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Sample records for reversible ductus arteriosus

  1. Patent ductus arteriosus

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001560.htm Patent ductus arteriosus To use the sharing features on this page, please enable JavaScript. Patent ductus arteriosus (PDA) is a condition in which the ductus ...

  2. What Is Patent Ductus Arteriosus?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Is Patent Ductus Arteriosus? Patent ductus arteriosus (PDA) is a heart problem ... the lung arteries. Normal Heart and Heart With Patent Ductus Arteriosus Figure A shows the interior of a normal ...

  3. Reversal of severe mitral regurgitation by device closure of a large patent ductus arteriosus in a premature infant.

    Science.gov (United States)

    Kheiwa, Ahmed; Ross, Robert D; Kobayashi, Daisuke

    2017-01-01

    We report a critically ill premature infant with severe mitral valve regurgitation associated with pulmonary hypertension and a severely dilated left atrium from a large patent ductus arteriosus. The mitral valve regurgitation improved significantly with normalisation of left atrial size 4 weeks after percutaneous closure of the patent ductus arteriosus. This case highlights the potential reversibility of severe mitral valve regurgitation with treatment of an underlying cardiac shunt.

  4. REVERSE PDA – LESS COMMON TYPE OF PATENT DUCTUS ARTERIOSUS -CASE REPORT

    Directory of Open Access Journals (Sweden)

    Iuliu Scurtu

    2016-11-01

    Full Text Available Introduction: PDA represents one of the most frequently diagnosed type of congenital heart disease. Ductus arteriosus is a normal structure in foetal life, which permits shunting of oxygenated blood from the pulmonary artery into the aorta. Failure of sealing after birth is an abnormal condition and is called patent ductus arteriosus. In normal PDA, due to fact that systemic pressure is fivefold higher than pulmonary circulation, blood is shunted from the aorta into the pulmonary artery. In reverse PDA, pulmonary artery pressure does not drop after birth, and blood will be shunted form right to left. Aims: We want to evaluate clinical, haematological, ECG and echocardiographic changes in case of reverse PDA. Materials and Methods: Two-year old female Bichon Frise was referred to our clinic with signs of effort intolerance and dyspnoea for more than a year. ECG was performed in the right lateral recumbency using a digital device and echocardiography was done with Esaote MyLab40 Vet with a phased array transducer matched with the size of the dog (7.5 MHz. Results: We identified a dog with a good body score, quite alert and without any sign of illness. Haematological investigation underlined polycythaemia and very high PCV. The ECG revealed a normal sinus rhythm with a deep S wave, changes consistent with right ventricle enlargement.  Right atrial dilation and right ventricle hypertrophy were found on cardiac ultrasonography. The right ventricle free wall was hypertrophied and interventricular septum was flattened, changes consistent with increased pressure on the right side of the heart. The left heart was small. Positive diagnosis was done, performing “bubble study” and identification of contrast bubble within the abdominal aorta.   Conclusion: Reverse PDA is a rarely diagnosed congenital heart disease. Polycythaemia in young dogs could raise the suspicion of reverse PDA.  For positive diagnosis, echocardiography and bubble study are

  5. Protective strategies to prevent patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    Kris C. Sekar

    2010-01-01

    Ductus arteriosus is the communication between the proximal aorta and the pulmonary artery which diverts well oxygenated blood from the placenta to the systemic circulation bypassing the fluid filled lung in the fetal circulation. Therefore it is very essential for fetal survival. After birth, in term infants the ductus usually closes within the first day of life, starting with functional closure followed by anatomical closure by vascular remodeling.1

  6. Patent ductus arteriosus with Eisenmenger syndrome.

    Science.gov (United States)

    Moustafa, Sherif; Patton, David J; Balon, Yvonne; Connelly, Michael S; Alvarez, Nanette

    2013-11-01

    Herein we report a 21 year-old woman with a previously documented patent ductus arteriosus and Eisenmenger physiology. She presented with increasing cyanosis and exercise intolerance which could be explained by a new finding of right to left shunting through an interatrial communication. She was started on Bosentan therapy aiming to reduce the pulmonary pressure with consideration for heart-lung transplantation should any further deterioration occur.

  7. A rare association with patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Dhanya Warrier

    2012-01-01

    Full Text Available Persistent fifth aortic arch (PFAA, also known as congenital double-lumen aortic arch, is a rare developmental anomaly of the aortic arch. A 5-month-old baby who presented with congestive cardiac failure was diagnosed to have a large patent ductus arteriosus with PFAA. Although this arch anomaly had no hemodynamic relevance in this case, preoperative diagnosis prevented surprises "on table."

  8. Etiology of patent ductus arteriosus in dogs.

    Science.gov (United States)

    Buchanan, James W; Patterson, Donald F

    2003-01-01

    Patent ductus arteriosus (PDA) is the most common congenital heart disease in dogs and usually causes heart failure and death unless corrected at a young age. Previous histologic studies in a line of dogs derived from Miniature Poodles with hereditary PDA identified varying degrees of hypoplasia and asymmetry of ductus-specific smooth muscle and the presence of aortalike elastic tissue in the ductus wall sufficient to cause patency. To determine if similar structural abnormalities cause PDA in other dogs, serial-section, 3-dimensional histology of ductal architecture was studied in 8 non-Poodle purebred dogs with PDA with no immediate family history of PDA. Morphologic abnormalities were observed in 7 of 8 dogs with PDA and essentially were the same as those in dogs known to have a hereditary form of PDA. These findings suggest that apparently sporadic PDA in these breeds is caused by a genetic defect in the structure of the ductus arteriosus that is similar or identical to that in the Poodle. The relatives of dogs with PDA, particularly parents, offspring, and siblings, should be screened for evidence of PDA. Dogs with PDA should not be used for breeding, regardless of breed.

  9. Identification of differentially regulated genes in human patent ductus arteriosus.

    Science.gov (United States)

    Parikh, Pratik; Bai, Haiqing; Swartz, Michael F; Alfieris, George M; Dean, David A

    2016-07-27

    In order to identify differentially expressed genes that are specific to the ductus arteriosus, 18 candidate genes were evaluated in matched ductus arteriosus and aortic samples from infants with coarctation of the aorta. The cell specificity of the gene's promoters was assessed by performing transient transfection studies in primary cells derived from several patients. Segments of ductus arteriosus and aorta were isolated from infants requiring repair for coarctation of the aorta and used for mRNA quantitation and culturing of cells. Differences in expression were determined by quantitative PCR using the ΔΔCt method. Promoter regions of six of these genes were cloned into luciferase reporter plasmids for transient transfection studies in matched human ductus arteriosus and aorta cells. Transcription factor AP-2b and phospholipase A2 were significantly up-regulated in ductus arteriosus compared to aorta in whole tissues and cultured cells, respectively. In transient transfection experiments, Angiotensin II type 1 receptor and Prostaglandin E receptor 4 promoters consistently gave higher expression in matched ductus arteriosus versus aorta cells from multiple patients. Taken together, these results demonstrate that several genes are differentially expressed in ductus arteriosus and that their promoters may be used to drive ductus arteriosus-enriched transgene expression.

  10. Pharmacologic management of patent ductus arteriosus.

    Science.gov (United States)

    Bhatt, V; Nahata, M C

    1989-01-01

    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.

  11. Management of patent ductus arteriosus in premature infants.

    Science.gov (United States)

    Bhat, Rama; Das, Utpala G

    2015-01-01

    Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach.

  12. Frontal Cardiac area in patent ductus arteriosus patients

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    Kim, Kun Sang; Choo, Dong Woon [Seoul Natinal University College of Medicine, Seoul (Korea, Republic of)

    1972-03-15

    Cardiac mensuration by radiographic frontal cardiac area method was carried out on 21 patent ductus arteriosus patients, 15 females and 6 males. Formula used in this study is as follows. Frontal cardiac area = {pi}/4 X long diameter X broad diameter. Increase of frontal cardiac area in patent ductus arteriosus patients seems to be evident but the degree of the cardiomegaly is variable. Comparing to normal data by Choo and Kim, frontal cardiac area in patent ductus arteriosus patients in this series is increased in 15.9% to 98.1%. After surgical ligation of the ductus arteriosus, significant decrease of the frontal cardiac area is observed and the average is 12.5%.

  13. Ibuprofen and paracetamol for patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Carlo Dani

    2014-06-01

    Full Text Available We aimed to assess the state of the art of pharmacological treatment of patency of ductus arteriosus (PDA with ibuprofen and paracetamol in preterm infants. We pointed out that ibuprofen is the first choice drug for PDA treatment and indomethacin should be abandoned for its frequent adverse effects. However, also the pharmacological prevention of PDA should be abandoned because many preterm infants have spontaneous closure of PDA and ibuprofen may have dangerous adverse effects. Oral paracetamol has been found in two randomized controlled studies to have the same effectiveness of ibuprofen in closing PDA but without toxicity. If these data will be confirmed the management of PDA in preterm infants should be re-evaluated. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  14. The patent ductus arteriosus in term infants, children, and adults.

    Science.gov (United States)

    Schneider, Douglas J

    2012-04-01

    During fetal life, the ductus arteriosus is a normal and essential structure that connects the pulmonary artery to the distal aortic arch, permitting right ventricular ejection into the aorta. After birth, with commencement of pulmonary blood flow and a 2-ventricle circulation, a variety of physiological and biochemical signals normally result in complete closure of the ductus. Persistent patency of the ductus arteriosus may impair systemic cardiac output and result in deleterious effects on the cardiovascular system and lungs. Although surgery is still the treatment of choice for most premature infants with patent ductus arteriosus (PDA), transcatheter techniques have largely supplanted surgery for closure of PDA in children and adults. This article is a review of the PDA in term infants, children, and adults, with focus on the clinical manifestations and management.

  15. Velocity time integral for right upper pulmonary vein in VLBW infants with patent ductus arteriosus.

    Science.gov (United States)

    Lista, Gianluca; Bianchi, Silvia; Mannarino, Savina; Schena, Federico; Castoldi, Francesca; Stronati, Mauro; Mosca, Fabio

    2016-10-01

    Early diagnosis of significant patent ductus arteriosus reduces the risk of clinical worsening in very low birth weight infants. Echocardiographic patent ductus arteriosus shunt flow pattern can be used to predict significant patent ductus arteriosus. Pulmonary venous flow, expressed as vein velocity time integral, is correlated to ductus arteriosus closure. The aim of this study is to investigate the relationship between significant reductions in vein velocity time integral and non-significant patent ductus arteriosus in the first week of life. A multicenter, prospective, observational study was conducted to evaluate very low birth weight infants (patent ductus compared to those with closed patent ductus arteriosus and the difference was significant. A significant reduction in vein velocity time integral in the first days of life is associated with ductus closure. This parameter correlates well with other echocardiographic parameters and may aid in the diagnosis and management of patent ductus arteriosus.

  16. Pros and cons of patent ductus arteriosus ligation: hemodynamic changes and other morbidities after patent ductus arteriosus ligation.

    Science.gov (United States)

    Noori, Shahab

    2012-04-01

    Although surgical ligation of a persistent patent ductus arteriosus resolves the adverse hemodynamic consequences of the systemic-to-pulmonary shunt and may confer some long-term benefits, it is also associated with both immediate and long-term negative effects. The population that benefits from or is harmed by the procedure is not clearly defined. Although indiscriminate ligation of the patent ductus arteriosus in all patients is not supported by the available information, the recent suggestion declaring the ductus harmless is not supported either. As we await the results of appropriately designed randomized control studies to define the indications for ligation, we must use clinical and echocardiographic indicators of a hemodynamically significant ductus arteriosus and thoughtful assessment of each individual patient to help guide us in addressing this complex problem.

  17. Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants

    NARCIS (Netherlands)

    Lemmers, Petra M. A.; Toet, Mona C.; van Bel, Frank

    2008-01-01

    OBJECTIVES. A hemodynamically important patent ductus arteriosus is a common problem in the first week of life in the preterm infant. Although patent ductus arteriosus induces alterations in organ perfusion, scarce information is available of the impact of patent ductus arteriosus and its subsequent

  18. TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS

    Institute of Scientific and Technical Information of China (English)

    高伟; 周爱卿; 余志庆; 李奋; 王荣发; 黄美蓉

    2002-01-01

    Objective To explore the efficacy of transcatheter closure of patent ductus arteriosus (PDA) with detachable coil and Amplatzer duct occluder (ADO). Methods Transcatheter colsure of PDA was performed in 160 cases, aged 4.56±2.67 years, of whom 3 had residual shunt after surgical ligation, 2 had pulmomary stenosis (PS), 1 had coarctation of aorta (COA), 1 had right aortic arch, and 2 had atrial septal defect (ASD). Results Detachable coils (Duct Occlude pfm or Cook Inc) were successfully used in 51 patients with a smallest PDA diameter of 1.86±0.78mm. Amplatzer duct occluders were also successfully performed in other 109 with a moderate to large PDA diameter of 3.89±1.32mm, of whom 3 with PS or COA were performed balloon dilation firstly, and 2 with ASD were performed PDA occlusion firstly; 1 month to 4.8years follow-up coil or Amplatzer device closure of PDA showed that neither residual shunt nor any complication. Conclusion It is suggested that the detachable coil and Amplatzer duct occluder are simple and safe for the catheter closure from small to large sized PDA.

  19. Unusual presentation for a patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    C. D. Vizza

    2009-09-01

    Full Text Available A 63-yr-old black female, with a 1-yr history of hepatitis C and ascites was referred to an expert centre with suspicion of portopulmonary hypertension (PPHTN. Her poor condition made a rapid diagnosis imperative and precluded a normal diagnostic work-up. Echocardiography confirmed severe pulmonary hypertension (PH. A hepatic scintigraphy and an abdominal echo-Doppler study excluded liver cirrhosis and portal hypertension. Cardiac magnetic resonance imaging showed marked dilation of the right ventricle with significant hypertrophy of the free wall, a finding that is uncommon in idiopathic pulmonary arterial hypertension or PPHTN. Right heart catheterisation demonstrated severe pre-capillary PH without response to acute vasodilator testing. Finally the patient underwent computed tomography angiography, which showed marked dilation of the pulmonary artery without thromboembolic disease and, unexpectedly, a partially calcified large patent ductus arteriosus. The correct diagnosis of the underlying cause of pulmonary arterial hypertension is essential. Patients with underlying heart defects may have an atypical presentation and be referred to expert centres with an incorrect diagnosis. A full investigation is necessary; careful examination of right ventricular anatomy can provide clues about the aetiology of PH, and it is important to exclude intra- and extracardiac shunts during haemodynamic studies.

  20. Adult patent ductus arteriosus complicated by endocarditis and hemolytic anemia.

    Science.gov (United States)

    Sabzi, Feridoun; Faraji, Reza

    2015-01-01

    An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.

  1. Magnetic resonance imaging of the ductus arteriosus - case report

    Energy Technology Data Exchange (ETDEWEB)

    Yousry, T.; Bacherler, B.; Tiling, R.; Fink, U.; Werdan, K.

    1989-03-01

    In a female patient suffering from renal insufficiency in whom angiography could not be performed, it was possible to confirm the diagnosis of a ductus arteriosus (ductus of Botalli) by magnetic resonance imaging. The present case report shows that it is possible to visualise this congenital heart disease by MRI. This can be of importance especially if angiography cannot be performed (as in this case) because of renal insufficiency or because of contrast medium allergy.

  2. Adrenal function in preterm infants undergoing patent ductus arteriosus ligation.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif

    2013-01-01

    Targeted milrinone treatment for low left ventricular output (LVO) reduces the incidence of acute cardiorespiratory instability following ligation of patent ductus arteriosus (PDA) in preterm infants. Despite this, some infants continue to experience postoperative deterioration. Adrenal insufficiency related to prematurity has been postulated as a possible mechanism.

  3. Patent Ductus Arteriosus Treatment in Very Preterm Infants

    DEFF Research Database (Denmark)

    Edstedt Bonamy, Anna-Karin; Gudmundsdottir, Anna; Maier, Rolf F

    2017-01-01

    BACKGROUND: Spontaneous closure of patent ductus arteriosus (PDA) occurs frequently in very preterm infants and despite the lack of evidence for treatment benefits, treatment for PDA is common in neonatal medicine. OBJECTIVES: The aim of this work was to study regional variations in PDA treatment...

  4. Ibuprofen pharmacokinetics in preterm infants with patent ductus arteriosus

    NARCIS (Netherlands)

    Van Overmeire, B; Touw, D; Schepens, P J; Kearns, G L; van den Anker, J N

    2001-01-01

    OBJECTIVE: Our objective was to study the pharmacokinetics of ibuprofen in premature infants with patent ductus arteriosus on day 3 and day 5 after birth. METHODS: Ibuprofen was administered on days 3, 4, and 5 by a 15-minute intravenous infusion of 10, 5, and 5 mg/kg, respectively, with the aim of

  5. Congenital absence of pericardium in babies with patent ductus arteriosus.

    Science.gov (United States)

    Azhar, I O; Anas, R

    2013-06-01

    We report a case of two babies with absence of pericardium and patent ductus arteriosus (PDA). The absence of pericardium was found coincidentally during PDA ligation. The PDA was successfully ligated but the pericardium was not reconstructed. Postoperatively, the agenesis of the pericardium did not interfere with cardiac function.

  6. Surgical ligation of patent ductus arteriosus in premature infants

    DEFF Research Database (Denmark)

    Sørensen, Cristel M; Steensberg, Jesper N; Greisen, Gorm

    2010-01-01

    The objective was to evaluate the mortality and the morbidity in neonates operated for persistent ductus arteriosus at Copenhagen University Hospital in the 10-year period from 1 January 1998 to 31 December 2007, and to compare the results with results reported in extant literature....

  7. Ibuprofen pharmacokinetics in preterm infants with patent ductus arteriosus

    NARCIS (Netherlands)

    Van Overmeire, B; Touw, D; Schepens, P J; Kearns, G L; van den Anker, J N

    2001-01-01

    OBJECTIVE: Our objective was to study the pharmacokinetics of ibuprofen in premature infants with patent ductus arteriosus on day 3 and day 5 after birth. METHODS: Ibuprofen was administered on days 3, 4, and 5 by a 15-minute intravenous infusion of 10, 5, and 5 mg/kg, respectively, with the aim of

  8. Guinea pig ductus arteriosus. II - Irreversible closure after birth.

    Science.gov (United States)

    Fay, F. S.; Cooke, P. H.

    1972-01-01

    To investigate the mechanism underlying irreversibility of ductal closure after birth, studies were undertaken to determine the exact time course for the onset of irreversible closure of the guinea pig ductus arteriosus. Parallel studies of the reactivity of ductal smooth muscle to oxygen and studies of the postpartum cellular changes within the vessel were also carried out.

  9. A novel approach to ductal spasm during percutaneous device occlusion of patent ductus arteriosus.

    Science.gov (United States)

    De Decker, Rik; Comitis, George; Thomas, Jenny; van der Merwe, Elmarie; Lawrenson, John

    2016-10-01

    Ductal spasm is a rare yet important complication of device occlusions of patent ductus arteriosus. Spasm may result in failure of the procedure, under-sizing of the device, or embolisation of the implanted device as the spasm resolves after the procedure. We describe a novel protocol that rapidly and completely reversed the spasm in eight prematurely born infants who experienced ductal spasm during cardiac catheterisations for patent ductus arteriosus occlusion. In total, eight infants born between 25 and 34 weeks of gestation presented for transcatheter patent ductus arteriosus occlusion between 13 and 87 months of age. All eight patients experienced ductal spasm either immediately before, during, or soon after induction of anaesthesia or only after entering the ductus arteriosus with a catheter. After detection of the spasm, the anaesthetist, in each case, changed the mode of anaesthesia from inhaled sevoflurane to total intravenous anaesthesia with propofol, reduced the inhaled oxygen fraction to 21%, and initiated a continuous intravenous infusion of prostaglandin E1. The first two steps (total intravenous anaesthesia and FiO2 0.21) resulted in only partial relaxation of the spasm. Complete relaxation was attained after intravenous prostaglandin E1 infusions of only 10-15 minutes' duration. While maintaining this protocol, six ducti were successfully occluded and two were considered to be unsuitable for device occlusion and were referred for surgery. Ductal spasm during transcatheter occlusion may be reliably resolved and the procedure safely completed by a simple anaesthetic protocol, including the continuous infusion of intravenous prostaglandin E1.

  10. Evaluation of cerebral electrical activity and cardiac output after patent ductus arteriosus ligation in preterm infants.

    LENUS (Irish Health Repository)

    Leslie, A T F S

    2013-11-01

    To characterize and investigate the relationship between systemic blood flow and pre- and postoperative cerebral electrical activity in preterm neonates undergoing patent ductus arteriosus (PDA) ligation.

  11. History of the ductus arteriosus: 1. Anatomy and spontaneous closure.

    Science.gov (United States)

    Obladen, Michael

    2011-01-01

    Ductus arteriosus and foramen ovale were described by Galen without understanding their functions. His beliefs in soul localization and spiritization within the left ventricle established religious pneumatology which became a theological need in the Middle Ages. Pulmonary transit was recognized by Servetus and Colombo after the Reformation around 1550. This prompted Harvey's full understanding of the fetal circulation. Botallo did not describe the ductus arteriosus, but in 1564 redescribed the foramen ovale, making his way into the nomina anatomica by mistake. Most authors of the 19th and 20th century believed ductal patency to be passive, and postnatal closure to be an active process, explained by mechanical theories. After the discovery of prostaglandins by Bergstrom and Vane, Coceani proved that ductal patency is maintained by the relaxant action of prostaglandins.

  12. Pentoxifylline as adjunct therapy to long-term clinical management of a right-to-left patent ductus arteriosus.

    Science.gov (United States)

    Turner, Elizabeth

    2016-06-01

    Management of a right-to-left ("reversed") patent ductus arteriosus (PDA) focuses on control of clinical signs associated with hyperviscosity due to erythrocytosis. Pentoxifylline therapy is presented as an adjunct to routine phlebotomies for the long-term clinical management of reversed PDA in a 10-year-old Chihuahua.

  13. Efficacy of paracetamol on patent ductus arteriosus closure may be dose dependent: evidence from human and murine studies.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif

    2014-09-01

    We evaluated the clinical effectiveness of variable courses of paracetamol on patent ductus arteriosus (PDA) closure and examined its effect on the in vitro term and preterm murine ductus arteriosus (DA).

  14. Gentamicin pharmacokinetics in preterm infants with a patent and a closed ductus arteriosus

    NARCIS (Netherlands)

    Touw, D J; Proost, J H; Stevens, R; Lafeber, H N; van Weissenbruch, M M

    2001-01-01

    BACKGROUND AND AIM: A patent ductus arteriosus (PDA) may influence renal and hepatic blood flow and hence pharmacokinetics of drugs in neonates compared to neonates with a closed ductus arteriosus (CDA). A 10-percent difference of gentamicin pharmacokinetic parameters between PDA and CDA has been re

  15. Use of a Stent Graft for Patent Ductus Arteriosus in an Octogenarian Eliminates Ductus Flow.

    Science.gov (United States)

    Tatsuishi, Wataru; Kataoka, Go; Asano, Ryota; Sato, Atsuhiko; Nakano, Kiyoharu

    2016-06-20

    Closure of a patent ductus arteriosus (PDA) in the elderly is a high-risk procedure because of tissue fragility and many possible complications. The patient in our case was an 81-year-old woman with a window-type PDA caused by cardiac failure. Based on the anatomy of the PDA and aorta and to minimize invasion, we used a stent graft to close the PDA. This approach was successful; hemodynamics improved and ductus flow was eliminated during the follow-up period without intervention from the pulmonary artery side.

  16. Thrombosed aneurysmal nonpatent ductus arteriosus: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Sattar, P. [Radiology Department, Regionalspital Biel, Vogelsang 84, CH-2502 Biel-Bienne (Switzerland); Ehrensperger, J. [Pediatric Surgery Department, Kinderspital Wildermeth, Kloosweg 22, CH-2502 Biel-Bienne (Switzerland); Ducommun, J.C. [Radiology Department, Regionalspital Biel, Vogelsang 84, CH-2502 Biel-Bienne (Switzerland)

    1996-03-01

    We report our observations made clinically and by conventional radiography, ultrasound, computed tomography and MRI on a newborn full-term infant with a thrombosed patent aneurysmal ductus arteriosus of Botallo. The baby had no heart murmurs, but from the beginning of the 2nd day of life developed sinus tachycardia, especially when in a left-sided position, and dyspnoea mainly when drinking. From his 1st day of life we observed generalized muscular hypotonia and a tendency for hyperextension at neurological examination. (orig.). With 5 figs.

  17. Wall shear stress distributions on stented patent ductus arteriosus

    Science.gov (United States)

    Kori, Mohamad Ikhwan; Jamalruhanordin, Fara Lyana; Taib, Ishkrizat; Mohammed, Akmal Nizam; Abdullah, Mohammad Kamil; Ariffin, Ahmad Mubarak Tajul; Osman, Kahar

    2017-04-01

    A formation of thrombosis due to hemodynamic conditions after the implantation of stent in patent ductus arteriosus (PDA) will derived the development of re-stenosis. The phenomenon of thrombosis formation is significantly related to the distribution of wall shear stress (WSS) on the arterial wall. Thus, the aims of this study is to investigate the distribution of WSS on the arterial wall after the insertion of stent. Three dimensional model of patent ductus arteriosus inserted with different types of commercial stent are modelled. Computational modelling is used to calculate the distributions of WSS on the arterial stented PDA. The hemodynamic parameters such as high WSS and WSSlow are considered in this study. The result shows that the stented PDA with Type III stent has better hemodynamic performance as compared to others stent. This model has the lowest distributions of WSSlow and also the WSS value more than 20 dyne/cm2. From the observed, the stented PDA with stent Type II showed the highest distributions area of WSS more than 20 dyne/cm2. This situation revealed that the high possibility of atherosclerosis to be developed. However, the highest distribution of WSSlow for stented PDA with stent Type II indicated that high possibility of thrombosis to be formed. In conclusion, the stented PDA model calculated with the lowest distributions of WSSlow and WSS value more than 20dyne/cm2 are considered to be performed well in stent hemodynamic performance as compared to other stents.

  18. Observation of right descending pulmonary arterial size and frontal cardiac area in patent ductus arteriosus patients

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Kyung Soo; Seol, Hae Yung; Suh, Won Huk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)

    1979-12-15

    Frontal cardiac area, right descending pulmonary arterial size and size of the ductus arteriosus were measured on 29 patients with patent ductus arteriosus,21 females and 8 males. The results are as follows: 1. Frontal cardiac area in PDA patient in this series is increased in 0.63% to 100.11 % and the average is 38.91-23.54%. 2. Central branch of the right descending pulmonary artery is dilated in 28 cases (96.55%) on pre-operative stage, and combination with dilation of central branch and constriction of peripheral branch is in 18 cases (62.1%). 3. Degree of dilation of central branch is correlated with increase of age, but it is not related with size of ductus arteriosus. 4. Increase rate of frontal cardiac area is not related with size of ductus arteriosus.

  19. A Case of Pulmonary Artery Aneurysm Associated with Patent Ductus Arteriosus : Detection by Radionuclide Cardiac Angiography

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    Sohn, I.; Lee, M. C.; Cho, B. Y.; Koh, C. S.; Yoon, Y. S.; Hong, C. Y.; Rho, J. R.; Youn, K. M.; Han, M. C. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1981-09-15

    A Case of main pulmonary artery aneurysm in a 9-year-old boy with patent ductus arteriosus is presented. In this case presented with a huge mass density on the chest X-ray, radionuclide cardiac angiography showed a vascular lesion, which was confirmed as an aneurysm of the main pulmonary artery at roentgenologic angiogram. The aneurysm appeared following an episode of bacterial endocarditis and pulmonary hypertension. A successful aneurysmectomy with multiple ligation of ductus arteriosus was performed.

  20. Notch signal reception is required in vascular smooth muscle cells for ductus arteriosus closure.

    Science.gov (United States)

    Krebs, Luke T; Norton, Christine R; Gridley, Thomas

    2016-02-01

    The ductus arteriosus is an arterial vessel that shunts blood flow away from the lungs during fetal life, but normally occludes after birth to establish the adult circulation pattern. Failure of the ductus arteriosus to close after birth is termed patent ductus arteriosus, and is one of the most common congenital heart defects. Our previous work demonstrated that vascular smooth muscle cell expression of the Jag1 gene, which encodes a ligand for Notch family receptors, is essential for postnatal closure of the ductus arteriosus in mice. However, it was not known what cell population was responsible for receiving the Jag1-mediated signal. Here we show, using smooth muscle cell-specific deletion of the Rbpj gene, which encodes a transcription factor that mediates all canonical Notch signaling, that Notch signal reception in the vascular smooth muscle cell compartment is required for ductus arteriosus closure. These data indicate that homotypic vascular smooth muscle cell interactions are required for proper contractile smooth muscle cell differentiation and postnatal closure of the ductus arteriosus in mice.

  1. Risk factors for patent ductus arteriosus in preterm neonates

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    Novia Bernati

    2014-05-01

    Full Text Available Background The reported prevalences of patent ductus arteriosus (PDA in preterm neonates vary, and are currently unknown in Palembang. Birth weight, gestational age, asphyxia, history of antenatal steroid use, hyaline membrane disease (HMD, race and ethnicity, are potential risk factors for PDA. Objective To determine the prevalence of PDA and its risk factors in preterm neonates at Mmohammad Hoesin Hospital, Palembang. Methods This cross-sectional study was conducted from October 2011 to April 2012. Echocardiographic examinations were performed on 242 preterm neonates aged 15 hours to 7 days. Data was taken from medical records and interviews, and analyzed by Chi square and logistic regression analyses. Results Patent ductus arteriosus was found in 142 (58.7% preterm neonates with a prevalence ratio of 1.43. Neonates with birthweight ≤2,000 grams tended to have 1.9 (95% CI 1.17 to 3.32 times higher risk for PDA (P=0.01. Neonates ≤30 weeks gestation were also at 1.9 times higher risk for PDA (P=0.16. Probabilities for PDA occurrence in neonates with asphyxia, without antenatal corticosteroids and HMD were 1.6 (95% CI 1.13 to 3.36 times, 1.3 (95%CI 0.73 to 2.50 times and 2.2 (95%CI 1.29 to 3.72 times higher risk for PDA, respectively (P=0.22, 0.41, and 0.005, respectively. Conclusion Birth weight and HMD are statistically significant risk factors of PDA, but the more significant one is HMD.

  2. Patent ductus arteriosus: peculiarities of early neonatal, postnatal diagnostics, clinical manifestations, treatment and prognosis

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    K.A. Kalashnikova

    2017-05-01

    Full Text Available The article presents the published data on the prevalence, the main clinical manifestations, and modern methods of early neonatal and postnatal diagnosis, treatment and prognosis of patent ductus arteriosus — the congenital malformation of cardiovascular system. The International Statistical Classification of Diseases version10 defines it Q25.0 Patent ductus arteriosus. Patent ductus Botalli. Botallo’s duct patency. The pre-valence of the patent ductus arteriosus is from 0.006 to 0.02 % in mature newborns, in premature newborns — from 15 to 80 %. Clinical manifestation of the malformation depends on its size, pulmonary pressure, and proportion of pulmonary and syste-mic circulation. One of the basic clinical signs of patent ductus arteriosus  is permanent eddy murmur  in II–III space along left sternal border. In newborns and infants and if severe pulmonary hypertension diastolic murmur can be absent while systolic and forced second sound on pulmonary artery, collapsing magnus pulse, increased pulse pressure are determined. Open ductus arteriosus is not determined auscultatory in low-weight premature children. The electrocardiograph reveals downloaded left ventricular. Echo-cardiograph images ductus arteriosis, increased left ventriclular, volume overload of left ventricular. Chest roentgenograms may reveal prominent pulmonary arterial markings, increased heart breadth due to hypertrophic left ventricular. Drug obliteration with indometacin is effective in newborns aged 2 weeks. The surgical indication is verified heart disease aged 6–12 months old. The appropriate age for surgical intervention is 2–5 years old.

  3. Transcatheter closure of patent ductus arteriosus: past, present and future.

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    Baruteau, Alban-Elouen; Hascoët, Sébastien; Baruteau, Julien; Boudjemline, Younes; Lambert, Virginie; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme; Pass, Robert

    2014-02-01

    This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques.

  4. The ductus arteriosus in the preterm infant: Histologic and clinical observations

    NARCIS (Netherlands)

    Gittenberger-de Groot, A.C.; Ertbruggen, I. van; Moulaert, A.J.M.G.; Harinck, E.

    1980-01-01

    In order to elucidate some of the unexplained phenomena in prolonged patency of the ductus arteriosus in preterm infants, the histology of the ductus was studied in 27 cases. Some of the infants had been treated with indomethacin. Four morphologic maturation stages are distinguinguished. There was n

  5. Association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants.

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    Lee, Jan Hau; Greenberg, Rachel G; Quek, Bin H; Clark, Reese H; Laughon, Matthew M; Smith, P Brian; Hornik, Christoph P

    2017-06-19

    In very low birth weight infants, persistence of a patent ductus arteriosus results in morbidity and mortality. Therapies to close the ductus are effective, but clinical outcomes may depend on the accuracy of diagnosis and the timing of administration. The objective of the present study was to characterise the association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants. This retrospective cohort study used electronic health record data on inborn infants of gestational age ⩽28 weeks and birth weight patent ductus arteriosus was diagnosed in 31,712/48,551 (65%). The diagnosis was more common in infants who had undergone early echocardiography (14,549/15,971 [91%] versus 17,163/32,580 [53%], ppatent ductus arteriosus (odds ratio 1.01, 95% CI 0.90-1.15). Early echocardiography was associated with an increased diagnosis of patent ductus arteriosus, but not with decreased mortality.

  6. Prostaglandin E2 and patent ductus arteriosus in premature infants

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    Mochammading,

    2016-01-01

    Full Text Available Background Patent ductus arteriosus (PDA is a congenital heart disease most commonly occurring in premature infants. Spontaneous ductus arteriosus (DA closure in premature infants has been suggested to be associated with duct lumen maturity and the DA sensitivity to prostaglandin E2 (PGE2. Objective To assess for a possible correlation between serum PGE2 levels and PDA size in premature infants. Methods This observational study using repeated measurements on premature infants with PDA detected at days 2-3 of life was undertaken in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, from April to May 2014. The PDA was diagnosed using 2-D echocardiography and PGE2 levels were measured by immunoassay. Pearson’s correlation test was used to evaluate a possible correlation between PGE2 level and DA diameter. Results Thirty-three premature infants of median gestational age 31 (range 28-32 weeks and median birth weight 1,360 (range 1,000-1,500 grams were enrolled. Almost two-thirds of the subjects were male. Almost all (30/33 subjects had spontaneous DA closure before the age of 10 days. Subjects’ mean DA diameter was 2.9 (SD 0.5 mm with maximum flow velocity of 0.2 (SD 0.06 cm/sec, and left atrial-to-aortic root ratio (LA/Ao of 1.5 (SD 0.2. Their mean PGE2 levels at the ages of 2-3, 5-7, and after 10 days were 5,238.6 (SD 1,225.2, 4,178.2 (SD 1,534.5, and 915.2 (SD 151.6 pg/mL, respectively. The PGE2 level at days 2-3 was significantly correlated with DA diameter (r = 0.667; P < 0.001, but not at days 5-7 (r = 0.292; P = 0.105 or at day 10 (r = 0.041; P = 0.941. Conclusion There is a strong, positive correlation between the PGE2 level and DA diameter in preterm infants at 2-3 days of age. However, there is no significant correlation between PGE2 level and persistence of PDA.

  7. Modern treatment of patent ductus arteriosus – single center experience

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    Senka Mesihović Dinarević

    2014-12-01

    Full Text Available  Introduction: Transcatheter closure is a treatment choice for the most children with patent ductus arteriosus (PDA. The closure of the ductus is indicated in any child or adolescent with developed symptoms of significant L-R shunt. The aim of this article is to present our results in 5 years treatment of patients with PDA and their outcome. Methods: From 2009 to 2014, 30 patients underwent a transcatheter closure of PDA at Centre for Heart and Pediatric clinic of Clinical University Centre of Sarajevo. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for selection of appropriate occluder device type and size. All procedures were performed by local team of cardiologists from the Department of Cardiology, Pediatric clinic, with invasive cardiologists team from Sweden and Austria. Echocardiography was repeated at intervals of 24 hours, then 1month, 3 months, and 1 year after the procedure to assess the outcome. Results: Thirty patients underwent transcatheter closure of PDA during the study period. PDA of ≤ 2.0 mm was present in 8 patients and they underwent PDA closure with coils, while 22 patients had PDA diameter  ≥ 2 mm, and they were treated by Amplatzer duct occluder (ADO. Only in 2 (6.2% patients complications have been observed. The length of hospital stay after the treatment was two to three days. Conclusion: Transcatheter closure of PDA is a modern, safe and efficient method that ensures a faster recovery of the patients, shortens the length of hospitalization.

  8. Transcatheter Closure of Patent Ductus Arteriosus: The Penang Hospital's Experience.

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    Amir Hamzah, A R; Tiow, C A; Koh, G T; Sharifah, A M

    2011-03-01

    Transcatheter closure of small and moderate sizes of Patent Ductus Arteriosus (PDA) is a standard and well accepted form of treatment. The aim of this study is to describe the experience of transcatheter closure of PDA in Penang Hospital. All patients who underwent transcatheter closure of PDA at our institution between 20th January 2006 and 27th June 2008 were retrospectively identified and studied. There were a total of 66 patients who had undergone transcatheter closure of PDA during this period which comprised of 24 male and 42 female. The PDA was closed by Amplatzer Duct Occluder (ADO) in 31 patients, Gianturco coil in 29 patients and other types of devices in 6 patients. There were 4 patients (6%) who had developed acute complication during the procedure (3 of them developed coil embolization and 1 had bleeding from puncture site). The PDA was successfully close in 95.5% of the study population without any residual PDA shunting. All the patients were alive but 5 of them (4.5%) have some abnormalities (2 has mild left pulmonary stenosis, 3 has small residual). Comparison between ADO and Gianturco coil revealed no significant difference in the outcome. Transcatheter closure of PDA has proven to be safe and effective with good midterm outcome. There was no significant difference between Amplatzer Ductal Occluder and Gianturco coil in term of the outcome.

  9. C-reactive protein, platelets, and patent ductus arteriosus.

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    Meinarde, Leonardo; Hillman, Macarena; Rizzotti, Alina; Basquiera, Ana Lisa; Tabares, Aldo; Cuestas, Eduardo

    2016-12-01

    The association between inflammation, platelets, and patent ductus arteriosus (PDA) has not been studied so far. The purpose of this study was to evaluate whether C-reactive protein (CRP) is related to low platelet count and PDA. This was a retrospective study of 88 infants with a birth weight ≤1500 g and a gestational age ≤30 weeks. Platelet count, CRP, and an echocardiogram were assessed in all infants. The subjects were matched by sex, gestational age, and birth weight. Differences were compared using the χ(2), t-test, or Mann-Whitney U-test, as appropriate. Significant variables were entered into a logistic regression model. The association between CRP and platelets was evaluated by correlation and regression analysis. Platelet count (167 000 vs. 213 000 µl(-1), p = 0.015) was lower and the CRP (0.45 vs. 0.20 mg/dl, p = 0.002) was higher, and the platelet count correlated inversely with CRP (r = -0.145, p = 0.049) in the infants with vs. without PDA. Only CRP was independently associated with PDA in a logistic regression model (OR 64.1, 95% confidence interval 1.4-2941, p = 0.033).

  10. Preterm patent ductus arteriosus: A continuing conundrum for the neonatologist?

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    Evans, Nick

    2015-08-01

    How to manage the preterm patent ductus arteriosus (PDA) remains a conundrum. On the one hand, physiology and statistical association with adverse outcomes suggest that it is pathological. On the other hand, clinical trials of treatment strategies have failed to show any long-term benefit. Ultrasound studies of PDA have suggested that the haemodynamic impact may be much earlier after birth than previously thought (in the first hours); however, we still do not know when to treat PDA. Studies that have tested symptomatic or pre-symptomatic treatment are mainly historical and have not tested the effect of no treatment. Prophylactic treatment is the best-studied regimen but improvements in some short-term outcomes do not translate to any difference in longer-term outcomes. Neonatologists have been reluctant to engage in trials that test treatment against almost never treating. Observations of very early postnatal haemodynamic significance suggest that targeting treatment on the basis of the early postnatal constrictive response of the duct may optimize benefits. A pilot trial of this strategy showed reduction in the incidence of pulmonary haemorrhage but more trials of this strategy are needed.

  11. Cardiac involvement of primary hyperoxaluria accompanied by non-compaction cardiomyopathy and patent ductus arteriosus.

    Science.gov (United States)

    Arat, Nurcan; Akyıldız, Murat; Tellioğlu, Gürkan; Tokat, Yaman

    2015-04-01

    Primary hyperoxaluria is a rare hereditary metabolic disorder resulting in accumulation of calcium oxalate in visceral organs, including the heart. We report a 19-year-old male with non- compaction cardiomyopathy combined with patent ductus arteriosus awaiting combined liver-kidney transplantation for primary hyperoxaluria. After surgical closure of the patent ductus arteriosus, the patient underwent a successful renal and subsequent liver transplantation. The presence of hypertrophic cardiomyopathy in hyperoxaluria patients has been reported before, but this is the first report of non-compaction myocardium with patent ductus arteriosus in a patient with primary hyperoxaluria. At the third month after combined liver and renal transplantation, improvement in cardiac functions were observed. Primary hyperoxaluria is a clinical entity to be taken into consideration in differential diagnosis of hypertrophied myocardium with high myocardial echocardiographic intensity. In cases of hyperoxaluria, additional congenital abnormalities may complicate the clinical picture.

  12. Does ibuprofen treatment in patent ductus arteriosus alter oxygen free radicals in premature infants?

    Science.gov (United States)

    Akar, Melek; Yildirim, Tulin G; Sandal, Gonca; Bozdag, Senol; Erdeve, Omer; Altug, Nahide; Uras, Nurdan; Oguz, Serife S; Dilmen, Ugur

    2016-06-20

    Introduction Ibuprofen is used widely to close patent ductus arteriosus in preterm infants. The anti-inflammatory activity of ibuprofen may also be partly due to its ability to scavenge reactive oxygen species and reactive nitrogen species. We evaluated the interaction between oxidative status and the medical treatment of patent ductus arteriosus with two forms of ibuprofen. Materials and methods This study enrolled newborns of gestational age ⩽32 weeks, birth weight ⩽1500 g, and postnatal age 48-96 hours, who received either intravenous or oral ibuprofen to treat patent ductus arteriosus. Venous blood was sampled before ibuprofen treatment from each patient to determine antioxidant and oxidant concentrations. Secondary samples were collected 24 hours after the end of the treatment. Total oxidant status and total antioxidant capacity were measured using Erel's method.

  13. [Antenatal closure of ductus arteriosus following maternal intoxication by niflumic acid].

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    Bouissou, A; Glorieux, I; Dulac, Y; Marcoux, M O; Casper, C

    2006-01-01

    Antenatal closure of the ductus arteriosus is an uncommon event that has been considered as a risk factor for development of congestive heart failure and persistent pulmonary hypertension of the newborn. We report here on a case of antenatal ductus arteriosus closure due to niflumic acid maternal intoxication at 32 weeks of gestation. Fetal extraction was performed few days later because of echographic signs of congestive heart failure. The child survived after 3 days of severe persistent pulmonary hypertension. This case emphasizes the potential risk of niflumic acid during pregnancy and the need of antenatal echographic monitoring for optimal management.

  14. Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

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    Eunhyun Cho

    2013-09-01

    Full Text Available Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA by using an Amplatzer vascular plug (AVP.&lt;br&gt; Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared.&lt;br&gt;Results: The mean age of the patients was 54.9±45.7 months old. The PDAs were of type C (n=5, type D (n=12 and type E (n=3. The mean pulmonary end diameter of the PDA was 1.7±0.6 mm, and the aortic end diameter was 3.6±1.4 mm. The mean length was 7.3±1.8 mm. We used 3 types of AVP devices: AVP I (n=5, AVP II (n=7, and AVP IV (n=8. The ratio of AVP size to the pulmonary end diameter was 3.37±1.64, and AVP size/aortic end ratio was 1.72±0.97. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P =0.002. The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter (1.10±0.31, P =0.032. &lt;br&gt;Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

  15. [The transcatheter closure of patent ductus arteriosus. The initial experience].

    Science.gov (United States)

    Vázquez-Antona, C A; Rijlaarsdam, M; Gaspar, J; Gil Moreno, M; Buendía Hernández, A; Martínez Ríos, M A; Attie, F

    1993-01-01

    Percutaneous closure of the patent ductus arteriosus (PDA) has been recently reported to be an effective alternative in the treatment of patients with ductal shunting. We report the initial experience and results during follow-up of percutaneous ductal occlusion with the Rashkind occluder (USCI) in six patients with isolated PDA. Ages ranged from 3 to 23 years. Diagnosis was corroborated with two dimensional and Doppler echocardiography in all patients. During cardiac catheterization systolic pulmonary artery pressure oscillated between 22 and 64 mmHg and Qp/Qs ratio between 1.3 and 4.1. In two patients prosthesis of 12 mm were used and in the remaining prosthesis of 17 mm. Only one patient demonstrated total occlusion during immediate control aortography, the other patients presented central residual shunting over the occluder. In the three patients occlusion with balloon-catheter was added to the procedure, resulting in total occlusion in two and significant reduction of the shunt magnitude in one. Two technical problems were resolved satisfactorily. None of the cases presented device embolization. Mean follow-up was 23.8 months with control echocardiograms at 24 hours, 1, 4, 12 and 24 months. In all patients immediate reduction of the left atrial dimension was demonstrated. Three patients presented residual shunts in the first 24 hours. In two of them total occlusion had occurred after one month and the other patient persisted with a small residual shunt until one year after the procedure. In conclusion, in this small study group good results were obtained with percutaneous ductal closure.

  16. Transcatheter Patent Ductus Arteriosus Occlusion in Small Infants.

    Science.gov (United States)

    Schwartz, Matthew C; Nykanen, David; Winner, Lawrence H; Perez, Jose; McMahan, Michael; Munro, Hamish M; Suguna Narasimhulu, Sukumar

    2016-12-01

    Transcatheter patent ductus arteriosus (PDA) occlusion is feasible in small infants and may improve lung function in symptomatic patients. We aimed to describe transcatheter PDA closure in small infants including predictors of technical success and rate of complication and to identify factors associated with improved respiratory status after closure. All patients in the NICU at our center who were referred for transcatheter PDA occlusion between 1/2010 and 11/2014 were retrospectively identified. Relevant details were extracted. Additionally, a modification of the respiratory severity score (RSS) (FiO2 × mean airway pressure) was used to characterize degree of pulmonary support before and at intervals after catheterization. Twenty patients were identified with median age of 96 days (13-247) and weight of 3.1 kg (1.7-4.7). The PDA was type F morphology in 14 (70%) patients. The PDA was successfully occluded in 16 (80%) patients. Ratio of minimum PDA diameter/length was >0.5 in all unsuccessful attempts and <0.4 in all successful cases (P = .01). Of the 16 cases of occlusion, Amplatzer Vascular Plug II was used in 15 (94%). No deaths or pulse loss occurred. Five (25%) patients required blood transfusion and transfusion was associated with lower hemoglobin (P = .049), lower weight (P = .008), and lower aortic pressure (P = .04). Excluding 1 patient with significant congenital heart disease, the RSS improved at 3 days in 9 (60%) patients and at 7 days in 12 (80%) compared with preintervention value. Patient factors were not associated with improved RSS at 3 or 7 days. In our cohort of symptomatic infants, transcatheter PDA occlusion was successful in most and a ratio of minimum PDA diameter/length of <0.4 was predictive of technical success. Using a surrogate for pulmonary support, the majority of patients were on less support 7 days after closure. © 2016 Wiley Periodicals, Inc.

  17. Closure of a short patent ductus arteriosus using an atrial septal occluder

    Institute of Scientific and Technical Information of China (English)

    Keyhan Sayadpour Zanjani

    2010-01-01

    @@ Patent ductus arteriosus (PDA) device closure was first attempted by Porstmann et al1 in 1967. Due to the rapid development in this field, it is the therapy of choice in current era. As most of PDAs have conical shape, Amplatzer PDA occluders were designed to fit into these ducts.

  18. Aneurysm after surgical ligation of patent ductus arteriosus: a case report

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    Kim, Sung Gyu; Yang, Sang Kyu; Chi, Jung Ik; Lee, Chang Jun [National Medical Center, Seoul (Korea, Republic of)

    2002-09-01

    Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. A rare complication occurring after its surgical treatment is the development of an aneurysm, and we report the radiologic findings in a case in which this occurred after surgical ligation.

  19. Epidemiology, presentation and population genetics of patent ductus arteriosus (PDA) in the Dutch Stabyhoun dog

    NARCIS (Netherlands)

    Toom, den Marjolein L.; Meiling, Agnes E.; Thomas, Rachel E.; Leegwater, Peter A.J.; Heuven, Henri C.M.

    2016-01-01

    Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart defects in dogs and is considered to be a complex, polygenic threshold trait for which a female sex predisposition has been described. Histological studies in dogs suggest that smooth muscle hypoplasia and asymm

  20. Spontaneous closure of patent ductus arteriosus after an episode of Kawasaki disease: a case report

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    Lin Ming-Chih

    2012-01-01

    Full Text Available Abstract Introduction Kawasaki disease is regarded as systemic vasculitis. Many experts believe that not only coronary arteries but also other small arteries are involved during the period of systemic inflammation. However, the evidence to support this point view is limited. Case presentation We report the case of a one-year-four-month-old Taiwanese girl whose patent ductus arteriosus was incidentally found during an episode of Kawasaki disease. The ductus closed spontaneously after the acute phase of Kawasaki disease. Conclusions In this patient, the patent ductus arteriosus may have closed spontaneously after Kawasaki disease due to its involvement in the generalized vasculitis that this disease incurs. This would support the theory that the vasculitis of Kawasaki disease is limited not only to coronary arteries but also to all medium- sized arteries.

  1. Is thoracoscopic patent ductus arteriosus closure superior to conventional surgery?

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    Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Marczak, Jakub; Cichon, Romuald

    2015-10-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether thoracoscopic patent ductus arteriosus (PDA) closure is superior to conventional surgery. Altogether 821 papers were found using the reported search, 11 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Eleven studies included in the analysis consisted of two prospective and three retrospective, non-randomized studies and six case series. Four included studies focused only on preterm infants, three studies enrolled neonates and the other four analysed all age groups from neonates to older children or young adults. There were no differences in mortality between video-assisted thoracoscopic surgery (VATS) and conventional surgery. Two studies suggested that VATS offers shorter operative times. Two papers observed shorter hospital stay, although the other two noted no significant difference. A large prospective trial found VATS to be associated with a lower number of postoperative complications in neonates and infants, whereas other studies suggested no significant differences in short-term postoperative complications. There is little evidence to suggest better musculoskeletal status and cosmesis in neonates following VATS. Conversion from thoracoscopy to thoracotomy described in six papers was seldom and it did not lead to any additional complications. All observational studies confirmed that both techniques are free from major adverse cardiovascular complications and these two techniques can be safely used in all patients qualified for surgical PDA closure. Two studies compared cost-effectiveness between the two techniques; one of them described VATS as significantly more cost-efficient, whereas the other study observed no difference. However, it should be noted that data

  2. Pan-nitinol occluder and special delivery device for closure of patent ductus arteriosus: a canine-model feasibility study.

    Science.gov (United States)

    Jiang, Hai-bin; Bai, Yuan; Zong, Gang-jun; Han, Lin; Li, Wei-ping; Lu, Yang; Qin, Yong-wen; Zhao, Xian-xian

    2013-01-01

    The aim of this study was to evaluate a new type of occluder for patent ductus arteriosus. Patent ductus arteriosus was established in a canine model by anastomosing a length of autologous jugular vein to the descending aorta and the left pulmonary artery in an end-to-side fashion. Transcatheter closure of each patent ductus arteriosus was performed on 10 dogs, which were then monitored for as long as 6 months with aortography, echocardiography, and histologic evaluation. Transcatheter closure with use of the novel pan-nitinol device was successful in all canine models. Postoperative echocardiography showed that the location and shape of the occluders were normal, without any residual shunting. Further histologic evaluation confirmed that the occluder surface was completely endothelialized 3 months after implantation. Transcatheter patent ductus arteriosus closure with the pan-nitinol occluder can be performed safely and successfully in a canine model and shows good biological compatibility and low mortality rates.

