography was always performed before any invasive procedure. An adequate window for imaging the DA was obtained by parasternal, two-dimensional echocardiography in 209 patients (98%). A persistent ductus arteriosus (PDA) was detected by invasive methods in 79 of 209 patients (38%), and by two-dimensional and Doppler echocardiography in 76 (sensitivity, 96%; specificity, 100%). The echocardiographic and angiographic findings agreed closely as to the duct's morphology. Our technique permits an accurate visualization of the duct in neonates, infants, and small children with various forms of congenital heart disease.     

Effects of prolonged versus acute indomethacin therapy in very low birth-weight infants with patent ductus arteriosus

Indomethacin has proven effective in closing the patent ductus arteriosus (PDA) in most low birth weight (LBW) neonates with this disorder. Early reopening of the ductus is a problem and often leads to the need for surgery. Prolonged use of indomethacin for several days has been suggested as a means to alleviate this problem. The present study was designed to determine if prolonged therapy over 5 days is more effective than a two-dose regimen in preventing reopening of the PDA. Seventy neonates were randomized for either prolonged therapy over 1 week or to receive two doses of indomethacin. All infants were given two doses of indomethacin 0.15 mg per kg, 12 h apart. The maintenance group received an additional 0.1 mg per kg daily for 5 days. Ten days after the infants' initial dose of indomethacin, 6 of 22 in the nonmaintenance group as compared to 0 of 22 in the maintenance group had reopening of their ductus arteriosus. Ten infants in the maintenance group eventually had the ductus reopen at a median of 29, range 11–66 days compared to a median of 3, range 2–44 days in the nonmaintenance group. Significantly fewer babies in the maintenance group had a grade II–IV intraventricular hemorrhage compared to the nonmaintenance group. There was no other significant difference in the two groups in the incidence of necrotizing enterocolitis, retrolental fibroplasia or death. Indomethacin given over 5 days is effective for closure of the ductus arteriosus and will prevent reopening until after the acute clinical course in babies under 1500 g; however, the overall incidence of reopening was not different.Abbreviations HMD hyaline membrane disease - IVH intraventricular hemorrhage - NICU neonatal intensive care unit - NIH National Institutes of Health - PDA patent ductus arteriosus - LBW low birht weight - VLBW very low birth weight (less than 1500 g)     

胎儿肝脏静脉导管的形态学观测分析

目的解剖观测胎儿肝脏静脉导管的形态。方法选择4-10月胎儿肝脏44例,暴露静脉导管,观察形态,测量其长度,近心端、远心端和中间压扁直径,并分组进行处理。结果静脉导管长度,近心端、远心端和中间压扁直径,4-6月分别为0.88±0.28cm,0.44±0.13cm,0.38±0.12cm,0.32±0.14cm;7-10月分别为1.22±0.28cm,0.56±0.14cm,0.48±0.15cm,0.41±0.09cm;合计平均为1.06±0.32cm,0.50±0.15cm,0.43±0.14cm,0.37±0.12cm。结论静脉导管长度和直径随胎龄增大而增大;静脉导管为中间细两端稍粗的管道,近心端最粗,远心端次之,而中间直径最细。     

成人动脉导管未闭的体外循环管理

目的 回顾8例成人动脉导管未闭（PDA）在体外循环（CPB）下行手术的患者，总结体外循环经验。方法 CPB采用深低温低流量（DHLF），心肌保护为4：1高钾含血停搏液灌注。心脏停跳后切开肺动脉堵住动脉导管开口，防止灌注肺。结果 CPB时间53～96min，心脏阻断25～63min，均自动复跳，顺利脱机，痊愈出院。结论 采用深低温低流量CPB行成人动脉导管直视缝合术是一种安全，有效的方法。     

Sinus venosus atrial septal defect associated with vein of Galen malformations: Report of two cases

Summary Two unique cases are presented of infants with signs of vein of Galen malformations, whose unsuspected associated sinus venosus atrial septal defects were detected during routine echocardiography. A conservative approach to cardiac treatment is advocated.     

Aneurysmal change of the ductus arteriosus after prostaglandin E1 administration for pulmonary atresia: Demonstration with magnetic resonance imaging

Summary We report a case of pulmonary atresia in which the ductus arteriosus underwent aneurysmal dilatation after infusion of prostaglandin E₁ incorporated in lipid microspheres. To our knowledge this is the first case in which this rare morphological change has been demonstrated with the noninvasive method of magnetic resonance imaging.     

Anatomical and experimental study of the ductus venosus

Summary The authors report an anatomical study of the ductus venosus in the stillborn fetus based on resin-corrosion casts and angiography. Study in adult material was done by dissection. In the first part of this paper the classical anatomy of the ductus venosus is described and an anomalous case of a hepatic parenchymal bridge between the left and caudate lobes of the liver is reported. In the second part of this paper study of patency and dilation of the ligamentum venosum to a diameter exceeding 10 mm in adult cadavers is presented. A brief study of portal flow demonstrated that an increase in flow of 30% can be obtained by experimental induction of patency. A patent ligamentum venosum was grafted onto the abdominal aorta in the rabbit. The transplanted segment was fully patent and competent immediately after grafting, but showed thrombosis when the animal was sacrified two months after the operation. In the opinion of the authors, it may be possible to use the patent ductus venosus in man once the problems of long term resistance and patency have been solved. The latter problems are currently under investigation in our laboratory.

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Etude anatomique et expérimentale du canal d'Arantius ou ductus venosus

Résumé Les auteurs rapportent une étude anatomique du canal d'Arantius chez le ftus mort-né, à partir de moulages et d'angiographies, et chez l'adulte à partir de dissections. Ils rappellent l'anatomie classique du Canal d'Arantius et rapportent un cas de pont parenchymateux hépatique entre le lobe gauche et le lobe de Spiegel. Dans une deuxième partie ils réalisent des reperméabilisations et des dilatations jusquá un diamètre de plus de 10 mm sur des cadavres d'adulte. Une courte étude débitmétrique a montré la possibilité d'augmenter le débit portal de 30 %. Un ligament veineux reperméabilisé a été utilisé comme greffon sur une aorte abdominale de lapin. Perméable et étanche d'emblée, il est retrouvé thromboséá deux mois. Les auteurs pensent possible l'utilisation du ligament veineux reperméabilisé chez l'homme lorsqu'auront été résolus les problèmes de résistance et de perméabilité à long terme. Une étude est en cours.