  3. Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at A Tertiary Neonatal Intensive Care Unit

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    Cucerea Manuela

    2016-10-01

    Full Text Available Introduction: Congenital heart diseases (CHD have been reported to be responsible for 30 to 50% of infant mortality caused by congenital disabilities. In critical cases, survival of newborns with CHD depends on the patency of the ductus arteriosus (PDA, for maintaining the systemic or pulmonary circulation. The aim of the study was to assess the efficacy and side effects of PGE (prostaglandin E administration in newborns with critical congenital heart disease requiring maintenance of the ductus arteriosus.

  4. Severe intravascular hemolysis after transcatheter closure of a large patent ductus arteriosus using the Amplatzer duct occluder: successful resolution by intradevice coil deployment.

    Science.gov (United States)

    Joseph, George; Mandalay, Asishkumar; Zacharias, T U; George, Biju

    2002-02-01

    A 21-year-old female developed severe unremitting intravascular hemolysis following closure of a large patent ductus arteriosus using an Amplatzer duct occluder. Percutaneous deployment of fibered platinum coils within the nitinol wire cage of the Amplatzer duct occluder abolished the residual shunt through the device and resulted in cessation of intravascular hemolysis and reversal of its adverse sequelae. Copyright 2002 Wiley-Liss, Inc.

  5. A review of stent’s failure on patent ductus arteriosus

    Science.gov (United States)

    Lazim, Zulfaqih; Ismail, Al Emran; Taib, Ishkrizat; Atan, Bainun Akmal Mohd

    2017-01-01

    This paper presents a review of stent’s failure on patent ductus arteriosus (PDA). Ductus arteriosus (DA) is an opening for newborn babies and some patient that experienced cynotic congenital heart disease (CCHD) should maintain the duct opening for survival. To date, there are no specific research on mechanical stent failure study at DA. The challenging of the stent implantation on PDA is the PDA morphology. The failure of stent in term of stent fracture have been reported and reviewed in this paper. Furthermore, the failure prediction of stent is important for further stent design development. The morphology of PDA, stent type and material used in PDA and method for accessing the failure of stent is reviewed.

  6. Outcome following patent ductus arteriosus ligation in premature infants: a retrospective cohort analysis

    Directory of Open Access Journals (Sweden)

    Yates Robert

    2006-05-01

    Full Text Available Abstract Background The patent ductus arteriosus (PDA is an important problem in premature infants. Surgical PDA ligation is usually only be considered when medical treatment has either failed or was contraindicated. The aims of our study were to determine the mortality and morbidity following patent ductus arteriosus ligation in premature infants, and whether prostaglandin synthetase inhibitor (PSI use prior to ligation affects outcome. Methods A retrospective case note review study to determine the outcome of premature infants undergoing patent ductus arteriosus ligation in one tertiary neonatal intensive care unit and two paediatric cardiothoracic centres. Results We had follow-up data on 87 infants. Cumulative mortality rates at 7 days, 30 days and at hospital discharge were 2%, 8% and 20% respectively. The incidence of chronic lung disease, intraventricular haemorrhage, necrotising enterocolitis and retinopathy of prematurity were 77%, 39%, 26% and 28% respectively. There was no difference in mortality, incidence of chronic lung disease or duration of oxygen dependence between those who had and those who had not received a PSI prior to surgical ligation. In those who had received 2 or more courses of PSI prior to surgical ligation, there was a trend to increase in the duration of oxygen therapy and chronic lung disease, but no difference in mortality. Conclusion This study shows that patent ductus arteriosus ligation is a relatively safe procedure (30 day survival 92% but there is substantial late mortality and a high incidence of morbidity in the survivors. 2 or more courses of PSI prior to surgical ligation trends to increased oxygen dependence and chronic lung disease. This high risk population requires careful follow-up. A definitive prospective cohort study is lacking.

  7. Patent ductus arteriosus in an adult amur leopard (Panthera pardus orientalis).

    Science.gov (United States)

    Douay, Guillaume; Drut, Amandine; Ribas, Thibault; Gomis, David; Graille, Mélanie; Lemberger, Karin; Bublot, Isabelle

    2013-03-01

    A clinically healthy 16-yr-old female leopard (Panthera pardus orientalis) was diagnosed with a patent ductus arteriosus on echocardiography and later confirmed on necropsy A murmur was heard on auscultation during a routine examination, and the congenital defect was an incidental finding. The animal had been asymptomatic its entire life. This deformity is rarely observed in nondomestic felids and may be asymptomatic, as has been described in domestic cats.

  8. Left-Sided Patent Ductus Arteriosus in a Right-Sided Aortic Arch

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    Ming-Yen Ng

    2014-01-01

    Full Text Available We present a 31-year-old female with repaired tetralogy of Fallot (TOF and right-sided aortic arch (RAA with left-sided patent ductus arteriosus (PDA originating from the left brachiocephalic artery. This is a rare finding but most common site for a PDA in TOF and a RAA. To the best of our knowledge, this is the first demonstration of this rare finding on MRI in the literature.

  9. Transcatheter occlusion of a large coronary artery fistula using a patent ductus arteriosus occluder.

    Science.gov (United States)

    Białkowski, Jacek; Szkutnik, Małgorzata; Fiszer, Roland; Zembala, Marian

    2011-01-01

    A large fistula from the left coronary artery to the right ventricle was successfully closed percutaneously in a 40 year-old patient using a patent ductus arteriosus occluder. The device was positioned and deployed via the venous system using a guidewire that had been advanced via the aorta, coronary artery and fistula to the venous circulation (arterio-venous loop creation). No complications were reported at follow-up.

  10. Angiographic evidence of absent ductus arteriosus in severe right ventricular outflow obstruction.

    Science.gov (United States)

    Lacina, S J; Hamilton, W T; Thilenius, O G; Bharati, S; Lev, M; Arcilla, R A

    1983-01-01

    The angiocardiograms of 5 newborn infants with autopsy and/or surgically-proven congenital absence of the ductus arteriosus (ADA) and right ventricular outflow obstruction (Group A), and of 14 neonates with pulmonary atresia complex and patent ductus arteriosus (Group B) were reviewed. Aortic size was similar in both groups; however, the diameters of the right and left pulmonary arteries were much smaller in Group A than in Group B (right pulmonary artery: 2.6 vs 4.5 mm, P less than 0.005; left pulmonary artery: 2.5 vs 4.3 mm, P less than 0.005). Extensive bronchial collaterals were observed in Group A but not in Group B. Tricuspid aortic valve stenosis was present in 2 patients in Group A but in none in Group B. The diagnosis of ADA may be made in newborn infants with severe right ventricular outflow obstruction if the angiocardiograms reveal hypoplasia of the pulmonary arteries, extensive bronchial collaterals, and nonvisualization of the ductus arteriosus. Other suggestive features include aortic valve stenosis and/or right aortic arch with aberrant left subclavian artery.

  11. Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder

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    Er-Ping Xi

    2012-11-01

    Full Text Available OBJECTIVE: Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. METHODS: We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen Co., LTD, Guangdong, China utilizing standard techniques. RESULTS: Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology. CONCLUSION: Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective.

  12. Deleterious effects of maternal ingestion of cocoa upon fetal ductus arteriosus in late pregnancy

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    Paulo eZielinsky

    2014-12-01

    Full Text Available Cocoa powder has twice more antioxidants than red wine and three times more than green tea. Ten prcent of its weight is made up of flavonoids. Cocoa has antioxidant and antiinflamatory effects by downregulating cyclooxigenase-2 receptors expression in the endothelium and enhancing nitric oxide bioavailability. There are evidences that while polyphenols ingestion have cardioprotective effects in the adult, it may have deleterious effect on the fetus if ingested by the mother on the third trimester of pregnancy, causing intrauterine fetal ductus arteriosus constriction.Polyphenols present in many foods and their anti-inflammatory and antinociceptive activities have been shown to be as or more powerful than those of indomethacin. These effects are dependent on the inhibition of modulation of the arachidonic acid and the synthesis of prostaglandins, especially E-2, which is responsible for fetal ductus arteriosus patency. So, we hypothesized that this same mechanism is responsible for the harmful effect of polyphenol-rich foods, such as cocoa, upon the fetal ductus arteriosus after maternal intake of such substances in the third trimester of pregnancy, thereby rising the perspective of a note of caution for pregnant women diet.

  13. Ductus arteriosus aneurysm with community-acquired methicillin-resistant Staphylococcus aureus infection and spontaneous rupture: a potentially fatal quandary.

    Science.gov (United States)

    Stewart, Audra; Dyamenahalli, Umesh; Greenberg, S Bruce; Drummond-Webb, Jonathan

    2006-06-01

    We present the case of a 6-month-old previously healthy girl who presented with high fever, labored breathing, and an enlarged cardiac silhouette on her chest radiograph. Comprehensive evaluation discovered a ductus arteriosus aneurysm and pericardial effusion with methicillin-resistant Staphylococcus aureus bacteremia. Despite pericardiocentesis and appropriate intravenous antibiotics, there was rapid enlargement of the aneurysm and accumulation of echogenic material within the ductus arteriosus aneurysm. Infected aneurysm rupture was identified during emergency surgery. This infant also had vocal cord paresis, a likely complication of the surgery. The clinical course, diagnosis, and treatment of this patient are discussed. Infection of a ductus arteriosus or an infected ductal arteriosus aneurysm is a rare and potentially fatal clinical entity. In the era of increasing community-acquired methicillin-resistant S aureus infections, this is a diagnosis that requires a high index of suspicion.

  14. Outcome of patent ductus arteriosus ligation in premature infants in the East of England: a prospective cohort study.

    Science.gov (United States)

    Kang, Sok-Leng; Samsudin, Salehuddin; Kuruvilla, Minju; Dhelaria, Anshoo; Kent, Sue; Kelsall, Wilfred A

    2013-10-01

    Surgical ligation of patent ductus arteriosus is considered when medical treatment fails or is contraindicated. This study aims to determine the mortality and morbidity of preterm neonates referred for patent ductus arteriosus ligation. A prospective study was conducted in the East of England to follow the outcome of premature infants under 37 weeks’ gestation undergoing patent ductus arteriosus ligation. A standardised proforma was used to collect information before and after the procedure. A total of 102 premature infants were recruited, and patent ductus arteriosus ligation was performed in 92. Surgical complications occurred in 8.7% (8/92), which included pneumothorax (5/8), recurrent laryngeal nerve palsy (2/8), and chylothorax (1/8). Morbidity outcome data were not available for all infants. The incidence of chronic lung disease was 88% (88/99); intraventricular haemorrhage was 49% (49/100); necrotising enterocolitis 39% (39/99), and retinopathy of prematurity 42% (41/97). The overall mortality rate in our study was 7.8% (8/102). Mortality rate in infants who had patent ductus arteriosus ligation was 4.3% (4/92). The 30-day survival rate after ligation was 99% (91/92). Beyond 30 days post-ligation, three infants died from other causes that were not directly related to surgery. Patent ductus arteriosus ligation in premature infants is associated with low mortality and complication rates; however, there is a high incidence of neonatal morbidity. Surgical capacity for patent ductus arteriosus ligation needs to be carefully planned nationally as the duration of ‘‘waiting time’’ and transport to another surgical centre could adversely affect outcomes in this high-risk population.

  15. Ibubrofen in the treatment of patent ductus arteriosus in preterm infants: what we know, what we still do not know.

    Science.gov (United States)

    Mercanti, Isabelle; Ligi, Isabelle; Boubred, Farid; Grandvuillemin, Isabelle; Buffat, Christophe; Fayol, Laurance; Millet, Veronique; Simeoni, Umberto

    2012-01-01

    The patency of the ductus arteriosus has ever been considered as a pathological situation in preterm infants and one likely cause of mortality and morbidity, including broncho-pulmonary dysplasia, necrotizing enterocolitis, intraventricular haemorrhage, retinopathy of prematurity. The incidence of patent ductus arteriosus is inversely proportional to gestational age and infants with the lowest gestational ages are the most exposed to the complications of prematurity. So, associations between patent ductus arteriosus and the other morbidities may not be causative and patent ductus arteriosus could be more a sign of immaturity and severity of disease than the cause of these problems. Non-steroidal anti-inflammatory agents, such as indomethacin or ibuprofen, have been shown to be effective in closing or preventing patent ductus arteriosus, with differences in side effects. However nearly all randomized controlled trials have been designed with the closure of the ductus arteriosus, not mortality or morbidity, as the main endpoint. Thus, evidence is still lacking on the eventual benefits for the patient of pharmacological or surgical intervention on PDA. Moreover, both ibuprofen and indomethacin efficacy seems markedly reduced in extremely low gestational age infants, who are the most likely to benefit from such intervention. The explanation of the reduced pharmacodymanic effect in such population is unclear; so far, studies using increased dosing of ibuprofen have failed to show a clear benefit. Prophylaxis with indomethacin or ibuprofen has failed to show sustained benefits on neurodevelopment at 2 years of age in low gestational age infants. New curative trials may aim at investigating the effects of early curative administration of ibuprofen, which has reduced side effects compared to indomethacin, on immature kidney function, on mortality and morbidity in very low gestational age infants, ideally with a combined endpoint such as survival in the absence of severe

  16. Clinical pharmacology of indomethacin in preterm infants: implications in patent ductus arteriosus closure.

    Science.gov (United States)

    Pacifici, Gian Maria

    2013-10-01

    Indomethacin is a non-steroidal anti-inflammatory drug that is a potent inhibitor of prostaglandin E(2) synthesis. After birth, the ductus arteriosus closes spontaneously within 2-4 days in term infants. The major factor closing the ductus arteriosus is the tension of oxygen, which increases significantly after birth. Prostaglandin E(2) has the opposite effect to that of oxygen; it relaxes smooth muscle and tends to inhibit the closure of the ductus arteriosus. In preterm infants with respiratory distress syndrome, the ductus arteriosus fails to close (patent ductus arteriosus [PDA]) because the concentration of prostaglandin E2 is relatively high. PDA occurs in more than 70 % of neonates weighing less than 1,500 g at birth. The aim of this article was to review the published data on the clinical pharmacology of indomethacin in preterm infants in order to provide a critical analysis of the literature and a useful tool for physicians. The bibliographic search was performed electronically using the PubMed and EMBASE databases as search engines and February 2012 was the cutoff point. A remarkable interindividual variability was observed for the half-life (t(½)), clearance (CL), and volume of distribution (V(d)) of indomethacin. Prophylactic indomethacin consists of a continuous infusion of low levels of indomethacin and may be useful in preterm infants. Extremely preterm infants are less likely to respond to indomethacin. Infants with a postnatal age of 2 months do not respond to treatment with indomethacin. Indomethacin has several adverse effects, the most common of which is renal failure. An increase in serum creatinine of ≥0.5 % mg/dL after indomethacin was observed in about 10-15 % of the patients and creatinine returns to a normal level about 1 week after cessation of therapy. Indomethacin should be administered intravenously by syringe pump for at least 30 min to minimize adverse effects on cerebral, gastrointestinal, and renal blood flow velocities. A

  17. Paracetamol Accelerates Closure of the Ductus Arteriosus after Premature Birth: A Randomized Trial.

    Science.gov (United States)

    Härkin, Pia; Härmä, Antti; Aikio, Outi; Valkama, Marita; Leskinen, Markku; Saarela, Timo; Hallman, Mikko

    2016-10-01

    To study the biologic effect of paracetamol, an inhibitor of prostaglandin synthase, on early closure of ductus arteriosus, and to evaluate possible adverse effects associated with the drug. In a controlled, double-blind, phase I-II trial, very low gestational age (<32 weeks) infants requiring intensive care were randomly assigned to intravenous paracetamol or placebo (0.45% NaCl). A loading dose of 20 mg/kg was given within 24 hours of birth, followed by 7.5 mg/kg every 6 hours for 4 days. Daily cardiac ultrasound examinations of ductal calibers were performed before the first dose, and until 1 day after the last dose. The main outcome was a decrease in the ductal caliber without side effects. Of 63 screened infants, 48 were randomized: 23 were assigned to paracetamol and 25 to placebo. Before the intervention, their ductal calibers were similar. During the intervention, the ductus closed faster in the paracetamol group (hazard ratio 0.49, 95% CI 0.25-0.97, P = .016). The mean (95% CI) postnatal ages for ductal closure were 177 hours (31.1-324) for the paracetamol-treated vs 338 hours (118-557) for controls (P = .045). Paracetamol serum levels were within the therapeutic range, and no adverse effects were evident. Prophylactic paracetamol induced early closure of the ductus arteriosus without detectable side effects. Further trials are required to determine whether intravenous paracetamol may safely prevent symptomatic patent ductus arteriosus. ClinicalTrials.gov: NCT01938261; European Clinical Trials Database: EudraCT 2013-008142-33. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases

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    Luchese Stelamaris

    2003-01-01

    Full Text Available OBJECTIVE: To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction. METHODS: Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants. RESULTS: The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]. Mean gestational age was 32.5±3.1 (27-38 weeks and maternal age was 28.2±8.5 (17-42 years. Mean systolic velocity in the ductus was 2.22±0.34 (1.66-2.81 m/s, diastolic velocity 0.79±0.28 (0.45-1.5 m/s, and pulsatility index 1.33±0.36 (0.52-1.83. Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13±0.33 than in group B (0.68±0.15 (P=0.008. The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension. CONCLUSION: The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.

  19. Range-gated pulsed Doppler ultrasonographic evaluation of carotid arterial blood flow in small preterm infants with patent ductus arteriosus.

    Science.gov (United States)

    Wilcox, W D; Carrigan, T A; Dooley, K J; Giddens, D P; Dykes, F D; Lazzara, A; Ray, J L; Ahmann, P A

    1983-02-01

    Range-gated pulsed Doppler (RGPD) ultrasonography was utilized to study the effect of a patent ductus arteriosus (PDA) on carotid arterial blood flow in small preterm infants. Carotid arterial flow velocity studies were performed on 23 preterm infants, sampling right and left carotid arteries. Studies on seven infants after PDA ligation and on seven who developed no evidence of PDA were used as controls. A strong relationship was demonstrated between diastolic reversal in the carotid arteries and PDA. The results of this study indicate that the RGPD flow velocity curve from the carotid artery is more sensitive than M-mode echocardiography or clinical examination in detecting PDA, and that PDA in small preterm infants is associated with a distinct abnormality in the carotid arterial flow pattern.

  20. A case of coarctation of the aorta associated with the patent ductus arteriosus and the persistent left superior vena cava

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    Lee, Yoo Keun [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1974-10-15

    This is a case report of multiple congenital vascular anomalies in which coarctation of the aorta combined with the patent ductus arteriosus and the persistent left superior vena cava. The patient was a 15 year old girl and congenital heart disease was suspected during infancy. However, she heard the disease incurable, so she had been well with herb medicine until admission in our hospital. By physical examination and roentgenological studies including aortography, the diagnosis of the patent ductus arteriosus was detected and the coarctation of the aorta was suspected. The persistent left superior vena cava was found during surgery and it was proved roentgenologically by venography.

  1. Simultaneous transcatheter closure of intralobar pulmonary sequestration and patent ductus arteriosus in a patient with infantile Scimitar syndrome.

    Science.gov (United States)

    Aslan, Eyüp; Tanıdır, İbrahim Cansaran; Saygı, Murat; Onan, Sertaç Hanedan; Güzeltaş, Alper

    2015-03-01

    Scimitar syndrome is a rare disease associated with a right lung sequestration vascularised by arteries arising from the abdominal aorta and abnormal venous drainage into the inferior vena cava. The infantile form is generally presented with severe heart failure, pulmonary hypertension and respiratory distress. It may be associated with various intracardiac defects, including atrial septal defects, ventricular septal defects, patent ductus arteriosus or more complicated structural congenital heart defects. Here, we present a 2-month-old girl with Scimitar syndrome whose pulmonary arterial pressure decreased after transcatheter patent ductus arteriosus closure and embolization of the anomalous systemic arterial supply.

  2. Dynamic Changes of Pulmonary Arterial Pressure and Ductus Arteriosus in Human Newborns From Birth to 72 Hours of Age

    OpenAIRE

    2016-01-01

    Abstract Normal pulmonary artery pressure and pulmonary hypertension assessment of newborns is rarely reported. The aim of the study is to explore dynamic changes of pulmonary arterial pressure and ductus arteriosus in human newborns from birth to 72 h of age with echocardiography. A total of 76 cases of normal newborns were prospectively detected by echocardiography after birth of 2 h, 6 h, 12 h, 24 h, 48 h, and 72 h, respectively. Ductus arteriosus diameter, blood shunt direction, blood flo...

  3. Transcatheter closure of a patent ductus arteriosus in an elderly patient with the Gianturco-Grifka vascular occlusion device.

    Science.gov (United States)

    Befeler, B; Justiniano, A; Zahn, E

    2000-10-01

    This paper reports the unusual case of a 76-year-old woman who was discovered to have a hemodynamically significant patent ductus arteriosus following uneventful mitral valve replacement, utilizing cardiopulmonary bypass. The shunt was successfully eliminated using a new transcatheter device, thereby obviating the need for further surgery. The patient did not have calcification within the ductus, making diagnosis prior to surgery more difficult.

  4. Thoracic endovascular aortic repair for patent ductus arteriosus in an elderly patient with congestive heart failure.

    Science.gov (United States)

    Kato, Gentaro; Nakai, Mikizo; Tokunaga, Noriyuki; Shimizu, Shuji; Okada, Masahiro

    2016-05-01

    In elderly patients, open surgery for patent ductus arteriosus (PDA) is more difficult than that in children and often requires a cardiopulmonary bypass. We report the case of a 67-year-old patient with a PDA that was successfully treated with thoracic endovascular aortic repair (TEVAR). The patient was diagnosed with congestive heart failure (ejection fraction, 36 %) and PDA (9.7 mm in diameter). TEVAR was successfully performed to exclude the PDA. After TEVAR, the patient's heart failure was well controlled by diuretics. TEVAR may be a good alternative to open surgery.

  5. Endovascular occlusion of primary major pelvic arteriovenous fistula using patent ductus arteriosus occluder.

    Science.gov (United States)

    Xu, L; Wu, Z; Qu, L; Burchell, S

    2016-03-01

    The aim of the present study was to investigate the effects and safety of a patent ductus arteriosus occluder (PDAO) in the management of major abdominal arteriovenous fistula. A 56-year-old man was admitted into our hospital, presenting with impeded defecation and claudication. Computed tomographic angiography (CTA) was conducted upon admission, which revealed an aneurysm-like lesion, with the left internal iliac artery as its feeding artery. Super-selective embolization treatment was accomplished using a single PDAO. The results of the CTA at follow-up showed no recanalization of the lesion and that a PDAO was at the site. The patient had no pelvic ischemia complications.

  6. Eisenmenger syndrome in an adult patient with a large patent ductus arteriosus

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    Konstantinos Dimopoulos

    2013-12-01

    Full Text Available This is the case of a young female who was seen at our adult congenital heart disease and pulmonary hypertension service (Royal Brompton Hospital, London, UK at the age of 17 years. She initially presented at the age of 4 years with increasing shortness of breath. At that time, there was differential cyanosis with clubbing and lower oxygen saturations in the toes (82% compared with her fingers (95%. On echocardiography there was evidence of severe pulmonary hypertension and a large patent ductus arteriosus (PDA with low velocity bidirectional shunting. She underwent cardiac catheterisation at the time which showed a pulmonary arterial pressure equal to that of the aorta.

  7. Reflections of the changes in patent ductus arteriosus management during the last 10 years.

    Science.gov (United States)

    El-Khuffash, Afif; Weisz, Dany E; McNamara, Patrick J

    2016-09-01

    Despite a large body of scientific evidence on the management of premature infants with a patent ductus arteriosus controversy remains and neonatologists remain challenged for knowing which patient to treat, what is the most optimal timing of treatment and which treatments have a positive impact on both short-term and long-term outcomes. In this review article we discuss the increased body of evidence over the past 10 years, much of which questions the role of treatment and suggests the need to reconsider how haemodynamic significance is adjudicated. In addition, we discuss novel approaches to assessment and diagnosis, and highlight areas for future investigation.

  8. Should we definitively abandon prophylaxis for patent ductus arteriosus in preterm new-borns?

    Directory of Open Access Journals (Sweden)

    Vassilios Fanos

    2011-01-01

    Full Text Available Although the prophylactic administration of indomethacin in extremely low-birth weight infants reduces the frequency of patent ductus arteriosus and severe intraventricular hemorrhage, it does not appear to provide any long-term benefit in terms of survival without neurosensory and cognitive outcomes. Considering the increased drug-induced reduction in renal, intestinal, and cerebral blood flow, the use of prophylaxis cannot be routinely recommended in preterm neonates. However, a better understanding of the genetic background of each infant may allow for individualized prophylaxis using NSAIDs and metabolomics.

  9. [Management of persistent ductus arteriosus in the newborn with respiratory insufficiency].

    Science.gov (United States)

    Hurtado del Rio, D; Holden Barker, A M; Pezzotti, M A; Gutiérrez Bosque, R; Archundia, A; Pérez Mejia, J; Carrillo, H

    1979-01-01

    Sixteen newborn babies with severe respiratory distress and patent ductus arteriosus with congestive heart failure are presented. Fifteen of them were premature and one at full term. Management consisted of the accepted medical and ventilatory aids such as digitalis, diuretics, ventilators, etc. Thirteen cases were given indomethacin with clinical closure in five of them (38%). Ten cases underwent surgical closure with 30% mortality. It is recommended that these patients be given indomethacin inicially; if there is no response in 36 hours surgical closure of the duct should be performed prior to progressive deterioration and eventual death.

  10. Transcatheter interruption of large residual flow after device closure of "Type A" patent ductus arteriosus

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    Anuradha Sridhar

    2012-01-01

    Full Text Available We report a case of 3-year-old girl who had persistence of large residual flow following transcatheter closure of a 6 mm ′Type A′ patent ductus arteriosus using a 12 × 10 mm duct occluder. Angiography revealed a large left-to-right shunt coursing through and exiting around the implanted device. Near total abolition of the residual shunt was achieved by initial implantation of an embolization coil within the duct occluder and subsequently an Amplatzer duct occluder (ADO II adjacent to the duct occluder. This challenging case describes an additional technique of abolishing a large residual flow in and around a Nitinol duct occluder device.

  11. Calcium-dependent and calcium-sensitizing pathways in the mature and immature ductus arteriosus.

    Science.gov (United States)

    Clyman, Ronald I; Waleh, Nahid; Kajino, Hiroki; Roman, Christine; Mauray, Francoise

    2007-10-01

    Studies performed in sheep and baboons have shown that after birth, the normoxic muscle media of ductus arteriosus (DA) becomes profoundly hypoxic as it constricts and undergoes anatomic remodeling. We used isolated fetal lamb DA (pretreated with inhibitors of prostaglandin and nitric oxide production) to determine why the immature DA fails to remain tightly constricted during the hypoxic phase of remodeling. Under normoxic conditions, mature DA constricts to 70% of its maximal active tension (MAT). Half of its normoxic tension is due to Ca(2+) entry through calcium L-channels and store-operated calcium (SOC) channels. The other half is independent of extracellular Ca(2+) and is unaffected by inhibitors of sarcoplasmic reticulum (SR) Ca(2+) release (ryanodine) or reuptake [cyclopiazonic acid (CPA)]. The mature DA relaxes slightly during hypoxia (to 60% MAT) due to decreases in calcium L-channel-mediated Ca(2+) entry. Inhibitors of Rho kinase and tyrosine kinase inhibit both Ca(2+)-dependent and Ca(2+)-independent DA tension. Although Rho kinase activity may increase during gestation, immature DA develop lower tensions than mature DA, primarily because of differences in the way they process Ca(2+). Calcium L-channel expression increases with advancing gestation. Under normoxic conditions, differences in calcium L-channel-mediated Ca(2+) entry account for differences in tension between immature (60% MAT) and mature (70% MAT) DA. Under hypoxic conditions, differences in both calcium L-channel-dependent and calcium L-channel-independent Ca(2+) entry, account for differences in tension between immature (33% MAT) and mature (60% MAT) DA. Stimulation of Ca(2+) entry through reverse-mode Na(+)/Ca(2+) exchange or CPA-induced SOC channel activity constrict the DA and eliminate differences between immature and mature DA during both hypoxia and normoxia.

  12. 胎儿动脉导管异常的超声心动图表现%Diagnosis of fetal ductus arteriosus anomalies by echocardiography

    Institute of Scientific and Technical Information of China (English)

    许燕; 接连利; 刘清华; 赵霞; 董发进

    2011-01-01

    目的 总结胎儿动脉导管异常的声像图特征.方法 对8例经引产后尸体解剖及产后超声随访证实为动脉导管异常的胎儿产前超声心动图检查资料进行回顾性分析.结果 8例动脉导管异常胎儿中3例产前超声多切面扫查均不能显示动脉导管的管腔结构和血流,2例伴发法洛四联症,1例伴发永存动脉干,提示动脉导管缺如;2例胎儿动脉导管和主动脉弓血流方向相反,主动脉血流经动脉导管逆行灌注于肺动脉主干或左、右肺动脉,其中1例伴发于室间隔缺损型肺动脉闭锁,另1例伴发于室间隔完整型肺动脉闭锁,合并右心室发育不良,提示动脉导管逆行灌注;5例伴有复杂先天性心脏病的胎儿引产后经尸体解剖证实.2例胎儿动脉导管管腔细窄,血流速度增快,提示动脉导管狭窄;1例胎儿动脉导管管腔内充填实性低回声,内无血流信号,提示动脉导管早闭;2例动脉导管狭窄和1例动脉导管早闭的胎儿均表现右心房、右心室增大,伴有三尖瓣重度反流,并经产后超声心动图随访证实.结论 胎儿超声心动图能显示胎儿动脉导管缺如、逆行灌注、狭窄及早闭的异常声像图特征,在胎儿动脉导管异常的诊断中具有重要的临床价值.%Objective To summarize the features of fetal ductus arteriosus anomalies by ultrasound. Methods Eight cases of fetal ductus arteriosus anomalies confirmed by autopsy after abortion or postnatal follow-up were retrospectively analyzed by echocardiography. Results Among 8 cases of fetal ductus arteriosus anomalies, 3cases were diagnosed with ductus arteriosus absent including two cases associated with tetralogy of Fallot and one case associated with persistent truncus arteriosus, neither the structure nor the blood flow of ductus arteriosus was observed on multiple views.Two cases were shown with reverse flow in fetal ductus arteriosus, retrograde aortic blood flow infused into the

  13. Comparison of two dose regimens of ibuprofen for the closure of patent ductus arteriosus in preterm newborns.

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    Dornelles, Laura Vargas; Corso, Andréa Lúcia; Silveira, Rita de Cássia; Procianoy, Renato Soibelmann

    2016-01-01

    To compare the efficacy of intravenous ibuprofen at high (20-10-10mg/kg/dose) and low doses (10-5-5mg/kg/dose) the closure of patent ductus arteriosus in preterm newborns. A cohort study with historical control of newborns that received high- and low-dose intravenous ibuprofen, from 2010 to 2013 in a neonatal intensive care unit, for closure of the patent ductus arteriosus, documented by echocardiography. Secondary outcomes included the number of ibuprofen cycles, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, changes in renal function, and death. Seventy-seven patients received three doses of ibuprofen for the treatment of patent ductus arteriosus, with 33 receiving high-dose and 44 low-dose therapy. The ductus closed after the first cycle in 25 (56.8%) low-dose patients and in 17 (51.5%) high-dose patients (p>0.99). Sixteen patients received a second cycle of ibuprofen, and the ductus closed in 50% after low-dose and in 60% after high-dose therapy (p>0.99). Seven patients required surgery for ductus closure, 13.6% in the low-dose group and 3% in the high-dose group (p=0.22). Thirty-nine patients developed bronchopulmonary dysplasia, 50% in the low-dose group and 51.5% in the high-dose group (p>0.99). Twenty-two (50%) low-dose patients died vs. 15 (45.5%) high-dose patients (p=0.86). There was no difference in closure of the ductus arteriosus or occurrence of adverse effects between the two dose regimens. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  14. Comparison of two dose regimens of ibuprofen for the closure of patent ductus arteriosus in preterm newborns,

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    Laura Vargas Dornelles

    2016-06-01

    Full Text Available Abstract Objective: To compare the efficacy of intravenous ibuprofen at high (20-10-10 mg/kg/dose and low doses (10-5-5 mg/kg/dose the closure of patent ductus arteriosus in preterm newborns. Methods: A cohort study with historical control of newborns that received high- and low-dose intravenous ibuprofen, from 2010 to 2013 in a neonatal intensive care unit, for closure of the patent ductus arteriosus, documented by echocardiography. Secondary outcomes included the number of ibuprofen cycles, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, changes in renal function, and death. Results: Seventy-seven patients received three doses of ibuprofen for the treatment of patent ductus arteriosus, with 33 receiving high-dose and 44 low-dose therapy. The ductus closed after the first cycle in 25 (56.8% low-dose patients and in 17 (51.5% high-dose patients (p > 0.99. Sixteen patients received a second cycle of ibuprofen, and the ductus closed in 50% after low-dose and in 60% after high-dose therapy (p > 0.99. Seven patients required surgery for ductus closure, 13.6% in the low-dose group and 3% in the high-dose group (p = 0.22. Thirty-nine patients developed bronchopulmonary dysplasia, 50% in the low-dose group and 51.5% in the high-dose group (p > 0.99. Twenty-two (50% low-dose patients died vs. 15 (45.5% high-dose patients (p = 0.86. Conclusions: There was no difference in closure of the ductus arteriosus or occurrence of adverse effects between the two dose regimens.

  15. Percutaneous closure of patent ductus arteriosus: Experience of a tertiary referral center

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    Hasan Kaya

    2013-01-01

    Full Text Available Objective: We sought to evaluate our clinical experienceand short-term results of percutaneous closure of patentductus arteriosus (PDA.Methods: We studied 20 patients (17 female, mean age24±8 years undergoing percutaneous closure of PDA betweenMarch 2010-March 2013 in our clinic. Amplatzerduct occluder (ADO I was used in 13 patients and ADOII was used in 7 patients for PDA closure. Clinical characteristicsof patients, properties of percutaneous closureintervention, complications and short-term results areevaluated.Results: The mean ductus waist diameter measured byangiographic examination was 5±2 mm (2-9 mm. Procedurewas successfully performed in all patients. Occluderdevice embolization was occurred in one patientin whom device was retrieved by snare catheter and PDAwas successfully closed with same device. The early totalocclusion rate was 85%. Occlusion rate as determinedby echocardiographic control performed the day afterwas 95% whereas 100% at first month. In the follow-up of19±9 months, no complications were observed.Conclusion: Percutaneous closure of PDA using ADO Iand II devices are safe and effective.Key words: patent ductus arteriosus, percutaneous closure,Amplatzer duct occluder

  16. Transcatheter closure of tubular type patent ductus arteriosus using Amplatzer� ductal occluder II: a case report

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    Mulyadi M Djer

    2013-09-01

    Full Text Available Patent ductus arteriosus (PDA is a common congenital heart disease, accounting for 5-10% of all congenital heart diseases. The incidence of PDA is even higher in preterm neonates, ranging from 20-60%.1-4 Closure of PDA is indicated in all cases, except for duct-dependent congenital heart diseases or PDA with Eisenmenger syndrome.1,5,6 In small asymptomatic PDAs, closure is indicated to prevent the risk of complications, such as endarteritis, endocarditis, aneurysm of ductus arteriosus, or congestive heart failure.1,2,7 In recent years, interventional cardiology has become a gold standard therapy for the majority of PDA cases beyond neonatal age. Since its introduction in 1967, many devices and methods have been developed to allow transcatheter closure of virtually all PDAs, regardless of size or configuration. Nevertheless, the tubular shape (type C PDA, which has the highest residual shunt rate, still poses a great challenge for the interventionist.8-10 The second generation of Amplatzer® device occluders (ADO II, released in 2007, has been suggested to be effective in closing tubular PDAs.10 The purpose of this study was to report the initial clinical experience using ADO II to close a tubular type PDA in Indonesia

  17. Coarctation of the Aorta as a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Infant

    Science.gov (United States)

    Qasim, Amna; Jain, Sunil K.; Jiwani, Amyn K.

    2017-01-01

    Surgical ligation of a patent ductus arteriosus (PDA) is a commonly performed procedure. Complications are infrequent and most commonly include recurrent laryngeal nerve injury and rarely ligation of left pulmonary artery. We report a case of accidental ligation of the descending thoracic aorta leading to a clinically significant coarctation. PMID:28386503

  18. Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

    NARCIS (Netherlands)

    Cohen, Emily; Dix, Laura; Baerts, Willem; Alderliesten, Thomas; Lemmers, Petra; van Bel, Frank

    2016-01-01

    BACKGROUND: A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebra

  19. Right pulmonary artery agenesis with patent ductus arteriosus and Eisenmenger syndrome: a rare case diagnosed during the postpartum period.

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    Beker-Acay, Mehtap; Ozkececi, Gulay; Unlu, Ebru; Hocaoglu, Elif; Kacar, Emre; Onrat, Ersel

    2014-01-01

    Unilateral absence of a pulmonary artery a very rare congenital disorder. We here present a case of a 22-year-old female patient with agenesis of the right pulmonary artery accompanying patent ductus arteriosus and Eisenmenger syndrome, diagnosed by chest X-ray and multidetector computed tomography 5 days after giving birth.

  20. Serum ibuprofen levels of extremely preterm infants treated prophylactically with oral ibuprofen to prevent patent ductus arteriosus

    NARCIS (Netherlands)

    Kanmaz, Gozde; Erdeve, Omer; Canpolat, Fuat Emre; Oguz, Serife Suna; Uras, Nurdan; Altug, Nahide; Greijdanus, Ben; Dilmen, Ugur

    2013-01-01

    The aim of this study was to explore the effects of early oral ibuprofen administration on the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) and define the association between serum ibuprofen levels and ductal closure. Preterm infants with a gestational age of <28 weeks a

  1. Isolated left brachiocephalic artery with the right aortic arch: A rare differential of large patent ductus arteriosus

    Science.gov (United States)

    Dubey, Gajendra; Gupta, Saurabh Kumar; Kothari, Shyam Sundar

    2017-01-01

    We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis. PMID:28163435

  2. [Chylothorax--a rare complication of surgical ligation of patent ductus arteriosus in a premature infant-a case report].

    Science.gov (United States)

    Stempniewicz, Krzysztof; Walas, Wojciech

    2007-01-01

    A case of left sided chylothorax in preterm infant is reported. The chylothorax was a complication of ligation of patent ductus arteriosus. Treatment consisted of parenteral nutrition, pleural taps, drainage of pleural cavity, mechanical ventilation and replacement of immunoprotein losses. When the lymph effusion reduced, enteral nutrition was started with a formula containing medium chain triglycerides. Treatment of this patient was successful.

  3. Ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation: effects on cerebral oxygenation and hemodynamics.

    NARCIS (Netherlands)

    Heyst, A.F.J. van; Staak, F.H.J.M. van der; Hopman, J.C.W.; Tanke, R.B.; Sengers, R.C.A.; Liem, K.D.

    2003-01-01

    OBJECTIVE: To investigate the effect on cerebral oxygenation and hemodynamics of a patent ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation in a lamb model. DESIGN: Prospective intervention study in animals. SETTING: Animal research laboratory of a

  4. Utility of fetal cardiac magnetic resonance imaging to assess fetuses with right aortic arch and right ductus arteriosus.

    Science.gov (United States)

    Dong, Su-Zhen; Zhu, Ming

    2017-05-07

    To evaluate the utility of fetal cardiac magnetic resonance imaging (MRI) to diagnose right aortic arch (RAA) with right ductus arteriosus. This retrospective study included six fetuses with right aortic arch and right ductus arteriosus. The six fetal cases were examined using a 1.5-T magnetic resonance unit. The steady-state free precession (SSFP) and single-shot turbo spin echo (SSTSE) sequences were used to evaluate the fetal heart and airway. The gestational age of the six fetuses ranged from 22 to 35 weeks (mean, 26.5 weeks). The age of the pregnant women ranged from 23 to 40 years (mean 31 years). Fetal cardiac MRI diagnosed the six fetal cases with RAA with right ductus arteriosus correctly. Among the six fetuses, four were associated with other congenital heart defects. In three of six cases, the diagnoses established using prenatal echocardiography (echo) was correct when compared with postnatal diagnosis. Fetal cardiac MRI is a useful complementary tool to assess fetuses with RAA and right ductus arteriosus.

  5. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

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    Ozge Korkmaz

    2016-01-01

    Full Text Available Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach.

  6. Radionuclide determination of left-to-right shunt in patients with patent ductus arteriosus

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    Klepzig, H. Jr.; Sievert, H.; Mildenberger, D.; Bussmann, W.D.; Kaltenbach, M.; Standke, R.; Hoer, G.

    1987-02-01

    In 9 patients with patent ductus arteriosus, quantification of left-to-right shunt was performed with dye dilution curves after peripheral injection and with radionuclide ventriculography. The study was repeated within 7 days after successful transluminal occlusion of the ductus with an Ivalon-plug. Reproducibility of the method could be studied in one patient in whom reopening of the ductus occurred. Dye dilution curves were analyzed using the method of Carter et al. Radionuclide ventriculography was performed as a combined first-pass and equilibrium study: effective stroke volume was derived from the first pass of the tracer through the heart; during the equilibrium phase left ventricular ejection fraction (EF) and left ventricular enddiastolic volume (EDV) were evaluated. The difference between total left ventricular stroke volume (product of EF and EDV) and effective stroke volume was taken as shunt volume. This volume as a fraction of total left ventricular stroke volume resulted in percent left-to-right shunt. The sensitivity of the dye technique was 78%; a quantification of the shunt lesion was possible in 55% of all cases (shunt greater than 35%). The sensitivity of the radionuclide technique was 90%. The severity of the lesion could not be determined in one patient with a minimal shunt. After successful occlusion of the ductus, dye dilution curves normalized in all cases. Radionuclide ventriculography showed normalization in all but one patient. This patient with concomitant mitral regurgitation still showed moderate left ventricular volume overload. After occlusion, left ventricular enddiastolic volume significantly decreased (from 224 to 181 ml, p < 0.05), effective cardiac output increased (from 6186 to 7476 ml, p < 0.01) and ejection fraction remained unchanged (55 vs. 51%). (orig./TRV).

  7. Isobaric Tags for Relative and Absolute Quantitation-Based Proteomic Analysis of Patent and Constricted Ductus Arteriosus Tissues Confirms the Systemic Regulation of Ductus Arteriosus Closure.

    Science.gov (United States)

    Hong, Haifa; Ye, Lincai; Chen, Huiwen; Xia, Yu; Liu, Yue; Liu, Jinfen; Lu, Yanan; Zhang, Haibo

    2015-08-01

    We aimed to evaluate global changes in protein expression associated with patency by undertaking proteomic analysis of human constricted and patent ductus arteriosus (DA). Ten constricted and 10 patent human DAs were excised from infants with ductal-dependent heart disease during surgery. Using isobaric tags for relative and absolute quantitation-based quantitative proteomics, 132 differentially expressed proteins were identified. Of 132 proteins, voltage-gated sodium channel 1.3 (SCN3A), myosin 1d (Myo1d), Rho GTPase activating protein 26 (ARHGAP26), and retinitis pigmentosa 1 (RP1) were selected for validation by Western blot and quantitative real-time polymerase chain reaction analyses. Significant upregulation of SCN3A, Myo1d, and RP1 messenger RNA, and protein levels was observed in the patent DA group (all P ≤ 0.048). ARHGAP26 messenger RNA and protein levels were decreased in patent DA tissue (both P ≤ 0.018). Immunohistochemistry analysis revealed that Myo1d, ARHGAP26, and RP1 were specifically expressed in the subendothelial region of constricted DAs; however, diffuse expression of these proteins was noted in the patent group. Proteomic analysis revealed global changes in the expression of proteins that regulate oxygen sensing, ion channels, smooth muscle cell migration, nervous system, immune system, and metabolism, suggesting a basis for the systemic regulation of DA patency by diverse signaling pathways, which will be confirmed in further studies.

  8. 介入治疗动脉导管未闭的护理体会%Nursing experience for treating patent ductus arteriosus by interventional therapy

    Institute of Scientific and Technical Information of China (English)

    王磊

    2015-01-01

    介入治疗在医治动脉导管未闭方面具有创伤小、风险小、术后恢复快等优点。对74例动脉导管未闭患者采取了介入治疗、护理之后,有72例痊愈,疗效显著,值得在临床上推广。%In treating patent ductus arteriosus, the interventional therapy hold the advantages of little trauma, low risk, faster postoperative recovery etc. 74 patients with patent ductus arteriosus received the interventional therapy and nursing. 72 cases of patent ductus arteriosus were cured. The interventional therapy was effective on patent ductus arteriosus, and worthy of promotion in clinic.

  9. History of the ductus arteriosus: 2. Persisting patency in the preterm infant.

    Science.gov (United States)

    Obladen, Michael

    2011-01-01

    By 1769, it was known to Morgagni that the ductus arteriosus may persist until adulthood. In 1835, Jörg linked delayed postnatal closure with disturbed respiration, a discovery that was afterwards forgotten for a century. When blood gas analysis became available, the association between persisting patency and diminished oxygenation resurfaced. When it became known that prostaglandins played a role in maintaining ductal patency, the development of pharmacologic intervention with cyclooxygenase inhibitors immediately followed. This rapid progress was due to the interaction between basic science, pediatric cardiology, and neonatology disciplines at the Cardiovascular Research Institute in San Francisco, coordinated by Julius Comroe, as well as President Kennedy's foundation of the National Institute of Child Health and Development. This series of events exemplifies how clinical research became an integrated managed multidisciplinary endeavor in the 20th century.

  10. Early or Late Surgical Ligation of Medical Refractory Patent Ductus Arteriosus in Premature Infants

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    Chien-Chou Hsiao

    2009-01-01

    Full Text Available Optimal time to surgical ligation of patent ductus arteriosus (PDA in very-low-birth-weight ( 14 days groups. Basic clinical features, major morbidity of prematurity and mortality were compared. Clinical features and major outcomes were similar. The early ligation group had earlier onset of symptomatic PDA (5.7 ± 1.6 days vs. 8.1 ± 3.6 days, p = 0.024, and fewer days of total parenteral nutrition (TPN (39.6 ± 13.9 days vs. 60.4 ± 31.4 days, p = 0.025 and ventilator use (11.1 ± 6.7 days vs. 18.6 ± 10.5 days, p = 0.019. Early ligation of medical refractory PDA in very-low-birth-weight premature infants improves enteral feeding tolerance and reduces TPN and ventilator use, but long-term benefits need further investigation.

  11. Three-dimensional modeling of a patent ductus arteriosus in a cat.

    Science.gov (United States)

    Saunders, A B; Birch, S A

    2015-12-01

    A left-to-right shunting patent ductus arteriosus was diagnosed in a 13-week-old, 2.5 kg, male, domestic Shorthair cat with a continuous murmur. Echocardiographic abnormalities were identified, including: cardiomegaly, wide and presumably short ductal ampulla, and a large right branch pulmonary artery. When these findings were combined with the small patient size, additional imaging was considered prior to surgical ligation, and computed tomography angiography was preferred over standard angiography to provide multi-dimensional appreciation of the anatomy prior to surgery. The dataset from a computed tomography angiographic study performed prior to surgical ligation was used to create a three-dimensional model of the heart and great vessels. The rendered images accurately depicted the cardiac anatomy in situ, which can be utilized for surgical procedural planning and to enhance visuospatial understanding of the anatomy at all levels of training.

  12. Chest closure without drainage after open patent ductus arteriosus ligation in Ugandan children: A non blinded randomized controlled trial.

    Science.gov (United States)

    Kebba, Naomi; Mwambu, Tom; Oketcho, Michael; Izudi, Jonathan; Obuku, Ekwaro A

    2016-09-29

    There is clinical equipoise regarding post-operative management of patients with patent ductus arteriosus (PDA) without insertion of a chest drain. This study evaluated post operative outcomes of chest closure with or without a drain following Patent Ductus Arteriosus ligation among childen at Uganda Heart Instritute (UHI). This was an open label randomized controlled trial of 62 children 12 years of age and below diagnosed with patent ductus arteriosus at Mulago National Teaching and Referral Hospital, Uganda. Participants were randomized in the ratio of 1:1 with surgical ligation of patent ductus arteriosus to either thoracotomy closure with a chest tube or without a chest tube. All participants received standard care and were monitored hourly for 24 hours then until hospital discharge. The combined primary endpoint consisted of significant pleural space accumulation of fluid or air, higher oxygen need or infection of the surgical site. Analysis was conducted by multivariable logistic regression analysis at 5 % significance level. We enrolled 62 participants, 46 (74 %) of whom were females. Their median age was 12 months (IQR: 8-36). Participants in the no-drain arm significantly had less post-operative complications compared to the drain arm (Unadjusted odds ratio [uOR]: 0.21, 95 % CI: 0.06-0.73, p = 0.015). This "protective effect" remained without statistical significance in the multivariable regression model (Adjusted odds ratio [aOR]: 0.07, 95 % CI: 0.00-2.50, p = 0.144). Children aged below 6 years with patent ductus arterious can safely and effectively have thoracotomy closure without using a drain in uncomplicated surgical ligation of the PDA. Chest drain was associated with post-operative complications. The trial was registered in the Pan African Clinical Trials registry on 1st/July/2012, retrospectively registered. Identifier number PACTR201207000395469 .

  13. Thromboxane A(2 receptor stimulation promotes closure of the rat ductus arteriosus through enhancing neointima formation.

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    Tomohiro Yokota

    Full Text Available Ductus arteriosus (DA closure follows constriction and remodeling of the entire vessel wall. Patent ductus arteriosus occurs when the DA does not close after birth, and this condition is currently treated using cyclooxygenase inhibitors. However, the efficacy of cyclooxygenase inhibitors is often limited. Our previous study demonstrated that low-dose thromboxane A2 receptor (TP stimulation constricted the DA with minimal adverse effects in rat neonates. However, its effect on DA remodeling remains unknown. In this study, we focused on the impact of the exogenous TP stimulation on the DA remodeling, especially intimal thickening. Using DA explants from rat fetuses at embryonic day 19 as a ex vivo model and primary cultured rat DA smooth muscle cells from embryonic day 21 as a in vitro model, we evaluated the effect of TP stimulation on the DA remodeling. The selective TP agonists U46619 and I-BOP promoted neointima formation in the ex vivo DA explants, and TP stimulation increased DA SMC migration in a dose-dependent manner. Both effects were inhibited by the selective TP antagonist SQ29548 or the siRNA against TP. TP stimulation also increased DA SMC proliferation in the presence of 10% fetal bovine serum. LC/MS/MS analysis revealed that TP stimulation increased secretion of several extracellular matrix proteins that may contribute to an increase in neointima formation. In conclusion, we uncovered that exogenous administration of TP agonist promotes neointima formation through the induction of migration and proliferation of DA SMC, which could contribute to DA closure and also to its vasoconstrictive action.

  14. [Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure].

    Science.gov (United States)

    Vieu, T; Beaurain, S; Angel, C; Leriche, H; Petit, J; Conso, J F; Planché, C; Losay, J

    1995-10-01

    The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

  15. Pharmacokinetics and clinical efficacy of indomethacin in premature infants with patent ductus arteriosus.

    Science.gov (United States)

    Regazzi, M B; Rondanelli, R; Vidale, E; Chirico, G; Rondini, G; Chiara, A; Piccolo, A

    1984-01-01

    Despite a considerable amount of investigation, controversy continues concerning the use of indomethacin in inducing the closure of patent ductus arteriosus. This controversy may be attributable to differences in dosage, route of administration, postnatal age at treatment and the variable pharmacokinetics of the drug in premature infants. The pharmacokinetics and clinical efficacy of i.v. administered indomethacin in five premature infants with PDA were evaluated. There was considerable intersubject variability in the half life of elimination (63.1 +/- 38 h). This variability was mainly due to clearance (0.0086 +/- 0.0069 l/h/kg) rather than to distribution volume variability (0.54 +/- 0.27 l/kg). A reduction of half life was observed after the second dose, probably due to a maturation process. A permanent closure of the ductus was obtained in two patients after the first dose and in two patients after the second dose. The side-effects observed in our infants were transient and no long-term complication was attributable to this drug.

  16. [Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

    Science.gov (United States)

    Avila-Alvarez, Alejandro; Serantes Lourido, Marta; Barriga Bujan, Rebeca; Blanco Rodriguez, Carolina; Portela-Torron, Francisco; Bautista-Hernandez, Victor

    2017-05-01

    Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Evaluation of Risk Factors Related with Neonatal Patent Ductus Arteriosus in Hospitalized Neonates of Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Reza Saeidi

    2012-06-01

    Full Text Available Background: Patent ductus arteriosus or patent arterial duct (PDA is a condition in which a structure called the ductus arteriosus, normal in fetal life, remains into infancy and onwards, when it should have disappeared. Thus, in this study we want to discuss about frequency of its symptoms and risk factors. Materials and Methods: It is a descriptive study which has been done among 100 newborns registered in Ghaem Hospital of Mashhad. Sampling was gathered easily.Results: The most prevalent symptom among newborn babies was systolic heart murmur (89%. According to the obtained risk factors, hypoxia (71% and acidosis (70% are followed by prematurity (41%. Out of all registered newborn babies 68% were suffering from associated disorders.Conclusion: For achieving an on-time diagnosis of PDA, clinical examination of heart and respiratory symptoms must be examined very precisely. Newborn babies must be examined in terms of two risk factors: prematurity and light weight.

  18. Neurogenic chronic idiopathic intestinal pseudo-obstruction, patent ductus arteriosus, and thrombocytopenia segregating as an X linked recessive disorder.

    Science.gov (United States)

    FitzPatrick, D R; Strain, L; Thomas, A E; Barr, D G; Todd, A; Smith, N M; Scobie, W G

    1997-08-01

    We present a family with three affected males in two generations with congenital neurogenic chronic idiopathic intestinal pseudo-obstruction (CIIP), patent ductus arteriosus, and large platelet thrombocytopenia apparently segregating as an X linked recessive disorder. The pattern of segregation of DNA markers within the family is consistent with linkage to the previously described neurogenic CIIP (CIIPX) locus at Xq28. This combination may represent a new contiguous gene disorder and appears to have a good prognosis with supportive therapy.

  19. A Major Cause of Mortality and Morbidity of Very Low Birth Weight Infants: Patent Ductus Arteriosus

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    Fatih Aygün

    2012-04-01

    Full Text Available In­tro­duc­ti­on: Patent Ductus Arteriosus (PDA, a cardiac pathology commonly seen in preterm infants, has negative effects on mortality and morbidity. Persistent patency of PDA is positively correlated with respiratory distress syndrome (RDS, prolonged respiratory support, pulmonary hemorrhage, broncopulmonary dysplasia (BPD, necrotizing enterocolitis (NEC, intraventricular hemorrhage, renal failure, neurodevelopmental impairment (cerebral palsy, retinopathy of prematurity and death. The standard treatment regimen is to close symptomatic PDA and cyclooxygenase inhibitors such as indomethacin, ibuprofen are the first choises. Our aim in this study is to report PDA rate, treatment and complications in premature infants. Materials and Methods: This study retrospectively enrolled 103 infants born <33 gestational weeks, without any major congenital anomaly or congenital heart defects between January 2010-November 2011. Echocardiograms was performed in the first week. PDA related pulmonary hemorrhage, NEC, BPD, ROP and death were demonstrated.Results: Among of 103 infants, 45 were male and 58 were female. Seventy infants were born with cesarian section and 33 were born with normal labor. The mean gestational week was 29.7±2.2, the mean gestational week of infants with PDA was 28.8±2.3. The mean birth weight of infants was 1323±375 grams. The mean Apgar score was 7.25±1.83, the scores of infants with patent ductus arteriosus were significantly low (6.7±1.9. Echocardiography was performed on the mean of 4.8±4.4 days, PDA was determined in 48 of 103 infants (%46. The mean of birth weight of infants with persistant PDA was 1162±351 grams, it was 1465±340 g in the closed group. The rate of pulmonary hemorrhage, NEC, BPD, ROP and death was significantly higher in infants with PDA compared with infants having ductal closure (p<0.05.Conclusion: The early closure of PDA in very low birth weight infants will reduce both mortality and early or late

  20. Anatomic, histopathologic, and echocardiographic features in a dog with an atypical pulmonary valve stenosis with a fibrous band of tissue and a patent ductus arteriosus.

    Science.gov (United States)

    Yoon, Hakyoung; Kim, Jaehwan; Nahm, Sang-Soep; Eom, Kidong

    2017-07-11

    Congenital pulmonary valve stenosis and patent ductus arteriosus are common congenital heart defects in dogs. However, concurrence of atypical pulmonary valve stenosis and patent ductus arteriosus is uncommon. This report describes the anatomic, histopathologic, and echocardiographic features in a dog with concomitant pulmonary valve stenosis and patent ductus arteriosus with atypical pulmonary valve dysplasia that included a fibrous band of tissue. A 1.5-year-old intact female Chihuahua dog weighing 3.3 kg presented with a continuous grade VI cardiac murmur, poor exercise tolerance, and an intermittent cough. Echocardiography indicated pulmonary valve stenosis, a thickened dysplastic valve without annular hypoplasia, and a type IIA patent ductus arteriosus. The pulmonary valve was thick line-shaped in systole and dome-shaped towards the right ventricular outflow tract in diastole. The dog suffered a fatal cardiac arrest during an attempted balloon pulmonary valvuloplasty. Necropsy revealed pulmonary valve dysplasia, commissural fusion, and incomplete opening and closing of the pulmonary valve because of a fibrous band of tissue causing adhesion between the right ventricular outflow tract and the dysplastic intermediate cusp of the valve. A fibrous band of tissue between the right ventricular outflow track and the pulmonary valve should be considered as a cause of pulmonary valve stenosis. Pulmonary valve stenosis and patent ductus arteriosus can have conflicting effects on diastolic and systolic dysfunction, respectively. Therefore, beta-blockers should always be used carefully, particularly in patients with a heart defect where there is concern about left ventricular systolic function.

  1. The expression of VEGF and its receptors in the human ductus arteriosus.

    Science.gov (United States)

    Weber, Sven C; Rheinlaender, Cornelia; Sarioglu, Nanette; Peiser, Christian; Rüdiger, Mario; Obladen, Michael; Koehne, Petra S

    2008-10-01

    Programmed proliferative degeneration of the human fetal ductus arteriosus (DA) preceding definite postnatal closure has a large developmental variability and is controlled by several signaling pathways. Among these vascular endothelial growth factor (VEGF) and its receptors (VEGF-Rs) play an important role. Until now, gestational age dependent expression of VEGF and its receptors has not been investigated in a large number of human DA tissue specimens. We examined protein expression of VEGF and the three VEGF-Rs immunohistochemically in 63 human fetal autopsy DA specimens of 11-38 wk gestation. Specimens were classified into different maturity stages according to their histologic appearance. VEGF and VEGF-Rs-staining was detected in all maturity stages. VEGF-staining was localized perinuclearly in all vascular layers and did not change during development. VEGF-R1 and VEGF-R3 expression was marked in the endothelium in early maturity stages and decreased during development. In contrast, -R2 predominated in the media in later developmental stages. Our results emphasize the importance of VEGF as a mediator during programmed proliferative degeneration of fetal DA and support the hypothesis that VEGF-R1 and VEGF-R3 are required for normal blood vessel development during embryogenesis. In contrast, VEGF-R2 is the predominant receptor in later angiogenic signaling.

  2. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation.

    LENUS (Irish Health Repository)

    Noori, S

    2014-08-14

    Objective:We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.Study Design:A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was >15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).Result:Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.Conclusion:We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.Journal of Perinatology advance online publication, 14 August 2014; doi:10.1038\\/jp.2014.151.

  3. Pharmacoeconomics of Surgical Interventions vs. Cyclooxygenase Inhibitors for the Treatment of Patent Ductus Arteriosus

    Science.gov (United States)

    Turck, Charles J; Marsh, Wallace; Stevenson, James G.; York, John M.; Miller, Henry; Patel, Snehal

    2007-01-01

    Management of neonatal patent ductus arteriosus (PDA) often is resource-intensive and costly. Therefore, it is in hospitals' best interests to ensure the most cost-efficient use of associated resources. Clinical status, comorbidities, and response to prior therapy are considered in selecting the most appropriate intervention for PDA management. Currently, supportive measures (e.g., fluid restriction), surgical ligation, and pharmacologically based medical therapy are the primary treatment modalities for correcting PDA. Medical therapy, which comprises a small percentage (2.0%–5.0%)1 of overall PDA treatment expenses in the United States, consists of either of the 2 intravenous (IV) cyclooxygenase (COX) inhibitors: IV indomethacin and the newly available IV ibuprofen lysine. Although IV COX inhibitors represent a small portion of medical expenses, their benefits appear to be considerable. Pharmacoeconomic studies have evaluated indomethacin's beneficial impact on cost-effectiveness per quality-adjusted life year in PDA prophylaxis; however, no analysis to date prospectively assesses the effect of COX inhibitors on resource use or expenses in treating PDA. Such analysis is desirable and should consider efficacy and safety outcomes, impact on health care resource use and length of stay (LOS), and any differential effects of the agents' safety profiles; notably, IV indomethacin adversely affects renal and mesenteric blood flow and increases serum creatinine and oliguria significantly more than IV ibuprofen. These observations lay the foundation to conduct studies assessing the influence of these differences on resource use, LOS and expenses associated with PDA management. PMID:23055853

  4. Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

    Directory of Open Access Journals (Sweden)

    Hesham Abdel-Hady

    2013-01-01

    Full Text Available Patent ductus arteriosus (PDA is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD, decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.

  5. Transcatheter Closure of Patent Ductus Arteriosus and Atrial Septal Defects Using the Amplatzer Occluder

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective:To evalte the efficiency,safety and complications of transcatheter closure of patent ductus arteriosus (PDA) or secundum atrial septal defects (ASD)using the Amplatzer occluder device.Methods:30 patients underwent transcatheter closure of PDA or ASD with the Amplatzer occluder.The lateral descending aortographies were performed to evaluate immediate results in the 20 patients of PDA.Hemodynamics was studied before and after the procedure.X-ray and echocardiography were performed in order to detect residual shunt and recanalization.Results:The device was successfully implanted in 28 patients.There was on clinical evidence of hemolysis andon incidence of device emboliszation.The median operation time waw 56min and median fluoroscopy time was 11min .The devices'positions were optmal and on residual shunt was found 24h and 1month after the procedure No complicatios were observed during the 3-month follow-up in 25 patients.Conclusions:The Amplatzer occluder device is a highly efficient prosthesis that can be safely applied in most patients with PDA or ASD.

  6. Management of patent ductus arteriosus in preterm infants--where do we stand?

    Science.gov (United States)

    Mitra, Souvik; Rønnestad, Arild; Holmstrøm, Henrik

    2013-01-01

    Patent ductus arteriosus (PDA) in preterm infants is a controversial topic in the management of preterm neonates. There are no generally accepted guidelines for diagnosis, treatment, and follow-up of PDA, and few publications have covered the whole topic or have been conclusively summarized to give a proper direction for the treating physician. Major issues remain to be clarified, both with respect to diagnosis and treatment. The definition of hemodynamic significance varies because of different use of echocardiographic criteria and uncertainty about the role of biomarkers. The detailed risks and benefits of available treatment alternatives are still under investigation. There has been a general shift in the management of PDA in preterm neonates from the "aggressive approach" to a more "conservative approach," but the effects of this strategy on morbidity in a longer time perspective are not fully known. An individualized therapeutic strategy with special emphasis on identification of hemodynamically significance seems to be the way forward. In this review we put forward the scientific background in favor of a seemingly growing body of evidence against active treatment, but we raise caution against shying away from all forms of treatment or instituting them too late. Finally, we try to integrate the current knowledge into suggestions for the management of PDA in premature infants.

  7. Mechanical and in vitro evaluation of an experimental canine patent ductus arteriosus occlusion device.

    Science.gov (United States)

    Wierzbicki, Mark A; Bryant, Jesse; Miller, Matthew W; Keller, Brandis; Maitland, Duncan J

    2016-06-01

    Patent ductus arteriosus (PDA) is a congenital cardiovascular malformation in which a fetal connection between the aorta and pulmonary artery remains patent after birth. This defect commonly results in clinical complications, even death, necessitating closure. Surgical ligation is the most common treatment but requires a thoracotomy and is therefore invasive. A minimally invasive option is preferable. A prototype device for PDA occlusion which utilizes shape memory polymer foams has been developed and evaluated using mechanical and in vitro experiments. Removal force and radial pressure measurements show that the prototype device exhibited a lower removal force and radial pressure than a commercially available device. The in vitro experiments conducted within simplified and physiological PDA models showed that the prototype does not migrate out of position into the pulmonary artery at either physiological or elevated pressures in multiple model configurations. While the radial pressure and removal force were lower than commercial devices, the device performed acceptably in the in vitro benchtop experiments warranting further prototype development.

  8. Preoperative echocardiographic measures of left ventricular mechanics are associated with postoperative vasoactive support in preterm infants undergoing patent ductus arteriosus ligation.

    Science.gov (United States)

    Gray, Margaret A; Graham, Eric M; Atz, Andrew M; Bradley, Scott M; Kavarana, Minoo N; Chowdhury, Shahryar M

    2017-07-05

    Preoperative risk factors associated with poor outcomes after patent ductus arteriosus ligation in preterm infants have not been well defined. The aim of this study was to determine the association between preoperative echocardiographic measures of left ventricular mechanics and postoperative clinical outcomes after patent ductus arteriosus ligation. Preterm infants less than 90 days of age with no other significant congenital anomalies who underwent patent ductus arteriosus ligation between 2007 and 2015 were considered for retrospective analysis. The primary outcome was peak postoperative vasoactive inotropic score. Conventional echocardiographic measures of ventricular size, function, and patent ductus arteriosus size were performed. Echocardiographic single-beat, pressure-volume loop analysis estimates of contractility (end-systolic elastance) and afterload (arterial elastance) were calculated. Ventriculoarterial coupling was assessed using the arterial elastance/end-systolic elastance ratio. Multivariable linear regression was performed using clinical and echocardiographic data. Echocardiograms from 101 patients (42.5% male) were analyzed. We found a statistically significant association between vasoactive inotropic score and both end-systolic elastance and arterial elastance. No patient with arterial elastance/end-systolic elastance greater than 0.78 (n = 32) had a vasoactive inotropic score 20 or greater. Analysis of our secondary outcomes found associations between preoperative end-systolic elastance and postoperative urine output less than 1 mL/kg/h at 24 hours, creatinine change greater than 0.5 mg/dL, and time to first extubation. End-systolic elastance and arterial elastance were the only predictors of postoperative vasoactive inotropic score after patent ductus arteriosus ligation in preterm infants. Those neonates with increased contractility and low afterload were at highest risk for elevated inotropic support. These findings suggest a role

  9. Anomalous left coronary artery from the pulmonary artery with a large patent ductus arteriosus: aversion of a catastrophe.

    Science.gov (United States)

    Aggarwal, Sanjeev; Delius, Ralph E; Pettersen, Michael D

    2013-01-01

    We present an infant who had an anomalous left coronary artery arising from the pulmonary artery (ALCAPA) and a large patent ductus arteriosus (PDA), who was diagnosed before a potentially catastrophic closure of PDA. In the presence of normal left ventricular function and the absence of coronary artery collaterals, it is difficult to diagnose ALCAPA. A disproportionate degree of left ventricular dilation and severity of mitral valve regurgitation relative to the degree of PDA shunt, and echogenic papillary muscles on an echocardiogram should raise a suspicion of coronary artery anomalies. The infant underwent surgical ligation of PDA with translocation of coronary arteries and had an uneventful recovery.

  10. Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

    Science.gov (United States)

    Cordero, L; Nankervis, C A; Delooze, D; Giannone, P J

    2007-03-01

    Indomethacin prophylaxis or expectant treatment are common strategies for the prevention or management of symptomatic patent ductus arteriosus (sPDA). To compare the clinical responses of extremely low birth weight (ELBW) infants to indomethacin prophylaxis with that of other infants who were managed expectantly by being treated with indomethacin or surgically only after an sPDA was detected. Retrospective cohort investigation of 167 ELBW infants who received indomethacin prophylaxis (study) and 167 ELBW infants (control) treated expectantly who were matched by year of birth (1999 to 2006), birth weight, gestational age (GA) and gender. Mothers of the two groups of infants were comparable demographically and on the history of preterm labor, pre-eclampsia, antepartum steroids and cesarean delivery. Study and control infants were similar in birth weight, GA, low 5 min Apgar scores, surfactant administration, the need for arterial blood pressure control, bronchopulmonary dysplasia and neonatal mortality. Necrotizing enterocolitis, spontaneous intestinal perforations, intraventricular hemorrhage grade III to IV, periventricular leukomalacia and stage 3 to 5 retinopathy of prematurity occurred also with similar frequency in both groups of infants. In the indomethacin prophylaxis group, 29% of the infants developed sPDA, and of them 38% responded to indomethacin treatment. In the expectantly treated group, 37% developed sPDA, and of them 59% responded to indomethacin treatment. Overall, surgical ligation rate for sPDA was similar between both groups of patients. In our experience, indomethacin prophylaxis does not show any advantages over expectant early treatment on the management of sPDA in ELBW infants. Although no deleterious effects were observed, prophylaxis exposed a significant number of infants who may have never developed sPDA, to potential indomethacin-related complications.

  11. Differential temporal and spatial progerin expression during closure of the ductus arteriosus in neonates.

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    Regina Bökenkamp

    Full Text Available Closure of the ductus arteriosus (DA at birth is essential for the transition from fetal to postnatal life. Before birth the DA bypasses the uninflated lungs by shunting blood from the pulmonary trunk into the systemic circulation. The molecular mechanism underlying DA closure and degeneration has not been fully elucidated, but is associated with apoptosis and cytolytic necrosis in the inner media and intima. We detected features of histology during DA degeneration that are comparable to Hutchinson Gilford Progeria syndrome and ageing. Immunohistochemistry on human fetal and neonatal DA, and aorta showed that lamin A/C was expressed in all layers of the vessel wall. As a novel finding we report that progerin, a splicing variant of lamin A/C was expressed almost selectively in the normal closing neonatal DA, from which we hypothesized that progerin is involved in DA closure. Progerin was detected in 16.2%±7.2 cells of the DA. Progerin-expressing cells were predominantly located in intima and inner media where cytolytic necrosis accompanied by apoptosis will develop. Concomitantly we found loss of α-smooth muscle actin as well as reduced lamin A/C expression compared to the fetal and non-closing DA. In cells of the adjacent aorta, that remains patent, progerin expression was only sporadically detected in 2.5%±1.5 of the cells. Data were substantiated by the detection of mRNA of progerin in the neonatal DA but not in the aorta, by PCR and sequencing analysis. The fetal DA and the non-closing persistent DA did not present with progerin expressing cells. Our analysis revealed that the spatiotemporal expression of lamin A/C and progerin in the neonatal DA was mutually exclusive. We suggest that activation of LMNA alternative splicing is involved in vascular remodeling in the circulatory system during normal neonatal DA closure.

  12. Clinical Exploration of Transcatheter Closure of Patent Ductus Arteriosus With Duct Occluder in Infants

    Institute of Scientific and Technical Information of China (English)

    Mingyang Qian; Yufen Li; Zhiwei Zhang; jijun Shi; Shushui Wang; Junjie Li

    2007-01-01

    To explore the feasibility,necessity,and security of transcatheter closure of patent ductus arteriosus (PDA) in infants.Methods There were 230 infants with PDA.The ages were (7.3 ± 3.2) months and the weight (6.6 ± 2.8) Kg in average.They were separated into two groups.Group A was formed by the infants weighing less than 6 Kg,Group B over 6 Kg.Right heart catheterizaton was performed first to calculate the ratio of Qp/Qs.Then descending aortography demonstrated the diameter and shape of PDA.Proper occluder was selected to finish the intervention.Echocardiography was performed after intervention 24 hours and 1,3,6,12 and 24 months.Results In Group A the technical achievement ratio was 94.6% with the average diameter of PDA (6.2 ± 3.2) mm.In Group B the technical achievement ratio was 100% with the average diameter of PDA (4.8 ±2.5) mm.We used the Amplatzer Duct Occluder with the type from 6-8 mm to 12-14 mm,the delivery sheath from 6 French to 8 French.24 hours after intervention,echocardiography demonstrated that there were 6 residual shunts in Group A while 22 in Group B.After 1 year,residual shunt existed in neither group.There were 4 patients whose femoral arteries pulsed weakly after intervention in Group A,while in Group B there were 3.They all recovered 24 hours after the application of urokinase.In Group A blood flow velocity in descending aorta increased in 5 infants,while in Group B there were 3.They all resumed in 6-12 months.Conclusions Transcatheter closure of PDA in infants is safe and technically feasible.However,indication should be strictly selected and the intervention should be performed by experienced physician.

  13. Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

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    Azhar Ahmad

    2009-01-01

    Full Text Available Background and Objectives : Initial experience with transcatheter closure of patent ductus arteriosus (PDA using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. Methods: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. Results: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. Conclusion: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.

  14. Different doses of ibuprofen in the treatment of patent ductus arteriosus: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    E Amini

    2012-11-01

    Full Text Available Background: Patent ductus arteriosus (PDA is a common finding among premature or low-birth-weight infants and it often does not close. Nowadays, drugs used for its treatment include indomethacin and more commonly ibuprofen. Oral ibuprofen was recently shown to be as effective and have several important advantages in preterm infants. Studies performed to find the best dose of ibuprofen for PDA treatment are limited; hence, we compared the effects of two different doses of ibuprofen in this interventional study.Methods: In this randomized controlled clinical trial, we randomly divided 60 patients with echocardiographically confirmed PDA into two groups of 30. This study was done in NICU of Valiasr hospital in 1387-89 years. In the first group, we administered a loading dose of 10 mg/kg ibuprofen on the first day, followed by two doses of 5 mg/kg in the next two days. In the second group, we administered a loading dose of 15 mg/kg ibuprofen on the first day followed by two doses of 7.5 mg/kg in next two days. Eventually, we compared PDA closure rates and complications of therapy between the two groups. Results: Thirty (100% patients in 15-mg/kg group and 23 (76.7% patients in 10 mg/kg group had successful PDA closure with no need for surgery. The two groups had a statistically significant difference (P=0.011 and the highest response to treatment was seen within the first 24 hours of treatment.Conclusion: We may conclude that higher doses of ibuprofen (15 and 2×7.5 mg/kg would offer better outcomes for PDA closure without gastrointestinal or renal complications and less need for surgery.

  15. Treatment of severe pulmonary hypertension in the setting of the large patent ductus arteriosus.

    Science.gov (United States)

    Niu, Mary C; Mallory, George B; Justino, Henri; Ruiz, Fadel E; Petit, Christopher J

    2013-05-01

    Treatment of the large patent ductus arteriosus (PDA) in the setting of pulmonary hypertension (PH) is challenging. Left patent, the large PDA can result in irreversible pulmonary vascular disease. Occlusion, however, may lead to right ventricular failure for certain patients with severe PH. Our center has adopted a staged management strategy using medical management, noninvasive imaging, and invasive cardiac catheterization to treat PH in the presence of a large PDA. This approach determines the safety of ductal closure but also leverages medical therapy to create an opportunity for safe PDA occlusion. We reviewed our experience with this approach. Patients with both severe PH and PDAs were studied. PH treatment history and hemodynamic data obtained during catheterizations were reviewed. Repeat catheterizations, echocardiograms, and clinical status at latest follow-up were also reviewed. Seven patients had both PH and large, unrestrictive PDAs. At baseline, all patients had near-systemic right ventricular pressures. Nine catheterizations were performed. Two patients underwent 2 catheterizations each due to poor initial response to balloon test occlusion. Six of 7 patients exhibited subsystemic pulmonary pressures during test occlusion and underwent successful PDA occlusion. One patient did not undergo PDA occlusion. In follow-up, 2 additional catheterizations were performed after successful PDA occlusion for subsequent hemodynamic assessment. At the latest follow-up, the 6 patients who underwent PDA occlusion are well, with continued improvement in PH. Five patients remain on PH treatment. A staged approach to PDA closure for patients with severe PH is an effective treatment paradigm. Aggressive treatment of PH creates a window of opportunity for PDA occlusion, echocardiography assists in identifying the timing for closure, and balloon test occlusion during cardiac catheterization is critical in determining safety of closure. By safely eliminating the large PDA

  16. Mandatory Closure Versus Nonintervention for Patent Ductus Arteriosus in Very Preterm Infants.

    Science.gov (United States)

    Sung, Se In; Chang, Yun Sil; Chun, Ji Young; Yoon, Shin Ae; Yoo, Hye Soo; Ahn, So Yoon; Park, Won Soon

    2016-10-01

    To determine whether a nonintervention approach for treating hemodynamically significant patent ductus arteriosus (PDA) is associated with decreased mortality and/or morbidity compared with a mandatory closure approach in extremely low birth weight infants. We reviewed the medical records of 178 infants of 23-26 weeks' gestational age with PDA, requiring ventilator treatment, and with hemodynamically significant PDA ≥2 mm in size. Mandatory closure was used during period I (July 2009 to December 2011, n = 81), and nonintervention was used during period II (January 2012 to June 2014, n = 97). During period I, 64% of infants were first treated with indomethacin, and 82% were ultimately ligated surgically. During period II, no infant was treated with indomethacin and/or ligation. The average postnatal day of PDA closure was day 13 and day 44 during periods I and II, respectively. There was significantly more use of diuretics and fluid restriction during period II compared with period I. There was no difference in mortality or morbidities such as necrotizing enterocolitis or intraventricular hemorrhage. The incidence of bronchopulmonary dysplasia (BPD) and the propensity score adjusted OR of BPD were significantly lower during period II compared with period I. Despite longer PDA exposure, nonintervention was associated with significantly less BPD compared with mandatory closure. Additional study is warranted to determine the benefits and risks of non-intervention for the hemodynamically significant PDA in extremely low birth weight infants. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

  17. Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment.

    Science.gov (United States)

    Yoo, Hani; Lee, Jin A; Oh, Sohee; Jung, Young Hwa; Sohn, Jin A; Shin, Seung Han; Choi, Chang Won; Kim, Ee Kyung; Kim, Han Suk; Kim, Beyong Il

    2017-01-01

    The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23-27] vs. 26 [23-27] weeks; P = 0.012) and lighter (655 [500-930] vs. 880 [370-1,780] grams; P patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ≤ 2 postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent.

  18. Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infants.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif F

    2011-03-01

    There is little consensus regarding the use of echocardiography in patent ductus arteriosus (PDA) treatment in preterm infants. The use of troponin T (cTnT) and N-terminal Pro-BNP (NTpBNP) in combination with echocardiography assessment may facilitate the development of a superior predictive model.

  19. Effect of Indomethacin Infused over 30 Minutes on Cerebral Fractional Tissue Oxygen Extraction in Preterm Newborns with a Patent Ductus Arteriosus

    NARCIS (Netherlands)

    Keating, Paul; Verhagen, Elise; van Hoften, Jacorina; ter Horst, Henk; Bos, Arend F.

    2010-01-01

    Background: A significant patent ductus arteriosus (PDA) is a common finding in the first days of life and, if persistent, is associated with an increased morbidity and mortality in the preterm newborn. Objectives: Our aim was to investigate, using near-infrared spectroscopy, the effect of indometha

  20. Limited effects of intravenous paracetamol on patent ductus arteriosus in very low birth weight infants with contraindications for ibuprofen or after ibuprofen failure

    NARCIS (Netherlands)

    D.W.E. Roofthooft (Daniella); I.M. van Beynum (I.); J.C.A. de Klerk (Johan C. A.); M. van Dijk (Monique); J.N. van den Anker (John); I.K.M. Reiss (Irwin); D. Tibboel (Dick); S.H. Simons (Sinno)

    2015-01-01

    textabstractFinding the optimal pharmacological treatment of a patent ductus arteriosus (PDA) in preterm neonates remains challenging. There is a growing interest in paracetamol as a new drug for PDA closure. In this prospective observational cohort study, we evaluated the effectiveness of intraveno

  1. Concurrent transcatheter closure of an apical muscular ventricular septal defect and a patent ductus arteriosus in a child with severe hyperkinetic pulmonary hypertension.

    Science.gov (United States)

    Joseph, G; Muthunayagam, J V; Mandalay, A

    2003-01-01

    Definitive treatment of congenital apical muscular ventricular septal defect (VSD) with large left-to-right shunt, severe pulmonary hypertension, and major associated lesions such as patent ductus arteriosus (PDA) has so far been possible only by surgery that has significant attendant morbidity and mortality [2]. Transcatheter device closure of both shunt lesions, if feasible, is a potentially simpler and safer alternative to surgery.

  2. Large patent ductus arteriosus in a 44-year-old woman leading to calcium deposition in the left atrium and mitral and aortic valves.

    Science.gov (United States)

    Roberts, Carey Camille; Roberts, William Clifford

    2015-06-01

    This report describes unusual autopsy findings in a 44-year-old woman who had a large, calcified patent ductus arteriosus that produced substantial left-to-right shunting. The patient died in 1962, 7 days after patch closure of the aortic orifice of the ductus. Numerous calcific deposits were present in the mural left atrial endocardium, the mitral valve leaflets and annulus, and the aortic valve cusps. The cause of the left-sided calcific deposits was perhaps related to the patient's several-decades-old giant aortopulmonary shunt, causing a major increase in the volume of blood passing through the left-sided cardiac chambers in comparison with the volume in the right side. To our knowledge, such findings in a patient with patent ductus arteriosus have not been reported previously.

  3. Secondary scoliosis after thoracotomy in patients with aortic coarctation and patent ductus arteriosus.

    Science.gov (United States)

    Roclawski, Marek; Pankowski, Rafal; Smoczynski, Andrzej; Ceynowa, Marcin; Kloc, Wojciech; Wasilewski, Wojciech; Jende, Piotr; Liczbik, Wieslaw; Beldzinski, Piotr; Libionka, Witold; Pierzak, Olaf; Adamski, Stanislaw; Niedbala, Miroslaw

    2012-01-01

    The aim of this study was to determine the influence of lateral thoracotomy on the development of scoliosis in subjects undergoing repair of coarctation of the aorta (CoAo) and patent ductus arteriosus (PDA). A group of 133 patients with CoAo and PDA was evaluated. Forty-five patients with CoAo and 38 with PDA were operated on using lateral thoracotomy (operative group) while 12 patients with CoAo and 31 with PDA were treated using balloon dilatation and stent or coil implantation (non-operative group). Clinical examination and the evaluation of spinal roentgenograms were performed. Among the operated patients 46.6% of those with CoAo and 39.5% of those with PDA had clinical scoliosis. In the non-operated patients scoliosis was present in only 16.6% of those with CoAo and 12.9% of those with PDA. Scoliosis ranged between 10° and 42° and it was mild in the majority of cases. In 90.4% of the operated scoliotic patients with CoAo and 73.3% of those with PDA the curve was thoracic and in 47.6% of the CoAo group and 53,3% of the PDA group the curve was left sided. All curves were right sided in non-operated subjects. Scoliosis in the operated group was higher in males than in females (63.3% versus 60% in CoAo and 68.2% versus 37.5% in PDA). The prevalence of scoliosis after thoracotomy was significantly higher than after non-surgical methods of treatment of both CoAo and PDA as well as in the general population. The rate of single thoracic and the rate of left thoracic curves in patients after thoracotomy is higher than in patients treated non-surgically or in idiopathic scoliosis. The rate of scoliosis after thoracotomy is higher in males than females especially following thoracotomy for PDA.

  4. Permissive tolerance of the patent ductus arteriosus may increase the risk of Chronic Lung Disease

    Directory of Open Access Journals (Sweden)

    Kaempf JW

    2013-03-01

    Full Text Available Joseph W Kaempf,1 Robert Huston,2 YingXing Wu,1 Andrew J Kaempf,1 Lian Wang,1 Gary Grunkemeier,1 Rebecca Mischel,2 Howard Cohen,3 Bret Freitag41Providence St Vincent Medical Center, Portland, OR, 2Randall Children’s Hospital at Legacy Emanuel, Portland, OR, 3Salem Hospital, Salem, OR, 4Legacy Salmon Creek Hospital, Vancouver, WA, USAPurpose: Because early closure therapies of the patent ductus arteriosus (PDA have not been shown to confer benefit to premature infants, the authors’ four neonatal intensive care units adopted a less aggressive PDA management protocol.Study design: A before–after investigation in infants with PDAs born 501–1500 g. Era 1 (January 2005 to December 2007 featured traditional management with indomethacin and/or surgical ligation used early to close PDAs; Era 2 (January 2008 to June 2009 featured fluid restriction and watchful waiting for PDA closure, limiting indomethacin or surgical ligation to only those infants with large PDAs needing significant respiratory support.Results: Era 2 infants (n = 129, mean ± standard deviation 27 ± 2 weeks received less and later indomethacin and less Day 1–28 total fluids as compared to Era 1 infants (n = 240, mean ± standard deviation 27 ± 2 weeks. The Chronic Lung Disease (CLD rate was higher in Era 2 (48% versus 34%, P < 0.01 as was the combined outcome of Death after Day 7 or CLD (57% versus 42%, P < 0.01. Multiple regression analysis showed Era 2 birth was a predictor of CLD. However, Poisson regression analysis determined the predictors of all seven major Vermont Oxford Network morbidities were earlier gestational age, lower birth weight, and male gender, not the era of birth. Significantly more infants were discharged home with PDAs in Era 2.Conclusion: Permissive tolerance of PDAs may increase the risk of CLD and Death after Day 7 or CLD but is not associated with significant changes in other Vermont Oxford Network morbidities.Keywords: premature infant

  5. A Retrospective Study of 1526 Cases of Transcatheter Occlusion of Patent Ductus Arteriosus

    Institute of Scientific and Technical Information of China (English)

    Mei Jin; Yong-Mei Liang; Xiao-Fang Wang; Bao-Jing Guo; Ke Zheng; Yan Gu; Zhen-Yu Lyu

    2015-01-01

    Background:Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China.Since then,several devices have been invented for occluding PDA.This study aimed to evaluate the technical feasibility,safety,and efficacy of transcatheter occlusion of PDA with different devices.Methods:One thousand five hundred and twenty-six patients (537 boys,989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure.We retrospectively analyzed data of these patients,including gender,age,weight,size and morphology of PDA,and devices used in transcatheter occlusion,outcomes,and postoperational complications.Results:Median age and median weight were 4.0 years (range:0.3-52.0 years old) and 15.3 kg (range:4.5-91.0 kg),respectively.Mean ductal diameter,aortic ductal diameter,ductal length,and pulmonary artery pressure were 3.50 ± 2.15 mm,l 0.08 ± 2.46 mm,7.49 ± 3.02 mm,and 30.21 ± 17.28 mmHg,respectively.Morphology of PDA assessed by descending aortogram was of type A in 1428 patients,type B in 6 patients,type C in 79 patients,type D in 4 patients,and type E in 9 patients according to the classification of Krichenko.Of all the 1526 patients,1497 patients underwent transcatheter PDA closure,among which 1492 were successful.Devices used were Amplatzer duct occluder Ⅰ (ADO Ⅰ,1280,85.8%),Cook detachable coils (116,7.8%),ADO Ⅱ (ADO Ⅱ,68,4.6%),muscular VSD occluder (12,0.8%),and Amplatzer vascular plug (16,1.0%).Conclusions:Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types.With transcatheter occlusion technique and devices developing,more patients with PDA can be treated with transcatheter closure both safely and efficiently.

  6. Transcription profiles of endothelial cells in the rat ductus arteriosus during a perinatal period.

    Directory of Open Access Journals (Sweden)

    Norika Mengchia Liu

    Full Text Available Endothelial cells (ECs lining the blood vessels serve a variety of functions and play a central role in the homeostasis of the circulatory system. Since the ductus arteriosus (DA has different arterial characteristics from its connecting vessels, we hypothesized that ECs of the DA exhibited a unique gene profile involved in the regulation of DA-specific morphology and function. Using a fluorescence-activated cell sorter, we isolated ECs from pooled tissues from the DA or the descending aorta of Wistar rat fetuses at full-term of gestation (F group or neonates 30 minutes after birth (N group. Using anti-CD31 and anti-CD45 antibodies as cell surface markers for ECs and hematopoietic derived cells, respectively, cDNAs from the CD31-positive and CD45-negative cells were hybridized to the Affymetrix GeneChip® Rat Gene 1.0 ST Array. Among 26,469 gene-level probe sets, 82 genes in the F group and 81 genes in the N group were expressed at higher levels in DA ECs than in aortic ECs (p2.0. In addition to well-known endothelium-enriched genes such as Tgfb2 and Vegfa, novel DA endothelium-dominant genes including Slc38a1, Capn6, and Lrat were discovered. Enrichment analysis using GeneGo MetaCore software showed that DA endothelium-related biological processes were involved in morphogenesis and development. We identified many overlapping genes in each process including neural crest-related genes (Hoxa1, Hoxa4, and Hand2, etc and the second heart field-related genes (Tbx1, Isl1, and Fgf10, etc. Moreover, we found that regulation of epithelial-to-mesenchymal transition, cell adhesion, and retinol metabolism are the active pathways involved in the network via potential interactions with many of the identified genes to form DA-specific endothelia. In conclusion, the present study uncovered several significant differences of the transcriptional profile between the DA and aortic ECs. Newly identified DA endothelium-dominant genes may play an important role in DA

  7. Vasoactivity of the gasotransmitters hydrogen sulfide and carbon monoxide in the chicken ductus arteriosus.

    Science.gov (United States)

    van der Sterren, Saskia; Kleikers, Pamela; Zimmermann, Luc J I; Villamor, Eduardo

    2011-10-01

    Besides nitric oxide (NO) and carbon monoxide (CO), hydrogen sulfide (H(2)S) is a third gaseous messenger that may play a role in controlling vascular tone and has been proposed to serve as an O(2) sensor. However, whether H(2)S is vasoactive in the ductus arteriosus (DA) has not yet been studied. We investigated, using wire myography, the mechanical responses induced by Na(2)S (1 μM-1 mM), which forms H(2)S and HS(-) in solution, and by authentic CO (0.1 μM-0.1 mM) in DA rings from 19-day chicken embryos. Na(2)S elicited a 100% relaxation (pD(2) 4.02) of 21% O(2)-contracted and a 50.3% relaxation of 62.5 mM KCl-contracted DA rings. Na(2)S-induced relaxation was not affected by presence of the NO synthase inhibitor l-NAME, the soluble guanylate cyclase (sGC) inhibitor ODQ, or the K(+) channel inhibitors tetraethylammonium (TEA; nonselective), 4-aminopyridine (4-AP, K(V)), glibenclamide (K(ATP)), iberiotoxin (BK(Ca)), TRAM-34 (IK(Ca)), and apamin (SK(Ca)). CO also relaxed O(2)-contracted (60.8% relaxation) and KCl-contracted (18.6% relaxation) DA rings. CO-induced relaxation was impaired by ODQ, TEA, and 4-AP (but not by L-NAME, glibenclamide, iberiotoxin, TRAM-34 or apamin), suggesting the involvement of sGC and K(V) channel stimulation. The presence of inhibitors of H(2)S or CO synthesis as well as the H(2)S precursor L-cysteine or the CO precursor hemin did not significantly affect the response of the DA to changes in O(2) tension. Endothelium-dependent and -independent relaxations were also unaffected. In conclusion, our results indicate that the gasotransmitters H(2)S and CO are vasoactive in the chicken DA but they do not suggest an important role for endogenous H(2)S or CO in the control of chicken ductal reactivity.

  8. A Critical Review on the Surgical Treatment of 153 Cases of Adult Patent Ductus Arteriosus within 1964-2000

    Institute of Scientific and Technical Information of China (English)

    魏磊

    2001-01-01

    Objective This paper evaluates the experiences of treatment of adult patent ductus arteriosus (PDA) in Nanjing Medical University in recent 36 years. Methods From October 1964 to December 2000, 153 adult PDA patients in our hospital were operated by means of ligation of PDA(105), ductal division (24), intra-aortic suture with left heart bypass(11), cardiopulmonary bypass (CPB) without heart beating(7), and the duct occlusion with cardiac catheterization(6). Results The mortalities of the afore mentioned 5 techniques were 0.0%,4.2%,0.0%,14.3%,0.0% respectively. Conclusion Ligation of PDA is still a safe, simple and efficient method, while CPB is suitable for patients with certain special types of PDA or/and other deformities of the heart. Perhaps the advent of interventional therapy would offer a safer and simpler method of choice in the treatment of PDA.

  9. Entropy score, patent ductus arteriosus (PDA), and cardiopulmonary bypass (CPB): ligation of PDA on CPB can compromise cerebral blood flow.

    Science.gov (United States)

    Neema, Praveen Kumar; Dharan, Baiju S; Singha, Subrata Kumar; Sethuraman, Manikandan; Rathod, Ramesh Chandra

    2011-01-01

    A patent ductus arteriosus (PDA) is often present in patients undergoing correction of congenital heart disease. It is well appreciated that during cardiopulmonary bypass (CPB), a PDA steals arterial inflow into pulmonary circulation, and may lead to systemic hypoperfusion, excessive pulmonary blood flow (PBF) and distention of the left heart. Therefore, PDA is preferably ligated before initiation of CPB. We describe acute decreases of arterial blood pressure and entropy score with the initiation of CPB and immediate increase in entropy score following the PDA ligation in a child undergoing intracardiac repair of ventricular septal defect and right ventricular infundibular stenosis. The observation strongly indicates that a PDA steals arterial inflow into pulmonary circulation and if the PDA is dissected and ligated on CPB or its ligation on CPB is delayed the cerebral perfusion is potentially compromised.

  10. Pulmonary arterial dissection in a post-partum patient with patent ductus arteriosus: Case report and review of the literature.

    Science.gov (United States)

    Yaman, Mehmet; Arslan, Uğur; Ateş, Ahmet Hakan; Aksakal, Aytekin

    2015-02-26

    Pulmonary arterial dissection is an uncommon but usually a deadly complication of chronic pulmonary hypertension. A 26-year-old female patient was admitted to our clinics with sudden dyspnea and chest discomfort one hour after giving birth to twins by vaginal delivery. An echocardiography was performed with a pre-diagnosis of pulmonary embolism. However, echocardiographic examination revealed a dilated main pulmonary artery and a dissection flap extending from main pulmonary artery to left pulmonary artery. In summary, in this report, we described a very rare case of pulmonary artery dissection in a pregnant patient with a previously un-diagnosed patent ductus arteriosus without an obvious rise in pulmonary artery pressure and reviewed the relevant literature.

  11. Pulmonary arterial dissection in a post-partum patient with patent ductus arteriosus: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Mehmet; Yaman; Ugur; Arslan; Ahmet; Hakan; Ates; Aytekin; Aksakal

    2015-01-01

    Pulmonary arterial dissection is an uncommon but usually a deadly complication of chronic pulmonary hypertension. A 26-year-old female patient was admitted to our clinics with sudden dyspnea and chest discomfort one hour after giving birth to twins by vaginal delivery. An echocardiography was performed with a pre-diagnosis of pulmonary embolism. However, echocardiographic examination revealed a dilated main pulmonary artery and a dissection flap extending from main pulmonary artery to left pulmonary artery. In summary, in this report, we described a very rare case of pulmonary artery dissection in a pregnant patient with a previously un-diagnosed patent ductus arteriosus without an obvious rise in pulmonary artery pressure and reviewed the relevant literature.

  12. Transesophageal echocardiography guided patent ductus arteriosus occlusion in adults with severe pulmonary hypertension through a parasternal approach.

    Science.gov (United States)

    Dai, Xiao-Fu; Chen, Liang-Wan; Chen, Dong-Zhong; Chen, Qiang; Zhen, Guo-Zhong; Zhang, Gui-Can

    2015-01-01

    Between April 2010 and April 2014, 39 consective adult patients (> 18 years) with PDA associated severe pulmonary hypertension underwent transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach. Among 39 patients, the procedure was successful in 32 cases (82.1%) and failed in 7 cases (17.9%). In the failed cases, 3 cases had a large residual shunt and 4 cases had persistent pulmonary hypertension. The mean minimum miameter of the successfully closed PDAs was 15.2 ± 2.1 mm (range 9 to 24), and the mean diameter of the mushroom-shaped occluder was 17.5 ± 2.5 mm (range 11 to 26). The pulmonary artery pressure decreased significantly after occlusion (P 0.05). Echocardiography performed on the first postoperative day showed decreased volume within the left atrium, left ventricle, and pulmonary artery in 23 cases, decreased volume within the left atrium and left ventricle in 4 cases, and no change in the volume of the atrium and ventricle in 3 cases. A minor residual shunt was observed in 6 cases. The posteroanterior chest X-ray showed improved pulmonary congestion in all cases and significantly reduced cardiothoracic ratio in 25 cases. Patients were followed-up at least for 1 year. No symptoms including palpitation, dyspnoea, or chest tightness were observed. The heart function ranged from NYHA class I to II. A minor residual shunt was observed only in one case. There were varying degrees of decrease in volume within the atrium and ventricle. In conclusion, transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach is a feasible and effective method for the treatment of PDA in adults with severe pulmonary hypertension.

  13. Ductus arterioso: Ecoanatomía y mecanismos de cierre / Ductus Arteriosus: Ecographic anatomy and closure mechanisms

    Directory of Open Access Journals (Sweden)

    Carlos García Guevara

    2015-08-01

    Full Text Available El ductus arterioso es una estructura anatómica esencial en la vida del feto, que permite ser manipulado farmacológicamente y, de no completarse su cierre funcional y anatómico en la etapa de recién nacido, se considera una cardiopatía congénita. Su importancia fue motivo para efectuar la presente revisión, donde se tratan aspectos relacionados con la embriología, anatomía y función de esta estructura, ilustrados con imágenes ecocardiográficas de fetos estudiados en el Servicio de Cardiología Fetal del Cardiocentro Pediátrico William Soler, en las que se observan las vistas clásicas utili-zadas en su estudio, y ejemplos de anomalías diagnosticadas, con el objetivo de ofre-cer información resumida acompañada de nuestra experiencia en la evaluación del ductus, así como el diagnóstico de algunas de sus anomalías.

  14. Evaluation of the Efficacy and Safety of Oral İbuprofen in the Treatment of Patent Ductus Arteriosus

    Directory of Open Access Journals (Sweden)

    Mehmet Kervancıoğlu

    2005-01-01

    Full Text Available Since indomethacin has many side effects, ibuprofen has been started to be used with beneficial results and less side effects for the closure of patent ductus arteriosus (PDA in recent years. The frequency of PDA, and the effects and side effects of oral ibuprofen were investigated by echocardiographic evaluation, in 164 preterm neonates in Neonatology Unit of Dicle University,between April and December 2004. Oral ibufrofen was given at 10 mg/kg/day dose to infants who had significant left-right shunt on the third day of birth but those who had contraindication for ibuprofen were excluded. By daily echocardiographic evaluations in those without closure after the first dose, a second and third dose of 5 mg/kg/day were given if necessary. Ductus closure has ocured in 24 of 27 (88.8% patients, at a mean period of 1.7±0.9 (1-4 days. Complications like hyponatremia, hypercreatininemia, thrombocytopenia, and necrotizing enterocolitis were not seen. Only in one patient intracranial hemorrhage was occured two days after the treatment. In conclusion, treatment with oral ibuprofen is an effective and safe treatment method for the closure of the PDA in preterm infants.

  15. Progress of treatment in children with patent ductus arteriosus%儿童动脉导管未闭治疗进展

    Institute of Scientific and Technical Information of China (English)

    康磊

    2012-01-01

    Patent ductus arteriosus is a common congenital heart disease in children.Effective and promptly treatment can prevent complications,such as pneumonia,congestive heart failure,infective endocarditic and pulmonary artery hypertension.The treatments include medication,transcatheter intervention and surgery.The vast majority of the patent ductus arteriosus can be cured by transcatheter interventional therapy now.%动脉导管未闭是儿童常见先天性心脏病,及时有效治疗可防止肺炎、心力衰竭、感染性心内膜炎、肺动脉高压等并发症的发生.治疗方法包括药物治疗、经导管介入治疗和手术治疗.目前绝大部分动脉导管未闭通过介入封堵可获治愈.

  16. Treatment of patent ductus arteriosus by Amplatzer occluder device%Amplatzer伞堵闭术治疗动脉导管未闭

    Institute of Scientific and Technical Information of China (English)

    江隆福; 陈国方; 陈玉锋

    2002-01-01

    @@ 经皮动脉导管未闭封堵术是治疗动脉导管未闭(patent ductus arteriosus,PDA)的非手术方法,具有创伤小、术后恢复快等优点,即刻及近期疗效较好.我们对7例PDA进行封堵治疗,在此进行探讨.

  17. [Occlusion of patent ductus arteriosus with a Gianturco-Grifka device. First case at the Instituo Mexicano del Seguro Social (IMSS)].

    Science.gov (United States)

    Munayer Calderón, J; Aldana Pérez, T; San Luis Miranda, R; Maza Juárez, G; Lázaro Castillo, J L; Ramírez Reyes, H; Quintero, L R; Arias Monroy, L; Campos Gómez, A

    2000-01-01

    We present the initial experience of closing of patent ductus arteriosus (PDA) with a new device; Gianturco-Grifka, at the General Hospital of The Medical Center "La Raza". The patient was a 4 year's old girl, in whom we detected continuous murmur in the second intercostal space, echocardiography showed a long conical patent ductus arteriosus 4.9 mm of diameter, systolic pressure of the pulmonary artery was 35 mm Hg with QP/QS 1.6:1. Hemodynamic study revealed a long conical ductus arteriosus 5 mm of diameter, type A1 from Krichenko classification. We proceeded to occlude the PDA with a Gianturco-Grifka device of 7 mm. Immediately after the PDA occlusion the shunt disappeared, there were no complications during the procedure. More cases are needed to determine long term benefits and limitations, of this procedure. However we conclude that technically it is easy to use. There is greater decrease of residual shunt that the one reported with other devices.

  18. Transcatheter closure of hemodynamic significant patent ductus arteriosus in 32 premature infants by amplatzer ductal occluder additional size-ADOIIAS.

    Science.gov (United States)

    Morville, Patrice; Akhavi, Ahmad

    2017-05-04

    The advent of Amplatzer Duct Occluder II additional Size (ADOIIAS) provided the potential to close hemodynamic significant patent ductus arteriosus (HSPDA) and to analyze the feasibility, safety and efficacy of the device. Treatment of a patent ductus arteriosus (PDA) in very premature neonates is still a dilemma for the neonatalogist who has to consider its significance and has to choose among different treatment options. Because surgical ligation and medical therapy both have their drawbacks, interventional catheterization might provide an alternative means of closing HSPDA. Between September 2013 and June 2015, 32 premature infants with complications related to HSPDA defined by ultrasound (US) underwent transcatheter closure. The procedure was performed in the catheterization laboratory by venous cannulation without angiography. The position of the occluder was directed by X-ray and US. In particular we looked at procedural details, device size selection, complications, and short and mid-term outcomes. Thirty two premature infants, all of whom had clinical complications related to HSPDA, born at gestational ages ranging between 23.6 and 36 weeks (mean ± standard deviation 28 ± 3 weeks) underwent attempted transcatheter PDA closure using the ADOIIAS. Their mean age and weight at the time of procedure was 25 days (range 8-70 days) and 1373 g (range 680-2480 g), respectively. Ten infants weighed ≤1,000g. All ducts were tubular. The mean PDA and device waist diameters were 3.2 ± 0.6mm (range 2.2-4) and 4.4 ± 0.6 mm, respectively, and the mean PDA and device lengths 5.2 ± 2.0 mm (range 2-10) and 3.4 ± 1.3 mm. Median fluoroscopy and procedural times were 11 min (range 3-24) and 28 min (range 10-90), respectively. Complete closure was achieved in all but one patient. There was no device migration. A left pulmonary artery (LPA) obstruction developed in one patient. Five infants died. Four deaths were related to complications of

  19. Hybrid management of a large atrial septal defect and a patent ductus arteriosus in an infant with chronic lung disease

    Directory of Open Access Journals (Sweden)

    Pedra Simone

    2010-01-01

    Full Text Available We report a case wherein a dysmorphic four-month-old infant (weighing 4.5 kgs with an 8 mm atrial septal defect (ASD, a 1.5 mm patent ductus arteriosus (PDA, a 2 mm mid-muscular ventricular septal defect (VSD associated with chronic lung disease, and severe pulmonary hypertension, was successfully managed using a hybrid approach, without the use of cardiopulmonary bypass (CPB. Through a median sternotomy, the PDA was ligated and the ASD was closed with a 9 mm Amplatzer septal occluder implanted through peratrial access. The VSD was left untouched. Serial echocardiograms showed complete closure of the ASD and PDA, with progressive normalization of the pulmonary artery (PA pressures within three months. The child rapidly gained weight and was weaned from sildenafil and oxygen administration. After 12 months, the VSD closed spontaneously and the child remained well, with normal PA pressures. A hybrid approach without the use of CPB should be considered in the management of infants with congenital heart disease, associated with chronic lung disease and pulmonary hypertension.

  20. RARE ASSOCIATION OF POSTERIOR EMBRYOTOXON WITH MAXILLARY HYPOPLASIA, VENTRICULAR SEPTAL DEFECT, PULMONARY ATRESIA AND PATENT DUCTUS ARTERIOSUS

    Directory of Open Access Journals (Sweden)

    Pandey

    2014-12-01

    Full Text Available BACKGROUND: Posterior embryotoxon is a congenital anomaly, considered to be a relatively mild disorder and can occur in 15% of normal eyes. Bilateral posterior embryotoxon associated with maxillary hypoplasia, Ventricular Septal Defect (VSD, Pulmonary Atresia (PA with Patent Ductus Arteriosus (PDA is of rare occurrence and hasn’t been reported in literature till date. CASE: We report a case of 12 year old female who came to us in eye Out Patient Department for routine eye checkup and on detailed ocular examination we found anteriorly displaced Schwalbe’s line. On detailed physical examination and investigations she was found to have pan-systolic murmur and continuous machinery murmur. On Echocardiography, the patient was found to have large peri-membranous VSD with PA and PDA. On Oro-dental examination she was found to have maxillary hypoplasia. CONCLUSION: The present case is reported due to the rarity and sporadic character of the condition and its rare association with cardiac defect and maxillary hypoplasia.

  1. Effects of Intravenous Indomethacin on Reduction of Symptomatic Patent Ductus Arteriosus Cases and Decreasing the Need for Prolonged Mechanical Ventilation

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    Jannatdoust Abdollah

    2014-12-01

    Full Text Available Introduction: We decided to investigate the effects of injecting Indomethacin on reducing complications of Patent Ductus Arteriosus (PDA and the need for prolonged mechanical ventilation. Methods: During this randomized clinical trial, 70 premature infants with matched gestational age and birth weight were divided into case and control groups. In the study group, intravenous indomethacin started from the first 2-12 hours of birth. All patients were followed by echocardiography at the fourth day and skull ultrasound in the second week. Results: Symptomatic PDA rate was significantly higher in the control group (25.7% vs. 0%; P≤0.001. Incidence of grade 1-3 intraventricular hemorrhage was higher in the control group and the ratio of needed time for respiratory support in the control group to the case group was approximately 2.1. Conclusion: Intravenous Indomethacin reduced the number of PDA cases and incidence of grade 2 and 3 intraventricular hemorrhage, without any short term side effects.

  2. Amplatzer PDA occluder used in adult patent ductus arteriosus with serious pulmonary hypertension after testing balloon occlusio

    Institute of Scientific and Technical Information of China (English)

    卢才义; 魏璇; 黄丛春; 罗惠兰; 谈维洁; 毛树森

    2002-01-01

    @@ A 36-years-old female had heart palpitation and chest press for five years and the symptoms had been worsening for half a year. She was diagnosed with patent ductus arteriosus with moderate pulmonary hypertension in a local hospital 5 years before but was not operated. Physical examination showed: T 37℃, P 87?bpm, R 18?bpm and BP 130/70?mm?Hg. There was no distension of the jugular vein, and the lungs were clear. There was continuous mechanic murmur at the second intercostal space, and grade 2 systolic blowing murmur at the apex. P2 was strengthened. The liver and spleen were not enlarged and there was no edema in either leg. ECG showed a pulmonary P wave and right ventricular hypertrophy. Chest X-ray film showed pulmonary segment projection 3?cm, and the dimension of the right inferior pulmonary artery bed increased to 3?cm in diameter. On echocardiography, both atria, the pulmonary artery and the right ventricle were enlarged.

  3. A rare presentation of patent ductus arteriosus in an adult patient with normal pulmonary hypertension and limb edema

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    Pishgoo, Bahram; Saburi, Amin; Khosravi, Arezoo

    2014-01-01

    BACKGROUND Patent ductus arteriosus (PDA) at childhood is one of the five major and frequent congenital abnormalities, but it can be rarely seen in adults. Pulmonary hypertension (PHTN) and other presentations such as heart failure and edema are the identified complications of longstanding PDA, but adult case with no permanent heart symptoms and PHTN was rare. We reported a rare case of with an obvious PDA and normal pulmonary pressure. CASE REPORT A 61-year-old woman presented with dyspnea (New York Heart Association class 2), chest pain, and lower limb edema. Echocardiogram showed; normal left ventricular chamber size and function, normal size of both atria. Furthermore, an obvious PDA (diameter = 6-7 mm) connecting the aortic arch to the pulmonary artery was reported in echocardiography. No lung congestion and evidence for PHTN was reported by computed tomographic angiography [Pulmonary capillary wedge pressure (PCWP) = 30 mmHg]. The patient was treated with antihypertensive drugs and after 1 and 3 months follow-up, edema and other symptoms were resolved. CONCLUSION Finally, we conclude that PDA in adulthood can present with nonspecific cardiovascular symptoms, and it seems that PHTN is not a fixed echocardiographic finding in these patients. PMID:25477985

  4. Patent ductus arteriosus in the preterm infant: a survey of clinical practices in French neonatal intensive care units.

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    Brissaud, Olivier; Guichoux, Julie

    2011-06-01

    Patent ductus arteriosus (PDA) is one of the most common problems in the care of premature infants, especially the extremely premature. There is no real consensus regarding the diagnostic criteria or treatment of a hemodynamically significant PDA. Its diagnosis, assessment, and treatment still remain challenges. Therefore, we investigated clinical practices in French tertiary neonatology centers regarding the management of PDA to compare their similarities and differences. We sent a questionnaire by email to the PDA specialist in every French tertiary neonatal intensive care unit. It contained 27 items regarding the unit's structure, method of diagnosing PDA, and treatment choices. The completed questionnaire were returned via email and analyzed blindly. The questionnaire response rate was 87.5%, which allowed us to draw some conclusions regarding French clinical practices in the care of neonates with PDA. Although the diagnostic criteria are quite similar, the therapeutic practices are rather different across neonatal care units. We highlight the great variability in French clinical practices when it comes to treating PDA and underscore the necessity for harmonization of these practices, which could be achieved using multicenter, randomized studies to identify the advantages of one approach compared with another.

  5. Establishment of the patent ductus arteriosus model in preterm rats%早产大鼠动脉导管开放模型的建立

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    朱梦茹; 刘海岩; 刘盼盼; 武辉

    2016-01-01

    ObjectiveTo establish the patent ductus arteriosus model in preterm rats using the improved natural development method.MethodsIn the light of the lfaws of the natural development method in establishing the patent ductus arteriosus model, the experimental technology was modified to avoid the influence of fixation, dehydration, and section method on blood vessel diameter. Cesarean section was performed for a Wistar rat pregnant for 19 days, and 8 neonatal rats were obtained. After they were sacriifced by dislocation, they were embedded as a whole to avoid dehydration, and the microsection and horizontal section were made. After hematoxylin and eosin staining, a microscope was used to measure the inner diameters of the ductus arteriosus, the main pulmonary artery, and the descending aorta.ResultsAfter the cesarean section for the rat pregnant for 19 days, patent ductus arteriosus occurred in all the 8 neonatal rats. The measurements of the inner diameters of blood vessels were as follows: the long diameter and short diameter of the descending aorta were 354±106 and 182±140 μm, respectively; the short diameter of the ductus arteriosus was 155±122 μm, and its area was 36 847±42 582 μm2; the long axis and short axis of the main pulmonary artery were 589±150 and 174±170 μm, respectively.ConclusionsThe improved natural development method can help to successfully establish the patent ductus arteriosus model in preterm rats.%目的:利用改良的自然发育法构建早产大鼠动脉导管开放模型。方法基于自然发育法在构建早产大鼠动脉导管开放模型上的缺陷,本研究对实验技术进行了改进,避免固定方式、脱水处理及切片方式对血管管径的影响。将1只孕19 d的Wistar大鼠行剖宫产,取出8只新生大鼠,脱臼处死后整体包埋、避免脱水、微距切片、水平切片,苏木精-伊红染色后镜下测量动脉导管、主肺动脉、降主动脉内径。结果孕19 d

  6. A heart-hand syndrome gene: Tfap2b plays a critical role in the development and remodeling of mouse ductus arteriosus and limb patterning.

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    Feng Zhao

    Full Text Available BACKGROUND: Patent ductus arteriosus (PDA is one of the most common forms of congenital heart disease. Mutations in transcription factor TFAP2B cause Char syndrome, a human disorder characterized by PDA, facial dysmorphysm and hand anomalies. Animal research data are needed to understand the mechanisms. The aim of our study was to elucidate the pathogenesis of Char syndrome at the molecular level. METHODOLOGY/PRINCIPAL FINDINGS: Gene expression of Tfap2b during mouse development was studied, and newborns of Tfap2b-deficient mice were examined to identify phenotypes. Gel shift assays had been carried out to search for Tfap2 downstream genes. Promoters of candidate genes were cloned into a reporter construct and used to demonstrate their regulation by Tfap2b in cell transfection. In situ hybridizations showed that the murine transcription factor Tfap2b was expressed during the entire development of mouse ductus arteriosus. Histological examination of ductus arteriosus from Tfap2b knockout mice 6 hours after birth revealed that they were not closed. Consequently, the lungs of Tfap2b(-/- mice demonstrated progressive congestion of the pulmonary capillaries, which was postulated to result secondarily from PDA. In addition, Tfap2b was expressed in the limb buds, particularly in the posterior limb field during development. Lack of Tfap2b resulted in bilateral postaxial accessory digits. Further study indicated that expressions of bone morphogenetic protein (Bmp genes, which are reported to be involved in the limb patterning and ductal development, were altered in limb buds of Tfap2b-deficient embryos, due to direct control of Bmp2 and Bmp4 promoter activity by Tfap2b. CONCLUSIONS/SIGNIFICANCE: Tfap2b plays important roles in the development of mouse ductus arteriosus and limb patterning. Loss of Tfap2b results in altered Bmp expression that may cause the heart-limb defects observed in Tfap2b mouse mutants and Char syndrome patients. The Tfap2b knockout

  7. Long-Term Follow-up of Patent Ductus Arteriosus Closure with the Amplatzer Duct Occluder in Children

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    Mostafa Behjati-Ardakani

    2015-10-01

    Full Text Available Background: Transcatheter closure of patent ductus arteriosus (PDA has become an alternative treatment to surgery. We evaluated the long-term results of the transcatheter closure of PDA with the Amplatzer Duct Occluder (ADO in children.Methods: Between May 2004 and October 2012, 138 children with PDA (43 males and 95 females underwent transcatheter PDA closure. Clinical, electrocardiographic, echocardiographic, and hemodynamic data were assessed pre and postprocedurally and at follow-up.Results: The mean age of the patients at procedure was 3.53 ± 2.43 years (range = 1.1 to 9.5 years, mean weight was11.9±4.6 kg (range = 6 to 29 kg, median pulmonary end diameter of the PDA was 5 mm (range = 4 to 15 mm, and median diameter of the ADO was 8 mm (range = 6 to 16 mm. The mean follow-up time was 43.4 ± 23.5 months (range = 13.5 to98 months.The devices were successfully deployed in 136 (98.5% patients. Device embolization occurred in 2 patients, immediately in one patient and during the first postprocedural night in the other patient. The first patient had percutaneous device retrieval, followed by implantation of a larger device. The second patient had surgical device removal and PDA ligation. Immediately after device implantation, trivial to mild residual shunts were detected in 112 (80% patients; all the shunts, however, disappeared 24 hours after the procedure. One patient had left pulmonary artery stenosis with a gradient of 25 mm Hg at 24 hours', 40 mmHg at one month's, and 64 mmHg at 6 months' follow-up. There were no cases of late embolization, aortic obstruction, late hemolysis, infective endocarditis, or death.Conclusion: Transcatheter PDA closure with the ADO was safe and effective, with a high success rate at long-term follow-up.

  8. Current Status of Therapeutic Strategies for Patent Ductus Arteriosus in Very-Low-Birth-Weight Infants in Korea.

    Science.gov (United States)

    Lee, Jin A; Kim, Myo-Jing; Oh, Sohee; Choi, Byung Min

    2015-10-01

    This study aimed to investigate current therapeutic strategies for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants in Korea. A total of 2,254 VLBW infants among 2,386 from Korean Neonatal Network cohort born from January 2013 to June 2014 were included. No PDA was seen for 1,206 infants (53.5%) and the infants diagnosed or treated for PDA were 1,048 infants (46.5%). The proportion of infants with PDA was decreased according to the increase in gestational age (GA) and birthweight. Infants with PDA were divided into groups according to the therapeutic strategies of PDA: prophylactic treatment (PT, n = 69, 3.1%), pre-symptomatic treatment (PST, n = 212, 9.4%), symptomatic treatment (ST, n = 596, 26.4%), and conservative treatment (CT, n = 171, 7.6%). ST was the most preferred treatment modality for preterm PDA and the proportion of the patients was decreased in the order of PST, CT, and PT. Although ST was still the most favored treatment in GA < 24 weeks group, CT was more preferred than PST or ST when compared with GA ≥ 32 weeks group [CT vs. PST, OR 5.3, 95% CI 1.56-18.18; CT vs. ST, OR 2.9, 95% CI 1.03-8.13]. A total of 877 infants (38.9%) received pharmacological or surgical treatment about PDA, and 35.5% (801 infants) received pharmacological treatment, mostly with ibuprofen. Seventy-six infants (3.4%) received primary ligation and 8.9% (201 infants) received secondary ligation. Diverse treatment strategies are currently used for preterm PDA in Korea. Further analyses of neonatal outcomes according to the treatment strategies are necessary to obtain a standardized treatment guideline for preterm PDA.

  9. Transcatheter vs. surgical closure of patent ductus arteriosus: outcomes and cost analysis

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    Mulyadi M Djer

    2013-07-01

    Full Text Available Background Patent ductus arterious (PDA is a non-cyanotic congenital heart disease (CHD caused by the patency of the arterial duct after birth. For the last three decades, management of PDA with transcatheter closure has been gaining popularity, including in developing countries. However its effectiveness in terms of clinical outcomes and cost may vary among center and has not been thoroughly evaluated yet in Indonesia. Objectives To compare the cost and clinical effectiveness of PDA closure using transcatheter approach compared to surgical ligation. Methods We performed a retrospective review on patients underwent either transcatheter or surgical closure of PDA between January 2000 and December 2006 in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Clinical outcomes as well as cost were compared using the student T-test and Chi-square for numerical and categorical variables, respectively Results During the study period, 89 patients underwent transcatheter closure using an Amplatzer® device occluder (ADO device and 67 had surgical ligation. Successful PDA closure on first attempt was achieved in 87 (96% and 63 (94% children who underwent transcatheter and surgical closure, respectively (P=1.000. Two children with unsuccessful transcatheter closure eventually had their PDA closed by surgery, whereas one child with residual PDA after surgical closure had his PDA closed by coil. No residual PDA was found in the transcatheter closure group at one-week follow up. Duration of hospitalization was significantly less for patients having transcatheter closure compared to surgery [2.7 (SD 1.5 vs. 6.6 (SD 1.5 days, P<0.0001]. The cost for PDA closure with an Amplatzer® device was more expensive than surgical ligation [Rp. 29,930,000 (SD 57,200 vs. Rp. 12,205,000 (SD 89,300, P< 0.0001]. Conclusion Transcatheter closure is equally effective as surgical ligation in closing the PDA. Less hospitalization is required with transcatheter closure although the

  10. Cardiac output, pulmonary artery pressure, and patent ductus arteriosus during therapeutic cooling after global hypoxia-ischaemia.

    Science.gov (United States)

    Fugelseth, D; Satas, S; Steen, P A; Thoresen, M

    2003-05-01

    To assess by Doppler echocardiography the effects of 24 hours of whole body mild hypothermia compared with normothermia on cardiac output (CO), pulmonary artery pressure (PAP), and the presence of a persistent ductus arteriosus (PDA) after a global hypoxic-ischaemic insult in unsedated newborn animals. Thirty five pigs (mean (SD) age 26.6 (12.1) hours and weight 1.6 (0.3) kg) were anaesthetised with halothane, mechanically ventilated, and subjected to a 45 minute global hypoxic-ischaemic insult. At the end of hypoxia, halothane was stopped; the pigs were randomised to either normathermia (39 degrees C) or hypothermia (35 degrees C) for 24 hours. Rewarming was carried out for 24-30 hours followed by 42 hours of normothermia. Unanaesthetised pigs were examined with a VingMed CFM 750 ultrasound scanner before and 3, 24, 30, and 48 hours after the hypoxic-ischaemic insult. Aortic valve diameter, forward peak flow velocities across the four valves, and the occurrence of a PDA were measured. Tricuspid regurgitation (TR) velocity was used to estimate the PAP. Stroke volume was calculated from the aortic flow. Twelve animals (seven normothermic, five hypothermic) had a PDA on one or more examinations, which showed no association with cooling or severity of insult. There were no differences in stroke volume or TR velocity between the hypothermic and normothermic animals at any time point after the insult. CO was, however, 45% lower at the end of cooling in the subgroup of hypothermic pigs that had received a severe insult compared with the pigs with mild and moderate insults. CO and TR velocity were transiently increased three hours after the insult: 0.38 (0.08) v 0.42 (0.08) litres/min/kg (p = 0.007) for CO; 3.0 (0.42) v 3.4 (0.43) m/s (p Global hypoxia-ischaemia leads to similar transient increases in CO and estimated PAP in unsedated normothermic and hypothermic pigs. There were no signs of metabolic compromise in any subgroup, suggesting that 24 hours of mild

  11. Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus

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    Lilian S.R. Sadeck

    2014-12-01

    Full Text Available OBJECTIVE: To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g with patent ductus arteriosus (PDA, from the Brazilian Neonatal Research Network (BNRN on: death, bronchopulmonary dysplasia (BPD, severe intraventricular hemorrhage (IVH III/IV, retinopathy of prematurity requiring surgical (ROPsur, necrotizing enterocolitis requiring surgery (NECsur, and death/BPD. METHODS: This was a multicentric cohort study, retrospective data collection, including newborns (BW < 1000 g with gestational age (GA < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment, G2 - pharmacologic (indomethacin or ibuprofen, G3 - surgical ligation (independent of previous treatment. Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II, respiratory distress syndrome (RDS, late sepsis (LS, mechanical ventilation (MV, surfactant (< 2 h of life, and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks, IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI; logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. RESULTS: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%, G2 - 205 (41.5%, and G3 - 102 (20.6%. The highest mortality was observed in G1 (51.3% and the lowest in G3 (14.7%. The highest frequencies of BPD36wks (70.6% and ROPsur were observed in G3 (23.5%. The lowest occurrence of

  12. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results

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    ZHANG Cao-jin; HUANG Yi-gao; HUANG Xin-sheng; HUANG Tao; HUANG Wen-hui; XIA Chun-li; MO Yu-jing

    2012-01-01

    Background Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA.This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults.Methods After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH,transcatheter closure of PDA was performed.Patients were followed up clinically and echocardiographically at 24 hours,1 month,3months,6 months,12 months and 24 months after occlusion.Results Twenty-nine patients had successful occlusion,pulmonary artery pressure (PAP),left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106±25) mmHg vs.(50±14) mmHg,P <0.01; (63.7±7.2)% vs.(51.4±10.1)%,P <0.01 and (36.9±8.2)% vs.(28.9±8.6)%,P <0.05,respectively).At 1 month after PDA closure,the signs and symptoms improved markedly in all 29 patients,and PDAs were completely closed and remained closed during the follow-up.Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion.Nine patients whose pulmonary vascular resistence (PVR) >6 Wood units accepted targeted PAH therapy.After 1 to 3 months of peroral drug therapy,their exercise tolerance improved from New York Heart Association (NYHA) class Ⅲ-Ⅳ to NYHA class Ⅰ.During follow-up,no latent arrhythmias were found,the left atrial diameter (LAD),left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P <0.05),and FS and LVEF recovered compared to the immediate postclosure state.However,FS and LVEF remained low compared to the preclosure state.Conclusions Transcatheter closure

  13. Fechamento de canal arterial por minitoracotomia: técnica e resultados Patent ductus arteriosus (PDA closure with minithoracotomy: technique and results

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    Pedro R. SALERNO

    2000-09-01

    Full Text Available CASUÍSTICA E MÉTODOS: No período de novembro de 1996 a dezembro de 1997, 15 crianças portadoras de canal arterial (CA, sendo 12 do sexo feminino, com idade média de 2,7 anos, peso médio de 13,9 kg foram submetidas a fechamento do CA por minitoracotomia. O ecodopplercardiograma confirmou o diagnóstico em todos o casos e mostrou o diâmetro do CA entre 2 mm e 10 mm, com média de 4,06 mm. A indicação cirúrgica foi eletiva em todos os casos. A operação consistiu de minitoracotomia esquerda no 4º espaço intercostal de 2,5 cm a 3,0 cm, seguida de dissecção do CA e clipagem do mesmo com 2 clips metálicos. Não foi utilizada drenagem pleural em nenhum dos casos. RESULTADOS: Todos os pacientes receberam alta em média no 4º dia de pós-operatório, sem nenhum escape pelo CA ao ecodopplercardiograma. CONCLUSÃO: O fechamento de CA por minitoracotomia é uma alternativa de tratamento que reduz o período de internação, bom efeito cosmético e baixo índice de complicações.OBJECTIVE:The purpose of this study was to describe a new technique for closure of patent ductus arteriosus (PDA by minithoracotomy (2.5 a 3.0 cm and clipping the PDA with titanium clips. MATERIAL AND METHODS: From November 1996 to December 1997, 15 children with PDA underwent surgical closure. The mean age at the time of operation was 2.7 years, mean weight was 13.9 kg. The procedure was through a left minithoracotomy at the 4º intercostal space. The ductus was identified, dissected and isolated. Interruption of ductal flow was performed by direct clipping with two clips. The chest was closed without a chest drain. Unless the patient was ventilator dependent before the closure, the child usually was extubated in the operating room. RESULTS: Color doppler echocardiography demonstrated total occlusion of the ductus in all patients. All 15 patients were discharged from the hospital on the 4º postoperative day (mean. CONCLUSION: We conclude that surgical closure of

  14. Progress in pathogenesis of patent ductus arteriosus in preterm infants%早产儿动脉导管未闭发病机制的研究进展

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    杨文庆; 杨长仪; 陈涵强

    2010-01-01

    Patent ductus arteriosus(PDA) is a common condition in the premature infants. It is associated with an increase in mortality and sequelae in these infants. The various factors contributing to an patency of the ductus arteriosus in the preterm infants are involved in: insufficient histological development of ductus arteriosus, failure of remodeling theductus, abnormal sensitivity of the ductus to oxygen and vasoactive substances,and genes.%动脉导管未闭(PDA)是早产儿常见并发症,也是影响早产儿存活率和后遗症发生率的主要原因之一.近年研究发现,早产儿PDA的发生除与自身动脉导管的组织发育不成熟、不易发生重塑有关外,还与动脉导管对氧、血管活性物质的反应异常相关;遗传因素也参与早产儿PDA的发病.

  15. Patent ductus arteriosus in an adult cat with pulmonary hypertension and right-sided congestive heart failure: hemodynamic evaluation and clinical outcome following ductal closure.

    Science.gov (United States)

    Novo-Matos, José; Hurter, Karin; Bektas, Rima; Grest, Paula; Glaus, Tony

    2014-09-01

    Right-sided congestive heart failure (CHF) developed secondary to severe pulmonary hypertension (PH) in an 8-year-old cat with a left-to-right shunting patent ductus arteriosus (PDA). Vascular reactivity was tested prior to shunt ligation by treatment with oxygen and sildenafil. This treatment was associated with a significant decrease in pulmonary artery pressure as assessed by echocardiography. Subsequently surgical shunt ligation was planned. During thoracotomy, digital occlusion of the PDA was performed for 10 min with simultaneous catheter measurement of right ventricular pressure, which did not increase. Permanent shunt ligation resulted in a complete and sustained clinical recovery. A lung biopsy sample obtained during thoracotomy demonstrated histopathological arterial changes typical of PH. Cats can develop clinically severe PH and right-sided CHF secondary to a left-to-right PDA even at an advanced age. Assuming there is evidence of pulmonary reactivity, PDA occlusion might be tolerated and can potentially produce long-term clinical benefits.

  16. Reduced Hospital Mortality With Surgical Ligation of Patent Ductus Arteriosus in Premature, Extremely Low Birth Weight Infants: A Propensity Score-matched Outcome Study.

    Science.gov (United States)

    Tashiro, Jun; Perez, Eduardo A; Sola, Juan E

    2016-03-01

    To evaluate outcomes after surgical ligation (SL) of patent ductus arteriosus (PDA) in premature, extremely low birth weight (ELBW) infants. Optimal management of PDA in this specialized population remains undefined. Currently, surgical therapy is largely reserved for infants failing medical management. To date, a large-scale, risk-matched population-based study has not been performed to evaluate differences in mortality and resource utilization. Data on identified premature (Propensity score-matched analysis of 1620 SL versus 1584 non-SL found reduced mortality (15% vs 26%) and more routine disposition (48% vs 41%) for SL (P Propensity score-matched analysis demonstrates reduced mortality in premature/ELBW infants with SL for PDA. NEC and sepsis are predictors of mortality and resource utilization.

  17. Differential shunting in the diagnosis of patent ductus arteriosus with Eisenmenger physiology by radionuclide angiography. [/sup 99m/Te-pertechnetate; (sup 99m/Te-MAA; aorta-pulmanary artery shunts

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    Thomas, J.L.; Scherer, J.; Kahl, F.R.; Watson, N.; Cowan, R.

    1978-06-01

    Radionuclide angiography and static whole-body imaging performed with technetium-99m-labeled particulates can clearly demonstrate differential shunting in patients with patent ductus arteriosus (PDA) with Eisenmenger physiology. The anatomic arterial relationships in this condition which direct deoxygenated blood into the lower body (differential cyanosis) produce specific radionuclide images characterized by differential shunting of the technetium-99m-labeled particulates into the abdomen and lower extremity.

  18. Correção cirúrgica da persistência do canal arterial em crianças de baixo peso e neonatos Surgical treatment of patent ductus arteriosus in low-weight child and neonates

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    Ciro Denevitz de Castro Herdy

    1996-09-01

    Full Text Available A persistência do canal arterial ocorre com freqüência em neonatos prematuros, provocando um grave quadro de disfunção cardiopulmonar. O tratamento envolve duas abordagens, sendo uma clínica e outra cirúrgica. A operação para a ligadura do canal arterial é praticada desde 1938. O enfoque clínico preconiza o uso da indometacina, com o intuito de promover a oclusão do canal arterial. O presente trabalho tem por objetivo avaliar os resultados obtidos com o tratamento cirúrgico da persistência do canal arterial, através de toracotomia e ligadura em 14 pacientes, incluindo crianças de baixo peso e neonatos prematuros com quadro clínico instável. A principal indicação cirúrgica, nestes casos, foi a presença de insuficiência respiratória aguda e insuficiência cardíaca. A técnica empregada foi a tripla ligadura do canal arterial. Nos 14 casos não obtivemos nenhum tipo de complicação e sem mortalidade. A presença de uma Unidade de Tratamento Intensivo Neonatal (U.T.I no Hospital foi de extremo valor no preparo dos pacientes e na evolução no período de pós-operatório. Este trabalho comprova a eficácia do método cirúrgico empregado, com baixas taxas de morbidade e mortalidade e a importância da U.T.I neonatal no acompanhamento dos pacientes.The patent ductus arterious frequently occurs in premature neonates causing serious cardiopulmonary disfunction. The treatment includes two options; one clinic and the other surgical procedure. The surgery for patent ductus arteriosus has been done since 1938. Clinical treatment with indometacin induces closure of the arteriosus ductus. The aim of the article is to analize the surgical results with thoractomy by triple-ligature of the ductus for the treatment of persistent ductus arteriosus in fourteen patients including low weight children and premature neonates with cardiopulmonary disfunction. The indications for surgery in these cases were respiratory distress and congestive

  19. Transcatheter occlusion of patent ductus arteriosus in small weight infants%低体重婴儿动脉导管未闭介入治疗研究

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    肖云彬; 黄希勇; 陈智; 王祥; 王勋

    2013-01-01

    目的 评价国产封堵器治疗动脉导管未闭(patent ductus arteriosus,PDA)低体重婴儿的有效性和安全性.方法 2010年10月至2011年10月应用国产封堵器治疗30例体重低于8 kg 的PDA婴儿.术后24 h查血常规、尿常规,并于术后24 h、1、3和6个月行心脏彩色多普勒超声、胸部正位片、心电图检查.结果 1例患儿术后24 h彩色多普勒超声示残余分流,1个月随访时残余分流消失,其余29例术后及随访期间均未出现残余分流;未出现介入治疗的主要并发症,无一例死亡.结论 应用国产PDA封堵器介入治疗体重低于8 kg的PDA婴儿的近、中期疗效确切,安全.%Objective To evaluate the efficacy and safety of transcatheter occlusion of patent ductus arteriosus (PDA) by using domestic occluder in small weight infants. Methods During the period from Oct. 2010 to Oct. 2011 transcatheter occlusion of PDA by using domestic occluder was carried out in 30 PDA infants with body weight ≤ 8 kg. Two-dimensional and color Doppler echocardiography, chest radiograph, electrocardiogram, routine blood test and routine urine test were performed after the treatment in all infants. The results were analyzed. Results Colour Doppler echocardiography performed at 24 hours after the procedure showed that residual shunt was seen in one infant, which disappeared one month later. In the remaining 29 infants no residual shunt was detected during the follow-up period. Neither intervention-related complications nor death occurred. Conclusion For the treatment of PDA infants with body weight ≤ 8 kg, transcatheter occlusion of PDA by using domestic occluder is quite safe with reliable short-term and mid-term efficacy.

  20. 新生儿动脉导管未闭的高危因素分析%Risk factors for patent ductus arteriosus in neonates

    Institute of Scientific and Technical Information of China (English)

    屈晓羽; 周先锋; 屈艺; 唐彬秩; 母得志

    2011-01-01

    Objective To identify the risk factors for patent ductus arteriosus (PDA) in neonates. Methods Fifty infants with PDA and 100 infants without PDA were enrolled. Chi-square test, Student's t test and the linear correlation analysis were used to study the clinical data. Logistic regression analysis was used to investigate the independent risk factors for PDA. Results The prevalence of PDA was negatively correlated with the gestation age ( r = -0.03, P <0.05)and birth weight (r = - 0.04, P < 0.05). Oxygen inhalation was a protective factor for the development of PDA. Fetal distress, meconium-stained amniotic fluid, oligohydramnios, cord entanglement, 1 minute Apgar score < 8, maternal infection and hypoxic-ischemic encephalopathy were the independent risk factors for the development of PDA. Conclusions The incidence of PDA can be reduced by preventing maternal infection, premature birth, low birth weight and hypoxia.%目的 探讨新生儿动脉导管未闭(patent ductus arteriosus,PDA)的高危因素,为PDA的预防提供临床依据.方法 以50例PDA新生儿为病例组,100例非PDA新生儿为对照组,采用x2检验、t检验或直线相关分析对两组患儿的临床资料进行分析,采用logistic回归分析研究PDA的独立危险因素.结果 PDA的发生与胎龄(r=-0.03,P<0.05)、出生体重(r=-0.04,P<0.05)呈负相关.出生时吸氧治疗为保护因素.宫内窘迫、羊水粪染、羊水过少、脐带绕颈、1 min Apgar评分<8分、母孕期感染、合并缺氧缺血性脑病是新生儿PDA的独立高危因素.结论 避免母孕期感染、早产、低出生体重、缺氧的发生,有利于减少PDA的发生.

  1. Estudo anatomotopográfico do canal arterial em fetos natimortos dirigido para sua abordagem por videotoracoscopia Anatomotopographic study of ductus arteriosus in newborn cadavers directed for its videotoracoscopic approach

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    Josué Viana de Castro Neto

    2001-03-01

    Full Text Available Este trabalho objetiva realizar um estudo anatomotopográfico do Canal Arterial em fetos natimortos enfatizando o seu comprimento e seu diâmetro de acordo com o tamanho de cada feto. Além de que, descrevemos as distâncias entre este e pontos de reparo importantes para sua abordagem por videotoracoscopia. Estudamos dezesseis fetos natimortos, sendo que oito eram do sexo masculino. O tamanho do feto e os perímetros torácico e cefálico variaram de 42-57, 26-35 e 29-35,5 cm, respectivamente. A média de comprimento e diâmetro foram 11,06 e 5,56 cm. Distâncias entre o Canal e as seguintes estruturas: clavícula-22,13mm, segunda costela-20,75mm, esterno-33,88mm e a.subclávia esquerda-5,30mm. Acreditamos que as medidas apresentadas podem facilitar a abordagem do canal por videotoracoscopia.The purpose of this work is to realize an anatomic and topographic study of the ductus arteriosus in newborn cadavers emphasizing its lenght and diameter according to each size of the newborn cadaver. We also describe distances between the ductus and important structures for thoracoscopic approach. We study sixteen newborn cadavers. Eight were male. Size of the cadavers, thoracic and cephalic perimeters ranged from 42-47,26-35 and 29-35,5 cm, respectively. Median lenght and diameter were 11,06 and 5,56 mm. Distances between ductus arteriosus and follow structures were: collarbone-22,13mm, second rib-20,75mm, sternum-33,88mm and left subclavian artery-5,30mm. We belived that these distances described can facilitate thoracoscopic surgical approach to the ductus arteriosus.

  2. A High Ductal Flow Velocity Is Associated with Successful Pharmacological Closure of Patent Ductus Arteriosus in Infants 22–27 Weeks Gestational Age

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    Karl Wilhelm Olsson

    2012-01-01

    Full Text Available Objective. To identify factors affecting closure of patent ductus arteriosus (PDA in newborn infants born at 22–27 weeks gestational age (GA during pharmacological treatment with cyclooxygenase inhibitors. Method. Infants born at 22–27 weeks of GA between January 2006 and December 2009 who had been treated pharmacologically for PDA were identified retrospectively. Medical records were assessed for clinical, ventilatory, and outcome parameters. Echocardiographic examinations during treatment were reviewed. Results. Fifty-six infants were included in the study. Overall success rate of ductal closure with pharmacological treatment was 52%. Infants whose PDA was successfully closed had a higher GA (25+4 weeks versus 24+3 weeks; P=0.047, and a higher pretreatment left to right maximal ductal flow velocity (1.6 m/s versus 1.1 m/s; P=0.023. Correcting for GA, preeclampsia, antenatal steroids, and age at start of treatment, a higher maximal ductal flow velocity was still associated with successful ductal closure (OR 3.04; P=0.049. Conclusion. Maximal ductal flow velocity was independently associated with success of PDA treatment.

  3. Increased cardiac workload by closure of the ductus arteriosus leads to hypertrophy and apoptosis rather than to hyperplasia in the late fetal period.

    Science.gov (United States)

    van den Hoff, Maurice J B; Deprez, Ronald H Lekanne; Ruijter, Jan M; de Boer, Piet A J; Tesink-Taekema, Sabina; Buffing, Anita A; Lamers, Wouter H; Moorman, Antoon F M

    2004-09-01

    It is generally thought that adult mammalian cardiomyocytes compensate for an increased workload by hypertrophy, whereas fetal myocardium grows by cellular proliferation. We analyzed the response of late-fetal rat hearts upon an increased workload imposed by premature constriction of the ductus arteriosus with indomethacin. Initially the fetal heart responds by proliferative growth, as both wet weight and labeling index (bromodeoxyuridine incorporation) of the ventricles increased, whereas neither a change in the fibroblast fraction, ploidy and nucleation in the ventricles is observed. However, this hyperplastic growth is abrogated by a subsequent burst in apoptosis and followed by a hypertrophic response as based on a decrease in DNA and increase in both RNA and protein concentration. This hypertrophic growth was accompanied by a 1.4-fold increase in the volume of the cardiomyocytes. Changes in the molecular phenotype characteristic of pressure-overload hypertrophic growth accompany the process. Thus, the levels of expression of beta-myosin heavy chain and atrial natriuretic factor mRNA increased, of sarcoplasmic/endoplasmic reticulum ATPase (SERCA2) mRNA decreased, and of alpha-myosin heavy chain, phospholamban, and calsequestrin mRNA did not change. In situ hybridization showed that the pattern of mRNA expression changed first in the right ventricular wall and subsequently in the left ventricular free wall as well. It is concluded that pressure-overload imposed on the late-fetal heart induces limited proliferative growth complemented by extensive hypertrophic growth.

  4. The timing of surgical ligation for patent ductus arteriosus is associated with neonatal morbidity in extremely preterm infants born at 23-25 weeks of gestation.

    Science.gov (United States)

    Sung, Se In; Choi, Soo Young; Park, Jae Hyun; Lee, Myung Sook; Yoo, Hye Soo; Ahn, So Yoon; Chang, Yun Sil; Park, Won Soon

    2014-04-01

    The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17 ± 12 vs 11 ± 8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.

  5. Elevated NCX1 and NCKX4 expression in the patent postnatal ductus arteriosus of ductal-dependent congenital heart disease patients.

    Science.gov (United States)

    Hong, Haifa; Xia, Yu; Sun, Yanjun; Ye, Lincai; Liu, Jinfen; Bai, Jie; Zhang, Haibo

    2015-04-01

    Patency of the ductus arteriosus (DA) after birth is essential in ductal-dependent congenital heart disease. The Na(+)/Ca(2+) exchanger (NCX) has been demonstrated to play a key role in regulating vascular tone. The potassium-dependent Na(+)/Ca(2+) exchanger (NCKX) is a related family of NCX depending on the K(+) gradients which triggers DA constriction. The present study investigated the comparative expression of NCX and NCKX between a constricted DA and patent DA in human ductal-dependant congenital heart disease. Human DAs, which were patent (n = 10, age = 20.2 ± 4.3 days) or constricted (n = 10, age = 18.3 ± 3.9 days), were excised during surgery from neonates with ductal-dependent congenital heart disease. Western blotting analysis, real-time quantitative polymerase chain reaction analysis and immunofluorescence studies were performed to detect the protein and mRNA levels of NCX1, NCKX3, and NCKX4. The expressions of NCX1 and NCKX4 were significantly higher in the patent DA group at both the protein and mRNA levels, and expression was localized to the smooth muscle layer. These findings indicate that NCX1 and NCKX4 are up-regulated in human postnatal patent DAs and may represent potential therapeutic targets for maintaining DA patency in ductal-dependent congenital heart disease.

  6. 动脉导管未闭的治疗方法研究进展%Research progress of therapeutic methods for patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    白敏; 许丹焰

    2015-01-01

    Patent ductus arteriosus (PDA) is a frequent congenital heart disease .Incidence rate of PDA accounts for 10% ~21% of total incidence rate of congenital heart disease .In recent years ,along with the continuous deepening understanding of anatomical structure and pathology of PDA ,there were a variety of treatment methods ,including drug therapy ,interventional therapy and operation .The present article made a review about indications ,contraindi‐cations ,advantages and disadvantages of above three treatments .%动脉导管未闭(PDA )是一种常见的先天性心脏病,其发病率占先天性心脏病总发病率的10%~21%。近年来随着人们对PDA的解剖结构及病理生理的认识不断加深,临床上出现了多种治疗方式(药物治疗、介入治疗及手术治疗)。本文就这三种治疗方式的适应证、禁忌证及优缺点作一综述。

  7. Single nucleotide polymorphisms in AGTR1, TFAP2B, and TRAF1 are not associated with the incidence of patent ductus arteriosus in Japanese preterm infants.

    Science.gov (United States)

    Kawase, Koya; Sugiura, Tokio; Nagaya, Yoshiaki; Yamada, Takaharu; Sugimoto, Mari; Ito, Koichi; Togawa, Takao; Nagasaki, Rika; Kato, Takenori; Kouwaki, Masanori; Koyama, Norihisa; Saitoh, Shinji

    2016-06-01

    Persistent patent ductus arteriosus (PDA) is a frequent complication in preterm infants. Single nucleotide polymorphisms (SNP) in several genes, including angiotensin II receptor, type 1 (AGTR1), transcription factor AP-2 beta (TFAP2B) and tumor necrosis factor receptor-associated factor 1 (TRAF1), have been reported to be associated with PDA in preterm infants. The aim of this study was to evaluate the relationships between PDA in preterm infants and polymorphisms in AGTR1, TFAP2B and TRAF1 in the Japanese population. The subjects consisted of 107 preterm infants with gestational age AGTR1, rs987237 and rs6930924 in TFAP2B, and rs1056567 and rs10985070 in TRAF1, were genotyped using TaqMan SNP genotyping assays. There were no significant differences in the distributions of the genotypes and allele frequencies of all studied SNP between the PDA group (n = 46) and the non-PDA group (n = 61). There were no significant associations between the studied SNP and the incidence of PDA in Japanese preterm infants. These SNP may not be clinically important predisposing factors for PDA in Japanese preterm infants. © 2015 Japan Pediatric Society.

  8. 高龄动脉导管未闭的外科治疗%Surgical treatment of patent ductus arteriosus in advanced age

    Institute of Scientific and Technical Information of China (English)

    陶宝华; 刘捷夫

    2000-01-01

    Objective Ten patients with patent ductus arteriosus (PDA) in advanced age were retrospectivelyevaluated. Methods The PDA included aneurysmal dilatation of ductus arteriosus(4),giant ductus(3),and severepulmonary hypertension(2),PDA accompanied with rheumatic mitral valvular disease(1), Results Seven were lig-ated under hypothermia,2 ligated with Dacron pledget of PDA under temporary cardiopulmonary bypass;division of 1PDA under hypothermia; there were two early deaths(20%), The mean follow-up period was 50 months,all werefree from symptoms and cardiac murmur.Conclusion Optimum results achieved must be in accordance with propertechniques used in situations of PDAs in advanced age. Correction with Dacron patch is a safe, simple and reliablemethod for preventing rupture of PDA or aorta.(Shanghai Med J, 2000,23:458-460)%目的 探讨高龄动脉导管未闭患者的特点和手术方法的选择对手术结果的影响。方法 10例患者术前均经超声心动图证实诊断,导管直径0.9~2.5 cm(平均1.7 cm)。萁中2例肺动脉高压,导管水平有双向分流。4例肺动脉呈瘤样扩张。1例同时伴有风湿性二尖瓣美闭不全并发慢性右心衰竭。7例在全麻低温下施以带特制垫片结扎术。在低温部分阻断循环和左心辅助循环下行导管切断缝合各1例。正中切口,体外循环下行导管缝闭合并人工二尖瓣置换术1例。结果 住院死亡2例。其余8例痊愈出院。随访14~50个月,(平均32个月)无复发再通。结论 高静动脉导管未闭患者常并发各种病变,手术治疗效果主要取决于手术方法的选择。带特制垫片的结扎术对防止导管和主动脉破裂似乎是一种简单、安全、可靠的方法之一。

  9. Patent ductus arteriosus stenting in complex congenital heart disease: early and midterm results for a single-center experience at children hospital, Mansoura, Egypt.

    Science.gov (United States)

    Matter, Mohamed; Almarsafawey, Hala; Hafez, Mona; Attia, Gehan; Abuelkheir, Mohamed-Magdy

    2013-06-01

    This study aimed to assess the efficacy and outcome of transcatheter ductus arteriosus stenting in newborns and infants with ductal-dependent or decreased pulmonary circulation. Between September 2009 and December 2011, 33 newborns and infants were subjected to patent ductus arteriosus (PDA) stenting as an alternative to a surgical shunt. Of the 33 patients, 20 had pulmonary atresia (PA) with a ventricular septal defect, 4 had PA with an intact ventricular septum, 5 had PA with a double-outlet right ventricle, and 4 had critical pulmonary stenosis. The McGoon ratio ranged from 0.8 to 1.9 (median 1.27). The ages of the patients ranged from 3 to 56 days, and their weight ranged from 2.7 to 4.1 kg. The oxygen saturation ranged from 45 to 61 %, and the pH ranged from 7.13 to 7.27. Premounted coronary stents with diameters of 3, 3.5, and 4 mm were used to cover the whole length of the ductus. The PDA was tortuous in 23 patients and straight in 10 patients. The mean ductal length was 12.2 ± 3.7 mm (range 7.8-23 mm). The mean stent length was 14.3 ± 3.4 mm (range, 8-23 mm), and the mean narrowest ductal diameter was 1.9 ± 0.6 mm (range, 0.8-2.9 mm). Immediately after the procedure, the oxygen saturation was increased from a mean of 75.1 ± 13.2-91.5 ± 6.3 % (p < 0.0001), and the PDA diameter was increased from a mean of 1.9 ± 0.6-4.3 ± 0.8 mm (p < 0.0001). Stent redilation was necessary in two patients 8 days after the procedure, and their oxygen saturation increased 79-88 %. The mean fluoroscopy time was 39.4 ± 15.5 min. Stent dislocation to the left main pulmonary artery was seen in one patient, with another stent placed in the arterial duct. No procedure-related mortality occurred. Two neonates died a few days after the procedure due to sepsis related to the procedure. The surviving patients were discharged home 8-30 days (median, 9.5 days) after the procedure. Stent patency was achieved for 8-550 days. The McGoon ratio increased and ranged from 1.6 to 2

  10. Evolução ecocardiográfica de recém-nascidos com persistência do canal arterial Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus

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    Jorge Yussef Afiune

    2005-12-01

    ínico associado.OBJECTIVE: To identify clinical and echocardiography predictors of the spontaneous closure of patent ductus arteriosus in preterm neonates. METHODS: Sixty-one consecutive preterm neonates (gestational age 30±2 weeks, birth weight 1.2±0.2 kg were evaluated by echocardiogram on their third day of life and those with patent ductus arteriosus were selected for a prospective cohort. Echocardiography was repeated weekly until they reached term. Based on their progress, the sample population was divided into two groups, depending on whether spontaneous closure of patent ductus arteriosus took place (Group A or not (Group B. The prevalence of clinical signs of patent ductus arteriosus and echocardiography findings at baseline were compared between the groups. RESULTS: Patent ductus arteriosus was found in 21 neonates (34%. Spontaneuous closure was observed during follow-up of seven patients (Group A, 33% of those with patent ductus arteriosus, in contrast with the remaining 14 patients (Group B, 67%. Clinical signs of patent ductus arteriosus were present in 14% of the patients in Group A, compared with 71% in group B (p = 0.01. At baseline, Group B had a larger ductus diameter in relation to Group A (2.6±0.6 mm vs. 1.4±0.6 mm; p = 0.003. The area under the ROC curve in relation to ductus diameter was 0.93 (p = 0.003 and 100% sensitivity for identifying cases without spontaneous closure was obtained at the cutoff point of 1.7 mm, while 100% specificity was observed taking 2.2 mm as the cutoff. CONCLUSIONS: In preterm neonates, a patent ductus arteriosus greater than 2.2 mm on the third day of life predicts no spontaneous closure and suggests a need for early treatment, especially when associated with clinical signs.

  11. Tratamento do canal arterial persistente em neonatos prematuros: análise de 18 casos Treatment of patent ductus arteriosus in neonate premature: analysis of 18 cases

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    Wagner Ciongoli

    1993-12-01

    Full Text Available A presente investigação tem o propósito de analisar, retrospectivamente, os resultados obtidos em 18 pacientes neonatos prematuros, submetidos a operação para oclusão da PCA, no período entre julho de 1990 e dezembro de 1993 (42 meses, sendo 12 (66,6% pacientes do sexo feminino, com idade que variou entre 10 e 44 (20,8±8,3 dias, idade gestacional entre 26 e 28 (27,2±0,9 semanas. No dia da operação o peso dos pacientes esteve compreendido entre 700 e 1380 (985,8±181,6 gramas. A insuficiência respiratória aguda ocorreu em todos os pacientes sendo a principal indicação cirúrgica, estando em 6 (33,3% pacientes associada à insuficiência cardíaca congestiva. A indometacina endovenosa foi utilizada no período pré-operatório em 9 (50% pacientes na tentativa de se obter o fechamento farmacológico, sem sucesso, do canal arterial e apesar de não influenciar nos resultados pós-operatórios, apresentou como principal efeito secundário a redução significativa da diurese (p 40% 60% (p=0,033. O período de internação hospitalar variou de 43 a 157 (96,0±24,8 dias. Não houve mortalidade operatória, observando-se ainda baixa morbidade com este método. As causas de óbito, no período pós-operatório, não estiveram relacionadas com o tratamento cirúrgico. Pode-se concluir que a ligadura cirúrgica da PCA, nos pacientes neonatos e prematuros, é método eficaz e seguro podendo ser praticado com baixa morbidade e mortalidade.The purpose of our study was to analyse the results obtained in 18 neonate premature patients who underwent surgical closure of the patent ductus arteriosus, between July 1990 and December 1993 (42 months. Twelve (66.6% patients were female, with age between 10 and 44 (20.8±8.3 days, gestacional age ranged from 26 to 28 (27.2±0.9 weeks. In the surgery day the birth weight was between 700 and 1380 (985.8 ±181.6 grams. Acute respiratory insufficiency was present in all patients, as the principal surgical

  12. [Patent ductus arteriosus in the dog: a retrospective study of clinical presentation, diagnostics and comparison of interventional techniques in 102 dogs (2003-2011)].

    Science.gov (United States)

    Meijer, M; Beijerink, N J

    2012-06-01

    A left-to-right shunting patent ductus arteriosus (PDA) is a common congenital heart defect in dogs. If it is left uncorrected, life expectancy in most cases is decreased due to the development of left-sided congestive heart failure. The aim of this study was to describe the dogs diagnosed with PDA in the Utrecht University Companion Animal Clinic from 2003 to 2011. The medical records of 102 patients were retrieved, and the clinical presentation and outcome of PDA closure by surgical ligation or transarterial catheter occlusion (TCO) were reviewed. In the TCO group, the result of coiling was compared with the placement of an Amplatz Canine Duct Occluder (ACDO). A predisposition to PDA was found in the German Brak, Stabyhoun, and Schapendoes. Dogs treated with surgical ligation were significantly older and heavier than those treated with TCO; within the TCO group, dogs treated with ACDO were significantly older and heavier The initial success rate (complete disappearance of the audible murmur in a patient that survived the procedure) was not significantly different between the different treatment modalities. Major complications were more common with surgical ligation, but the incidence of minor complications was not significantly different. There was no diference in survival between dogs treated with surgical ligation and dogs treated with TCO. This study shows a previously unreported predisposition to PDA in certain breeds. Both surgical ligation and TCO are suitable techniques for PDA closure, although major complications were more common with surgical ligation. ACDO appears to be the method with the least complications and thus can be considered the safest method.

  13. The Changes of Left Ventricular Form and Function After Closure of Moderate-to Large-sized Patent Ductus Arteriosus Using Domestic-made Occluder

    Institute of Scientific and Technical Information of China (English)

    Mo Jianmei; Wu Weifeng; Liu Tangwei; Huang Kai; Guo Shenglan; Zhang Bingdong; Wu Ji

    2005-01-01

    Objectives To evaluate the changes of the left ventricular form and function after closure of moderate- to large-sized patent ductus arteriosus (PDA) using domestic-made occluder.Methods 22 patients with PDA underwent procedure successfuly using the domestic-made occluder. The mean PDA minimal (pulmonary end) diameter by aortography was 8.01±2.47 mm (range 4 to 15.Smm).All patients underwent transthoracic echocardiography (TTE) study before the procedure and the following 48hours, 3 months after procedure. Results All patients had been implanted the domestic-made occluders successfully with no haematolysis, infective endocarditis, recanalization and other complications.At 3 months, mean LVED was decreased to 50.05±6.55mm, compared to the pre-procedure (55.67±8.48mm), P < 0.01. After 48 hours of the procedure, mean LVEDD and LVESD decreased significantly (156.22±51.40 mLvs. 121.28±35.73ml, 57.16±32.07 mL vs.45.88±15.97 mL), P<0.05. At3 months, LVEDDdecreased to 110.93±15.08ml, LVSV reached 73.50±9.19 mL, compared to the pre-procedure, P < 0.01.LVESD decreased to 37.43±10.44 mL at 3 months, P <0.05. Conclusions Closuring of moderate- to largesized PDA using domestic-made occluder is effective and safe. After procedure, left ventricular form and function improved.

  14. Experience with percutaneous closure of ductus arteriosus using the Amplatzer duct occluder in 243 consecutive patients and long-term results-A single centre study

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    Mostafa Behjati-Ardakani

    2014-01-01

    Full Text Available Background: Percutaneous closure of patent ductus arteriosus (PDA with Amplatzer duct occluder (ADO has become increasingly popular in many cardiovascular centres. This study analysed the long-term results of percutaneous closure of PDA with ADO in a single centre. Materials and Methods: Between May 2004 and January 2013, 243 patients with median age of 2.5 years (range = 30 months to 38 years and median weight of 10 Kg (range 4.5-80.5 Kg underwent percutaneous closure of PDA using the ADO. The devices were implanted under fluoroscopic guidance. Patients were followed-up for any complications. Results: The mean diameter of narrow part of PDA was 6.4 ± 2.2 mm. The mean diameter of devices was 7.8 ± 2.3 mm. The devices were successfully implanted in 239 (98.3% cases. At immediate, 1 day, 1, 6, 12 months and late follow-up, the complete occlusion rate was 33% (79 case, 97.1% (236 case, 97.5% (237 case, 98.3% (238 case, 98.3% (238 case and 98.3% (238 case, respectively. Residual shunt remained in one case at late follow-up. The device embolisation occurred in five patients. The devices were successful retrieved in three patient and second larger devices were inserted. Two other devices were surgically retrieved and PDAs were ligated. Moderate left pulmonary artery stenosis (LPA in one child and mild LPA stenosis in one infant were detected. Mild aortic obstruction occurred in one infant. Conclusions: Long-term follow-up of patients indicate that percutaneous closure of PDA using ADO is a safe and effective procedure. However, some complications, including device embolisation, left pulmonary stenosis and aortic obstruction may be observed in some cases.

  15. Transcatheter closure of special types of patent ductus arteriosus%特殊类型动脉导管未闭的介入治疗(附30例报告)

    Institute of Scientific and Technical Information of China (English)

    邓军; 孔祥清; 杨荣; 盛燕辉; 钱玲梅; 周蕾; 杨振文; 孙伟; 曹克将

    2005-01-01

    目的:探讨特殊类型动脉导管未闭(patent ductus arteriosus,PDA)介入治疗的方法.方法:应用蘑菇伞封堵器(patent ductus arteriosus occluder,PDAO)介入封堵特殊类型的PDA 30例.结果:30例中巨大PDA 5例[最窄径平均12.4±1.7 mm (10.1~16.3 mm)],细小PDA 15例(最窄径平均2.10±0.42 mm),外科手术后再通的PDA 6例(最窄径平均3.20±0.34 mm),伴重度肺动脉压增高的PDA 3例[(平均肺动脉压88±7 mmHg(75~97 mmHg)],合并严重脊柱侧弯畸形1例.对5种不同类型的PDA根据其不同特点,采取不同的方法均成功封堵.结论:对于特殊类型动脉导管未闭选择恰当的方法可成功封堵.

  16. 早产儿动脉导管未闭现状和危险因素调查研究%Investigation on the present situation and risk factors of premature infants with patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    石小娟; 冯璇

    2013-01-01

    Objective To study the present situation of premature infants with patent ductus arteriosus and its risk factors.Methods A total of 824 premature infants in our hospital from October 2011 to October 2012 were selected as research object,then the patent ductus arteriosus rate of all the premature infants was investigated,and the rates of premature infants with different maternal factors and neonatal factors were compared.Results 190 cases of 824 premature infants were with patent ductus arteriosus,the rate was 23.05%,the patent ductus arteriosus rate of premature infants with meconium stained amniotic fluid,oligohydramnios,infection during pregnancy and gestational diabetes mellitus were higher than those of others,the rate of those with maternal hormone application was lower than that without hormone,the rates of those with lower gestational age and birth weight,intrauterine distress,Apgar score < 8 points were all higher than those of others (all P < 0.05),there were significant differences.Conclusions The risk factors of premature infants with patent ductus arteriosus is more,and it mainly includes the maternal gestational factors and neonatal factors.So they should be paid enough attention.%目的 调查分析早产儿动脉导管未闭的现状及其危险因素.方法 选取2011年10月至2012年10月的824例早产儿为研究对象,将其动脉导管未闭发生率进行调查,并将其中不同母体因素及新生儿因素的发生率进行比较.结果 824例早产儿中发生动脉导管未闭190例,发生率为23.05%;羊水粪染、羊水过少、孕期感染及妊娠期糖尿病患者的动脉导管未闭发生率高于其他患者,而母体应用激素者低于未用激素者(P均<0.05);胎龄及出生体重较小、宫内窘迫、Apgar评分<8分患儿动脉导管未闭发生率均高于其他患儿,差异有统计学意义(P<0.05).结论 早产儿动脉导管未闭的危险因素较多,主要包括母体妊娠期因素及新生儿因素,应给予充分重视.

  17. 早产儿动脉导管未闭超声参数预测早期自然关闭的价值%Evaluation of predicting the ductus arteriosus closure in preterm infants by echocardiography

    Institute of Scientific and Technical Information of China (English)

    杨正春; 冉素真; 沈红霞; 魏俊; 张焜; 黄泽君

    2015-01-01

    Objective To investigate the values of echocardiographic parameters for predicting the spontaneous closure of the ductus arteriosus in preterm infants .Methods A retrospective study of 110 preterm infants from October 2013 to October 2014 in our hospital was done .Examination was done at 1 ,3 ,7 d with echocardiography for those infants .Diameter of left atrium(LA) ,aotic root(AO) and arterial canal‐related parameters (the smallest width of ductal color Doppler flow jet and the maximum velocity at the ductus) at first .Preterm infants in this study were divided into two groups .The early patent ductus arterisus group included ones whoes ductus didn′t closed spontaneous in 7 d ,and the control group included ones whoes ductus closed spontaneous in 7 d ,and then the echocardiographic parameters between the two groups were compared .Results (1)The rates of ductus arteriosus sponta‐neous closure in preterm infants at 3 ,7 d were 70 .9% (78/110) ,78 .2% (86/110) ,respectivly .(2)When compared with the control group ,The rate of LA/AO in patent ductus arterisus group were higher than that of the control group(P<0 .01);The smallest width of ductal color Doppler flow jet in patent ductus arterisus group were bigger than that of the control group(P<0 .01);The maximum velocity at the ductus in patent ductus arterisus group were lower than that of the control group(P<0 .05) .(3)The best critical points of the LA/AO ,the smallest width of ductal color Doppler flow jet and the maximum velocity at the ductus of the spontaneous ductus arteriosus closure in preterm infants were 1 .32 mm ,2 .56 mm and 185 .5 cm/s ,respectivly .Conclusion Echo‐cardiography plays a significant role in prediction of the spontaneous closure of the ductus arteriosus in preterm infants .%目的:探讨早产儿动脉导管未闭超声参数预测早期自然关闭的价值。方法对2013年10月至2014年10月在重庆市妇幼保健院出生的早产儿110例进行前瞻

  18. Experiência global no fechamento percutâneo do canal arterial Overall experience with percutaneous occlusion of the patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Cardoso Pedra

    1998-12-01

    Full Text Available OBJETIVO: Avaliar a experiência global da nossa instituição com o fechamento percutâneo do canal arterial. MÉTODOS: Desde dezembro/92, 150 pacientes foram submetidos a 178 procedimentos (85 - técnica de Rashkind; 87 - coils de Gianturco; 6 - coils Duct Occlud. A mediana de idade foi de 6,5 anos (1 a 57. A média do diâmetro mínimo do canal foi de 3,05±1,24mm (1 a 8. Avaliações clínicas e ecocardiográficas foram realizadas seriadamente. RESULTADOS: Implantes adequados ocorreram em 143 (95,3% pacientes. A prevalência de shunt residual imediato foi de 52,1%, decrescendo para 15,9% no seguimento. Esta taxa caiu para 5,2% após a realização de procedimentos adicionais. Embolização de coils ocorreu em 12 procedimentos e de umbrella em 1. Um paciente apresentou hemólise e outro estenose discreta da artéria pulmonar esquerda. Não houve mortalidade. CONCLUSÃO: Esta modalidade terapêutica é segura e eficaz, proporcionando bons resultados a longo prazo.PURPOSE: To evaluate the overall experience of our institution with percutaneous occlusion of the patent ductus arteriosus. METHODS: Since December/92, 150 patients underwent 178 procedures (85 - Rashkind technique; 87 - Gianturco coils; 6 - Duct Occlud. Median age was 6.5 years (1 to 57. Mean minimum ductal diameter was 3.05±1.24mm (1 to 8. Clinical and echocardiographic evaluations were performed periodically. RESULTS: Adequate implantation was achieved in 143 (95.3% patients. Prevalence of immediate residual shunting was 52.1%, falling to 15.9% during follow-up. This figure decreased to 5.2% after new additional procedures. Umbrella and coil embolization occurred in 1 and 12 procedures, respectively. Hemolysis and mild stenosis of left pulmonary artery were observed in one patient each. There was no mortality. CONCLUSION: This therapeutic modality is safe and efficacious with good follow-up results.

  19. Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates.

    Science.gov (United States)

    Blohm, Martin Ernst; Hartwich, Jana; Obrecht, Denise; Kersten, Jan Felix; Singer, Dominique

    2017-06-01

    This prospective single-center observational study compared impedance cardiography [electrical velocimetry (EV)] with transthoracic echocardiography (TTE, based on trans-aortic flow) and analyzed the influence of physiological shunts, such as patent ductus arteriosus (PDA) or patent foramen ovale (PFO), on measurement accuracy. Two hundred and ninety-one triplicate simultaneous paired left ventricular stroke volume (LVSV) measurements by EV (LVSVEV) and TTE (LVSVTTE) in 99 spontaneously breathing neonates (mean weight 3270 g; range 1227-4600 g) were included. For the whole cohort, the mean absolute LVSVEV was 5.5 mL, mean LVSVTTE was 4.9 mL, resulting in an absolute Bland-Altman bias of -0.7 mL (limits of agreement LOA -3.0 to 1.7 mL), relative bias -12.8 %; mean percentage error MPE 44.9 %; true precision TPEV 33.4 % (n = 99 aggregated data points). In neonates without shunts (n = 32): mean LVSVEV 5.0 mL, mean LVSVTTE 4.6 mL, Bland-Altman bias -0.4 mL (LOA -2.8 to 2.0 mL), relative bias -8.2 %; MPE 50.7 %; TPEV 40.9 %. In neonates with shunts (PDA and/or PFO; n = 67): mean LVSVEV 5.8 mL, mean LVSVTTE 5.0 mL, bias -0.8 mL (LOA -3.1 to 1.5 mL), relative bias -14.8 %, MPE 41.9 %, TPEV 29.3 %. Accuracy was affected by PDA and/or PFO, with a significant increase in the relative difference in LVSVEV versus LVSVTTE: Subjects without shunts -2.9 % (n = 91), PFO alone -9.6 % (n = 125), PDA alone -14.0 % (n = 12), and PDA and PFO -18.5 % (n = 63). Physiological shunts (PDA and/or PFO) in neonates affect measurement accuracy and cause overestimation of LVSVEV compared with LVSVTTE.

  20. Application of patent ductus arteriosus occluder in transcatheter occlusion of coronary artery fistula%动脉导管未闭封堵器在冠状动脉瘘介入治疗的应用

    Institute of Scientific and Technical Information of China (English)

    肖云彬; 陈智; 黄希勇; 王祥; 杨舟

    2014-01-01

    Objective To assess the clinical short-term to mid-term efficacy of transcatheter closure of coronary artery fistula by using patent ductus arteriosus occluder in pediatric patients. Methods During the period from Jan. 2008 to May 2013 at authors’ hospital, transcatheter closure of coronary artery fistula using patent ductus arteriosus occluder was performed in 8 pediatric patients. The clinical data, including follow-up information, were retrospectively analyzed. Results A total of 8 pediatric patients with a mean age of (4.1 ± 3.8) years were enrolled in this study. The fistula originated from the right coronary artery in five cases and from the left coronary artery in three cases. The blood flow shunted to the right atrium (n=4) or to the right ventricle (n = 4). Obstruction of the fistula was successfully accomplished in all patients. All patients were followed up for (2.2 ± 1.2) years. No procedure-related complications or cardiac ischemia occurred. Conclusion For the treatment of coronary artery fistula in pediatric patients, the use of domestic patent ductus arteriosus occluder is safe and effective with satisfactory short-term to mid-term clinical efficacy.%目的:评价动脉导管未闭(PDA)封堵器在小儿冠状动脉瘘介入封堵治疗的近中期疗效。方法回顾性分析2008年1月-2013年5月在我院采用PDA封堵器进行冠状动脉瘘介入封堵治疗患儿的临床资料及术后随访资料。结果本组8例患儿,年龄(4.1±3.8)岁,右冠状动脉起源5例,左冠状动脉起源3例,分流入右心房、右心室各4例。所有患儿均成功进行封堵治疗,术后随访(2.2±1.2)年,无介入治疗相关并发症、心肌缺血表现。结论 PDA封堵器应用于冠状动脉瘘介入封堵治疗近中期疗效满意。

  1. The Clinical Application Analysis of Evidence-based Nursing in Congenital Patent Ductus Arteriosus Closure Occlusion%循证护理在先天性动脉导管未闭封堵术中的应用分析

    Institute of Scientific and Technical Information of China (English)

    张敏

    2012-01-01

      Objective  Explore evidence-based care in congenital patent ductus arteriosus closure occlusion value. Method Select the hospital in January 2010 to November 2012 were congenital patent ductus arteriosus in patients with 110 cases of the study were randomly divided into control and experimental groups and control group for patients with postoperative conventional care. The experimental group patients using evidence-based care model for care, patients were observed incidence of postoperative complications, patient satisfaction and other indicators. Results The incidence of postoperative complications of the experimental group was significantly lower than the control group; experimental group were satisfied with degrees higher than that in the control group, the difference was statistically different(P<0.05). Conclusion Congenital patent ductus arteriosus closure in patients with evidence-based care model for post-operative care can effectively reduce the incidence of postoperative complications, improve patient satisfaction.%  目的探讨循证护理在先天性动脉导管未闭封堵术中的应用价值.方法选取本院从2010年1月至2012年11月收治的先天性动脉导管未闭患儿55例作为研究对象,将其随机分为对照组和实验组,对照组患儿实施术后传统常规护理,实验组患儿术后介入循证护理模式,观察两组患儿术后并发症发生情况、患者满意度等指标.结果实验组术后并发症发生率(14.3%)显著低于对照组(33.3%),差异有统计学差异(P <0.05);实验组患儿及其家属满意度(96.4%)高于对照组(63%),差异有统计学差异(P <0.05).结论对先天性动脉导管未闭封堵术患儿采用循证护理模式,可有效降低术后并发症发生率,提高患儿及其家属满意度.

  2. 动脉导管未闭患儿TFAP-2B基因突变的研究%Mutation of TFAP-2B gene in patients with patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    陈轶维; 赵武; 李奋; 吉炜; 傅启华; 张志芳; 王剑

    2010-01-01

    目的 发现我国动脉导管未闭(patent ductus arteriosus,PDA)患儿分子遗传方面缺陷,为PDA早期预防及遗传咨询提供支持.方法 收集100例单纯性PDA患儿的临床资料和外周静脉血样本,以100名健康儿童为对照.应用聚合酶链式反应(polymerase chain reaction,PCR)扩增TFAP-2B基因的全部外显子和外显子两侧部分内含子,并对扩增片段进行双向测序.应用BLAST程序将所测TFAP-2B基因序列与GeneBank中的已知序列进行对比以检测基因突变.采用逆转录聚合酶链式反应(reverse transcription polymerase chain reaction,RT-PCR)对1例家族史阳性患儿及其家属共16人TFAP-2B部分cDNA片段进行扩增,扩增产物直接进行双向序列测定.结果 基因分析显示,在1例家族史阳性患儿及其患病亲属中,TFAP-2B第3内含子剪接位点+5位发生突变[intron3(+5)G>A],患儿TFAP-2B基因部分cDNA巢式PCR扩增结果 提示3号外显子完全缺失.此外,还发现了一个新的单核苷酸多态性,即转录起始点上游第34位的鸟嘌呤变为腺嘌呤,这个多态在PDA患者和健康对照组的频率分布差异有统计学意义(Z=-2.513,P=0.012).结论 TFAP-2B基因突变能够导致家族型PDA.%Objective To identify novel genetic mutations in Chinese patients with congenital patent ductus arteriosus (PDA). Method Clinical data and peripheral blood specimens from a kindred spanning 3 generations in which 5 of 16 individuals had PDA and a cohort of 95 unrelated subjects with PDA were collected, and 100 unrelated healthy individuals were included as controls. The coding exons and flanking introns of TFAP-2B gene were amplified by polymerase chain reaction ( PCR ) with specific primers. We aligned the acquired sequences with which publicized in GenBank by the aid of program BLAST. Reverse transcription-polymerase chain reaction (RT-PCR) was used to amplify the parts of TFAP-2B and sequencing was performed on PCR products forward and reversely

  3. Surgical treatment of interrupted aortic arch associated with ventricular septal defect and patent ductus arteriosus in patients over one year of age

    Institute of Scientific and Technical Information of China (English)

    Li Zhiqiang; Li Bin; Fan Xiangming; Su Junwu; Zhang Jing; He Yan; Liu Yinglong

    2014-01-01

    Background Interrupted aortic arch (IAA) is a rare congenital anomaly affecting 1.5% of infants with congenital heart disease.Neonatal repair of IAA is required to avoid irreversible pulmonary vascular lesion.However,in China,patients with IAA associated with ventricular septal defect (VSD) and patent ductus arteriosus (PDA) over one year of age are common.So we investigated the outcome of surgical treatment of IAA with VSD and PDA in patients over one year of age.Methods From January 2009 to December 2012,19 patients with IAA have undergone complete single-stage repair.The patients' mean age was 4.4 years,ranging 1 to 15 years; and their mean weight was 12.8 kg,ranging 4.2 to 36.0 kg.Fifteen IAA were type A,four were type B.Preoperative cardiac catheterization data were available from all patients.Mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) were measured.The measurements of postoperative pulmonary artery pressure were taken in the operating room at the end of the case.All patients underwent echocardiographic examinations before discharged from the hospital.In addition,cardiac catheterization and echocardiographic examinations were performed during follow-up.Selective brain perfusion through the innominate artery during aortic arch reconstruction was used in all patients.Mean follow-up was (1.6±0.8) years.Results There were two hospital deaths (2/19,11%).One patient died of pulmonary hypertension crisis,and another died of postoperative low cardiac output.Five cases had other main postoperative complications but no postoperative neurologic complications.Seventeen survivors were followed up,and there were no late deaths or reoperation.Mean cross-clamp duration was (85±22) minutes and selective brain perfusion duration was (34±11) minutes.Two patients required delayed sternal closure at two days postoperatively.Intensive care unit and hospital stays were (9±8) days and (47±24) days,respectively.Pressure gradients across

  4. 影响吲哚美辛对早产儿动脉导管未闭疗效的相关因素分析%Correlative Factors of Indomethacin Treatment for Patent Ductus Arteriosus in Premature Infants

    Institute of Scientific and Technical Information of China (English)

    刘新晖; 高喜容; 黄维清; 杨慧; 周勇; 庄严

    2013-01-01

    目的:调查分析影响吲哚美辛对动脉导管未闭(PDA)早产儿疗效的临床相关因素.方法:收集36例我院住院确诊为PDA并应用吲哚美辛治疗的患儿的临床资料,建立数据库并分析临床相关因素与治疗效果的关系.结果:给予吲哚美辛治疗后,患儿的PDA关闭28例,关闭率为77.78%,未成功关闭8例,占22.22%.单因素分析结果显示,孕周、出生体重、首次用药时间对于PDA关闭率有显著影响(P<0.05);Logistic回归分析显示,出生体重、首次用药时间对PDA关闭率的影响差异有统计学意义(P<0.05).结论:影响吲哚美辛对早产儿PDA关闭临床疗效的主要因素为出生体重及首次用药时间.%Objective: To investigate and analyze the clinical associated risk factors of indomethacin treatment for patent ductus arteriosus (PDA) in premature infants. Methods; The clinical data of 36 cases who were diagnosed as PDA and received indomethacin treatment in our hospital were collected. The therapeutic efficacy was observed, and the clinical associated risk factors were recorded. The database of clinical records was established and analyzed by using regression analysis method. Results; After indomethacin treatment, ductus arteriosus were closed successfully in 28 patients (77.78% ) , and only eight premature infants (22.22% ) required surgical ligation of the ductus. By using univariate analysis, the gestational weeks, birth weight and the timing of first dose were identified as risk factors to the outcome; multivariate logistic regression analysis showed that birth weight and the timing of first dose were identified as risk factors to the outcome. Conclusions; The main clinical associated risk factors of indomethacin treatment for PDA in premature infants were birth weight and the timing of first dose.

  5. 高海拔地区动脉导管未闭藏族患者介入治疗的疗效分析%Evaluation of interventional therapy in high - altitude Tibetan patients with patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    白晟遥; 马东星; 吴晓霞; 张雪梅; 张凤羽; 刘惠亮

    2011-01-01

    目的 探讨高海拔缺氧地区动脉导管未闭(patent ductus arteriosus,PDA)藏族患者介入手术治疗效果.方法 9例来自西藏、生长环境均在海拔3500 m以上的藏区PDA患者.年龄3~21岁,平均(10 4±5 5)岁,入我院行超声心动图检查确诊后行介入治疗.其中合并轻度肺动脉高压( pulmonary hypertension,PH)1例,中度肺动脉高压1例,重度肺动脉高压2例.手术皆采用国产封堵器在降主动脉造影下行介入封堵.结果 除1例试封堵失败转外科外,余8例手术均取得成功.2例重度PH患者术前测肺动脉收缩压分别为78、83 mmHg,术后即刻测肺动脉收缩压降至16、48 mmHg,中度及轻度PH患者术后即刻肺动脉压均降至正常.术后2例出现一过性血小板减少症,2例存在少量残余分流,无严重肺部感染及封堵器脱落等严重并发症.结论 长期生活在高海拔低氧地区可逆性PH的PDA患者经导管介入封堵治疗安全有效.%Objective To study the efficacy of interventional operations in high -altitude patients with patent ductus arteriosus (PDA). Methods The sample consisted of 9 Tibetan patients who were living at an altitude of over 3500 meters. Their age ranged from 3 to 21 years. Echocardiography was performed, which identified 1 case of patent ductus arteriosus (PDA) associated with severe subaortic stenosis (AS) , in whom interventional therapy was not successful. 8 cases, after diagnostic confirmation, received arterial catheter interventional treatment, one of whom was complicated by mild pulmonary hypertension ( PH) , another one by moderate pulmonary hypertension, and two by severe pulmonary hypertension. The operation proceeded with the domestic occluder in transcatheter closure under the descending aorta angiography. Results In two patients with severe pulmonary arterial hypertension whose preopera-tive pulmonary artery pressure was 78mmHg and 83mmHg respectively, the postoperative pulmonary arterial pressure fell to

  6. Changes of pulmonary artery pressure after interventional transcatheter closure in patients with patent ductus arteriosus%动脉导管未闭介入治疗后肺动脉压改变的研究

    Institute of Scientific and Technical Information of China (English)

    张克成; 袁杰; 于波; 孙勇

    2012-01-01

    目的:探讨动脉导管未闭(PDA)患者介入封堵治疗后肺动脉压改变的影响因素.方法:回顾性分析2008年1月至2011年9月在我院行介入封堵治疗的43例PDA患者的临床及介入手术资料.结果:与治疗前比较,PDA患者介入封堵治疗后肺动脉收缩压[PASP,(76±51)mmHg比(46.26±17.26)mmHg]、肺动脉舒张压[PADP,(39.47±17.11)mmHg比(15.84±10.74)mmHg]、平均肺动脉压[MPAP,(54.72±19.21)mmHg比(28.53±14.41)mmHg]均显著降低(P均=0.0001),PADP下降程度比PASP更明显[(0.54±0.38)比(0.38±0.15),P=0.012]; PDA患者介入治疗后PASP、MPAP下降程度与年龄呈负相关(B=-0.04,P=0.012;B=-0.006,P=0.009);术后MPAP下降程度与动脉导管管径呈正相关(B=0.022,P=0.01).结论:介入封堵治疗对动脉导管未闭有益,应在年龄较小时尽早手术.%Objective; To analyze influencing factors of change of pulmonary artery pressure after interventional transcatheter closure in patients with patent ductus arteriosus (PDA). Methods: Clinical and intervention data of 43 PDA patients undergoing interventional transcatheter closure in our hospital from Jan 2008 to Sep 2011 were retrospectively analyzed. Results: Compared with before treatment, there were significant decrease in pulmonary arterial systolic pressure [PASP, (76 ?51) mmHg vs. (46. 26 ?17. 26) mmHg], pulmonary arterial diastolic pressure [PADP, (39. 47 ?7. 11) mmHg vs. (15. 84 + 10. 74) mmHg] and mean pulmonary arterial pressure [MPAP, (54.72 + 19. 21) mmHg vs. (28. 53 ?14. 41) mmHg] in PDA patients after interventional transcatheter closure (P = 0. 0001 all), decrease degree of PADP was more significant than that of PASP [ (0. 54 + 0. 38) vs. (0. 38 ?0.15), P = 0. 012]; decrease degree of PASP and MPAP in PDA patients after interventional transcatheter closure were negatively correlated with age (B= - 0. 04, P= 0. 012; B= - 0. 006, P = 0. 009); decrease degree of MPAP after operation was positively correlated with ductus arteriosus

  7. The application of transthoracic echocardiography in performing transcatheter occlusion of patent ductus arteriosus%经胸超声心动图在动脉导管未闭封堵术中的应用价值

    Institute of Scientific and Technical Information of China (English)

    李国英; 李叶阔; 徐明; 罗国新; 何建新; 袁桂忠

    2013-01-01

    目的 评价经胸超声心动图(TTE)指导动脉导管未闭(patent ductus arteriosus,PDA)封堵术术前及术中的应用价值.方法 2008年5月至2012年5月收治132例PDA患者,术前用彩色多普勒超声诊断仪经胸观察PDA形态,并测量各切面PDA内径,据此结果直接选择相应封堵器.经心导管PDA封堵术中应用TTE监测介入过程,确定封堵器牢固程度及有无残余分流.结果 TTE术前检查PDA直径为2 ~ 12mm,平均(5.49±1.93)mm,选用PDA封堵器大小为4~ 22 mm,平均(10.43±2.91)mm.超声测量PDA直径与封堵器大小相关性良好(r=0.74,P< 0.001).手术成功率100%,封堵器牢固,无脱落,无分流.结论 TTE术前及术中直接指导PDA封堵术是一种可行、有效、便捷的方法,尤其适用于小儿.%Objective To discuss the application value of transthoracic echocardiography (TTE) in guiding the performance of transcatheter occlusion of patent ductus arteriosus (PDA). Methods During the period from May 2008 to May 2012, a total of one hundred and thirty-two patients with PDA were admitted to authors' hospital. The patient's age ranged from 7 months to 67 years. Before operation the size and shape of PDA were measured by TTE (GE vivid7 and Philips IE33). The inner diameter of the relevant cross - sections were determined, based on which the proper occluder was selected for each patient. With the help of TIE monitoring the transcatheter occlusion of PDA was carried out. The fixation degree of the occluder was estimated, and the presence or absence of residual shunt was determined. Results Preoperative TTE examination showed that the diameter of PDA was 2-12 mm with a mean of (5.49 ± 1.93 )mm. The size of occluder used in the operation was 4-22 mm with a mean of (10.43 ± 2.91) mm. A significant correlation existed between the PDA diameter measured by TTE and the size of the used occluder (r = 0.74, P < 0.001). The success rate of the operation was 100%. All the occluders were fixed

  8. Fisioterapia em recém-nascidos com persistência do canal arterial e complicações pulmonares Chest physical therapy in newborn infants with patent ductus arteriosus and pulmonary complications

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    Ivete Furtado Ribeiro

    2008-03-01

    Full Text Available OBJETIVOS: Revisar as complicações pulmonares e intervenções fisioterapêuticas disponíveis para recém-nascidos com persistência do canal arterial (PCA. FONTES DE DADOS: Artigos publicados nas fontes de dados Medline e Lilacs, além de capítulos de livros nos idiomas português e inglês, entre 1992 e 2006. As palavras-chave utilizadas para busca foram: "canal arterial", "prematuridade", "síndrome do desconforto respiratório", "complicações" e "pulmão". SÍNTESE DOS DADOS: A PCA é uma intercorrência freqüente em recém-nascidos pré-termos, que pode se associar a complicações pulmonares, tais como atelectasias, infecções pulmonares e falha na extubação, aumentando o tempo de ventilação mecânica e de internação na Unidade de Terapia Intensiva Neonatal. Os recursos fisioterapêuticos visam melhorar as condições pulmonares, propiciando o aumento da complacência pulmonar e a diminuição da resistência de vias aéreas, além de otimizar o mecanismo de depuração mucociliar e, dessa forma, reduzir o trabalho respiratório. CONCLUSÕES: A fisioterapia respiratória contribui para melhorar a evolução dos neonatos com complicações pulmonares por persistência de canal arterial, permitindo otimizar a mecânica respiratória, além de melhorar a oxigenação e a relação ventilação/perfusão.OBJECTIVE: To review the pulmonary complications and the available chest physical therapy interventions for neonates with patent ductus arteriosus (PDA. DATA SOURCES: Studies were retrieved from Medline and Lilacs and textbooks in Portuguese and in English, from 1992 to 2006. The following key-words were searched: "ductus arteriosus", "prematurity", "respiratory distress syndrome", "complications", "lung". DATA SYNTHESIS: PDA is frequently observed among preterm infants and can be associated with pulmonary complications, such as atelectasis, infections, extubation failure, increased mechanical ventilation dependency and longer

  9. Analysis on the efficacy of interventional therapy in the treatment of patent ductus arteriosus in children%介入封堵儿童动脉导管未闭疗效分析

    Institute of Scientific and Technical Information of China (English)

    沈兴; 赵香芝; 贾鹏; 刘斌; 孙玉琴

    2012-01-01

    目的:探讨介入治疗儿童动脉导管未闭(Patent ductus arteriosus,PDA)的临床疗效.方法:回顾分析2007年11月-2010年12月在本院作经皮PDA封堵的63例病人资料,着重分析动脉导管的测量、手术方法、临床疗效.结果:典型PDA经胸超声测量值与造影后X线测量值差异无统计学意义,但在小型和大型PDA中两者差异有统计学意义;所有病人中61例封堵成功,其中7例植入弹簧圈,其余54例采取蘑菇伞堵闭器封堵成功.结论:经皮PDA封堵术安全有效,术中注重患者的个体情况,注意操作细节,能更好地避免并发症,提高成功率.%Objective:To explore the efficacy of interventional therapy in the treatment of patent ductus arteriosus (PDA) in children. Methods: Totally 63 patients with PDA in our hospital from November 2007 to December 2010 were treated by transcatheter closure. Their clinical data were retrospectively analyzed focusing on the measurement of arterial ducts, operation methods and therapeutic results. Results : There was no significant difference in the measurements between transthoracic echocardiography (TTE) and aortography in typical PDA cases, but there were significant differences between small and large PDA cases. The devices were successfully implanted in 61 cases,among which coils were implanted in 7 cases and Amplatzer duct occluder in 54 cases. Conclusion:Transcatheter PDA occlusion is safe and effective. Success rate can be improved and complications can be avoided if due attention is paid to the individual condition and operational details.

  10. Bedside surgical ligation of patent ductus arteriosus in low body weight premature infants%低体重早产儿动脉导管未闭的床旁外科治疗

    Institute of Scientific and Technical Information of China (English)

    王辉; 杨学勇; 刘宇航; 付松; 李秋平; 封志纯; 周更须

    2011-01-01

    Objective To discuss the experience of bedside surgical treatment of patent ductus arteriosus(PDA) by ligature or clip ligation for premature infants.Methods The clinical data of 25 bedside surgical ligations of PDA from Oct.2009 to Oct.2010 were retrospectively analyzed.Results All these 25 cases recovered uneventfully,no death or surgical complication occurred.ConclusionsThe PDA canbe adequately exposed by a limited left posterolateral thoracotomy.Premature ICU department could satisfy the requirement of anesthesia and surgical operation.Surgical ligation of PDA,either by ligature or clip,is a good option for premature infants with PDA.%目的 探讨内科保守治疗动脉导管未闭(patent ductus arteriosus,PDA)效果不佳的早产儿实施床旁外科手术结扎(或钳夹)的经验.方法 回顾性分析我院2009年10月至2010年10月心外科对25例行床旁动脉导管结扎(或钳夹)术的手术过程及术后转归.结论 所有行动脉导管结扎术(或钳夹术)患儿中,无术中死亡病例,术后均未出现与手术相关的并发症.结论 经左胸后外侧切口治疗早产儿PDA,术中暴露视野清晰、操作简便.层流病房可满足麻醉、术中监护及外科手术操作的需要,手术治疗效果肯定.早产儿经内科保守治疗PDA无效,或存在多系统疾病,或存在药物治疗禁忌的情况下,均应行动脉导管结扎(或钳夹)术.

  11. Surgical Closure of Patent Ductus Arteriosus via Left Subaxiliary Small Incision%左腋下小切口动脉导管夹闭术100例报告

    Institute of Scientific and Technical Information of China (English)

    刘勇; 刘健; 黄击修; 林小彬; 付建

    2011-01-01

    Objective To evaluate the value of surgical closure for patent ductus arteriosus (PDA) through a small left gubaxillary incision. Methods From January 2004 to January 2011, 100 patients who received Hetn-o-lok ligation for PDA were enrolled in this study. Results No perioperative death occurred in this series. The mean length of the small incision was (6. 5 ± 1. 8)cm, mean opration time (56 ±21) min, and mean hospital stay (9.7 ± 1.9) days. The patients were followed up for 2 months to 3 years with a mean of 2. 3 years, during which no re-patent or pseudo-aneurysma was detected. Conclusion Surgical closure through a small incision at the left subaxillary is safe, effective, and easy-to-perform for PDA with concealed incision and quick recovery.%目的 探讨左腋下小切口动脉导管夹闭术治疗动脉导管未闭(patent ductus arteriosus,PDA)的价值. 方法 2004年1月~2011年1月对100例PDA全麻下经左腋下小切口直视下借助Hem-o-lok结扎夹行动脉导管夹闭术. 结果 切口长度(6.5±1.8)cm,手术时间(56±21)min,术后住院时间(9.7±1.9)d.100例随访2个月~3年,平均2.3年,无再通及假性动脉瘤形成. 结论 经左腋下小切口动脉导管夹闭术是治疗PDA的有效方法,切口隐蔽,术后恢复快,安全可靠,操作简单,利于推广.

  12. 早产儿动脉导管未闭介入封堵术一例并文献复习%Transcatheter occlusion of patent ductus arteriosus in a preterm infant and review of literatures

    Institute of Scientific and Technical Information of China (English)

    周开宇; 唐军; 华益民; 石晓青; 王一斌; 乔莉娜; 王晓琴; 母得志

    2016-01-01

    Objective To investigate the characteristics of haemodynamically significant patent ductus arteriosus (hsPDA), and the indications of percutaneous transcatheter PDA occlusion.Method The data of a preterm infant admitted to West China Second Hospital in December.2013, who finally underwent percutaneous transcatheter PDA occlusion were analyzed With the key words of "preterm" "patent ductus arteriosus" " transcatheter", Pubmed were searched and potentially relevant reports were retrieved and assessed by manual sorting from 2005 to 2015.Relevant reports in literature were reviewed.Result A preterm infnat at gestational age of 35 weeks with birth weight of 1 900 g was admitted to our department.Oral ibuprofen for closure of the patent ductus arteriosus failed, and the patient exhibited the features of "ventilator dependent" PDA of premature infants.On the 30th postnatal day, with the body weight of 1 950 g, under basal anesthesia, the infant underwent percutaneous transcatheter PDA occlusion, and the procedure successfully occluded the ductus with Amplatzer duct occluder (ADO).The ventilator was weaned 19 hours post procedure, and the child was discharged 7 days post operation with good recovery, and her growth and development was good.Follow-up for 13 months indicated that the intelligence and physical development evaluated by Bayley scales of infant development test were at the same level of normal agematched infants.Fifty-two preterm infants treated with percutaneous transcatheter PDA occlusion in 8 reports were enrolled.The preterm infants were born at 23-35 gestational weeks, with PDA diameter of 1-4 mm.The occlusive device included coil, ADO, ADO Ⅱ, ADO Ⅱ AS, AVP Ⅱ and AVP Ⅳ respectively, with body weight of 870-2 610 g on operational days and age of 11-90 postnatal days.All those infants either failed or had contraindications to drug therapy, and exhibited as hsPDA cases.Percutaneous transcatheter PDA occlusions were performed successfully in all 52

  13. Effect of the valved stent on closure of patent ductus arteriosus in a miniswine model%带瓣膜心血管内支架封堵动脉导管未闭的可行性研究

    Institute of Scientific and Technical Information of China (English)

    周永新; 王永武; 邵杰; 孙林; 李刚; 梅运清; 胡大一

    2009-01-01

    Objective To evaluate the feasibility of a valved stent on closure patent ductus arteriosas in a Chinese miniswine model. Methods Self-expandable nitinol stents were made of Ni-Ti shape memory alloy (9 nun in diameter). Bovine pericardium was shaped and sutured onto the stents. Fluid passing test, pre-releasing test and static test of pressure in tube were performed in all devices before use. In eight Chinese miniswine, vascular grafts (PTFE vascular prosthesis) were surgically inserted between the descending thoracic aorta and pulmonary artery for establishment of patent duetus arteriasus model Valved stents were deployed to occlude the patent ductus arteriosus. Echocardiography was performed two hours post operation. Aortic angiography was made 30 days post operation in survived animals. Animals were then sacrificed for autopsy and electron microscopy examinations. Results In vitro testing showed that the closure of the valved stent leaflets was satisfactory and fluid flows were not restricted in the opposite direction. The valved stenta could be released through catheter, expanded completely, rapidly fixed in the tube. Closure of patent ductus arteriosas was succeeded in 6 out of 8 animals. One animal died of respiratory failure 2 hours post operation, another one died of pulmonary embolism due to valved stent displacement. Resident shunt was not evidenced by echocardiography, aortic angiography and dissection examinations in the remaining 6 animals. The new endothelial tissue fully covered the pulmonary and aortic sides of patent ductus arteriosus in 4 and 3 animals respectively. The electron microscopic observation revealed endothelial coverage of diveea. Conclusion The valved stent could effectively close artificial patent dactus arteriosus in vivo with satisfactory new intima covering on beth sides of patent ductus arteriosus.%目的 探讨带瓣膜心血管内支架在动脉导管封堵中应用的可行性及其体内特性,以期研制一种用于封堵

  14. 低体重早产儿动脉导管未闭治疗进展%Therapy progress of patent ductus arteriosus in low-birth-weight premature infants

    Institute of Scientific and Technical Information of China (English)

    郑祥鑫(综述); 王文生(审校)

    2015-01-01

    动脉导管未闭是一种新生儿常见疾病。在早产儿,尤其是低体重儿中其发病率更高。如未及时治疗,往往会导致新生儿颅内出血、呼吸窘迫综合征、慢性肺疾病等严重并发症。目前临床上有药物治疗、手术治疗、介入治疗及对症治疗,该文对低体重早产儿动脉导管未闭治疗的进展作一综述。%Patent ductus arteriosus( PDA) has high morbidity in new-borns. This disease tends to occur in premature,especially in the low-birth-weight infants. It can lead to severe complications including intracranial hemorrhage,respiratory distress syndrome,and chronic lung disease without treatment. Treatment for PDA usual-ly involves medications,operations,interventions and symptomatic treatment. This paper summarizes the progres-ses of the therapy of PDA in low-birth-weight premature infants.

  15. 极低出生体重早产儿动脉导管未闭的治疗%Treatment of patent ductus arteriosus in very low birth weight preterm infants

    Institute of Scientific and Technical Information of China (English)

    陈涵强; 杨长仪; 杨文庆; 石惠英; 林云峰

    2011-01-01

    Objective To investigate the treatment of symptomatic patent ductus arteriosus (PDA) in very low birth weight preterm infants. Methods From January 1, 2008 to December 31, 2010, 78 very low birth weight preterm infants (birth weight<1500 g) were diagnosed as symptomatic PDA. Among which, 42 cases administered orally with indomethacin (0.2 mg/kg, every 12 hrs for three times) were taken as treatment group, while five cases in this group who failed to indomethacin treatment were interrupted with video-assisted thoracoscopic surgery. And 36 cases who did not receive treatment for ductus arteriosus were taken as control group. The clinical outcomes, complications and prognosis of these patients were observed. Results There were no significant differences between the gentle percentage, gestational age, diameter of ductus arteriosus, rate of complicated with heart failure, sepsis, neonatal respiratory distress syndrome and intraventricular hemorrhage of two groups (P>0.05, respectively). The ductus arteriosus closed in 33 patients of treatment group (78.6%) and in nine patients of control group (25.0%)(χ2=22.39,P=0.000). There were no significant differences in serum creatinine level and platelet count between before and after the treatment in treatment group(P>0.05). Compared with control group, the treatment group had lower incidence of intraventricular hemorrhage (z=1.167, P=0.030), shorter duration of oxygen therapy [(8.0±5.5) d vs (13.3±9.3) d, t=2.225, P=0.032] and shorter hospital stay [(39.0±7.7) d vs (43.6±10.6) d, t=2.229, P=0.029]; while the incidence of bronchopulmonary dysplasia and necrotizing enterocolitis were similar (P>0.05). The five cases of PDA who received video-assisted thoracoscopic surgery were successfully interrupted with no residual shunt left, while three of them had lung infections and one had pleural effusion, but no pneumothorax and infant death associated with surgery occurred. Conclusions Symptomatic PDA of very low birth weight

  16. Efficacy of a first course of Ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight.

    Directory of Open Access Journals (Sweden)

    Doriane Madeleneau

    Full Text Available Therapeutic strategies for patent ductus arteriosus (PDA in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA newborns.This single-centre retrospective study included 185 infants born at 24+0-27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea: 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes.The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2-12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3-70.5] p=0.003.There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.

  17. Microinvasive iigation of patent ductus arteriosus: Report of 13 cases%微小切口结扎动脉导管未闭(附13例报告)

    Institute of Scientific and Technical Information of China (English)

    李香伟

    2001-01-01

    Objective: To study the significance of patent ductus arteriosus (PDA)ligating through microinvasive vertical cut trans-left oxter. Methods: Thirteen children with PDA received ligation through microinvasive vertical cut trans-left oxter. Which was thoracotomy through a 5 cm cut in fourth intercostal space followed by rutine PDA ligating.Results:All operations got good exposure and smooth completion. Patients hadless complications and no death. Conclusion:Microinvasive vertical cut trans-left oxter with occult apparence and satisfactory result is particularly suitable for ligation of children with PDA.%目的:探讨左腋下微小切口结扎动脉导管未闭(PDA)的临床应用。方法:本组对13例小儿PDA应用左腋下微小直切口结扎术,切口以第4肋间上下延长共约5cm进胸后常规行PDA结扎术。结果:全组术野显露良好,术中经过顺利,术后并发症少,无死亡。结论:左腋下微小切直切口手术径路隐蔽美观,效果满意,特别适合小儿PDA结扎,值得临床推广。

  18. 单纯超声心动图引导下行动脉导管未闭封堵术的安全性和有效性%Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance

    Institute of Scientific and Technical Information of China (English)

    潘湘斌; 欧阳文斌; 李守军; 郭改丽; 刘垚; 张大伟; 张凤文; 逄坤静; 方能新

    2015-01-01

    目的 探讨超声心动图作为唯一影像学工具引导动脉导管未闭封堵术的安全性和有效性.方法 2013年6月至2014年6月,连续入选单纯动脉导管未闭患者30例,年龄(6.3±2.5)岁,体质量(22.5±7.3)kg,动脉导管直径(3.8 ±0.9)mm.患者均在经胸超声心动图引导下经股动脉行动脉导管未闭封堵术,封堵后以超声心动图评价治疗效果.术后1个月在门诊随访.结果 30例患者均成功在超声心动图引导下完成动脉导管未闭封堵术,手术操作时间为(32.8±5.7) min,Amplatzer ADOⅡ封堵器直径(4.9 ±1.0)mm.6例患者术后早期有微量残余分流,无外周血管损伤及心脏穿孔等并发症.所有患者均康复出院,住院时间为(3.4±0.7)d.术后1个月随访,患者均无残余分流、心包积液等并发症.结论 单纯超声心动图引导下经股动脉行动脉导管未闭封堵术安全、有效,能避免使用X线和对比剂.%Objective To avoid the radiation injuries and use of contrast agent,we assessed the safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance.Methods From June 2013 to June 2014,thirty patients (mean age:(6.3 ± 2.5) years,mean body weight:(22.5 ± 7.3) kg) with pure patent ductus arteriosus were continuously included in this study.The mean diameter of patent ductus arteriosus was (3.8 ± 0.9) mm.Patients were all treated by percutaneous patent ductus arteriosus closure via right femoral artery solely under thoracic echocardiography guidance.The efficacy of the procedure was evaluated by thoracic echocardiography.Follow-up was performed at one month after procedure.Results All 30 cases were successfully treated with percutaneous patent ductus arteriosus closure solely under thracic echocardiography guidance.The procedural time was (32.8 ± 5.7) minutes.The mean diameter of Amplatzer ADO Ⅱ was (4.9 ± 1.0) mm.Postoperative trivial residual shunt occurred in six patients

  19. Evaluation of the efficacy and safety of oral ibuprofen suspension in treatment of neonatal patent ductus arteriosus%布洛芬治疗新生儿动脉导管未闭的有效性及安全性评价

    Institute of Scientific and Technical Information of China (English)

    门晓英; 张丽范

    2010-01-01

    目的 评价口服布洛芬混悬剂治疗新生儿动脉导管未闭的有效性及安全性. 方法 将2006年1月至2009年12月收治的新生儿动脉导管未闭128例作为观察组,口服布洛芬混悬剂治疗;将2003年1月至2005年12月收治的新生儿动脉导管未闭92例作为对照组,采用吲哚美辛治疗;比较两组患者的疗效及不良反应发生情况. 结果 观察组的关闭情况明显优于对照组,且不良反应发生率明显少于对照组,两组比较,差异均有统计学意义(均P<0.05). 结论 口服布洛芬混悬剂治疗新生儿动脉导管未闭疗效满意,且不良反应少,值得临床推广应用.%Objective To observe the efficacy and safety of oral ibuprofen suspension in treatment of neonatal patent ductus arteriosus. Methods From January 2006 to December 2009 in our hospital,128 cases with neonatal patent ductus arteriosus were accepted as the observation group,treated with oral Ibuprofen Suspension:from January 2003 to December 2005 in our hospital,92 cases with neonatal patent ductus arteriosus were accepted as the control group,treated with lndomethacin.Efficacy and adverse reaction of two groups were compared. Results The closure of the observation group was better than the control group,and the incidence of adverse events was less than the control group,the differences between two groups were statistically significant(P<0.05). Conclusion Oral ibuprofen suspension in treatment of neonatal patent ductus arteriosus had satisfactory effect and less adverse reaction,it was worthy of clinic application.

  20. Medical Cost Management of Single Clinical Pathway in Patients with Patent Ductus Arteriosus%动脉导管未闭单病种临床路径的成本管理

    Institute of Scientific and Technical Information of China (English)

    杨仲毅; 杨锐; 李玉秀; 郑莹

    2011-01-01

    Objective To investigate the effect of single clinical pathway on hospital stay and medical cost in children with patent ductus arteriosus(PDA) so as to develop a reasonable control system of disease and cost for enhancing the quality of disease management and disease cost control. Methods From February 2007 to June 2010,112 PDA children were enrolled in the study. According to odd-even days of the hospitalization sequence,all the patients were divided into routine treatment group(n=52) and clinical pathway group(n=50). The patients in the routine treatment received the routine diagnosis and treatments. While the patients in the clinical pathway group were diagnosed and treated with "PDA occluder standardized patient clinical pathway process" and "PDA occluder clinical path form". Comparisons were conducted on the examination fees , inspection fees, medication costs , medical expenses , hospitalization dates , and other related contents in all the patients. Results Compared with the routine treatment group,the average length of stay of children was decreased in the clinical pathway group (P<O.05) ;the inspection fees during hospitalization, drugs, other fees and total expenses were also significantly decreased(P<O.05). Conclusion The implementation of the clinical pathway can effectively improve the quality of medical management and control medical costs.%目的 探讨单病种临床路径管理对动脉导管未闭(patent ductus arteriosus,PDA)患儿的住院时间和费用的影响,以制定合理的病种费用控制体系,加强病种质量管理和病种费用控制.方法 选择2007年2月至2010年6月住院的PDA患儿共112名,按住院单双日分为常规治疗组52例,临床路径组60例.常规治疗组采用常规诊断和治疗方案;临床路径组采用和规范治疗流程进行诊断和治疗.对比两组患者的检验费用、检查费用、用药费用、医疗费用、住院日期等相关内容.结果 与常规治疗组相比,临床路

  1. Avaliação tomográfica pulmonar tardia em prematuros com displasia broncopulmonar e persistência de canal arterial Late pulmonary tomography assessment in premature infants with bronchopulmonary dysplasia submitted to patent ductus arteriosus managemnent

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    Lilian Beani

    2007-12-01

    Full Text Available OBJETIVO: Avaliação tomográfica do parênquima pulmonar de crianças nascidas prematuras de muito baixo peso, com persistência do canal arterial submetidas a tratamento clínico ou cirúrgico e que apresentaram displasia broncopulmonar. MÉTODOS: Entre dezembro de 2006 e janeiro de 2007, 14 crianças foram submetidas à tomografia computadorizada de alta resolução (TCAR, que nasceram prematuras, peso inferior a 1500 gramas, com displasia broncopulmonar (DBP e persistência do canal arterial (PCA, os quais necessitaram tratamento para oclusão do canal, sendo divididos em dois grupos: A - clínico (n = 6 e B - cirúrgico (n = 8. Nove pacientes eram do sexo masculino e cinco, do feminino, com idade média de 36,5±4,3 meses. As TCAR foram analisadas por dois observadores independentes e as lesões quantificadas em cada paciente. Para análises estatísticas, foi utilizado o teste de Mann-Whitney e considerados significantes valores de pOBJECTIVE: To assess through high-resolution computed tomography the pulmonary parenchyma of children prematurely born with both very low birth weight and patent ductus arteriosus submitted to medical or surgical treatment that developed bronchopulmonary dysplasia. METHODS: Between December 2006 and January 2007, 14 children prematurely born with a weight less than 1500g with bronchopulmonary dysplasia (BPD and patent ductus arteriosus (PDA were submitted to high-resolution computed tomography (HRCT. All of them underwent surgical closure of the canal divided into two groups: A - medical (n=6 and B - surgical (n=8. The pool of patients comprised 9 baby boys and 5 girls who were 36.5±4.3 month-old. The HRCT were analyzed by two independent observers and quantified in each patient. The statistical analyses were assessed using the Mann-Whitney test, and p<0.05 was considered statistically significant. RESULTS: Three patients presented normal tomographies, being two of A group and one of B. In A, the most

  2. Dissecção e rotura da artéria pulmonar associada a persistência do canal arterial: relato de um caso Dissection and rupture of pulmonary artery associated to patent ductus arteriosus: case report

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    Mabel de Moura Barros Zamorano

    1987-08-01

    Full Text Available É descrito um caso de dissecção da artéria pulmonar, com rotura intrapericárdica e tamponamento cardíaco, em menina de 13 anos de idade, portadora de canal arterial grande e valva pulmonar bicúspide. Havia hipertensão pulmonar com arteriopatia plexogênica grave; nas grandes artérias elásticas, a camada média tinha alterações necróticas e reparadoras profundas. Discute-se o papel da medionecrose, condição que é exacerbada pela hipertensão e por características individuais, na patogenia do aneurisma dissecante e no caso em questão. A análise da literatura mostra que, na artéria pulmonar, a dissecção é sempre um acidente fatal, por rotura ou obstrução arterial. O tratamento desta intercorrência, eminentemente cirúrgico, raramente é possível, devido ao caráter fulminante da evolução e à ausência de sinais definidos para o diagnóstico em tempo hábil.The author presents a case of a 13-year old girl with pulmonary trunk dissection and rupture with a cardiac tamponade. There was a ductus arteriosus persistent and a non stenotic bicuspid pulmonary valve. A plexogenic pulmonary arteriopathy and severe process of injury and repair in the elastic vessels are present. The significance of medionecrosis in the pathogenesis ot pulmonary dissection is discussed. An analysis of reports in dissecting pulmonary aneurysm reveals a fatal outcome in the vast majority of them, due either to arterial rupture or obstruction.

  3. Tratamento da persistência de canal arterial em recém-nascidos prematuros: análise clínica e cirúrgica Patent ductus arteriosus treatment in the premature newborn: clinical and surgical analisys

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    Rafael Fagionato Locali

    2008-05-01

    Full Text Available FUNDAMENTO: O tratamento cirúrgico da persistência de canal arterial é indicado quando a intervenção clínica fracassa. No entanto, esse tratamento não é livre de complicações. OBJETIVO: Analisar aspectos clínicos e cirúrgicos envolvidos no tratamento da persistência do canal arterial, em recém-nascidos prematuros. MÉTODOS: No período de janeiro de 2000 a junho de 2006, foram analisados 22 recém-nascidos prematuros submetidos a tratamento cirúrgico para persistência de canal arterial. Do total de pacientes, 77,3% eram do sexo feminino, com peso médio ao nascimento de 952,5 g e idade gestacional média de 27 semanas. O uso de agentes vasoativos, indometacina, parâmetros ecocardiográficos e complicações, nos períodos pré e pós-operatórios, foi avaliado. RESULTADOS: Na casuística avaliada, 59,1% dos pacientes necessitaram de intubação orotraqueal ao nascimento; 77,3%, de surfactante; e 59,1% usaram agentes vasoativos no pré-operatório. O número médio de aplicações de indometacina foi de 3,4, com dosagem variando de 0,1 a 0,25 mg/kg/dia. O calibre médio do canal arterial foi de 1,96 mm. O procedimento cirúrgico foi realizado por abordagem extrapleural em 59,1% dos casos, e no pós-operatório o tempo médio de intubação foi de 30,9 dias, com emprego de agentes vasoativos em 50% dos pacientes. Observaram-se 18,1% de complicações pós-operatórias não-fatais. CONCLUSÃO: Mais da metade dos pacientes necessitou de intubação orotraqueal ao nascimento, emprego de surfactante e agentes vasoativos no período pré-operatório. Houve maior prevalência de abordagem extrapleural durante o ato operatório. No período pós-operatório, houve menor demanda de agentes vasoativos e não houve óbitos diretamente relacionados ao procedimento cirúrgico.BACKGROUND: The surgical treatment of patency ductus arteriosus is indicated when the clinical intervention fails. However, this treatment may have some complications

  4. 口服对乙酰氨基酚治疗早产儿动脉导管未闭的效果及安全性%Effect and safety of oral paracetamol in premature infants with patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    赵捷; 杨传忠; 张谦慎; 连朝辉; 董国庆

    2014-01-01

    目的:探讨口服对乙酰氨基酚治疗早产儿动脉导管未闭(patent ductus arteriosus,PDA)的效果及安全性。方法:采用前瞻性对照研究方法观察PDA早产儿治疗临床资料,72例经心脏彩超诊断有临床表现的 PDA 的早产儿分为口服对乙酰氨基酚治疗组(18例)和口服布洛芬对照组(54例),观察两组 PDA 关闭率、副作用及并发症。结果:治疗组和对照组总关闭率分别为66.7%(12例)和70.4%(38例),差异无统计学意义(χ2=0.087,P=0.768)。除但治疗组高胆红素血症发生率低于对照组外(P<0.05),两组患儿在少尿、NEC、肾功能异常、IVH3-4级发生率寄消化道出血等药物副作用方面的差异均无统计学意义(P>0.05)。结论:对乙酰氨基酚在治疗PDA方面的疗效与布洛芬接近,且高胆红素血症发生率低,适合于在临床推广应用。%Objective To investigate the clinical effect and safety of paracetamol in premature infants with patent ductus arteriosus(PDA). Method A protrospective comparsion study was performed onthe data of premature infants with PDA. Seventy-two premature infants with echocardiographically comfirmed PDA were randomized into the oral paracetamol group(n1=18) and the ibuprofen group(n2=54), and the rate of ductal closure, side effects and complications were compared between the two groups. Results The ductus was 66.7% (12 infants) in the paracetamol group, which was similar to 70.4% (38 cases) in the ibuprofen group, with no significant difference(χ2=0.087,P=0.768).Except for the incidence of hyperbilirubinemia in the paracetamol group was higher than that in the ibuprofen group (P0.05), including oliguria,NEC,renal impairment,the incidence of IVH3-4 and gastrointestinal bleeding. Conclusions The clinical effect of paracetamol in premature infants with PDA is similar to that of ibuprofen , withlower incidence of hyperbilirubinemia, and

  5. Therapy of patent ductus arteriosus in very-low-birth-weight premature infants%极低体重早产儿动脉导管未闭的治疗

    Institute of Scientific and Technical Information of China (English)

    朱燕林; 郭立琳; 徐瑞燚; 朱文玲; 苗齐

    2011-01-01

    目的:探讨极低体重早产儿动脉导管未闭(PDA)的治疗方法.方法:本研究回顾性分析6例经外科手术治疗的PDA的极低体重早产儿的临床特点.结果:4例患者布洛芬治疗失败、2例患者因药物禁忌行动脉导管结扎术,术后由对呼吸机依赖转为3~4 d过渡脱机,胃肠内喂养耐受性及体重增加显著改善[(45±41)∶(258±77)g/周,P<0.001],5例存活患者均无手术并发症,1例患者死于早产儿并发症.结论:对于有手术指征的PDA的极低体重早产儿,外科手术结扎是安全而有效的方法.%To explore the therapy of patent ductus arteriosus (PDA) in very low birth weight pre mature infants. Method: Clinical features of six very low birth weight premature infants who underwent surgical ligation of PDA were analyzed. Result:Six infants underwent surgical closure of PDA after failure (4/6) of or hav ing contraindications (2/6) to medical treatment. Five infants who were ventilator dependent stopped ventilator use in 3 -4 days after operation. Surgical ligation of PDA improved enteral feeding tolerance and body growth [45 + 41]g/week vs [258+77]g/week, P<0. 001). There was one death caused by complications of prematurity af ter operation. Conclusion; Surgical ligation is safe and effective for PDA in very low birth weight premature infantswith indication.

  6. 动脉导管未闭早产儿口服布洛芬治疗中超声心动图监测的价值%Role of echocardiography monitoring in oral ibuprofen for treating patent ductus arteriosus in preterm infants

    Institute of Scientific and Technical Information of China (English)

    周昕; 左维嵩; 陈俊; 刘廷会

    2013-01-01

    Objective To investigate the value of echocardiography monitoring in oral ibuprofen for the treatment of patent ductus arteriosus(PDA) in preterm infants.Methods A total of 142 preterrn infants within 7 days after birth was randomized into two groups of A(82 cases,teated with oral ibuprofen) and B(60 cases,without ibuprofen).All infants were diagnosed with PDA(<5 mm in diameter of the ductus arteriosus).The closure rate of the ductus was calculated.Results In the cases with diameter of the ductus< 3 mm,the closure rate was 90.3% in group A,which was higher than 67.5% in group B(P<0.05).In the cases with diameter of the ductus 3-5 rnm,the closure rate was 30.0% in group A,which was higher than 15.0% in group B(P<0.05).Conclusion Echocardiography is valuable in evaluating the efficacy of oral ibuprofen therapy and guiding the selection of treatment in preterm infants with PDA.%目的 探讨动脉导管未闭(PDA)早产儿口服布洛芬治疗中超声心动图监测的价值.方法 将生后7d内经超声心动图确诊的PDA早产儿(PDA直径小于5mm) 142例随机分为两组:观察组82例,口服布洛芬治疗;对照组60例,未服用布洛芬.超声心动图监测动脉导管关闭率.结果 观察组PDA直径<3m者,闭合率90.3%,明显高于对照组的67.5% (P<0.05).观察组PDA直径为3-5 mm者,治疗后闭合率30.0%,明显高于对照组的15.0% (P<0.05).结论 超声心动图监测有助于评估PDA早产儿口服布洛芬疗效,并可根据PDA直径大小指导临床治疗.

  7. Nurusing care or a child with lateral pulmonary artery originated from ascending aortic artery in combination with patent ductus arteriosus%单侧肺动脉起源异常合并动脉导管未闭患儿的术后护理

    Institute of Scientific and Technical Information of China (English)

    顾海燕

    2011-01-01

    This paper summarizes the nursing care of a pediatric case with lateral pulmonary artery originated from ascending aortic artery in combination with patent ductus arteriosus. The keypoints of nursing care included continuous monitoring of pulmonary artery pressure,application of Nitric oxide,management of airway and respiratory system,and so on. After meticulous treatment and nursing care,the child was discharged with recovery.%总结1例单侧肺动脉起源于升主动脉合并动脉导管未闭患儿肺动脉高压的护理。护理要点包括:术后持续监测肺动脉压,一氧化氮(NO)的使用,气道管理,呼吸管理等。经过精心治疗与护理,患儿痊愈出院。

  8. B型利钠肽和氮端B型利钠肽原在早产儿动脉导管未闭诊治的研究进展%The use of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide concentrations to guide diagnosis and treatment of patent ductus arteriosus in preterm infants

    Institute of Scientific and Technical Information of China (English)

    刘颖; 周于新

    2016-01-01

    早产儿动脉导管未闭(PDA)发病率高,可引发很多并发症,但其诊治和预后判断标准仍存在争议.近期报道B型利钠肽和氮端B型利钠肽原用于早产儿血流动力学显著PDA(hsPDA)的诊断,且有助于其治疗策略的选择和对药物治疗反应的判断,但研究方法和临界值等尚未统一,笔者将国内外B型利钠肽和氮端B型利钠肽原在早产儿动脉导管未闭诊治的研究进展作一综述,为儿科临床及基础研究提供依据.%The high morbidity and compliments of patent ductus arteriosus (PDA) in preterm infants are reported,but the diagnostic and prognostic appraisal of PDA is still debatable.The B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are found efficient in diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants,and also helpful in therapy decisions and prediction of treatment response.However,the type of assay and cut-off values have not yet reached a consent,so that further researches are needed.

  9. A CASE OF TRUNCUS ARTERIOSUS

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    Sudeep

    2013-05-01

    Full Text Available INTRODUCTION: TRUNCUS ARTERIOSUS was first recognized in 1798 and account for 0.7-1.2% of all congenital Cardiac malformation. It occurs with equal frequency in males and Females. Truncus has been reported with Trisomy 18, Trisomy 21 and C hromosome 22q11 deletion. It is also been reported with Di George syndrome which include Hype rtelorism, low set ears , Micrognathia, small fish like mouth, short down slanting palpebral fiss ure, absent pinna, cleft lip and high arch palate . In TRUNCUS ARTERIOSUS, a single artery with a singl e semilunar valve leaves the base of heart and gives rise to pulmonary, Systemic and Cor onary circulation. The single arterial trunk receives blood from both the ventricle so a ventric ular septal defect is obligatory. Anomalies associated with TA are Right aortic arch, Truncal valve abnormality coronary artery anomaly atresia of Right or left pulmonary a rtery, Atresia of ductus arteriosus, single ventric le, TAPVC, subclavian artery and SVC abnormality. At ti mes Right aortic arch accompanies Truncus Arteriosus.

  10. Coronary fistula resembling patent ductus arteriosus

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    Sgarbieri Ricardo Nilsson

    2003-01-01

    Full Text Available A 14-year-old girl, presenting with heart failure and a continuous murmur, similar to that of a patent arterial duct, was investigated using echocardiogram and cardiac catheterization revealing a left to right shunt throught a coronary artery fistulae between the first septal branch and the right ventricular outflow tract. The patient was submitted to surgery, occluding the anomalous branch by the suturing of its orifice in the right ventricular outflow tract, under cardiopulmonary bypass. After the operation, cardiac catheterization revealed complete occlusion of the fistula without any residual shunt or compromise to the coronary circulation. In seven years of follow-up the patient is completely free of symptoms.

  11. 浅谈超声心动图检测正常胎儿动脉导管血流频谱的定量研究%Quantitative Study on the Detection of Ultrasonic Beckoning Diagram on Blood Flow Spectrum of Fetal Ductus Arteriosus

    Institute of Scientific and Technical Information of China (English)

    朱福海; 彭维绮; 蔡华

    2015-01-01

    目的:探究超声心动图检测在正常胎儿动脉导管血流频谱定量研究中的应用意义。方法:择取本院2012年9月-2014年9月收治的行产前超声检查并分娩的156例正常单胎为研究对象,应用彩色多普勒超声心动图,检测正常胎儿动脉导管,详细观察胎儿各个发育时期动态变化规律。结果:156例正常胎儿均获取相对清晰的动脉导管二维超声心动图与血流频谱图,动脉导管脉冲多普勒频谱呈双峰型;经由回归性分析发现,孕龄与AT、PFVd、PFVs呈正相关(P<0.05)。结论:超声心动图检测在正常胎儿动脉导管血流频谱定量研究中具有至关重要的应用意义,可提供胎儿循环系统生理信息,及早评估胎儿风险值,并及时采取干预措施,临床上应引起足够重视。%Objective:To explore the application of detection of ultrasonic beckoning diagram on blood flow spectrum of fetal ductus arteriosus. Method:To select 156 patients with normal singleton birth for prenatal ultrasonography in our hospital from September 2012 to September 2014 as the research objects,application of color doppler ultrasound beckoning diagram,detection of normal fetal ductus arteriosus,variation rules of dynamic observation of the fetal period with different development. Result:156 patients with normal fetal ductus were obtain two-dimensional ultrasound relatively clear beckoning with color Doppler flow spectrum,transcatheter arterial pulse doppler spectrum showed a bimodal pattern;through regression analysis,related to gestational age and AT,PFVd,PFVs positive(P<0.05). Conclusion:The application of graph is of vital significance of beckoning detected in normal fetal ductus arteriosus blood flow spectrum in quantitative study of ultrasound,fetal circulation system can provide physiological information,early assessment of fetal risk value,timely intervention,clinical attention should be paid.

  12. 导管介入封堵术与外科手术治疗动脉导管未闭的疗效分析%Analysis of the effect of transcatheter closure and surgical operation treatment of patent ductus arteriosus

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    杨房

    2015-01-01

    目的:探究导管介入手术与外科手术治疗动脉导管未闭的疗效。方法选取2013年2月~2014年2月在我院已经被确诊的动脉导管未闭患者70例作为研究对象,依据治疗方式不同分为实验组和对照组,对照组患者接受导管介入封堵手术,实验组患者接受外科手术,术后分析两组患者的各项临床指标。结果对照组患者术后完全封堵率100%与实验组97.1%的完全封堵率之间的差异无统计学意义(P>0.05);但是对照组的并发症发生率、住院时间及住院费用均明显低于实验组患者,两组患者的上述数据之间的差异具有统计学意义(P<0.05)。结论相比于导管介入封堵术,外科手术治疗导管未闭具有并发症低、效果好、安全等优点,值得在今后的临床治疗中继续推广使用。%Objective To explore the clinical effect of interventional operation and surgical operation treatment of patent ductus arteriosus.Methods Select cases of patent ductus arteriosus diagnosed patients as the research object in our hospital, the patients were divided into the experimental group and the control group, the control group patients received transcatheter closure operation, patients in the experimental group received surgical operation, heart function in the patients of the two groups of postoperative changes.Results The control group of patients after the difference between the fully complete closure plugging rate and the rate of the experimental group was not significant(P>0.05). But the control group the incidence of complications, length of hospital stay and hospital costs were signiifcantly lower than those of the patients in the experimental group, the differences between the two groups of data were statistically significant(P<0.05).Conclusion Compared to the catheter interventional therapy, surgical treatment of patent ductus arteriosus has the advantages of less complications and good effect

  13. Surgical Treatment of Patent Ductus Arteriosus Associated with Pulmonary Hypertension under Profound Hypothermia and Extracorporal Circulation with Low Flow Perfusion%深低温低流量体外循环下动脉导管未闭合并肺动脉高压的手术治疗

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    高秉仁; 姚忠喜; 张志芳; 高百顺; 辛军; 岳凤珍

    1991-01-01

    本文报告了36例动脉导管未闭合并重度肺动脉高压采用深低温低流量体外循环下手术治疗的体会.全组中死亡1例,其余随访6年至半年,均获满意疗效.本文着重讨论了手术安全性,适应证,心肌保护和灌注肺的预防等问题.%This paper reports the operations on 36 cases of patent ductus arteriosus (PDA) associated with severe pulmonary hypertension (PH) under profound hypothermia and cardiopulmonary by-pass (CPB) with low flow perfusion.Thirty five cases recovered promptly but one died of ventricular fibrillation which was nothing to do with hypothermia and low flow perfusion.Vertical incision on the anterior wall of pulmonary artery was made to expose the orifice of PDA.Mattress sutures and pledget were used for repair.Sutures bite the prominent posterior edge of PDA orifice,passing through the anterior wall of the pulmonary artery,and tied on the pledget outside the vessel.Open-heart surgery is preferable to PDA with severe pulmonary hypertension.The authers emphasize the importance of myocardial protection and "infusion lung" prevention.

  14. 超声心动图血流参数预测早产儿动脉导管早期自然关闭的价值%The value of echocardiography flow parameters in predicting spontaneous closure of patent ductus arteriosus in preterm infants

    Institute of Scientific and Technical Information of China (English)

    容跃; 杨正春; 冉素真; 黄泽君

    2015-01-01

    Objective To investigate the value of echocardiography flow parameters in predicting spontaneous closure of pa-tent ductus arteriosus(PDA) in preterm infants .Methods We conducted prospective study on 130 preterm infants who born in Chongqing Health Center for Women and Children from October 2013 to December 2014 .They were accepted echocardiographic ex-aminations at 72 h and 7 d .They were be divided into two groups according to whether spontaneous closure of ductus arteriosus happen with in 7 days after birth (the control group) or not (the PDA group) .The echocardiographic flow parameters were com-pared between the two groups .we measured the pulmonary artery pressure ,The differential pressure descending aorta and pulmona-ry artery and patent foramen shunt rate for the first examination which should must be finished 24 h after birth .Results (1) PDA group compared with control group :① the differential pressure descending aorta and pulmonary artery in PDA group were lower than the control group(P< 0 .001) ;② the pulmonary artery in PDA group were higher than the control group(P < 0 .001) ;③ the patent foramen shunt rate in PDA group were lower than the control group(P< 0 .05) ;(2)The best critical points of the differential pressure descending aorta and pulmonary artery ,the patent foramen shunt rate ,and the pulmonary artery to predict whether ductus arteriosus could be spontaneous closed in preterm infants were 19 .69 mm Hg ,33 .76 mm Hg and 57 .16 cm/s .Conclusion The echocardiographic flow parameters has great significantly in predicting whether ductus arteriosus could be spontaneous closed early in preterm infants .%目的:探讨超声血流参数预测早产儿动脉导管早期是否自然关闭的价值。方法对2013年10月至2014年12月在重庆市妇幼保健院住院且生后24 h 内进行超声心动图检查有动脉导管未闭(PDA)的早产儿130例进行前瞻性研究,分别于72 h 及7 d 对早产

  15. Unexpected occluder dislocation after transcatheter closure of patent ductus arteriosus in two patients%动脉导管未闭介入堵闭后封堵器非常规脱落二例

    Institute of Scientific and Technical Information of China (English)

    刘振江; 沈向前; 赵延恕; 方臻飞; 胡信群; 刘启明; 周胜华

    2009-01-01

    @@ 动脉导管未闭(patent ductus arterious,PDA)属婴幼儿常见先心病,近年介入治疗合并肺动脉高压(pulmonary artery hypertension,PAH)的PDA也已取得较好的疗效.但近期我院有2例合并PAH的PDA患者在封堵后第2天封堵器意外脱落,经努力2例均经导管将脱落封堵器取出,现就其经验教训做一报道.

  16. 不同方法评价56例动脉导管未闭患者左心室功能的比较%Comparison of different methods in assessment of left ventricular function in patients with patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    梁梅馨; 林建军; 黄培隽; 翟璐璐

    2015-01-01

    ObjectiveTo evaluate the accuracy and superiority of real-time three-dimensional echocard-iography (RT-3DE) in the assessment of left ventricular function in patients with patent ductus arteriosus (PDA), and to explore the clinical value.MethodM-mode echocardiography (ME), two dimensional echocardiography (2DE) simpson method and RT-3DE examination were performed on 56 PDA patients, 48 healthy volunteers respectively to determine left ventricular mass index (LVMI), left ventricular end-diastolic volume index (LVEDVI) and left ventricular ejection fraction (LVEF).ResultLVMI and LVEDVI in patients with PDA were more than health volunteers, and the differences were statistically signiifcant (P<0.05). Patient with PDA, LVMI, LVEDVI and LVEF measured by RT-3DE was less than which measured by ME, but larger than which measured by 2DE, and the differences were statistically signiifcant (P<0.05).Conclusion Compared with ME and 2DE, RT-3DE is a reliable means to estimate the index of left ventricular function accurately. RT-3DE played a signiifcant role in assess the left ventricle function.%目的:探讨实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评价动脉导管未闭(patent ductus arteriosus,PDA)患者左心室功能的准确性及优越性。方法分别采用M型超声(M-mode echocardiography,ME)、二维超声(two dimensional echocardiography,2DE)及RT-3DE测算PDA患者(PDA组,56例)和健康志愿者(正常对照组,56例)的左心室心肌质量指数(left ventricular mass index,LVMI)、左心室舒张末期容积指数(left ventricular end-diastolic volume index,LVEDVI)、左心室射血分数(left ventricle ejection fraction,LVEF)。结果 PDA组患者LVMI及LVEDVI大于正常对照组(P<0.05)。PDA组患者LVMI、LVEDVI及LVEF的ME测值大于RT-3DE测值,2DE测值小于RT-3DE测值(P<0.05)。结论与ME、2DE相比,RT-3DE可以准确测

  17. Surgical mini-incision treatment of patent ductus arteriosus of premature infants with titanium clip in 110 cases%床旁微创小切口钛夹闭合早产儿动脉导管110例临床分析

    Institute of Scientific and Technical Information of China (English)

    付松; 封志纯

    2013-01-01

    Objective To investigate the clinical effects of surgical small incision treatment of patent ductus arteriosus (PDA) in premature infants with titanium clip.Methods One hundred children received and cured by our hospital from January 2010 to January 2013 were divided into two groups.Group A:body weight > 1.5 kg of patent ductus arteriosus (PDA),71 cases of premature children; group B:body weight < 1.5 kg of low body weight preterm the children PDA,29 cases.The operations were performed in the newborn intensive care unit (NICU).The patient was placed in a lateral position with the left arm abduction under general anesthesia.A 1.5-2.5 cm long posterolateral mini-thoracotomy was made and the pleural cavity was entered via the 2-3rd intercostal space.The PDA was closed with two titanium clips.Results Ninety-nine cases were cured,1 died.2 residual shunt postoperatively.One patient on postoperative 5 day was found wound infected,wound healing after the use of antibiotics by intravenous.There was no significant difference in incidence of postoperative complications and mortality rate between group A and group B (P > 0.05).Majority of children successfully weaned from the ventilator due to the rapid improvement of hemodynamics and lung conditions.In group B,mechanical ventilation time (12.6 ± 7.5) d and postoperative hospital stay (21.0 ± 15.4) d was significantly longer than group A ((9.6 ± 4.2) d and (12.0 ± 10.8) d),the difference between the two groups was significant (t =7.35,9.12,P < 0.05).Conclusion (1) It is a viable treatment that bedside minimally invasive titanium clip closed ductus arteriosus in preterm children PDA.(2) As the treatment of low body weight premature children is poor,the tolerance of the surgical trauma of the surgery as a minimally invasive,simple method is particularly suitable for low body weight premature children PDA.%目的 探讨床旁微创小切口钛夹闭合早产儿动脉导管的临床疗效.方法 将2010年1月至2013

  18. Aspectos biofarmacêuticos da formulação de medicamentos para neonatos: fundamentos da complexação de indometacina com hidroxipropil-beta-ciclodextrina para tratamento oral do fechamento do canal arterial Biopharmaceutical aspects of drug formulation for neonatology: rational for indomethacin's complexation with hydroxypropyl-beta-cyclodextrin to treat patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Ana Cristina Ribeiro Rama

    2005-09-01

    alternative to prepare oral formulations. With this review we intend to evaluate the rational for using indomethacin's complexation with hydroxypropyl-beta-cyclodextrin, to enhance bioavailability and reduce gastric toxicity characteristics, allowing its oral administration to treat patent ductus arteriosus on preterm and full-term newborns.

  19. Radiologic findings of truncus arteriosus; incidence and associated anomalies

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyeon Kyeong; Yeon, Kyung Mo; Kim, In One; Choe, Du Whan; Lee, Kyung Hwan [Seoul National University College of Medicine, Seoul (Korea, Republic of); Choe, Young Hi; Choe, Yun Hyun [Sejong General Hospital, Bucheon (Korea, Republic of); Choi, Yo Won [Armed Forces Chungpyung Hospital, Chungpyung (Korea, Republic of); Ahn, In Ok [Kumkang Hospital, Seoul (Korea, Republic of)

    1992-01-15

    Truncus arteriosus is characterized by a single arterial vessel arising from the base of the heart and giving origin to the systemic, pulmonary and coronary circulation. To evaluate the incidence, types, and associated anomalies, 18 cases of truncus arteriosus diagnosed by angiocardiography, were reviewed and were compared with other reports. Ten of them were confirmed by operation. The overall incidence of truncus arteriosus was 0.127%. According to Collett and Edwards classification, type I was encountered in 11 cases (61%), type II in 4 cases (22%), and type III in 3 cases (17%). All the patients had subtruncal ventricular septal defects. Eight patients showed truncal valve regurgitation and valve stenosis was noted in one case. A right aortic arch was present in 9 cases. Associated anomalies were atrial septal defect (8 cases), patent ductus arteriosus (3 cases), coarctation of the aorta (2 cases), isolation of the left subclavian artery (2 cases) and right aortic arch with an aberrant left subclavian artery (1 case). Truncus arteriosus is an uncommon congenital cardio vascular malformation. In the group of cases which we encountered, type I was the most common anomaly. Frequently associated anomalies were right aortic arch, incompetent truncal valve and atrial septal defect.

  20. Evaluation of therapeutic effects and safety of different treatment methods for premature patent ductus arteriosus%不同治疗方式对早产儿动脉导管未闭的疗效及安全性评价

    Institute of Scientific and Technical Information of China (English)

    陈丹; 毛健

    2015-01-01

    ObjectiveTo explore the clinical treatment methods and their effects in the treatment of premature patent ductus arteriosus (PDA) and to summarize the experience of surgical treatment for PDA.MethodsNineteen premature infants who were diagnosed with PDA and received surgical treatment betwen January 2013 and December 2014 were selected as the surgical group, and 19 premature infants with PDA who did not receive surgical treatment during the same period were selected as the non-surgical group. The differences in medical history, clinical conditions, mortality, and major complications between the two groups were analyzed, and the characteristics of surgical treatment and its clinical effects were analyzed from the aspects of preoperative preparation and surgical results.Results Compared with the surgical group, the gestational age and birth weight in the non-surgical group were significantly greater (P1.3, and the square of catheter diameter/birth weight (d2/BW) ratio >9 mm2/kg in the surgical group was signiifcantly higher than in the non-surgical group (P0.05).ConclusionsFor premature infants with clinical symptoms and no improvement after conservative medical treatment or drug therapy, surgical ligation is a relatively safe and effective treatment method for PDA.%目的:探讨早产儿动脉导管未闭(PDA)的临床治疗方式及效果,总结手术治疗PDA的经验。方法2013年1月至2014年12月诊断为PDA并行手术治疗的早产儿19例为手术组,同期未行手术治疗的19例PDA早产儿为非手术组。分析两组在病史因素、临床因素、病死率及主要并发症等方面的差异,同时从术前准备及手术结果方面分析手术治疗的特点及临床效果。结果非手术组早产儿胎龄及出生体重均大于手术组(P1.3及导管直径的平方/出生体重(d2/BW)比值>9 mm2/kg的发生率均高于非手术组(P0.05)。结论对有临床症状且内科保守治疗或药物治疗无好转的早

  1. Comparação de ibuprofeno via oral e indometacina intravenosa no tratamento da persistência do canal arterial em neonatos com extremo baixo peso ao nascer Comparison of oral ibuprofen and intravenous indomethacin for the treatment of patent ductus arteriosus in extremely low birth weight infants

    Directory of Open Access Journals (Sweden)

    Eun Mi Yang

    2013-02-01

    Full Text Available OBJETIVO: Existem poucos relatórios publicados com relação à eficácia do ibuprofeno via oral no tratamento da persistência do canal arterial (PCA em neonatos com extremo baixo peso ao nascer (EBPN. Comparamos o ibuprofeno via oral à indometacina intravenosa no que diz respeito à eficácia e segurança no tratamento de PCA em neonatos com peso inferior a 1.000 g ao nascer. MÉTODO: Este foi um estudo retrospectivo em um único centro. Coletamos dados de neonatos com EBPN que tiveram PCA ecocardiograficamente confirmada. Os neonatos foram tratados tanto com indometacina intravenosa quanto com ibuprofeno via oral. A taxa de fechamento do canal, a necessidade de tratamentos adicionais, os efeitos colaterais ou as complicações relacionadas ao medicamento e a mortalidade foram comparados entre os dois grupos de tratamento. RESULTADO: Examinamos 26 neonatos que receberam indometacina e 22 que receberam ibuprofeno. A taxa geral de fechamento do canal foi semelhante nos dois tratamentos: o fechamento do canal ocorreu em 23 dos 26 neonatos (88,5% no grupo indometacina, e em 18 dos 22 neonatos (81,8% no grupo ibuprofeno (p = 0,40. A taxa de ligadura cirúrgica (11,5% em comparação a 18,2%; p = 0,40 não diferiu de forma significativa entre os dois grupos de tratamento. Após o tratamento, não foi encontrada nenhuma diferença significativa nas concentrações de creatinina sérica entre os dois grupos. Não houve diferenças significativas com relação a efeitos colaterais ou complicações adicionais. CONCLUSÃO: Em neonatos com EBPN, o ibuprofeno via oral é tão eficaz quanto a indometacina intravenosa no tratamento da PCA. Não há diferenças entre os medicamentos no que diz respeito à segurança. O ibuprofeno via oral poderia ser usado como um agente alternativo no tratamento da PCA em neonatos com EBPN.OBJECTIVE: There are few published reports concerning the efficacy of oral ibuprofen for the treatment of patent ductus arteriosus

  2. Efficacy and safety of oral ibuprofen for closure of patent ductus arteriosus in preterm infants: a meta-analysis%口服布洛芬治疗早产儿动脉导管未闭疗效和安全性的meta分析

    Institute of Scientific and Technical Information of China (English)

    张鹏; 孟靓靓; 程国强

    2013-01-01

    Objective To evaluate the efficacy and safety of oral ibuprofen for closure of patent ductus arteriosus (PDA) in preterm infants.Methods The related literatures till December 31st,2011 in Cochrane Library,PubMed,EMBASE,Ovid,Springer,China Academic Journal Full-text Database,Wanfang Database,VIP Database and China Biological Medical Literature Database were searched.The inclusion criteria were:(1) the subject of the research was preterm infants with birth weight less than 2500 g and/or gestational age less than 37 weeks; (2) randomized or semirandomized controlled trial; (3) the intervention group received oral ibuprofen,while the control group received oral placebos / intravenous indomethacin or ibuprofen; (4) the main outcome was the failure rate of PDA closure; (5) hemodynamic changes with PDA were detected by ultrasonography.Meta-analysis was performed by Review Manager 4.22 software.Results Eleven randomized controlled trials were included,among which,three were high quality reports.Meta-analysis showed lower failure rate of PDA closure in subjects received oral ibuprofen than in those received placebos orally (RR =0.22,95 % CI:0.14-0.35),while the number of infants required operative closure of PDA decreased significantly (RR =0.16,95% CI:0.03-0.86).Further analysis showed the effect of oral ibuprofen was similar to intravenous indomethacin (RR =0.93,95 % CI:0.57-1.53),but better than intravenous ibuprofen (RR=0.42,95%CI:0.26-0.67).However,oral ibuprofen did not reduced the ratio of patients required operation compared with intravenous indomethacin or ibuprofen (RR=0.58,95%CI:0.24-1.41).The incidence of gastrointestinal hemorrhage was higher in oral ibuprofen group than that in placebos(RR=1.99,95%CI:1.13-3.50).The serum level of creatine was lower in oral ibuprofen group than in intravenous indomethacin or ibuprofen group (weighted average=-19.10,95% CI:-25.12-12.31).Compared with intravenous indomethcin group,less necrotizing enterocolitis

  3. The ductus arteriosus : a fetal vessel coming of age

    NARCIS (Netherlands)

    Bökenkamp-Gramann, Regina

    2012-01-01

    In this thesis we have studied various aspects of physiological DA closure and PDA in animal models and humans. We were intrigued by the fact that the DA reacts completely different to the postnatal change in environmental conditions than the adjacent vessels. Therefore we aimed to identify genes an

  4. 31. Left ventricular dysfunction after patent ductus arteriosus (PDA closure

    Directory of Open Access Journals (Sweden)

    Rihab Agouba

    2015-10-01

    Conclusions: Depressed LV-SFx may occur after PDA closure with higher incidence after catheter PDA device occlusion. All of preterm babies had surgical PDA occlusion and none of them presented with depressed LV-SFx in the post-operative follow-up. Further prospective studies are needed to investigate these observations.

  5. Assessment and treatment of post patent ductus arteriosus ligation syndrome.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif F

    2014-07-01

    To compare differences in tissue Doppler imaging, global longitudinal strain (GLS), and cardiac troponin T (cTnT) between infants with low (<200 mL\\/kg\\/min) and high (>200 mL\\/kg\\/min) left ventricular (LV) output 1 hour after duct ligation and assess the impact of milrinone treatment on cardiac output and myocardial performance.

  6. Clinical utility of ductus venosus flow in fetuses with right-sided congenital heart disease.

    Science.gov (United States)

    Arya, Bhawna; Krishnan, Anita; Donofrio, Mary T

    2014-09-01

    Abnormal ductus venosus flow is associated with fetal compromise and can be present in right-sided congenital heart disease. We hypothesized that the ductus venosus flow pattern in fetuses with obstructive right-sided congenital heart disease will have abnormal flow at baseline. Those with nonobstructive disease will have normal flow at baseline. We further hypothesized that abnormal ductus venosus flow will predict fetal compromise. We conducted a retrospective review of fetuses with right-sided congenital heart disease. Ductus venosus measurements included the presence of atrial reversal, velocity time integral, and peak velocity index. Fetuses were separated into those with obstructive (group 1) and nonobstructive (group 2) lesions. Compromise was defined as fetal distress (pericardial effusion, hydrops, or left ventricular dilatation/dysfunction) or death (fetal/neonatal mortality). Sixty fetuses with right-sided congenital heart disease were identified (mean gestational age ± SD, 24.2 ± 5.4 weeks; group 1, n = 45; group 2, n = 15). Ductus venosus reversal was more often present (49% versus 13%; P = .017), and the peak velocity index was significantly higher (1.39 ± 0.67 versus 0.98 ± 0.33; P= .026) in group 1. In group 1, ductus venosus reversal was more often present (93% versus 32%; P heart disease have ductus venosus reversal at baseline; an abnormal peak velocity index can be used to predict compromise. Fetuses with nonobstructive disease rarely have ductus venosus reversal; the peak velocity index cannot be used to predict outcomes in this group. © 2014 by the American Institute of Ultrasound in Medicine.

  7. The role of n terminal - probrain natriuretic peptide in the diagnosis of hemodynamic persistent asrteriosus ductus in premature neonates patient

    Science.gov (United States)

    Dasraf, D.; Djer, M. M.; Advani, N.

    2017-08-01

    Persistent ductus arteriosus is one of the most frequent congenital heart diseases found in infants, mainly in preterms. Echocardiography is the gold standard for the diagnosis of hemodynamically significant patent ductus arteriosus (hs-PDA) in preterm neonates. A few studies have suggested that the use of a simple blood assay to detect N-terminal pro-brain natriuretic peptide (NT-proBNP) may be useful in determining the diagnosis and management of hs-PDA. No such studies have been conducted in Indonesia, although the assay kit and characteristics of the patient (gestational age and chronological age) influence the accuracy of NT-proBNP levels in determining hs-PDA. The aim of this study was to determine the association between the NT-proBNP level and the prevalence of hs-PDA in an Indonesian patient population. A cross-sectional study was conducted at Dr. Cipto Mangunkusumo Hospital. PDA was determined using echocardiography in 49 preterm neonates (gestational age <37 weeks and birthweight <2000 g). Subsequently, these patients were divided into three groups: non-PDA, non-hsPDA, and hs-PDA. The blood NT-proBNP level was then determined in the non-hsPDA and hs-PDA groups, and between-group differences were compared. Among the 49 neonates, 33 patients had PDA, and 16 of these had hs-PDA. The results revealed a significant association between the NT-proBNP level and hs-PDA (p < 0.001).

  8. [Experience in the treatment of patent ductus arteriosus closure at a mexican hospital].

    Science.gov (United States)

    Márquez-González, Horacio; Castro-Contreras, Uriel; Cerrud-Sánchez, Carmen Emma; López-Gallegos, Diana; Yáñez-Gutiérrez, Lucelli

    2016-01-01

    Introducción: la persistencia del conducto arterioso (PCA) representa una de las enfermedades con mayor prevalencia en los hospitales que atienden cardiopatías congénitas (CC). En la actualidad en pacientes mayores de un año de edad el cierre percutáneo es la terapéutica estándar. El objetivo de este trabajo fue conocer la frecuencia, características y tratamiento de PCA en el servicio de Cardiopatías Congénitas en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI. Métodos: en el servicio de Cardiopatías Congénitas del Hospital de Cardiología del CMN SXXI se realizó un estudio descriptivo de 2010 a 2015 de los enfermos que fueron tratados con cierre percutáneo y cirugía de PCA. Se dividieron en las siguientes edades: lactantes, preescolares, escolares, adolescentes y adultos. Se registraron las frecuencias absolutas. Resultados: se seleccionaron 187 pacientes, de los cuales los preescolares y escolares representaron el 60% del total de la muestra. El cierre percutáneo por cateterismo intervencionsta se realizó en 90%; se registró un 2% de complicaciones. Conclusiones: en esta clínica de cardiopatías congénitas, la PCA es tratada por cateterismo intervencionista en la mayoría de las etapas del ser humano, lo que ha registrado mínimas complicaciones.

  9. Transcatheter Closure of Patent Ductus Arteriosus in Adolescents and Adults: A Case Series

    Directory of Open Access Journals (Sweden)

    Sukman Tulus Putra

    2017-02-01

    Full Text Available During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients  who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO. There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100% and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.

  10. [Echocardiographic screening vs. symptomatic diagnosis for patent ductus arteriosus in preterms].

    Science.gov (United States)

    Juárez-Domínguez, Gabriela; Iglesias-Leboreiro, José; Rendón-Macías, Mario Enrique; Bernardez-Zapata, Isabel; Patiño-Bahena, Emilia Josefina; Agami-Micha, Sion; Ortega-García, Karla Leticia; Torres-Palomino, Gregory; Delgado-Franco, Dagoberto

    2015-01-01

    Introducción: el objetivo es evaluar el posible beneficio en el tratamiento en el cierre de la persistencia del conducto arterioso cuando se realiza una pesquisa (conducto arterioso (PCA). Se analizaron las características del conducto, la presencia de hipertensión pulmonar y el tratamiento recibido. Se compararon los resultados entre: tardíos (34 a 36 semanas de gestación [SEG]), moderados (30 a 33 SEG) y extremos (conducto entre los grupo. El tratamiento recibido no difirió entre las estrategias en los prematuros moderados y tardíos, pero sí fue más agresivo en los extremos. Conclusiones: la pesquisa de una PCA por ecocardiografía en los infantes pretérmino extremos acorta el tiempo de detección y permite un tratamiento menos agresivo. No lo recomendamos en pretérminos moderados y tardíos.

  11. B-type natriuretic peptide to predict ductus intervention in infants <28 weeks.

    Science.gov (United States)

    Czernik, Christoph; Lemmer, Julia; Metze, Boris; Koehne, Petra S; Mueller, Christian; Obladen, Michael

    2008-09-01

    Patent ductus arteriosus (PDA) is frequent in neonates with gestational age of less than 28 wk. Clinical and echocardiographic signs define hemodynamic significance of PDA, but do not reveal the need for PDA intervention in the first days of life. B-type natriuretic peptide (BNP) has been proposed as a screening tool for PDA in preterm infants. To determine whether BNP can predict the need for PDA intervention, plasma BNP was measured by chemiluminescence immunoassay in 67 preterm infants <28 wk (median 26) on the second day of life in a prospective blinded study. PDA intervention was based on specified clinical and echocardiographic findings. Twenty-four patients (intervention group) received treatment for PDA and 43 patients (controls) remained without intervention. BNP concentrations were higher in the intervention (median 1069 pg/mL) than in the control group (247 pg/mL, p < 0.001). BNP correlated positively with ductal size (R = 0.46, p < 0.001) and atrial/aortic root ratio (R = 0.54, p < 0.001). In conclusion, plasma BNP proved to be a good predictor for ductus intervention (area under the curve: 0.86) with the best cutoff at 550 pg/mL on the second day of life in ventilated infants less than 28 wk gestation (sensitivity: 83%; specificity: 86%).

  12. Case Series: Fetal Pulmonary Vein A-Wave Reversal: An Early Marker of Left-Sided Cardiac Anomalies?

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    Aldo L. Schenone

    2015-04-01

    Full Text Available Background - Improvements in congenital heart disease (CHD screening are needed based on the lack of sensitivity of current screening methods and the understanding that the early detection of certain CHDs may improve outcomes. Fetal venous circulation has caught medical attention, and two studies demonstrated that it is feasible to register pulmonary vein flow velocity waveforms (FVWs during early gestation. Meanwhile, the latter study proposed pulmonary vein A-wave reversal as a marker of cardiac anomaly. Methods - We report a series of six consecutive fetuses with confirmed cardiac anomalies that underwent first-trimester screening, including pulmonary vein FVWs, at our center during 2013. CHD was confirmed by late pregnancy echocardiography, and in three cases fetal autopsies were performed. Result/Discussion - The ductus venosus (DV and nuchal translucency (NT predicted 50% of CHD cases, whereas the combination of markers identified 66.6% of CHD cases. When adding pulmonary vein assessment, the rate of detection rose to 83.3%. Total five of six cases of CHD had reversal of pulmonary vein A-wave during early pregnancy. The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus. Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy. The addition of pulmonary vein FVW assessment to the current CHD screening bundle could increase the rate detection of cardiac anomalies. This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.

  13. 孕11~14周静脉导管A波倒置在胎儿染色体异常中的筛查价值%Screening Value of Reversed A-wave in Fetal Ductus Venosus with Ultrasound on Chromosome Abnormalities at 11-14 Weeks Gestation

    Institute of Scientific and Technical Information of China (English)

    刘志辉; 邹翰琴; 王洁; 阳春芳; 张玉麒; 叶江; 颜嫒

    2015-01-01

    Objective To explore the clinical application value of the reversed A-wave in fetal ductus venosus assessed by ultrasound at 11~14 weeks gestation on screening fetal chromosomal abnormalities. Methods Regular antenatal examination was performed on pregnant women of 11~14 weeks gestation. The Doppler spectrum of the ductus venosus and the size of nuchal trans-lucency were conducted. The results of amniotic fluid puncture cultivate karyotype examination and the DV-RAW or NT thickening were followed up. Results Among 656 cases,DV-RAW were found in 21 cases,NT thickening were found in 19 cases,both in abnormalities were found in 12 cases. After followed-up of fetal chromosomal karyotype in 28 cases, chromosomal abnormalities were found in 17 cases,the trisomy 21 syndrome were found in 14 cases,Edwards' syndrome were found in 2 cases and 9 chromo-some structural abnormality was found only in 1 case. The sensitivity of DV-RAW in the detection of fetal chromosomal abnormali-ties was 82. 35%,the specificity was 36. 36% and the accuracy was 64. 29%. The sensitivity of NT thickening method in fetal chromosomal abnormalities was 76. 47%,the specificity was 45. 45% and the accuracy was 64. 29%. When combined the DV -RAW and NT methods,the diagnostic sensitivity was 58. 82%,the specificity was 81. 82% and the accuracy was 67. 86%. Con-clusion The reversed A-wave in fetal ductus venosus at 11~14 weeks gestation showed to be helpful in the early screening for fe-tal chromosomal abnormalities,and might help the early diagnosis of fetal abnormal chromosome karyotype.%目的 探讨孕11~14 周胎儿静脉导管A波倒置在胎儿染色体异常筛查中的临床应用价值. 方法 对11~14周的孕妇行常规产前检查,并进行静脉导管血流频谱和颈项透明层厚度检测. 随访A波倒置或颈项透明层增厚胎儿的羊水穿刺培养染色体核型检查结果. 结果 656例胎儿中,共28例异常,其中静脉导管A波倒置21例,颈项透明层增厚19

  14. Surgical correction of truncus arteriosus in infancy.

    Science.gov (United States)

    Sullivan, H; Sulayman, R; Replogle, R; Arcilla, R A

    1976-07-01

    An 8 week old infant with severe heart failure from type 1 truncus arteriosus underwent successful corrective surgery employing the Rastelli procedure with use of deep hypothermia and total circulatory arrest. Postoperative hemodynamic studies showed complete closure of the septal defect, disappearance of truncal stenosis, but presence of mild porcine valve stenosis. This procedure is possible even in very small subjects and is preferable to palliative pulmonary arterial banding.

  15. Estudo anatômico das vias bilíferas em búfalos: comportamento do ductus choledocus, ductus cysticus e vesica fellea. Sistematização do ductus biliferus principalis dexter

    Directory of Open Access Journals (Sweden)

    Wilson Machado de Souza

    1994-06-01

    Full Text Available Os autores estudaram o comportamento do ductus choledocus, ductus cysticus e vesica fellea e a constituição do ductus biliferus principalis dexter, parte das vias bilíferas em 40 búfalas da raça Jaffarabadi, adultas. Os fígados tiveram suas vias biliares injetadas com látex Neoprene 650 e celobar, e o procedimento utilizado pelos autores para evidenciação dos componentes estudados foram a dissecação e radiografias. Nos 40 órgãos analisados constatou-se que o ductus choledocus na maioria (97,5% sem tributários, acolhe num caso isolado (2,5% afluente inominado do lobus quadratus. Este ductus apresenta-se formado pela confluência dos ductus biliferus principalis dexter e do sinister (75%, pela confluência das raízes dorsomedial e ventrolateral mais o ductus biliferus principalis sinister (22,5%, e pela junção do ductus hepaticus e ductus cysticus (2,5%. O ductus cysticus, componente constante do ductus biliferus principalis dexter, associa-se ao ductus biliferus lateralis lobi dextri (67,5%, endereçando-se nas outras glândulas (32,5% a troncos diversos. A vesica fellea em 87,5% das peças mostra-se livre de afluentes, enquanto nas demais dessecações (12,5% recebe duetos hepaticocísticos oriundos apenas do lobus quadratus (5%, simultaneamente do lobus dexter e do lobus quadratus (5%, e unicamente do território lateral do lobus dexter (5%. O ductus biliferus principalis dexter é formado pelo ductus lateralis lobi dextri e ductus cysticus (100% e pelo ductus medialis lobi dextri, ductus dorsalis lobi dextri e ductus processi caudati (92,5%.

  16. Luaran Penutupan Duktus Arteriosus Persisten Transkateter di Rumah Sakit Dr. Hasan Sadikin Bandung

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    Rahmat Budi Kuswiyanto

    2016-12-01

    Full Text Available Transcatheter closure of patent ductus arteriosus (PDA is a treatment of choice with good efficacy, shorter hospitalization, less risks, and chest scar free. The objective of this study was to evaluate the immediate and mid-term outcomes of transcatheter closure of PDA. An analytic descriptive study was peformed on patients underwent transcatheter PDA occlusion in Dr. Hasan Sadikin General Hospital Bandung between May 2011 and June 2014. Evaluation was conducted through clinical examination and echocardiography 24 hours, 1, 3, 6 and 12 months after the procedure. The procedure was successful in 132 PDA patients (42 males and 90 females. The median age, body weight, systolic pulmonary artery pressure, PDA size, flow ratio, fluoroscopy time, and procedure time were 3.9 years, 11.25 kg, 56 mmHg, 3.4 mm, 2.8, 16 minutes, and 67 minutes, respectively. Immediately after the procedure, 54% patients had complete closure, 41% experienced smoky residual shunt and only 5% experienced small residual shunt. The mortality and complication rate was 3.8%. Most of the patients were discharged the next day after the procedure. All patients showed complete closure during followed-up. Transcatheter closure of PDA is safe and effective with shorter hospitalization and minimum complications. [MKB. 2016;48(4:234–40

  17. Ductus venosus Doppler at 11 to 13 weeks of gestation in the prediction of outcome in twin pregnancies.

    Science.gov (United States)

    Maiz, Nerea; Staboulidou, Ismini; Leal, Antonio M; Minekawa, Ryoko; Nicolaides, Kypros H

    2009-04-01

    To examine the independent contribution of abnormal flow in the ductus venosus at 11 to 13 weeks of gestation in the prediction of adverse pregnancy outcome in relation to chorionicity. This was a prospective study in 516 dichorionic and 179 monochorionic twin pregnancies in which the fetal ductus venosus flow was assessed at 11 0/7 to 13 6/7 weeks of gestation. The prevalence of reversed a-wave in the fetal ductus venosus was compared between monochorionic and dichorionic pregnancies and between those with and without pregnancy complications. Comparisons between each of the pregnancy outcomes and the normal outcome group and between monochorionic and dichorionic pregnancies were made using the Mann-Whitney U-test for continuous variables and the chi2 test and Fisher exact test for categorical variables. The prevalence of reversed a-wave in at least one of the fetuses was significantly higher in monochorionic than in dichorionic pregnancies (18.4% compared with 8.3%, P<.001) and in pregnancies complicated by miscarriage (28.6%, P=.005), fetal aneuploidy (70.0%, P<.001), and twin-twin transfusion syndrome (38.5%, P<.001) compared with the pregnancies with two healthy live births (7.7%). Pregnancy outcome was normal in 33 of the 43 (76.7%) dichorionic and in 14 of the 33 (42.4%) monochorionic twins with reversed a-wave in at least one of the fetuses. In twins, reversed a-wave in the ductus venosus at 11 to 13 weeks of gestation is associated with increased risk for aneuploidies, miscarriage, and development of severe twin-twin transfusion syndrome. However, in about 75% of dichorionic twins and 40% of monochorionic twins with reversed a-wave, the pregnancy outcome is normal. II.

  18. Thiamine responsive megaloblastic anemia syndrome associated with patent ductus arteriosus: First case report from Kashmir Valley of the Indian subcontinent

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    Mohd Ashraf Ganie

    2012-01-01

    Full Text Available Thiamine responsive megaloblastic anemia syndrome, an autosomal recessive inherited disorder characterized by a triad of anemia, diabetes mellitus and sensorineural deafness is caused by a deficiency of a thiamine transporter protein. The disorder is rare and has not been reported from our community which has high background of consanguinity. We report a six years old girl who presented with diabetes mellitus which remitted after thiamine replacement. The girl in addition had sensorineural deafness, reinopathy, atrial septal defect and megaloblastic anemia which responded to high doses of thymine. This is the first case reported from Kashmir valley and third from India. The presentation and management in such cases is discussed.

  19. Transcatheter closure of tubular type patent ductus arteriosus using Amplatzer® ductal occluder II: a case report

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    Mulyadi M Djer

    2013-10-01

    In recent years, interventional cardiology has become a gold standard therapy for the majority of PDA cases beyond neonatal age. Since its introduction in 1967, many devices and methods have been developed to allow transcatheter closure of virtually all PDAs, regardless of size or configuration. Nevertheless, the tubular shape (type C PDA, which has the highest residual shunt rate, still poses a great challenge for the interventionist.8-10 The second generation of Amplatzer® device occluders (ADO II, released in 2007, has been suggested to be effective in closing tubular PDAs.10 The purpose of this study was to report the initial clinical experience using ADO II to close a tubular type PDA in Indonesia.

  20. Clinical results and radiographic appearance of the Rashkind double umbrella device in patients with occlusion of the ductus arteriosus

    Energy Technology Data Exchange (ETDEWEB)

    Galal, O. [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia)]|[Department of Cardiovascular Diseases, MBC 16, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211 (Saudi Arabia); Sinner, W. von; Azhari, N.; Al-Fadley, F.; De Moor, M.; Boecker, J.; Fawzy, M.E..; Al-Halees, Z. [King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia)

    1997-12-01

    Background. The Rashkind double umbrella device for patent arterial duct occlusion has been used in many patients. Its radiographic appearance has not been sufficiently described. Objective. To present the varying radiographic appearances of the Rashkind double umbrella device on the chest X-ray. Materials and methods. The chest radiographs of 69 patients (median age 60 months; median weight 17 kg), who underwent closure of their patent arterial duct between March 1990 and August 1994, were reviewed. The following parameters were evaluated: (1) the size of the heart (cardio-thoracic ratio) and pulmonary vessels, (2) the position of the device in AP/PA and lateral projections. The results of occlusion of the patent arterial duct were also reviewed. Results. Sixty-two of 69 (90 %) pa- tients had complete occlusion after a follow-up between 2 months and 3{sup 1}/{sub 2} years. The cardio-thoracic ratio showed significant reduction at follow-up (P < 0.001). The two different size devices could be well differentiated in the AP and the lateral projection. In 14 patients (20 %) the device was in an asymmetrical position. There was no significant correlation between position of the device and success of occlusion in our material. Conclusion. Complete occlusion of the arterial duct using Rashkind double umbrella devices can be achieved in 90 % of our population. In 20 % the device will have an asymmetrical position. There is no correlation between asymmetrical position of the device in the chest radiograph and residual shunting. (orig.) With 7 figs., 12 refs.

  1. Thiamine responsive megaloblastic anemia syndrome associated with patent ductus arteriosus: First case report from Kashmir Valley of the Indian subcontinent.

    Science.gov (United States)

    Ganie, Mohd Ashraf; Ali, Imran; Ahangar, A G; Wani, Mohd Maqbool; Ahmed, Sanjeed; Bhat, Manzoor Ahmed; Seth, Sulaiman; Mudasir, Syed

    2012-07-01

    Thiamine responsive megaloblastic anemia syndrome, an autosomal recessive inherited disorder characterized by a triad of anemia, diabetes mellitus and sensorineural deafness is caused by a deficiency of a thiamine transporter protein. The disorder is rare and has not been reported from our community which has high background of consanguinity. We report a six years old girl who presented with diabetes mellitus which remitted after thiamine replacement. The girl in addition had sensorineural deafness, reinopathy, atrial septal defect and megaloblastic anemia which responded to high doses of thymine. This is the first case reported from Kashmir valley and third from India. The presentation and management in such cases is discussed.

  2. Screening for adverse pregnancy outcome by ductus venosus Doppler at 11-13+6 weeks of gestation.

    Science.gov (United States)

    Maiz, Nerea; Valencia, Catalina; Emmanuel, Edoho E; Staboulidou, Ismini; Nicolaides, Kypros H

    2008-09-01

    To estimate the independent contribution of abnormal flow in the ductus venosus at 11 to 13+6 weeks of gestation in the prediction of major fetal abnormalities and fetal death. This was a prospective assessment of singleton pregnancies by maternal history, serum free beta-hCG, pregnancy-associated plasma protein A (PAPP-A), fetal nuchal translucency thickness, and ductus venosus Doppler. The patients were subdivided into five groups: normal outcome (n=10,120), miscarriage or fetal death (n=185), abnormal karyotype (n=95), and major cardiac (n=20) or noncardiac defect (n=70). Regression analysis was performed to determine the significance of the contribution to adverse outcome of reversed a-wave in the ductus venosus, maternal characteristics, fetal delta nuchal translucency, maternal serum log PAPP-A multiples of the median, and log free beta-hCG multiples of the median. The prevalence of reversed a-wave was significantly higher in the groups with miscarriage or fetal death (10.8%), abnormal karyotype (62.1%), and fetal cardiac defect (25.0%) than in the normal outcome group (3.7%), but not noncardiac defect (4.3%). An adverse outcome was observed in 2.7% of the fetuses with nuchal translucency at or below the 95th centile (in 2.6% of those with normal a-wave and in 7.0% of those with reversed a-wave) and in 19.3% of the fetuses with nuchal translucency above the 95th centile (in 8.9% of those with normal a-wave and in 70.9% of those with reversed a-wave). Reversed a-wave is associated with increased risk for chromosomal abnormalities, cardiac defects, and fetal death. However, in about 80% of cases with reversed a-wave, the pregnancy outcome is normal.

  3. Routine chest drainage after patent ductus arteriosis ligation is not necessary.

    Directory of Open Access Journals (Sweden)

    Samuel Kai San YAPP

    2010-12-01

    Full Text Available Introduction: Chest drain insertion after surgical patent ductus arteriosus (PDA ligation creates significant morbidities in terms of pain, pleural space infection, reduced mobility as well as prolonged hospital stay. We investigated the safety and efficacy of performing drainless thoracotomy closure following PDA ligation in a paediatric population. Materials and Methods: Retrospective analysis of data collected from 13 paediatric patients undergoing PDA ligation at RIPAS hospital by a single surgeon over a period of five years (2001 to 2006 was performed. All continuous data were presented as mean ± standard deviation. Results: PDA ligation was performed via a left thoracotomy in 13 pediatric patients with a mean age of 2.24 ± 2.03 years (ten females and three males. Mean duration of the procedures was 67 ± 12 minutes. There was minimal blood loss and no transfusion was required. Postoperatively, ten patients required only oral paracetamol for pain relief. Two patients required additional non steroidal anti-inflammatory drugs (NSAIDs. One patient had one dose of pethidine immediately post-operatively. Post-operative chest radiographs confirmed full expansion of the left lung except in one patient who had a small apical pneumothorax. Two other patients developed mild surgical emphysema despite full expansion of the left lung. All three cases resolved spontaneously after a day. Median post-operative stay was two days. There were no cases of left recurrent nerve injuries and no mortality. Conclusion: Routine chest drainage is not necessary following uncomplicated surgical PDA ligation and patients recovered quicker and are discharge earlier.

  4. 低体重儿童动脉导管未闭封堵治疗的疗效观察%Therapeutic Effect of Patent Doctus Arteriosus Closer for Low Body Weight Children

    Institute of Scientific and Technical Information of China (English)

    郑林琼; 鲁一兵; 张伟华; 杨栋

    2014-01-01

    目的:探讨低体重儿童动脉导管未闭封堵治疗的疗效和安全性.方法2008年1月至2012年6月昆明医科大学附属延安医院对体重<8 kg的婴幼儿PDA 32例(男14例,女18例)实施经导管介入封堵治疗,年龄6~18月,平均(11±5.5)月,体重(7.2±0.6) kg,主动脉造影示PDA最窄径为1~8 mm (4.6±1.7) mm,封堵后即刻和30 min行侧位降主动脉造影,术后1 d,1、3、6个月分别行超声心动图及X线摄片检查.结果30例封堵治疗成功,成功的患者均采用国产PDA封堵器,1例术中造影合并降主动脉缩窄和室间隔缺损,转外科治疗;1例为PDA封堵器主动脉侧过大,导致降主动脉狭窄,放弃封堵;2例术后即刻存在微量-少量残余分流;随访均未发生严重并发症.结论应用国产封堵器经导管治疗体重<8 kg的婴幼儿的PDA是一种安全有效、简便、创伤小、恢复快的介入治疗方法.%Objective To discusses the efficacy and safety of patent ductus arteriosus sealing for low body weight children. Methods From January 2008 to June 2012 in our hospital,32 cases (male14 and female 18) of PDA babies< 8 kg weight were given transcatheter closure treatment. The enrolled PDA babies aged 6 month-18 months, average (11 ±5.5 months),weighted (7.2 ±0.6) kg,aortic imaging showed the narrowest diameter of PDA was 1 ~ 8 mm (4.6 ±1.7) mm,descending aorta imaging was performed immediately and 30 min after transcatheter closure treatment. Echocardiography and X-ray radiography examination were performed 1 d,1,3, 6 months after treatment. Results 30 cases got successful patent ductus arteriosus sealing,all the successful patients were treated with domestic closer,and 1 case was complicated with the descending aorta stenosis and ventricular septal defect, and was transferred to surgerical treatment. 1 case of PDA gave up patent ductus arteriosus sealing as descending aorta stenosis caused by the

  5. 30岁以上动脉导管未闭患者的手术治疗%Surgical treatment for ductus arterious in patients 30 years old or above

    Institute of Scientific and Technical Information of China (English)

    杜巍; 胡建国; 周新民; 刘锋

    2003-01-01

    @@ 成年人(30岁以上)动脉导管未闭(patent ductus arteriosus,PDA)往往继发肺动脉高压,且动脉导管管壁组织脆弱,可伴有粥样变或钙化斑块,结扎导管时易断裂、大出血,而危及患者生命[1].因此,应根据病情采用适当的手术方式.本研究回顾性分析我院1986年1月~2002年5月收治的48例30岁以上动脉导管未闭(PDA)患者,现将其主要特点、手术方式及疗效报告如下.

  6. Anomalous Origin of the Left Pulmonary Artery: Hemi-Truncus Arteriosus

    Science.gov (United States)

    Shakir, Mariam; Ariff, Shabina; Ali, Rehan; Hassan, Babar

    2017-01-01

    Hemi-truncus arteriosus is a rare congenital cardiovascular malformation. It usually presents in infancy and leads to development of progressive pulmonary vascular disease, heart failure, and death. We report a case of hemi truncus arteriosus in a 12-day-old neonate who was successfully managed at our institute.

  7. Persistent truncus arteriosus with intact ventricular septum diagnosed by echocardiography

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yu-qi; SHEN Rong; SUN Kun; ZHONG Shu-wen; WU Yu-rong

    2009-01-01

    Persistent truncus arteriosus (PTA) is a rare congenital cardiac anomaly, and has an incidence of about 0.5 to 0.9 per 10 000 live births. Almost all cases described in the literatures had a large ventricular septal defect, only few rare cases were reported with intact ventricular septum. From June 1998 to December 2008, cardiac angiography were performed in 10 880 patients with congenital heart disease in our hospital, 47 patients with PTA were diagnosed, one case with tricuspid atresia,hypoplastic right ventricle, and intact ventricular septum was encountered.

  8. Systematic analysis of the development of the ductus venosus in wild type mouse and human embryos

    NARCIS (Netherlands)

    Burger, N.B.; Haak, M.C.; Bakker, B.S. De; Shaibani, Z. Al; Groot, C.J. de; Christoffels, V.M.; Bekker, M.N.

    2013-01-01

    BACKGROUND: Doppler flow velocities of the ductus venosus are increasingly used to assess fetal increased nuchal translucency, growth-restriction and monochorionic twins, and might contribute to screening for cardiac defects. It is disputed whether a sphincter at the ductus venosus inlet actively re

  9. Systematic analysis of the development of the ductus venosus in wild type mouse and human embryos

    NARCIS (Netherlands)

    Burger, N.B.; Haak, M.C.; Bakker, B.S. De; Shaibani, Z. Al; Groot, C.J. de; Christoffels, V.M.; Bekker, M.N.

    2013-01-01

    BACKGROUND: Doppler flow velocities of the ductus venosus are increasingly used to assess fetal increased nuchal translucency, growth-restriction and monochorionic twins, and might contribute to screening for cardiac defects. It is disputed whether a sphincter at the ductus venosus inlet actively re

  10. Anatomical Variations of the Circulus Arteriosus in Cadaveric Human Brains

    Directory of Open Access Journals (Sweden)

    S. A. Gunnal

    2014-01-01

    Full Text Available Objective. Circulus arteriosus/circle of Willis (CW is a polygonal anastomotic channel at the base of the brain which unites the internal carotid and vertebrobasilar system. It maintains the steady and constant supply to the brain. The variations of CW are seen often. The Aim of the present work is to find out the percentage of normal pattern of CW, and the frequency of variations of the CW and to study the morphological and morphometric aspects of all components of CW. Methods. Circulus arteriosus of 150 formalin preserved brains were dissected. Dimensions of all the components forming circles were measured. Variations of all the segments were noted and well photographed. The variations such as aplasia, hypoplasia, duplication, fenestrations, and difference in dimensions with opposite segments were noted. The data collected in the study was analyzed. Results. Twenty-one different types of CW were found in the present study. Normal and complete CW was found in 60%. CW with gross morphological variations was seen in 40%. Maximum variations were seen in the PCoA followed by the ACoA in 50% and 40%, respectively. Conclusion. As it confirms high percentage of variations, all surgical interventions should be preceded by angiography. Awareness of these anatomical variations is important in neurovascular procedures.

  11. Tratamento cirúrgico da persistência do canal arterial na população adulta Surgical treatment of patent ductus arteriosus in adults

    Directory of Open Access Journals (Sweden)

    Marcelo Biscegli Jatene

    2011-03-01

    Full Text Available OBJETIVO: Analisar uma série de 34 pacientes adultos submetidos ao tratamento cirúrgico da persistência do canal arterial. MÉTODOS: Estudo retrospectivo, com coleta de dados dos prontuários de 34 pacientes consecutivos, com idade superior a 18 anos, com persistência do canal arterial submetidos a correção cirúrgica, no período de 1997 a 2008, no Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. RESULTADOS: A idade média foi de 28,7 (18 a 53 anos e 22 (64,7% pacientes eram do sexo feminino. O sintoma mais frequente foi dispneia (76,5%. A toracotomia lateral esquerda foi utilizada em 33 (97,1% pacientes e o canal arterial foi seccionado e suturado em 25 (73,5%. A circulação extracorpórea (CEC foi necessária em um paciente. Observou-se calcificação em oito (23,5% pacientes e 12 (35,3% haviam sido submetidos à tentativa de fechamento percutâneo. A incidência de complicações foi de 32%, sendo uma permanente, com paralisia de corda vocal (2,9%. Dois (5,8% pacientes permaneceram com shunt residual e três (8,8% apresentaram paralisia de corda vocal esquerda transitória. A cirurgia realizada efetivamente levou à melhora da classe funcional (POBJECTIVE: To analyze 34 patients submitted to surgical treatment of patent arterial duct with age beyond 18 years old. METHODS: Retrospective data collected from patient's charts with more than eighteen years old, submitted to surgical correction of patent arterial duct between 1997 and 2008 at Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. RESULTS: The mean age was 28.7 (18 a 53 years and 22 (64.7% were female. The more prevalent symptom was dyspnea (76.5%. Left lateral thoracotomy was used in 33 (97.1%; the DA was sectioned and sutured in 25 (73.5% cases and one patient needed cardiopulmonary bypass support. There were eight (23.5% calcified arterial duct and 12 (35.3% previous treatment with transcatheter devices were performed. The complication rate was 32%, with one (2.9% permanent vocal cord palsy. Two (5.8% patients had residual shunt less than 2mm. Transient left cord voice palsy was observed in 3 (8.8% The procedure improves functional class (P< 0.0001 and no mortality was observed. CONCLUSION: In this series, the surgical treatment of patent arterial duct in adults could be done without mortality and low incidence of complications.

  12. Detachable Gianturco spring coils to occlude small patent ductus arteriosus. Preliminary results; Occlusione percutanea del dotto di Botallo con spirali di Gianturco con rilascio controllato. Risultati preliminari

    Energy Technology Data Exchange (ETDEWEB)

    Gasparini, Daniele; Basadonna, Pier Tommaso [Azienda Ospedaliera ad alta specializzazione S. Maria della Misericordia, Udine (Italy). Istituto di Radiologia. Modulo di Radiologia vascolare e interventistica; Fontanelli, Alessandro; Bernardi, Guglielmo; Morocutti, Giorgio [Azienda Ospedaliera ad alta specializzazione S. Maria della Misericordia, Udine (Italy). Istituto di Cardiologia. Modulo di Emodinanica e interventistica

    1997-04-01

    Introduction: Botallo`s duct occlusion with Gianturco coils is effective in the fistulas with max diameter of 3.3 mm. The insertion technique does not permit to control coil positioning inside the fistula and the coil itself may migrate to the pulmonary artery. They report their experience with a new system of temporary hookup of the coil proximal end to a metal thread (Cook device) which permits to change the position of the coil or to replace it. Materials and methods: They treated 6 patients with persistence of Botallo`s duct (diameter: 2-3.5 mm, mean: 2.9 mm). The duct was occluded in 5/6 patients. The coil migrated to the pulmonary artery in a case where the hookup system permitted to retrieve and then replace it with too big for the small aorta. No complications were observed. Results: Follow-up chest films at 24 hours showed coil stability and color Doppler US confirmed the occlusion. The patients were discharged after 24 hours. The follow-up at 6 months confirmed the procedure success. Conclusions: The hookup system was effective to control coil positioning and to extract and replace the coils. The effectiveness of this occlusion technique would be improved if a wider range of coil sizes and types were available.

  13. Resistive indices of cerebral arteries in very preterm infants: values throughout stay in the neonatal intensive care unit and impact of patent ductus arteriosus

    NARCIS (Netherlands)

    G.M. Ecury-Goossen (Ginette); M.M.A. Raets (Marlou); F.A. Camfferman (Fleur); Vos, R.H.J. (Rik H. J.); J.M. van Rosmalen (Joost); I.K.M. Reiss (Irwin); P. Govaert (Paul); J. Dudink (Jeroen)

    2016-01-01

    textabstractBackground: Little is known about cerebral artery resistive index values in infants born extremely preterm. Objective: To report resistive index values in various cerebral arteries in a prospective cohort of preterm infants born at <29 weeks’ gestation, and to compare resistive index in

  14. Resistive indices of cerebral arteries in very preterm infants : values throughout stay in the neonatal intensive care unit and impact of patent ductus arteriosus

    NARCIS (Netherlands)

    Ecury-Goossen, Ginette M; Raets, Marlou M A; Camfferman, Fleur A; Vos, Rik H J; van Rosmalen, Joost; Reiss, Irwin K M; Govaert, Paul; Dudink, Jeroen

    2016-01-01

    BACKGROUND: Little is known about cerebral artery resistive index values in infants born extremely preterm. OBJECTIVE: To report resistive index values in various cerebral arteries in a prospective cohort of preterm infants born at <29 weeks' gestation, and to compare resistive index in these arteri

  15. Down Syndrome with Patent Ductus Venosus and Hepato-Biliary-Pancreatic Abnormalities.

    Science.gov (United States)

    Yamaguchi, Hiroshi; Kosugiyama, Kiyotaka; Honda, Shohei; Tadao, Okada; Taketomi, Akinobu; Iwata, Seido

    2016-01-01

    The association between Down syndrome and congenital portosystemic shunts, most commonly caused by patent ductus venosus, remains relatively unknown. The authors present a girl with Down syndrome with patent ductus venosus, pancreaticobiliary maljunction and paucity of interlobular bile ducts, presenting with neonatal cholestasis and transient abnormal myeloproliferative disorder. To the best of authors' knowledge, no report of the concurrent presence of the above in Down syndrome has been published.

  16. Genetics Home Reference: Char syndrome

    Science.gov (United States)

    ... a distinctive facial appearance, a heart defect called patent ductus arteriosus, and hand abnormalities. Most people with Char syndrome ... a triangular-shaped mouth, and thick, prominent lips. Patent ductus arteriosus is a common heart defect in newborns, and ...

  17. Facts about Hypoplastic Left Heart Syndrome

    Science.gov (United States)

    ... left and right sides of the heart: the patent ductus arteriosus and the patent foramen ovale . Normally, these openings ... functioning left side of the heart through the patent ductus arteriosus and the patent foramen ovale. The right side ...

  18. Cardiac defects, nuchal edema and abnormal lymphatic development are not associated with morphological changes in the ductus venosus

    NARCIS (Netherlands)

    Burger, Nicole B.; Haak, Monique C.; Kok, Evelien; de Groot, Christianne J M; Shou, Weinian; Scambler, Peter J.; Lee, Youngsook; Cho, Eunjin; Christoffels, Vincent M.; Bekker, Mireille N.

    2016-01-01

    Background In human fetuses with cardiac defects and increased nuchal translucency, abnormal ductus venosus flow velocity waveforms are observed. It is unknown whether abnormal ductus venosus flow velocity waveforms in fetuses with increased nuchal translucency are a reflection of altered cardiac fu

  19. A Morgagni hernia with an absent ductus venosus: An unusual case causing unusual consequences

    Directory of Open Access Journals (Sweden)

    Maria Phillis

    2016-09-01

    Full Text Available A Morgagni hernia is a rare form of congenital diaphragmatic hernia (CDH, comprising only 3–5% of all CDH cases. Agenesis of the ductus venosus with direct umbilical vein blood flow to the heart is a relatively uncommon finding that is often fatal in utero. We present a case of a 2-month-old infant with Morgagni hernia and absence of the ductus venosus. These combined defects led to neovascularization of the liver, severe pulmonary hypertension and right heart failure. In this report, we describe a Morgagni hernia that's presentation resembled that of a Bochdalek hernia likely because of concomitant absence of the ductus venosus causing severe pulmonary hypertension.

  20. Initial experience of occluding special type patent ductus arterioses using the Amplatzer vascular plug

    Institute of Scientific and Technical Information of China (English)

    ZHANG Po; ZHU Xian-yang; WANG Qi-guang; ZHANG Duan-zhen; HAN Xiu-min

    2013-01-01

    Background Occluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses.The Amplatzer vascular plug I (AVP1) has not been licensed for use for closure of patent ductus arteriose.We report our initial experience to occluding special type patent ductus arterioses with the AVP1-a single lobe device of single layer Nitinol mesh for short vessel landing zones.Methods Patients referred with small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter underwent occlusion using AVP1.All cases underwent pre-,intra-and post-procedural echocardiography and chest X-ray at the completion of the procedure,the next day and at a 30-day,3-month and 6-month follow-up visits.Device sizing for device waist diameter and length was based on aortography.Results From April 2008 to June 2012,26 patients with a mean age of (7.6±8.0) years (range 6 months-32 years)and a mean weight of (23.8±14.8) kg (range 7-67 kg) underwent successful patent ductus arteriose closure.The mean ductus diameter was (2.1±0.7) mm (range 1-3 mm).Transpulmonary (22/26) and transaortic approaches (4/26) were used.No persistent patency was observed after 24 hours and after one month.No device displacement,residual flow and iatrogenic coarctation of the aorta were observed after three months and six months.Conclusions The AVP1 makes it easy to close some Krichenko E patent ductus arterioses.Smaller delivery catheter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter and small patients through transaortic approaches.Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.

  1. Isolated truncus arteriosus associated with a mutation in the plexin-D1 gene.

    Science.gov (United States)

    Ta-Shma, Asaf; Pierri, Ciro Leonardo; Stepensky, Polina; Shaag, Avraham; Zenvirt, Shamir; Elpeleg, Orly; Rein, Azaria J J T

    2013-12-01

    Truncus arteriosus accounts for approximately 1% of congenital heart defects and the cause of isolated non-syndromic truncus arteriosus is largely unknown. In order to identify the underlying molecular defect in a consanguineous family with recurrent tuncus arteriosus, homozygosity mapping followed by whole exome sequencing was performed. This resulted in the identification of a homozygous mutation, Arg1299Cys, in the PLXND1 gene. The mutation affected a highly conserved residue, segregated with the disease in the family and was absent from available SNP databases and ethnic matched controls. in silico comparative modeling revealed that the mutation resides in the N-terminal segment of the human plexin-D1 intracellular region which interacts with the catalytic GTPase-activating protein homology region. The mutation likely destabilizes the intracellular region, perturbing its anchoring and catalytic activity. The phenotype in human PLXND1 mutation is closely related to that of knockout mice for PLXND1, its co-receptor neuropilin-1 or its ligand SEMA3C. It is therefore suggested that SEMA3C signaling, propagated through the heterodimer receptor plexin-D1/neuropilin, is important for truncus arteriosus septation. Confirmation of this observation will require the identification of PLXND1 mutations in additional patients. Exome analysis is valuable for molecular investigation of single patients with congenital heart defects in whom chromosomal copy number variants have been excluded. © 2013 Wiley Periodicals, Inc.

  2. Ductus venosus in the first trimester: contribution to screening of chromosomal, cardiac defects and monochorionic twin complications.

    Science.gov (United States)

    Maiz, Nerea; Nicolaides, Kypros H

    2010-01-01

    In the first trimester the ductus venosus can be easily identified with color Doppler and a ductus venosus waveform can be obtained by pulsed Doppler. At 11-13 weeks the prevalence of abnormal a-wave in the ductus venosus is inversely related to fetal crown-rump length and maternal serum pregnancy-associated plasma protein-A (PAPP-A), increases with fetal nuchal translucency (NT) thickness and is more common in women of Black racial origin and in fetuses with abnormal karyotype or cardiac defects. Ductus venosus flow provides an independent contribution in the prediction of chromosomal abnormalities when combined with NT and the maternal serum markers of PAPP-A and free beta-hCG, increasing the detection rate to 96% at a false-positive rate of 2.6%. Abnormal ductus venosus flow increases the risk of cardiac defects in fetuses with NT above the 95th centile, and it may increase the risk in fetuses with normal NT. In twin pregnancies, abnormal ductus venosus flow is associated with chromosomal abnormalities and cardiac defects. In monochorionic twins, abnormal flow in the ductus venosus in at least 1 of the fetuses increases the risk of developing twin-to-twin transfusion syndrome. Copyright (c) 2010 S. Karger AG, Basel.

  3. Agenesis of the ductus venosus and its correlation to hydrops fetalis.

    Science.gov (United States)

    Hoppen, T; Hofstaetter, C; Plath, H; Kau, N; Bartmann, P

    2000-01-01

    Absence of the ductus venosus is a rare vascular anomaly. We report a late onset of a hydrops fetalis seen in a fetus at 34 completed weeks of gestation. A persistence of the cranial parts of the left and right umbilical veins and of the paired cranial vitelline veins with an absent ductus venosus led to a bilateral hydrothorax, ascites and skin-edema. Postnatally the hydrops resolved within 7 days most probably due to the change from the fetal to the adult circulation. The abnormal venous system was confirmed by angiography. Agenesis of the ductus venosus can manifest in two different morphologic patterns: The umbilical vein drains exclusively into the left branch of the intrahepatic portal vein or the umbilical vein drains into the inferior vena cava or directly into the right atrium by-passing the liver completely. In both patterns, the preferential direction of the flow towards the foramen ovale is not present. While the first pattern leads to hyperperfusion of the liver parenchyma, the latter would result in reduced perfusion and oxygenation. Our findings suggest that agenesis of ductus venosus might induce hydrops fetalis. We conclude, that in every case of hydrops fetalis the venous system should be evaluated by ultrasonography prenatally and/or immediately postnatally.

  4. Persistent Truncus Arteriosus With Intact Ventricular Septum: Clinical, Hemodynamic and Short-term Surgical Outcome

    Directory of Open Access Journals (Sweden)

    Gholamhossein Ajami

    2015-10-01

    Full Text Available Introduction: Truncus arteriosus with intact ventricular septum is a rare and unique variant of persistent truncus arteriosus (PTA which usually presents with central cyanosis and congestive heart failure in neonate and early infancy. Associated cardiac and non-cardiac anomalies may affect morbidity and mortality of these patients. Case Presentation: We describe clinical presentation, echocardiography and angiographic features of a 7-month old boy with PTA and intact ventricular septum who underwent surgical repair of the anomaly at our institution. Operative findings, surgical procedure and short-term outcome are reported. Conclusions: While our patient had systemic pulmonary arterial pressure at the time of complete surgical repair, it was improved after surgery.

  5. Neonatal hemochromatosis and patent ductus venosus: clinical course and diagnostic pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, Andy; Paltiel, Harriet J.; Sena, Laureen M. [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Kim, Heung Bae; Fishman, Steven J. [Children' s Hospital Boston and Harvard Medical School, Department of Surgery, Boston, MA (United States); Alomari, Ahmad I. [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Children' s Hospital Boston, Division of Vascular and Interventional Radiology, Boston, MA (United States)

    2009-08-15

    Neonatal hemochromatosis is a rare metabolic disorder characterized by excessive iron deposition within the liver leading to hepatic failure and portal hypertension. We describe the clinical course and imaging findings in three infants with neonatal hemochromatosis associated with patent ductus venosus. We paid special attention to the diagnostic challenges encountered in these patients in order to emphasize some of the potential diagnostic pitfalls. We conducted a comprehensive search of our radiology database of the last 10 years (1999-2008) for the keywords ''neonatal hemochromatosis.'' Medical records and imaging studies of various modalities were reviewed. Three neonates were found to have neonatal hemochromatosis; all of them were associated with patent ductus venosus. Two of these patients were referred to our tertiary center for embolization of an inaccurately diagnosed hepatic vascular malformation. Two patients underwent successful liver transplantation and one died shortly after referral. The awareness and inclusion of neonatal hemochromatosis in the differential diagnosis of newborns with liver failure and patent ductus venosus has critical treatment implications. (orig.)

  6. Screening performance for trisomy 21 comparing first trimester combined screening and a first trimester contingent screening protocol including ductus venosus and tricuspid flow

    DEFF Research Database (Denmark)

    Ekelund, Charlotte Kvist; Petersen, Olav Bjørn; Sundberg, Karin Milner

    2012-01-01

    To compare the standard first trimester combined risk assessment for trisomy 21 with a contingent screening protocol including tricuspid flow and ductus venosus flow.......To compare the standard first trimester combined risk assessment for trisomy 21 with a contingent screening protocol including tricuspid flow and ductus venosus flow....

  7. Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report

    Directory of Open Access Journals (Sweden)

    P S Nagaraja

    2015-01-01

    Full Text Available Truncus arteriosus (TA is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1-year is uncommon. Here, we report a unique case of 12-year-old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management.

  8. An aborted human fetus with truncus arteriosus communis--possible teratogenic effect of Tedral.

    Science.gov (United States)

    Matsuoka, R; Gilbert, E F; Bruyers, H; Optiz, J M

    1985-08-01

    We recently performed a detailed anatomicopathologic examination on an aborted human embryo whose mother had taken four tablets of Tedral (one tablet of Tedral contains 130 mg theophylline, 25 mg ephedrine, 8 mg phenobarbital) for an upper respiratory tract infection when the embryo was at approximately 30 days of development. On the same day, the mother developed acute chest pain and a fast, irregular heart beat. The abortion occurred at approximately 80 days of gestation. The heart of the fetus showed truncus arteriosus (Van Praagh type A1). Although no direct cause and effect relationship was proven in this case, the possibility of a teratogenic effect of Tedral during early pregnancy is considered.

  9. Reverse Logistics

    OpenAIRE

    Kulikova, Olga

    2016-01-01

    This thesis was focused on the analysis of the concept of reverse logistics and actual reverse processes which are implemented in mining industry and finding solutions for the optimization of reverse logistics in this sphere. The objective of this paper was the assessment of the development of reverse logistics in mining industry on the example of potash production. The theoretical part was based on reverse logistics and mining waste related literature and provided foundations for further...

  10. Three-dimensional colour Doppler of ductus venous agenesis in the first trimester

    Directory of Open Access Journals (Sweden)

    Divya Singh

    2016-11-01

    Full Text Available Ductus venosus (DV has a pivotal role in the fetal circulation. It serves as a conduit connecting the fetal umbilical and portal venous system with the inferior vena cava (IVC. The absence of DV is an uncommon anomaly. In case of agenesis of DV, the umbilical vein joins the fetal systemic venous circulation via the intra-hepatic or extra-hepatic route. We report a case of absent DV with associated anomaly diagnosed in the first trimester using three-dimensional (3D colour Doppler.

  11. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience

    Science.gov (United States)

    Chen, Qiuming; Gao, Huawei; Hua, Zhongdong; Yang, Keming; Yan, Jun; Zhang, Hao; Ma, Kai; Zhang, Sen; Qi, Lei; Li, Shoujun

    2016-01-01

    Objective This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. Methods From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). Results Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. Conclusions Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up. PMID:26752522

  12. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

    Directory of Open Access Journals (Sweden)

    Qiuming Chen

    Full Text Available This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus.From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years.Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years. Thirty patients (60% were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9 units.m2 and 64.3±17.9 (range, 38 to 101 mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28% patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335-43.092; p = 0.022. Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II.Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

  13. Neurturin-GFRalpha2 signaling controls liver bud migration along the ductus venosus in the chick embryo.

    Science.gov (United States)

    Tatsumi, Norifumi; Miki, Rika; Katsu, Kenjiro; Yokouchi, Yuji

    2007-07-01

    During chick liver development, the liver bud arises from the foregut, invaginates into the septum transversum, and elongates along and envelops the ductus venosus. However, the mechanism of liver bud migration is only poorly understood. Here, we demonstrate that a GDNF family ligand involved in neuronal outgrowth and migration, neurturin (NRTN), and its receptor, GFRalpha2, are essential for liver bud migration. In the chick embryo, we found that GFRalpha2 was expressed in the liver bud and that NRTN was expressed in the endothelial cells of the ductus venosus. Inhibition of GFRalpha2 signaling suppressed liver bud elongation along the ductus venous without affecting cell proliferation and apoptosis. Moreover, ectopic expression of NRTN perturbed the directional migration along the ductus venosus, leading to splitting or ectopic branching of the liver. We showed that liver buds selectively migrated toward an NRTN-soaked bead in vitro. These data represent a new model for liver bud migration: NRTN secreted from endothelial cells functions as a chemoattractant to direct the migration of the GFRalpha2-expressing liver bud in early liver development.

  14. Fetal ductus venosus flow velocity waveforms and maternal serum AFP before and after first-trimester transabdominal chorionic villus sampling

    NARCIS (Netherlands)

    C.A. Brezinka (Christoph); A.M. Hagenaars (A.); J.W. Wladimiroff (Juriy); F.J. Los

    1995-01-01

    textabstractDoppler flow velocity waveform recording in the fetal ductus venosus and umbilical artery as well as maternal blood sampling for serum alpha-fetoprotein (MSAFP) was performed before and after transabdominal chorion villus sampling (TACVS) in 36 women of advanced maternal age (≥ 36 years)

  15. Normalisation of a severely abnormal ductus venosus Doppler flow velocity waveform in a growth-retarded fetus with absent end-diastolic flow in the umbilical artery and congenital anomalies.

    Science.gov (United States)

    Müller, T; Rehn, M; Girschick, G; Kristen, P; Dietl, J

    2001-01-01

    Doppler recordings of fetal venous blood flow seem to be superior to arterial velocimetry and CTG concerning the prediction of fetal outcome and optimal time of delivery in pregnancies with fetal growth retardation and AREDV. An improvement of arterial Doppler flow velocities has been described. We report the reappearance of a normal end-diastolic flow velocity in a ductus venosus temporarily showing reversed end-diastolic flow in a growth-retarded fetus with congenital anomalies. This normalization was accompanied by an improvement of the CTG, a loss of umbilical vein pulsations, a reappearance of umbilical diastolic flow and a progressive return of cerebral and venous blood flow into the 'normal' range. Improvement of fetal condition may be the explanation for our observation.

  16. Truncus arteriosus operado aos 28 anos: importância do diagnóstico diferencial

    Directory of Open Access Journals (Sweden)

    Lilian Maria Lopes

    2011-08-01

    Full Text Available Descrevemos um caso de adulto de 28 anos com suspeita de cardiopatia congênita desde o nascimento, não tratada na infância por opção da família. Aos 27 anos, foi feito diagnóstico de atresia pulmonar com comunicação interventricular e colaterais sistêmico-pulmonares, sendo contraindicada a cirurgia. Uma nova reavaliação em nosso serviço demonstrou tratar-se de um truncus arteriosus atípico. O fato de um tronco arterial comum com shunt esquerda-direita ter sido visualizado ao ecocardiograma foi um dado crucial para a indicação de novo cateterismo, abrindo perspectiva de correção cirúrgica. No momento, o paciente encontra-se bem, com 7 anos de evolução pós-operatória.

  17. The peptide hormone cholecystokinin modulates the tonus and compliance of the bulbus arteriosus and pre-branchial vessels of the rainbow trout (Oncorhynchus mykiss).

    Science.gov (United States)

    Seth, Henrik; Axelsson, Michael; Gräns, Albin

    2014-12-01

    The bulbus arteriosus is a compliant structure between the ventricle and ventral aorta of teleost fish. It serves as a "wind-kessel" that dampens pressure variations during the cardiac cycle allowing a continuous flow of blood into the gills. The bulbus arteriosus receives sympathetic innervation and is affected by several circulating substances, indicating neurohumoral control. We have previously shown that the peptide hormone, cholecystokinin (CCK), affects the hemodynamics of the cardiovascular system in rainbow trout (Oncorhynchus mykiss) by increasing flow pulse amplitude without affecting cardiac output. We hypothesized that this could be explained by an altered tonus or compliance/distensibility of the bulbus arteriosus. Our results show that there is a substantial effect of CCK on the bulbus arteriosus. Concentrations of CCK that altered the cardiac function of in situ perfused hearts also contracted the bulbus arteriosus in vitro. Pressure-volume curves revealed a change in both the tonus and the compliance/distensibility of this structure. Furthermore, the stimulatory (constricting) effect of CCK was also evident in the ventricle and vasculature leading to the gills, but absent in the atrium, efferent branchial arteries and dorsal aorta. In conclusion, CCK alters the mechanical properties of the ventricle, bulbus arteriosus, ventral aorta and afferent gill vasculature, thus maintaining adequate branchial and systemic blood flow and pressure when cardiorespiratory demands change, such as after feeding.

  18. First-trimester ultrasound screening for trisomy 21 based on maternal age, fetal nuchal translucency, and different methods of ductus venosus assessment.

    Science.gov (United States)

    Wagner, Philipp; Sonek, Jiri; Klein, Jessika; Hoopmann, Markus; Abele, Harald; Kagan, Karl Oliver

    2017-07-01

    To examine whether combining the dichotomous assessment of the a-wave and the ductus venosus (DV) pulsatility index for veins (PIV) measurement improves first-trimester screening performance. Retrospective study performed at the University Hospital of Tuebingen based on singleton pregnancies that underwent first-trimester screening including DV flow assessment. In each case, the risk of trisomy 21 was calculated based on maternal age, fetal nuchal translucency, and DV flow either as dichotomous classification of the a-wave, as measurement of the DV PIV, or both. There were 5280 euploid fetuses and 127 fetuses with trisomy 21. The DV a-wave was reversed in 2.3% and 66.1% in the euploid and trisomy 21 cases, respectively. The DV PIV measurements were above the 95th percentile in 8.3% and 77.2% the euploid and trisomy 21 cases, respectively. For a false positive rate of 3%, the detection rate for trisomy 21 based on maternal age, fetal NT, and DV flow is about 87% irrespective of whether DV is examined as a continuous or dichotomous variable. The combination of both resulted in a small decrease at 3% false positive rate. Assessment of the DV a-wave and the DV PIV result in similar DRs. Combining these two approaches does not appear to improve their individual screening performance. © 2017 John Wiley & Sons, Ltd. © 2017 John Wiley & Sons, Ltd.

  19. Implantación de stent en neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente

    Directory of Open Access Journals (Sweden)

    Juan P. Rojas

    2014-03-01

    Conclusiones: La implantación del stent ductal se convierte en una herramienta importante en el paciente con cardiopatía congénita cianosante ductus dependiente ya que ofrece menor tasa de morbilidad y mortalidad.

  20. Transcatheter Closure of Patent Ductus Arteriosus Using 0.052″ Gianturco Coil With Bioptome Controlled Delivery%0.052吋Gianturco coil弹簧栓子经导管封堵动脉导管未闭

    Institute of Scientific and Technical Information of China (English)

    夏呈森; 周银宝; 解春红

    2002-01-01

    目的:评价0.052吋Gianturco coil弹簧栓子经导管封堵动脉导管未闭(PDA)的疗效及安全性.方法:10例PDA患者在基础和骶管麻醉下,用心内膜心肌活检钳控制和传递0.052Gianturco coil弹簧栓子,顺行经导管封堵PDA.结果:8例1枚Gianturco coil弹簧栓子、1例3枚Gianturco coil弹簧栓子完全封堵成功,1例因Gianturco coil弹簧栓子未能回收至传递鞘内改行手术结扎.结论:用0.052Gianturco coil弹簧栓子经导管封堵3.0~4.0 mm直径的PDA,是安全、可靠的非手术方法.

  1. Effect of VitaminA on Development of Ductus Arteriosus in Fatal Rabbit%维生素A对胎兔动脉导管发育的影响

    Institute of Scientific and Technical Information of China (English)

    李涛; 王宏伟; 潘军; 邹典定; 肖玉; 徐少勇

    2006-01-01

    目的研究维生素A(VitA)对胎兔动脉导管发育的影响,为防治早产儿动脉导管未闭(PDA)寻找新的途径.方法孕兔8只随机分为4组,VitA 5000 IU/d,受孕d25服用1次(A组),孕d25、d26连续服用2次(B组),孕2周后隔天服用(C组)和对照组服用生理盐水(D组).取胎兔动脉导管固定,切片、HE染色,观察导管内膜增殖情况,测定导管内钙浓度.结果A、B、C组导管内膜增殖程度较D组明显增加,A、B、C组导管内钙浓度明显增加.结论VitA能增加导管内钙浓度,促进胎兔动脉导管发育.

  2. Reverse logistics

    NARCIS (Netherlands)

    M.P. de Brito (Marisa); S.D.P. Flapper; R. Dekker (Rommert)

    2002-01-01

    textabstractThis paper gives an overview of scientific literature that describes and discusses cases of reverse logistics activities in practice. Over sixty case studies are considered. Based on these studies we are able to indicate critical factors for the practice of reverse logistics. In addi

  3. Genetics Home Reference: CHOPS syndrome

    Science.gov (United States)

    ... defects, obesity, pulmonary involvement, short stature, and skeletal dysplasia Related Information How are ... Congenital Heart Defect -- Corrective Surgery Encyclopedia: Patent Ductus Arteriosus ...

  4. Complete interruption of the aortic arch

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Hak; Park, In Kyu; Lee, Won Hwa; Kim, Yong Joo; Kang, Duk Sik; Lee, Jong Tae [Kyungpook National University College of Medicine, Taegu (Korea, Republic of)

    1984-09-15

    Complete interrupture of the aortic arch is one of the least common cardiac malformation. In this condition, continuity between the ascending and descending protions of the aorta is not present, and the descending aorta is supplied through a reversing patent ductus arteriosus. In the majority of the patients a ventricular septal defect is present. Authors have experienced a case of the complete interruption of aortic arch, interruption between the left carotid and the left subclavian artery.

  5. Stent ductal en cardiopatías congénitas dependientes del ductus. Seguimiento a mediano plazo

    Directory of Open Access Journals (Sweden)

    Ricardo Gamboa

    2006-01-01

    Full Text Available Objetivo Presentar nuestra experiencia con el empleo de stent para mantener la permeabilidad ductal en cardiopatías congénitas dependientes del ductus. Método y resultados En tres pacientes de entre 2 y 9 días de vida con atresia pulmonar se colocaron cuatro stents por cateterismo, sin complicaciones. El tiempo de seguimiento promedio fue de 411 días (123 a 721 días. Dos stents se redilataron exitosamente. Un paciente fue sometido a cirugía, uno interrumpió sus controles cuatro meses después y otro espera cirugía. La saturación promedio aumentó del 61% al 80%. Conclusiones En pacientes con cardiopatías cuya circulación depende del ductus arterioso, el implante del stent fue factible y efectivo a corto y mediano plazos.

  6. [Silver-Russell syndrome (hemihypertrophy) and cor triatriatum in a newborn].

    Science.gov (United States)

    Ríos-Méndez, Raúl Enrique; Montero-Monar, Hernán Eduardo; Pernández-Alvarado, Antonio Pedro; Hidalgo-Flores, Einstein Gustavo

    2015-06-01

    Hemihypertrophy syndrome and cor triatriatum are extremely rare pathologies. Hemihypertrophy is defined as complete or partial overgrowth of one of the hemibodies. Cor triatriatum is a congenital heart disease characterized by a membrane which separates the left atrium into two chambers; if that membrane has a restrictive hole, it causes obstruction to blood passage from the pulmonary veins into the left ventricle causing hypertension and pulmonary edema. In this context, the patent ductus arteriosus can act as a means of decompression of the pulmonary circuit, because it allows the blood passage from the pulmonary artery to the aorta. We report a patient with Silver-Rusell syndrome (hemihypertrophy), cor triatriatum and ductus arteriosus with reverse flow. To our knowledge, this association of rare pathologies and this clinical presentation have not been described previously.

  7. Reversible Computing

    Science.gov (United States)

    1980-02-01

    will have been introduced. 9. Reversible celular autemata We shall assume the reader to have some familiarity with the concept of cel- lular...10003 Mr. Kin B. Thcmpson 1 copy Technical Director Information Systems Divisia.i Naval Research Laboratory (OP-91T) Technical Information Division

  8. Implantación de stent en neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente

    Directory of Open Access Journals (Sweden)

    Juan P Rojas

    2014-04-01

    Full Text Available Introducción: Los pacientes con cardiopatía congénita cianosante ductus dependiente, requieren de su permeabilidad para garantizar el flujo al sistema pulmonar o al sistémico. En casos de permeabilidad del ductus arterioso, la implantación de un stent ductal mejora la sobrevida del paciente y acarrea complicaciones mínimas. Objetivos: General: caracterizar neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente tratados con la implantación de stent ductal. Específicos: determinar la morbilidad y mortalidad en neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente, tratados con implantación de stent ductal. Materiales y métodos: Se incluyeron 37 pacientes recién nacidos con cardiopatía congénita cianosante ductus dependiente tratados con implantación de stent ductal, entre el 1.º de enero de 2008 al 31 de diciembre de 2012 (5 años, en Cali, Colombia. Resultados: La implantación del stent ductal fue exitosa en 26 pacientes; uno falleció inmediatamente después del procedimiento. No hubo complicaciones mayores durante el procedimiento de implantación del stent. Diez pacientes fueron sometidos a cirugía de Blalock-Taussig modificada después de la implantación fallida del stent ductal. Conclusiones: La implantación del stent ductal se convierte en una herramienta importante en el paciente con cardiopatía congénita cianosante ductus dependiente ya que ofrece menor tasa de morbilidad y mortalidad.

  9. Squamous cell carcinoma originating from a thyroglossus duct cyst; Plattenepithelkarzinom der Schilddruese ausgehend von einer Ductus thyreoglossus Zyste

    Energy Technology Data Exchange (ETDEWEB)

    Kresnik, E. [Nuklearmedizinische Abt., LKH Klagenfurt (Austria); Gallowitsch, H.J. [Nuklearmedizinische Abt., LKH Klagenfurt (Austria); Ploeb, J. [Nuklearmedizinische Abt., LKH Klagenfurt (Austria); Gomez, I. [Nuklearmedizinische Abt., LKH Klagenfurt (Austria); Mikosch, P. [Nuklearmedizinische Abt., LKH Klagenfurt (Austria); Dinges, H.P. [Pathologisches Inst., LKH Klagenfurt (Austria); Lind, P. [Nuklearmedizinische Abt., LKH Klagenfurt (Austria)

    1995-04-01

    A 73 y old female was found to suffer from a squamous cell carcinoma with a focal thymus-like differentiation in a thyroglossal duct cyst. A neoplasma of this type in a goitre with Graves` disease is extremely rare. Sonographic, radiological, scintigraphic and microscopic findings are discussed. (orig.) [Deutsch] Es wird ueber eine 73jaehrige Patientin mit dem sehr seltenen Fall eines Karzinoms berichtet, das sich in einer Ductus thyreoglossus-Zyste innerhalb einer Struma diffusa et nodosa entwickelt hatte. Zusaetzlich bestand eine Immunthyreopathie Typ Basedow. Sonographische, roentgenologische, szintigraphische und histologische Befunde werden vorgestellt. (orig.)

  10. Reversible Statistics

    DEFF Research Database (Denmark)

    Tryggestad, Kjell

    2004-01-01

    The study aims is to describe how the inclusion and exclusion of materials and calculative devices construct the boundaries and distinctions between statistical facts and artifacts in economics. My methodological approach is inspired by John Graunt's (1667) Political arithmetic and more recent work...... within constructivism and the field of Science and Technology Studies (STS). The result of this approach is here termed reversible statistics, reconstructing the findings of a statistical study within economics in three different ways. It is argued that all three accounts are quite normal, albeit...... in different ways. The presence and absence of diverse materials, both natural and political, is what distinguishes them from each other. Arguments are presented for a more symmetric relation between the scientific statistical text and the reader. I will argue that a more symmetric relation can be achieved...

  11. Rare case of truncus arteriosus with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) and unilateral left pulmonary artery agenesis.

    Science.gov (United States)

    Mittal, Kartik; Dey, Amit K; Gadewar, Rohit; Sharma, Rajaram; Pandit, Nilesh; Rajput, Priya; Hira, Priya

    2015-04-01

    The incidence of congenital heart disease (CHD) is 2.4-3.8/1000 live births. Up to 70.7 % of all cases of CHD are reported to be benign; complex heart anomalies are extremely rare. Our case is extremely rare, as we report three very rare findings-truncus arteriosus, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), and unilateral left pulmonary artery agenesis-in a single patient. Congenital complex cardiac abnormalities are very rare, and two-dimensional echocardiography screening should be supported by cardiac computed tomography (CT). We report a case of truncus arteriosus associated with ARCAPA and left pulmonary artery agenesis diagnosed by cardiac computed tomography; we believe that such an unusual case with all three of these entities has never been reported before.

  12. Managing Reverse Logistics or Reversing Logistics Management?

    OpenAIRE

    Brito, Marisa

    2004-01-01

    textabstractIn the past, supply chains were busy fine-tuning the logistics from raw material to the end customer. Today an increasing flow of products is going back in the chain. Thus, companies have to manage reverse logistics as well.This thesis contributes to a better understanding of reverse logistics. The thesis brings insights on reverse logistics decision-making and it lays down theoretical principles for reverse logistics as a research field.In particular it puts together a framework ...

  13. Managing Reverse Logistics or Reversing Logistics Management?

    NARCIS (Netherlands)

    M.P. de Brito (Marisa)

    2004-01-01

    textabstractIn the past, supply chains were busy fine-tuning the logistics from raw material to the end customer. Today an increasing flow of products is going back in the chain. Thus, companies have to manage reverse logistics as well.This thesis contributes to a better understanding of reverse

  14. Managing Reverse Logistics or Reversing Logistics Management?

    NARCIS (Netherlands)

    M.P. de Brito (Marisa)

    2004-01-01

    textabstractIn the past, supply chains were busy fine-tuning the logistics from raw material to the end customer. Today an increasing flow of products is going back in the chain. Thus, companies have to manage reverse logistics as well.This thesis contributes to a better understanding of reverse log

  15. A mixture model of ductus venosus pulsatility index in screening for aneuploidies at 11-13 weeks' gestation.

    Science.gov (United States)

    Maiz, Nerea; Wright, David; Ferreira, Ana Fatima A; Syngelaki, Argyro; Nicolaides, Kypros H

    2012-01-01

    To assess the value of ductus venosus pulsatility index for veins (DV PIV) in screening for aneuploidies at 11-13 weeks' gestation. Fetal DV PIV was measured in singleton pregnancies undergoing first-trimester screening for aneuploidies. In euploid (n = 44,756) and aneuploid (202 cases of trisomy 21, 72 cases of trisomy 18 and 30 cases of trisomy 13) fetuses, DV PIV was best described by a mixture model of distributions. Performance of screening for aneuploidies by DV PIV alone and in combination with fetal nuchal translucency (NT) thickness and serum free β-hCG and PAPP-A was estimated. In euploid pregnancies there was a bimodal distribution of DV PIV with a dominant crown-rump length (CRL)-dependent part, accounting for around 97% of cases in Caucasians and around 93% in Afro-Caribbeans, and a smaller CRL-independent distribution. In aneuploidies the dominant part was the CRL-independent distribution, which accounted for around 85% cases of trisomies 21 and 18 and 70% of cases of trisomy 13. In screening for trisomy 21 by maternal age, NT and biochemistry at a risk cutoff of 1 in 100, the detection rate was 89.7% and false positive rate was 2.74%; with addition of DV PIV, the values were 93.5 and 1.63%, respectively. Measurement of DV PIV improves the performance of first-trimester combined test for aneuploidies. Copyright © 2012 S. Karger AG, Basel.

  16. Reversible Thermoset Adhesives

    Science.gov (United States)

    Mac Murray, Benjamin C. (Inventor); Tong, Tat H. (Inventor); Hreha, Richard D. (Inventor)

    2016-01-01

    Embodiments of a reversible thermoset adhesive formed by incorporating thermally-reversible cross-linking units and a method for making the reversible thermoset adhesive are provided. One approach to formulating reversible thermoset adhesives includes incorporating dienes, such as furans, and dienophiles, such as maleimides, into a polymer network as reversible covalent cross-links using Diels Alder cross-link formation between the diene and dienophile. The chemical components may be selected based on their compatibility with adhesive chemistry as well as their ability to undergo controlled, reversible cross-linking chemistry.

  17. Reversibility of cortical hyperostosis following long-term prostaglandin E1 therapy in infants with ductus-dependent congenital heart disease

    DEFF Research Database (Denmark)

    Høst, A; Halken, S; Andersen, P E

    1988-01-01

    Two neonates with complex cyanotic congenital heart disease, receiving long-term prostaglandin E1 infusion, for 59 and 78 days respectively, demonstrated significant radiographic changes of symmetric cortical hyperostosis of the long bones. Bone biopsies from one of the patients elucidated...

  18. Reverse logistics - a framework

    OpenAIRE

    Brito, Marisa; Dekker, Rommert

    2002-01-01

    textabstractIn this paper we define and compare Reverse Logistics definitions. We start by giving an understanding framework of Reverse Logistics: the why-what-how. By this means, we put in context the driving forces for Reverse Logistics, a typology of return reasons, a classification of products, processes and actors. In addition we provide a decision framework for Reverse Logistics and we present it according to long, medium and short term decisions, i.e. strategic-tactic-operational decis...

  19. Reverse cholesterol transport revisited

    Institute of Scientific and Technical Information of China (English)

    Astrid; E; van; der; Velde

    2010-01-01

    Reverse cholesterol transport was originally described as the high-density lipoprotein-mediated cholesterol flux from the periphery via the hepatobiliary tract to the intestinal lumen, leading to fecal excretion. Since the introduction of reverse cholesterol transport in the 1970s, this pathway has been intensively investigated. In this topic highlight, the classical reverse cholesterol transport concepts are discussed and the subject reverse cholesterol transport is revisited.

  20. Reverse logistics - a framework

    NARCIS (Netherlands)

    M.P. de Brito (Marisa); R. Dekker (Rommert)

    2002-01-01

    textabstractIn this paper we define and compare Reverse Logistics definitions. We start by giving an understanding framework of Reverse Logistics: the why-what-how. By this means, we put in context the driving forces for Reverse Logistics, a typology of return reasons, a classification of product

  1. Reversible cortical blindness: posterior reversible encephalopathy syndrome.

    Science.gov (United States)

    Bandyopadhyay, Sabyasachi; Mondal, Kanchan Kumar; Das, Somnath; Gupta, Anindya; Biswas, Jaya; Bhattacharyya, Subir Kumar; Biswas, Gautam

    2010-11-01

    Cortical blindness is defined as visual failure with preserved pupillary reflexes in structurally intact eyes due to bilateral lesions affecting occipital cortex. Bilateral oedema and infarction of the posterior and middle cerebral arterial territory, trauma, glioma and meningioma of the occipital cortex are the main causes of cortical blindness. Posterior reversible encephalopathy syndrome (PRES) refers to the reversible subtype of cortical blindness and is usually associated with hypertension, diabetes, immunosuppression, puerperium with or without eclampsia. Here, 3 cases of PRES with complete or partial visual recovery following treatment in 6-month follow-up are reported.

  2. Introduction to reversible computing

    CERN Document Server

    Perumalla, Kalyan S

    2013-01-01

    Few books comprehensively cover the software and programming aspects of reversible computing. Filling this gap, Introduction to Reversible Computing offers an expanded view of the field that includes the traditional energy-motivated hardware viewpoint as well as the emerging application-motivated software approach. Collecting scattered knowledge into one coherent account, the book provides a compendium of both classical and recently developed results on reversible computing. It explores up-and-coming theories, techniques, and tools for the application of rever

  3. Reversible Logic Circuit Synthesis

    CERN Document Server

    Shende, V V; Markov, I L; Prasad, A K; Hayes, John P.; Markov, Igor L.; Prasad, Aditya K.; Shende, Vivek V.

    2002-01-01

    Reversible, or information-lossless, circuits have applications in digital signal processing, communication, computer graphics and cryptography. They are also a fundamental requirement for quantum computation. We investigate the synthesis of reversible circuits that employ a minimum number of gates and contain no redundant input-output line-pairs (temporary storage channels). We propose new constructions for reversible circuits composed of NOT, Controlled-NOT, and TOFFOLI gates (the CNT gate library) based on permutation theory. A new algorithm is given to synthesize optimal reversible circuits using an arbitrary gate library. We also describe much faster heuristic algorithms. We also pursue applications of the proposed techniques to the synthesis of quantum circuits.

  4. Percutaneous closure of huge patent ductus arterious associated with anomalous inferior vein cava drainage and dextrocardia with muscular ventricular septal defect occluder

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Transcatheter occlusion of patent ductus arterious (PDA) using various occluders and coils has been a well-established method1-5 since Porstmann and colleagues6 reported the first case in 1967. However, when patients associated with anomalous inferior vein cava drainage or/and huge high pulmonary artery pressure ductus (HPAP-PDA), the method is not suitable. First, it is unfeasible to carry out the procedure via femoral vein. Second, in the presence of high pulmonary artery pressure such devices including the Amplatzer ductu occluder carry the risk of embolising into the aorta.7 The muscular ventricular septal defect occluder (MVSDO), which is a device for transcatheter closure of muscular ventricular septal defect, may be more suitable for using with HPAP-PDA as its double disk tends to anchor the device, preventing embolisation into the aorta. We present a patient, who is suffering from huge PDA associated with anomalous inferior vein cava drainage and dextrocardia, in whom percutaneous closure of PDA using MVSDO was successfully accomplished via transjugular approach.

  5. Eye features in three Danish patients with multisystemic smooth muscle dysfunction syndrome

    DEFF Research Database (Denmark)

    Moller, Hans Ulrik; Fledelius, Hans C; Milewicz, Dianna M

    2012-01-01

    A de novo mutation of the ACTA2 gene encoding the smooth muscle cell α-actin has been established in patients with multisystemic smooth muscle dysfunction syndrome associated with patent ductus arteriosus and mydriasis present at birth....

  6. What Is a Heart Murmur?

    Science.gov (United States)

    ... Holes in the Heart How the Heart Works Patent Ductus Arteriosus Stress Testing Tetralogy of Fallot Rate This Content: Updated: December 9, 2016 Twitter Facebook YouTube Google+ SITE INDEX ACCESSIBILITY PRIVACY STATEMENT FOIA OIG CONTACT ...

  7. What Is Respiratory Distress Syndrome?

    Science.gov (United States)

    ... Clinical Trials Links Related Topics Atelectasis Bronchopulmonary Dysplasia Patent Ductus Arteriosus Pleurisy and Other Pleural Disorders Ventilator/ ... this page with Gmail. Bookmark this page with Google. Share this page from the NHLBI on LinkedIn. ...

  8. Doppler flow velocity waveforms in the fetal cardiac outflow tract: Reproducibility of waveform recording and analysis

    NARCIS (Netherlands)

    I.A.L. Groenenberg (Irene); W.C.J. Hop (Wim); J.W. Wladimiroff (Juriy)

    1991-01-01

    markdownabstract__Abstract__ Reproducibility of flow velocity waveform recording and analysis was studied at fetal cardiac level (ductus arteriosus, pulmonary artery and ascending aorta) in 42 normal pregnancies. The flow velocity parameters studied were the peak systolic velocity (PSV),

  9. Reverse Core Engine with Thrust Reverser

    Science.gov (United States)

    Suciu, Gabriel L. (Inventor); Chandler, Jesse M. (Inventor)

    2017-01-01

    An engine system has a gas generator, a bi-fi wall surrounding at least a portion of the gas generator, a casing surrounding a fan, and the casing having first and second thrust reverser doors which in a deployed position abut each other and the bi-fi wall.

  10. Quantum reverse hypercontractivity

    Energy Technology Data Exchange (ETDEWEB)

    Cubitt, Toby [Department of Computer Science, University College London, London, United Kingdom and Centre for Quantum Information and Foundations, DAMTP, University of Cambridge, Cambridge (United Kingdom); Kastoryano, Michael [NBIA, Niels Bohr Institute, University of Copenhagen, 2100 Copenhagen (Denmark); Montanaro, Ashley [School of Mathematics, University of Bristol, Bristol (United Kingdom); Temme, Kristan [Institute for Quantum Information and Matter, California Institute of Technology, Pasadena, California 91125 (United States)

    2015-10-15

    We develop reverse versions of hypercontractive inequalities for quantum channels. By generalizing classical techniques, we prove a reverse hypercontractive inequality for tensor products of qubit depolarizing channels. We apply this to obtain a rapid mixing result for depolarizing noise applied to large subspaces and to prove bounds on a quantum generalization of non-interactive correlation distillation.

  11. Clocked Thrust Reversers

    Science.gov (United States)

    Suciu, Gabriel L. (Inventor); Chandler, Jesse M. (Inventor)

    2017-01-01

    An aircraft includes a fuselage including a propulsion system supported within an aft portion. A thrust reverser is mounted proximate to the propulsion system for directing thrust in a direction to slow the aircraft. The thrust reverser directs thrust at an angle relative to a vertical plane to reduce interference on control surfaces and reduce generation of underbody lift.

  12. Atrioventricular Pacemaker Lead Reversal

    Directory of Open Access Journals (Sweden)

    Mehmet K Aktas, MD

    2007-01-01

    Full Text Available During cardiac surgery temporary epicardial atrial and ventricular leads are placed in case cardiac pacing is required postoperatively. We present the first reported series of patients with reversal of atrioventricular electrodes in the temporary pacemaker without any consequent deleterious hemodynamic effect. We review the electrocardiographic findings and discuss the findings that lead to the discovery of atrioventricular lead reversal.

  13. Reversible cerebral vasoconstriction syndrome

    Directory of Open Access Journals (Sweden)

    Saini Monica

    2009-01-01

    Full Text Available Reversible cerebral vasoconstriction syndromes (RCVS are a group of disorders that have in common an acute presentation with headache, reversible vasoconstriction of cerebral arteries, with or without neurological signs and symptoms. In contrast to primary central nervous system vasculitis, they have a relatively benign course. We describe here a patient who was diagnosed with RCVS.

  14. Towards Reversible Sessions

    Directory of Open Access Journals (Sweden)

    Francesco Tiezzi

    2014-06-01

    Full Text Available In this work, we incorporate reversibility into structured communication-based programming, to allow parties of a session to automatically undo, in a rollback fashion, the effect of previously executed interactions. This permits taking different computation paths along the same session, as well as reverting the whole session and starting a new one. Our aim is to define a theoretical basis for examining the interplay in concurrent systems between reversible computation and session-based interaction. We thus enrich a session-based variant of pi-calculus with memory devices, dedicated to keep track of the computation history of sessions in order to reverse it. We discuss our initial investigation concerning the definition of a session type discipline for the proposed reversible calculus, and its practical advantages for static verification of safe composition in communication-centric distributed software performing reversible computations.

  15. Analysis of CT angiography of persistent truncus arteriosus Ⅳ%永存动脉干Ⅳ型的CT血管造影分析

    Institute of Scientific and Technical Information of China (English)

    袁亮; 邹利光; 付刘霞

    2012-01-01

    目的 探讨永存动脉干Ⅳ型的CT血管造影特征.方法 回顾性分析CT血管造影证实的永存动脉干Ⅳ型共14例,男5例,女9例;评估心脏形态、室间隔缺损、动脉干骑跨、支气管动脉异常及侧支循环、其他心血管畸形特征.结果 CT血管造影显示:①双心室增大明显,伴右心房增大;②高位室间隔缺损,缺损平均直径(20.1±5.2) mm,其中男性为(23.7±5.2) mm,女性为(18.2±5.6) mm,差异无统计学意义(t=1.813,P=0.095,P>0.05);③动脉干骑跨率为(50±5.2)%,男性为(51±2.3)%,女性为(49±6.3)%,差异无统计学意义(t=0.522,P=0.611,P>0.05);动脉干平均内径(34.2±6.4) mm,男性为(39.1±4.3) mm,女性为(31.4±5.8) mm,差异有统计学意义( t=2.589,P=0.024,P<0.05);④无肺动脉主干,心腰明显凹陷,肺血由支气管动脉及侧支循环供应,部分支气管动脉呈"残根"征;⑤男女各2例伴右位主动脉弓,其中1例男性有左侧肺静脉异常粗大,女性1例伴永存左上腔静脉.结论 永存动脉干Ⅳ型特征复杂多变,CT血管造影有利于提高诊断准确率,对手术有重要参考价值.%Objective To evaluate the findings of computed tomography angiography of persistent truncus arteriosus Ⅳ. Methods 14 patients (5 men and 9 women) of persistent truncus arteriosus Ⅳ confirmed by CT angiography were involved in this study. The cardiac morphology,ventricular septal defect,arteriosus truncus straddle,anomalism bronchial arteries and complicating vascular malformations were analysed retrospectively. Results CT angiography showed:①Biventricular enlargement obviously and accompanying with right atrium enlargement;②The average diameter of ventricular septal defect was (20. 1±5. 2) mm, (23. 7 ± 5. 2) mm in men and (18. 2 + 5. 6) mm in women,there was no statistically signfificant difference between them(t= 1. 813,P = 0. 095 , P>0. 05) ; ③The average rate of the arteriosus truncus straddle was (50 ± 5. 2) % , (51 ± 2. 3)% in men

  16. An algebra of reversible computation

    OpenAIRE

    2016-01-01

    We design an axiomatization for reversible computation called reversible ACP (RACP). It has four extendible modules, basic reversible processes algebra (BRPA), algebra of reversible communicating processes (ARCP), recursion and abstraction. Just like process algebra ACP in classical computing, RACP can be treated as an axiomatization foundation for reversible computation.

  17. An Algebra of Reversible Computation

    OpenAIRE

    Yong WANG

    2014-01-01

    We design an axiomatization for reversible computation called reversible ACP (RACP). It has four extendible modules, basic reversible processes algebra (BRPA), algebra of reversible communicating processes (ARCP), recursion and abstraction. Just like process algebra ACP in classical computing, RACP can be treated as an axiomatization foundation for reversible computation.

  18. An algebra of reversible computation.

    Science.gov (United States)

    Wang, Yong

    2016-01-01

    We design an axiomatization for reversible computation called reversible ACP (RACP). It has four extendible modules: basic reversible processes algebra, algebra of reversible communicating processes, recursion and abstraction. Just like process algebra ACP in classical computing, RACP can be treated as an axiomatization foundation for reversible computation.

  19. Valor preditivo do resultado fetal da dopplervelocimetria de ducto venoso entre a 11ª e a 14ª semanas de gestação Predictive value for fetal outcome of Doppler velocimetry of the ductus venosus between the 11th and the 14th gestation week

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Gollo

    2008-01-01

    pregnancy, associated to the nuchal translucency thickness measurement, in the detection of adverse fetal outcome. METHODS: a transversal and prospective study in which a total of 1,268 fetuses were studied consecutively. In 56 cases, a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus and, in 1,181 cases, the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness and to Doppler velocimetry of the ductus venosus. Aiming at prevalence and accuracy indices, sensitivity, specificity, positive predictive value, negative predictive value, probability of false-positive, probability of false-negative, reason of positive probability and reason of negative probability were calculated and analyzed. RESULTS: from the total of 1,268 fetuses, 1,183 cases were selected for analysis. From this number, 1,170 fetuses were normal (98.9% and 13 fetuses presented adverse outcome at birth (1.1%, including fetal death (trisomy 21 and 22 in two cases; genetic syndrome (Nooman in one case; two cases of polymalformed fetuses; cardiopathy in three cases; and other structural defects in five cases. The prevalence of the modified ductus venosus (wave A zero/reverse in the studied population was of 14 cases (1.2%, with a false-positive rate of 0.7%. CONCLUSIONS: there is a significant correlation between the alteration of the ductus venosus Doppler velocimetry and the thickness of the nuchal translucency as an ultrasonographic marker for the first trimester of gestation, in the detection of adverse fetal outcome, especially serious malformations. The ductus venosus was able to diminish the false-positive result in comparison to the isolated use of the nuchal translucency thickness, improving considerably the positive predictive value of the test.

  20. Reversible Data Hiding Techniques

    Directory of Open Access Journals (Sweden)

    Dhananjay Yadav

    2012-03-01

    Full Text Available Reversible data hiding is a technique that is used to hide data inside an image. The data is hidden in such a way that the exact or original data is not visible. The hidden data can be retrieved as and when required. There are several methods that are used in reversible data hiding techniques like Watermarking, Lossless embedding and encryption. In this paper we present a review of reversible watermarking techniques and show different methods that are used to get reversible data hiding technique with higher embedding capacity and invisible objects. Watermark need not be hidden. Watermarking can be applied to 1. Images, 2. Text, 3. Audio/video, 4. Software.

  1. Reversible flowchart languages and the structured reversible program theorem

    DEFF Research Database (Denmark)

    Yokoyama, Tetsuo; Axelsen, Holger Bock; Glück, Robert

    2008-01-01

    Many irreversible computation models have reversible counterparts, but these are poorly understood at present. We introduce reversible flowcharts with an assertion operator and show that any reversible flowchart can be simulated by a structured reversible flowchart using only three control flow o...... justification for low-level machine code for reversible microprocessors as well as high-level block-structured reversible languages. We give examples for both such languages and illustrate them with a lossless encoder for permutations given by Dijkstra....

  2. Adaptive Pairing Reversible Watermarking.

    Science.gov (United States)

    Dragoi, Ioan-Catalin; Coltuc, Dinu

    2016-05-01

    This letter revisits the pairwise reversible watermarking scheme of Ou et al., 2013. An adaptive pixel pairing that considers only pixels with similar prediction errors is introduced. This adaptive approach provides an increased number of pixel pairs where both pixels are embedded and decreases the number of shifted pixels. The adaptive pairwise reversible watermarking outperforms the state-of-the-art low embedding bit-rate schemes proposed so far.

  3. Coincidence of congenital left-sided diaphragmatic hernia and ductus venosus agenesis: Relation between altered hemodynamic flow and lung-to-head-ratio?

    Directory of Open Access Journals (Sweden)

    T. Klein

    2015-06-01

    Full Text Available Left-sided diaphragmatic hernia (CDH as well as ductus venosus agenesis (ADV are rare complex congenital malformations. We present a case of coincidence of these malformations and an abnormally high lung-head-ratio (LHR. The left-sided liver-up CDH and the ADV were diagnosed in prenatal ultrasound examination. In CDH cases lung volume is decreased due to the herniation of abdominal organs into the thorax. With 1.4 the LHR of our patient exceeded the normal ratio in liver-up CDH cases considerably. One explanation for this unusually high LHR might be an altered blood flow due to the coinciding ADV. In ADV cases less blood bypasses the lung through the foramen ovale. Consecutively pulmonary circulation is improved which may constitute as an advantage in CDH cases. Diagnosis, prognostic factors, physiology, and therapy strategy are discussed.

  4. On thermodynamic and microscopic reversibility

    Energy Technology Data Exchange (ETDEWEB)

    Crooks, Gavin E.

    2011-07-12

    The word 'reversible' has two (apparently) distinct applications in statistical thermodynamics. A thermodynamically reversible process indicates an experimental protocol for which the entropy change is zero, whereas the principle of microscopic reversibility asserts that the probability of any trajectory of a system through phase space equals that of the time reversed trajectory. However, these two terms are actually synonymous: a thermodynamically reversible process is microscopically reversible, and vice versa.

  5. Reversible Communicating Processes

    Directory of Open Access Journals (Sweden)

    Geoffrey Brown

    2016-02-01

    Full Text Available Reversible distributed programs have the ability to abort unproductive computation paths and backtrack, while unwinding communication that occurred in the aborted paths. While it is natural to assume that reversibility implies full state recovery (as with traditional roll-back recovery protocols, an interesting alternative is to separate backtracking from local state recovery. For example, such a model could be used to create complex transactions out of nested compensable transactions where a programmer-supplied compensation defines the work required to "unwind" a transaction. Reversible distributed computing has received considerable theoretical attention, but little reduction to practice; the few published implementations of languages supporting reversibility depend upon a high degree of central control. The objective of this paper is to demonstrate that a practical reversible distributed language can be efficiently implemented in a fully distributed manner. We discuss such a language, supporting CSP-style synchronous communication, embedded in Scala. While this language provided the motivation for the work described in this paper, our focus is upon the distributed implementation. In particular, we demonstrate that a "high-level" semantic model can be implemented using a simple point-to-point protocol.

  6. Radiation controlling reversible window

    Energy Technology Data Exchange (ETDEWEB)

    Gell, H.A. Jr.

    1980-01-01

    A coated glass glazing system is presented including a transparent glass substrate having one surface coated with a radiation absorptive film which is overcoated with a radiation reflective film by a technique which renders the radiation reflective film radiation absorptive at the surface contracting the radiating absorptive film. The coated glass system is used as glazing for storm windows which are adapted to be reversible so that the radiation reflective surface may be exposed to the outside of the dwelling during the warm seasons to prevent excessive solar radiation from entering a dwelling and reversed during cold seasons to absorb solar radiation and utilize it to aid in keeping the dwelling interior warm.

  7. Sequential Polarity-Reversing Circuit

    Science.gov (United States)

    Labaw, Clayton C.

    1994-01-01

    Proposed circuit reverses polarity of electric power supplied to bidirectional dc motor, reversible electro-mechanical actuator, or other device operating in direction depending on polarity. Circuit reverses polarity each time power turned on, without need for additional polarity-reversing or direction signals and circuitry to process them.

  8. Time reversal communication system

    Science.gov (United States)

    Candy, James V.; Meyer, Alan W.

    2008-12-02

    A system of transmitting a signal through a channel medium comprises digitizing the signal, time-reversing the digitized signal, and transmitting the signal through the channel medium. The channel medium may be air, earth, water, tissue, metal, and/or non-metal.

  9. Engineering Encounters: Reverse Engineering

    Science.gov (United States)

    McGowan, Veronica Cassone; Ventura, Marcia; Bell, Philip

    2017-01-01

    This column presents ideas and techniques to enhance your science teaching. This month's issue shares information on how students' everyday experiences can support science learning through engineering design. In this article, the authors outline a reverse-engineering model of instruction and describe one example of how it looked in our fifth-grade…

  10. Reverse Coherent Information

    Science.gov (United States)

    García-Patrón, Raúl; Pirandola, Stefano; Lloyd, Seth; Shapiro, Jeffrey H.

    2009-05-01

    In this Letter we define a family of entanglement distribution protocols assisted by feedback classical communication that gives an operational interpretation to reverse coherent information, i.e., the symmetric counterpart of the well-known coherent information. This leads to the definition of a new entanglement distribution capacity that exceeds the unassisted capacity for some interesting channels.

  11. Reversed extension flow

    DEFF Research Database (Denmark)

    Nielsen, Jens Kromann; Rasmussen, Henrik K.

    2008-01-01

    Afilament stretching rheometer (FSR) was used for measuring the start-up of uni-axial elongational flow followed by reversed bi-axial flow, both with a constant elongational rate. A narrow molecular mass distribution linear polystyrene with a molecular weight of 145 kg / mole wis subjected to the...

  12. REVERSE SUPPLY CHAIN

    Directory of Open Access Journals (Sweden)

    Tomasz DOMAGAŁA

    2013-10-01

    Full Text Available The paper focuses on the presentation of the reverse supply chain, of which the role in the modern business grows along with the increasing number of environmental regulations and possibilities of reducing an operating cost. The paper also describes main problems in developing the profitable chain and possibilities to take an action in order to overcome them.

  13. On reverse hypercontractivity

    CERN Document Server

    Mossel, Elchanan; Sen, Arnab

    2011-01-01

    We study the notion of reverse hypercontractivity. We show that reverse hypercontractive inequalities are implied by standard hypercontractive inequalities as well as by the modified log-Sobolev inequality. Our proof is based on a new comparison lemma for Dirichlet forms and an extension of the Strook-Varapolos inequality. A consequence of our analysis is that {\\em all} simple operators $L=Id-\\E$ as well as their tensors satisfy uniform reverse hypercontractive inequalities. That is, for all $qreverse hypercontractive inequalities established here imply new mixing and isoperimetric results for short random walks in product spaces, for certain card-shufflings, for Glauber dynamics in high-temperat...

  14. Reversing Discrimination: A Perspective

    Science.gov (United States)

    Pati, Gopal; Reilly, Charles W.

    1977-01-01

    Examines the debate over affirmative action and reverse discrimination, and discusses how and why the present dilemma has developed. Suggests that organizations can best address the problem through an honest, in-depth analysis of their organizational structure and management practices. (JG)

  15. Reversible quantum cellular automata

    CERN Document Server

    Schumacher, B

    2004-01-01

    We define quantum cellular automata as infinite quantum lattice systems with discrete time dynamics, such that the time step commutes with lattice translations and has strictly finite propagation speed. In contrast to earlier definitions this allows us to give an explicit characterization of all local rules generating such automata. The same local rules also generate the global time step for automata with periodic boundary conditions. Our main structure theorem asserts that any quantum cellular automaton is structurally reversible, i.e., that it can be obtained by applying two blockwise unitary operations in a generalized Margolus partitioning scheme. This implies that, in contrast to the classical case, the inverse of a nearest neighbor quantum cellular automaton is again a nearest neighbor automaton. We present several construction methods for quantum cellular automata, based on unitaries commuting with their translates, on the quantization of (arbitrary) reversible classical cellular automata, on quantum c...

  16. Partial Reversible Gates(PRG) for Reversible BCD Arithmetic

    CERN Document Server

    Thapliyal, Himanshu; Bajpai, Rajnish; Sharma, Kamal K

    2007-01-01

    IEEE 754r is the ongoing revision to the IEEE 754 floating point standard and a major enhancement to the standard is the addition of decimal format. Furthermore, in the recent years reversible logic has emerged as a promising computing paradigm having its applications in low power CMOS, quantum computing, nanotechnology, and optical computing. The major goal in reversible logic is to minimize the number of reversible gates and garbage outputs. Thus, this paper proposes the novel concept of partial reversible gates that will satisfy the reversibility criteria for specific cases in BCD arithmetic. The partial reversible gate is proposed to minimize the number of reversible gates and garbage outputs, while designing the reversible BCD arithmetic circuits.

  17. Reversible hysteresis loop tuning

    Science.gov (United States)

    Berger, A.; Binek, Ch.; Margulies, D. T.; Moser, A.; Fullerton, E. E.

    2006-02-01

    We utilize antiferromagnetically coupled bilayer structures to magnetically tune hysteresis loop properties. Key element of this approach is the non-overlapping switching field distribution of the two magnetic layers that make up the system: a hard magnetic CoPtCrB layer (HL) and a soft magnetic CoCr layer (SL). Both layers are coupled antiferromagnetically through an only 0.6-nm-thick Ru interlayer. The non-overlapping switching field distribution allows the measurement of magnetization reversal in the SL at low fields while keeping the magnetization state of the HL unperturbed. Applying an appropriate high field or high field sequence changes the magnetic state of the HL, which then influences the SL magnetization reversal due to the interlayer coupling. In this way, the position and shape of the SL hysteresis loop can be changed or tuned in a fully reversible and highly effective manner. Here, we study specifically how the SL hysteresis loop characteristics change as we move the HL through an entire high field hysteresis loop sequence.

  18. Reversible multi-head finite automata characterize reversible logarithmic space

    DEFF Research Database (Denmark)

    Axelsen, Holger Bock

    2012-01-01

    Deterministic and non-deterministic multi-head finite automata are known to characterize the deterministic and non- deterministic logarithmic space complexity classes, respectively. Recently, Morita introduced reversible multi-head finite automata (RMFAs), and posed the question of whether RMFAs...... characterize reversible logarithmic space as well. Here, we resolve the question affirmatively, by exhibiting a clean RMFA simulation of logarithmic space reversible Turing machines. Indirectly, this also proves that reversible and deterministic multi-head finite automata recognize the same languages....

  19. Congenital Heart Disease in an Infant with 49,XXXXY Syndrome

    Directory of Open Access Journals (Sweden)

    Mustafa Argun

    2015-04-01

    Full Text Available 49,XXXXY syndrome which is characterized with the addition of three extra X chromosomes to 46,XY is the rarest sex chromosome aneuploidy syndrome. Its classical findings were defined as a triad of mental retardation, hypogonadism and radioulnar synostosis. In 49,XXXXY syndrome, congenital heart defects like patent ductus arteriosus, atrial septal defect, ventricular septal defect, pulmonary stenosis, Fallot’s tetralogy have been reported. We present a case diagnosed in the newborn stage with low birth weight, short stature, dysmorphic craniofacial findings and hypoplastic male genitalia who was found to have severe pulmonary hypertension and medium patent ductus arteriosus when admitted at 4 months of age with heart failure and who underwent transcathater ductus closure with Amplatzer Duct Occluder I. To our knowledge, our case is the first reported 49,XXXXY syndrome with patent ductus arteriosus closed with the transcathater route.

  20. [Reverse Chaddock sign].

    Science.gov (United States)

    Tashiro, Kunio

    2011-08-01

    It is widely accepted that the Babinski reflex is the most well-known and important pathological reflex in clinical neurology. Among many other pathological reflexes that elicit an upgoing great toe, such as Chaddock, Oppenheim, Gordon, Schaefer, and Stransky, only the Chaddock reflex is said to be as sensitive as the Babinski reflex. The optimal receptive fields of the Babinski and Chaddock reflexes are the lateral plantar surface and the external inframalleolar area of the dorsum, respectively. It has been said that the Babinski reflex, obtained by stroking the sole, is by far the best and most reliable method of eliciting an upgoing great toe. However, the Chaddock reflex, the external malleolar sign, is also considered sensitive and reliable according to the literature and everyday neurological practice. The major problems in eliciting the Babinski reflex by stroking the lateral part of the sole are false positive or negative responses due to foot withdrawal, tonic foot response, or some equivocal movements. On the other hand, according to my clinical experience, the external inframalleolar area, which is the receptive field of the Chaddock reflex, is definitely suitable for eliciting the upgoing great toe. In fact, the newly proposed method to stimulate the dorsum of the foot from the medial to the lateral side, which I term the "reversed Chaddock method," is equally sensitive to demonstrate pyramidal tract involvement. With the "reversed Chaddock method", the receptive field of the Chaddock reflex may be postulated to be in the territory of the sural nerve, which could be supported by the better response obtained on stimulation of the postero-lateral calf than the anterior shin. With regard to the receptive fields of the Babinski and Chaddock reflexes, the first sacral dermatome (S1) is also considered a reflexogenous zone, but since the dermatome shows marked overlapping, the zones vary among individuals. As upgoing toe responses are consistently observed in

  1. Reverse Engineering of RFID devices

    OpenAIRE

    Bokslag, Wouter

    2015-01-01

    This paper discusses the relevance and potential impact of both RFID and reverse engineering of RFID technology, followed by a discussion of common protocols and internals of RFID technology. The focus of the paper is on providing an overview of the different approaches to reverse engineering RFID technology and possible countermeasures that could limit the potential of such reverse engineering attempts.

  2. Reverse Engineering Malicious Applications

    Directory of Open Access Journals (Sweden)

    Ioan Cristian Iacob

    2015-06-01

    Full Text Available Detecting new and unknown malware is a major challenge in today’s software. Security profession. A lot of approaches for the detection of malware using data mining techniques have already been proposed. Majority of the works used static features of malware. However, static detection methods fall short of detecting present day complex malware. Although some researchers proposed dynamic detection methods, the methods did not use all the malware features. In this work, an approach for the detection of new and unknown malware was proposed and implemented. Each sample was reverse engineered for analyzing its effect on the operating environment and to extract the static and behavioral features. 

  3. Reversibly Bistable Flexible Electronics

    KAUST Repository

    Alfaraj, Nasir

    2015-05-01

    Introducing the notion of transformational silicon electronics has paved the way for integrating various applications with silicon-based, modern, high-performance electronic circuits that are mechanically flexible and optically semitransparent. While maintaining large-scale production and prototyping rapidity, this flexible and translucent scheme demonstrates the potential to transform conventionally stiff electronic devices into thin and foldable ones without compromising long-term performance and reliability. In this work, we report on the fabrication and characterization of reversibly bistable flexible electronic switches that utilize flexible n-channel metal-oxide-semiconductor field-effect transistors. The transistors are fabricated initially on rigid (100) silicon substrates before they are peeled off. They can be used to control flexible batches of light-emitting diodes, demonstrating both the relative ease of scaling at minimum cost and maximum reliability and the feasibility of integration. The peeled-off silicon fabric is about 25 µm thick. The fabricated devices are transferred to a reversibly bistable flexible platform through which, for example, a flexible smartphone can be wrapped around a user’s wrist and can also be set back to its original mechanical position. Buckling and cyclic bending of such host platforms brings a completely new dimension to the development of flexible electronics, especially rollable displays.

  4. Fundamentals of reversible flowchart languages

    DEFF Research Database (Denmark)

    Yokoyama, Tetsuo; Axelsen, Holger Bock; Glück, Robert

    2016-01-01

    . Although reversible flowcharts are superficially similar to classical flowcharts, there are crucial differences: atomic steps are limited to locally invertible operations, and join points require an explicit orthogonalizing conditional expression. Despite these constraints, we show that reversible......Abstract This paper presents the fundamentals of reversible flowcharts. They are intended to naturally represent the structure and control flow of reversible (imperative) programming languages in a simple computation model, in the same way classical flowcharts do for conventional languages......, structured reversible flowcharts are as expressive as unstructured ones, as shown by a reversible version of the classic Structured Program Theorem. We illustrate how reversible flowcharts can be concretized with two example programming languages, complete with syntax and semantics: a low-level unstructured...

  5. Reversible posterior leukoencephalopathy syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Ja; Yu, Won Jong; Ahn, Kook Jin; Jung, So Lyung; Lee, Yeon Soo; Kim, Ji Chang; Kang, Si Won [The Catholic Univ. of Korea, Taejon (Korea, Republic of); Song, Chang Joon [Chungnam National Univ. School of Medicine, Cheonju (Korea, Republic of); Song, Soon-Young; Koo, Ja Hong [Kwandong Univ. College of Medicine, Myungji Hospital, Seoul (Korea, Republic of); Kim, Man Deuk [College of Medicine Pochon CHA Univ., Seoul (Korea, Republic of)

    2001-10-01

    To review reversible posterior leukoencephalopathy syndrome. We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine ; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes ; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement ; in one, enhancement was mild, and in tow, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions ; in two, small infarctions remained but the extent of the lesions had decreased. Reversible posterior

  6. Reverse photoacoustic standoff spectroscopy

    Science.gov (United States)

    Van Neste, Charles W [Kingston, TN; Senesac, Lawrence R [Knoxville, TN; Thundat, Thomas G [Knoxville, TN

    2011-04-12

    A system and method are disclosed for generating a reversed photoacoustic spectrum at a greater distance. A source may emit a beam to a target and a detector measures signals generated as a result of the beam being emitted on the target. By emitting a chopped/pulsed light beam to the target, it may be possible to determine the target's optical absorbance by monitoring the intensity of light collected at the detector at different wavelengths. As the wavelength of light is changed, the target may absorb or reject each optical frequency. Rejection may increase the intensity at the sensing element and absorption may decrease the intensity. Accordingly, an identifying spectrum of the target may be made with the intensity variation of the detector as a function of illuminating wavelength.

  7. Is Computation Reversible?

    CERN Document Server

    Parker, M C; Parker, Michael C.; Walker, Stuart D.

    2004-01-01

    Recent investigations into the physical nature of information and fundamental limits to information transmission have revealed questions such as the possibility of superluminal data transfer or not; and whether reversible computation (information processing) is feasible. In some respects these uncertainties stem from the determination of whether information is inherent in points of non-analyticity (discontinuities) or smoother functions. The close relationship between information and entropy is also well known, e.g. Brillouin's concept of negentropy (negative entropy) as a measure for information. Since the leading edge of a step-discontinuity propagates in any dispersive medium at the speed of light in vacuum as a precursor to the main body of the dispersed pulse, we propose in this paper to treat information as being intrinsic to points of non-analyticity (discontinuities). This allows us to construct a theory addressing these dilemmas in a fashion consistent with causality, and the fundamental laws of ther...

  8. Reverse Osmosis Optimization

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-08-01

    This technology evaluation was prepared by Pacific Northwest National Laboratory on behalf of the U.S. Department of Energy’s Federal Energy Management Program (FEMP). The technology evaluation assesses techniques for optimizing reverse osmosis (RO) systems to increase RO system performance and water efficiency. This evaluation provides a general description of RO systems, the influence of RO systems on water use, and key areas where RO systems can be optimized to reduce water and energy consumption. The evaluation is intended to help facility managers at Federal sites understand the basic concepts of the RO process and system optimization options, enabling them to make informed decisions during the system design process for either new projects or recommissioning of existing equipment. This evaluation is focused on commercial-sized RO systems generally treating more than 80 gallons per hour.

  9. Reverse Osmosis Optimization

    Energy Technology Data Exchange (ETDEWEB)

    McMordie Stoughton, Kate; Duan, Xiaoli; Wendel, Emily M.

    2013-08-26

    This technology evaluation was prepared by Pacific Northwest National Laboratory on behalf of the U.S. Department of Energy’s Federal Energy Management Program (FEMP). ¬The technology evaluation assesses techniques for optimizing reverse osmosis (RO) systems to increase RO system performance and water efficiency. This evaluation provides a general description of RO systems, the influence of RO systems on water use, and key areas where RO systems can be optimized to reduce water and energy consumption. The evaluation is intended to help facility managers at Federal sites understand the basic concepts of the RO process and system optimization options, enabling them to make informed decisions during the system design process for either new projects or recommissioning of existing equipment. This evaluation is focused on commercial-sized RO systems generally treating more than 80 gallons per hour.¬

  10. Multiple stimulus reversible hydrogels

    Science.gov (United States)

    Gutowska, Anna; Krzyminski, Karol J.

    2003-12-09

    A polymeric solution capable of gelling upon exposure to a critical minimum value of a plurality of environmental stimuli is disclosed. The polymeric solution may be an aqueous solution utilized in vivo and capable of having the gelation reversed if at least one of the stimuli fall below, or outside the range of, the critical minimum value. The aqueous polymeric solution can be used either in industrial or pharmaceutical environments. In the medical environment, the aqueous polymeric solution is provided with either a chemical or radioisotopic therapeutic agent for delivery to a specific body part. The primary advantage of the process is that exposure to one environmental stimuli alone will not cause gelation, thereby enabling the therapeutic agent to be conducted through the body for relatively long distances without gelation occurring.

  11. A Reversible Processor Architecture and its Reversible Logic Design

    DEFF Research Database (Denmark)

    Thomsen, Michael Kirkedal; Axelsen, Holger Bock; Glück, Robert

    2012-01-01

    We describe the design of a purely reversible computing architecture, Bob, and its instruction set, BobISA. The special features of the design include a simple, yet expressive, locally-invertible instruction set, and fully reversible control logic and address calculation. We have designed...... an architecture with an ISA that is expressive enough to serve as the target for a compiler from a high-level structured reversible programming language. All-in-all, this paper demonstrates that the design of a complete reversible computing architecture is possible and can serve as the core of a programmable...

  12. [Posterior reversible encephalopathy syndrome].

    Science.gov (United States)

    Petrović, Branko; Kostić, Vladimir; Sternić, Nadezda; Kolar, Jovo; Tasić, Nebojsa

    2003-01-01

    Reversible Posterior Leukoencephalopathy Syndrome was introduced into clinical practice in 1996 in order to describe unique syndrome, clinically expressed during hypertensive and uremic encephalopathy, eclampsia and during immunosuppressive therapy [1]. First clinical investigations showed that leucoencephalopathy is major characteristic of the syndrome, but further investigations showed no significant destruction in white cerebral tissue [2, 3, 4]. In majority of cases changes are localise in posterior irrigation area of the brain and in the most severe cases anterior region is also involved. Taking into consideration all above mentioned facts, the suggested term was Posterior Reversible Encephalopathy Syndrome (PRES) for the syndrome clinically expressed by neurological manifestations derived from cortical and subcortical changes localised in posterior regions of cerebral hemispheres, cerebral trunk and cerebellum [5]. Patient, aged 53 years, was re-hospitalized in Cardiovascular Institute "Dediwe" two months after successful aorto-coronary bypass performed in June 2001 due to the chest bone infection. During the treatment of the infection (according to the antibiogram) in September 2001, patient in evening hours developed headache and blurred vision. The recorded blood pressure was 210/120 mmHg so antihypertensive treatment was applied (Nifedipin and Furosemid). After this therapy there was no improvement and intensive headache with fatigue and loss of vision developed. Neurological examination revealed cortical blindness and left hemiparesis. Manitol (20%, 60 ccm every 3 hours) and i.v. Nytroglicerin (high blood pressure). Brain CT revealed oedema of parieto-occipital regions of both hemispheres, more emphasized on the right. (Figure 1a, b, c). There was no sign of focal ischemia even in deeper sections (Figure 1d, e, f). Following three days enormous high blood pressure values were registered. On the fourth day the significant clinical improvement occurred

  13. 49 CFR 230.89 - Reverse gear.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Reverse gear. 230.89 Section 230.89 Transportation... Reversing Gear § 230.89 Reverse gear. (a) General provisions. Reverse gear, reverse levers, and quadrants... quadrant. Proper counterbalance shall be provided for the valve gear. (b) Air-operated power reverse...

  14. Aspiration Level and the Reversal of the Preference Reversal Phenomenon.

    Science.gov (United States)

    1986-09-01

    American Economic Review , 69, 623- 638...Grether, D. M., & Plott, C. R. (1982). Economic theory of choice and the preference reversal phenomenon: Reply. The American Economic Review , 72, 575. Har...34 - . • . ...... ., .. . -. -.,- ... , .. ... - ., . . . . .. . ... . . . . . . . *~~~7 T, W.. 1 d~ I t Y ~ VVW ~ Page 26 1 loomes, G., & Sugden, R. (1983). A rationale for preference reversal. The American Economic Review ,

  15. Design of Reversible Sequential Circuit Using Reversible Logic Synthesis

    Directory of Open Access Journals (Sweden)

    Md. Belayet Ali

    2011-12-01

    Full Text Available Reversible logic is one of the most vital issue at present time and it has different areas for its application,those are low power CMOS, quantum computing, nanotechnology, cryptography, optical computing, DNA computing, digital signal processing (DSP, quantum dot cellular auto meta, communication, computer graphics. It is not possible to realize quantum computing without implementation of reversible logic. The main purposes of designing reversible logic are to decrease quantum cost, depth of the circuits and the number of garbage outputs. In this paper, we have proposed a new reversible gate. And we have designed RS flip flop and D flip flop by using our proposed gate and Peres gate. The proposed designs are better than the existing proposed ones in terms of number of reversible gates and garbage outputs. So, this realization is more efficient and less costly than other realizations.

  16. Design of Reversible Sequential Circuit Using Reversible Logic Synthesis

    Directory of Open Access Journals (Sweden)

    Md. Mosharof Hossin

    2012-01-01

    Full Text Available Reversible logic is one of the most vital issue at present time and it has different areas for its application, those are low power CMOS, quantum computing, nanotechnology, cryptography, optical computing, DNA computing, digital signal processing (DSP, quantum dot cellular automata, communication, computer graphics. It is not possible to realize quantum computing without implementation of reversible logic. The main purposes of designing reversible logic are to decrease quantum cost, depth of the circuits and the number of garbage outputs. In this paper, we have proposed a new reversible gate. And we have designedRS flip flop and D flip flop by using our proposed gate and Peres gate. The proposed designs are better than the existing proposed ones in terms of number of reversible gates and garbage outputs. So, this realization is more efficient and less costly than other realizations.

  17. Time Reversal Violation

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, H; /SLAC

    2009-01-27

    This talk briefly reviews three types of time-asymmetry in physics, which I classify as universal, macroscopic and microscopic. Most of the talk is focused on the latter, namely the violation of T-reversal invariance in particle physics theories. In sum tests of microscopic T-invariance, or observations of its violation, are limited by the fact that, while we can measure many processes, only in very few cases can we construct a matched pair of process and inverse process and observe it with sufficient sensitivity to make a test. In both the cases discussed here we can achieve an observable T violation making use of flavor tagging, and in the second case also using the quantum properties of an antisymmetric coherent state of two B mesons to construct a CP-tag. Both these tagging properties depend only on very general properties of the flavor and/or CP quantum numbers and so provide model independent tests for T-invariance violations. The microscopic laws of physics are very close to T-symmetric. There are small effects that give CP- and T-violating processes in three-generation-probing weak decays. Where a T-violating observable can be constructed we see the relationships between T-violation and CP-violation expected in a CPT conserving theory. These microscopic effects are unrelated to the 'arrow of time' that is defined by increasing entropy, or in the time direction defined by the expansion of our Universe.

  18. Dopplervelocimetria do ducto venoso na predição da acidemia fetal Ductus venosus Doppler velocimetry to predict acidemia at birth in pregnancies with placental insufficiency

    Directory of Open Access Journals (Sweden)

    Francisco Herlânio C. Carvalho

    2005-08-01

    investigate the possibility of predicting acidemia at birth in pregnancies with placental insufficiency by Doppler velocimetry of the ductus venosus and to establish the best parameter and cut-off points in this prediction. METHODS: This was a prospective cross-sectional study, involving 47 single pregnancies with placental insufficiency after 26 weeks of gestation, carried out at the "Hospital São Paulo (UNIFESP and Maternidade-Escola Assis Chateaubriand (UFC". Placental insufficiency was defined as the umbilical artery pulsatility index above the 95th percentile for gestational age. Fetuses with chromosomal or structural anomalies were excluded. The time interval between the Doppler velocimetry and the birth was of less than 24 hours. The umbilical arterial blood samples were collected immediately after birth. Acidemia was defined as umbilical arterial pH < 7.2 in the absence of uterine contractions and < 7.15 in the presence of contractions. Metabolic or mixed acidemia at birth was considered pathological. Receiver operating characteristics (ROC curves were calculated for S, D and A-velocities, pulsatility index for veins and the S/A ratio and (S-A/S ratio of the ductus venosus. Parameters were compared using the MacNemar Test RESULTS: S, D and A-velocities of the ductus venosus were poor predictors of acidemia at birth. The pulsatility index for veins (area under the curve 0.79, p=0.003, S/A ratio and (S-A/S ratio (area under the curve 0.818, p=0.001 of the DV were strongly related to fetal acidemia. The cut-off points calculated were: pulsatility index for veins = 0.76; S/A ratio = 2.67 and (S-A/S ratio = 0.63. CONCLUSIONS: The angle-independent indices of the DV Doppler are adequate for the diagnosis of fetal acidemia in gestations with placental insufficiency. No statistically significant differences were observed between these parameters.

  19. Enzymatic reactions in reversed micelles

    NARCIS (Netherlands)

    Hilhorst, M.H.

    1984-01-01

    It has been recognised that enzymes in reversed micelles have potential for application in chemical synthesis. Before these expectations will be realised many problems must be overcome. This thesis deals with some of them.In Chapter 1 the present knowledge about reversed micelles and micellar enzymo

  20. Enzyme recovery using reversed micelles.

    NARCIS (Netherlands)

    Dekker, M.

    1990-01-01

    The objective of this study was to develop a liquid-liquid extraction process for the recovery of extracellular enzymes. The potentials of reaching this goal by using reversed micelles in an organic solvent have been investigated.Reversed micelles are aggregates of surfactant molecules containing an

  1. What do reversible programs compute?

    DEFF Research Database (Denmark)

    Axelsen, Holger Bock; Glück, Robert

    2011-01-01

    Reversible computing is the study of computation models that exhibit both forward and backward determinism. Understanding the fundamental properties of such models is not only relevant for reversible programming, but has also been found important in other fields, e.g., bidirectional model...... transformation, program transformations such as inversion, and general static prediction of program properties. Historically, work on reversible computing has focussed on reversible simulations of irreversible computations. Here, we take the viewpoint that the property of reversibility itself should...... are not strictly classically universal, but that they support another notion of universality; we call this RTM-universality. Thus, even though the RTMs are sub-universal in the classical sense, they are powerful enough as to include a self-interpreter. Lifting this to other computation models, we propose r...

  2. Optimization of reversible sequential circuits

    CERN Document Server

    Sayem, Abu Sadat Md

    2010-01-01

    In recent years reversible logic has been considered as an important issue for designing low power digital circuits. It has voluminous applications in the present rising nanotechnology such as DNA computing, Quantum Computing, low power VLSI and quantum dot automata. In this paper we have proposed optimized design of reversible sequential circuits in terms of number of gates, delay and hardware complexity. We have designed the latches with a new reversible gate and reduced the required number of gates, garbage outputs, and delay and hardware complexity. As the number of gates and garbage outputs increase the complexity of reversible circuits, this design will significantly enhance the performance. We have proposed reversible D-latch and JK latch which are better than the existing designs available in literature.

  3. Reversed polarity patches at the CMB and geomagnetic field reversal

    Institute of Scientific and Technical Information of China (English)

    XU; Wenyao(徐文耀); WEI; Zigang(魏自刚)

    2002-01-01

    The International Geomagnetic Reference Field models (IGRF) for 1900-2000 are used to calculate the geomagnetic field distribution in the Earth' interior from the ground surface to the core-mantle boundary (CMB) under the assumption of insulated mantle. Four reversed polarity patches, as one of the most important features of the CMB field, are revealed. Two patches with +Z polarity (downward) at the southern African and the southern American regions stand out against the background of -Z polarity (upward) in the southern hemisphere, and two patches of -Z polarity at the North Polar and the northern Pacific regions stand out against the +Z background in the northern hemisphere. During the 1900-2000 period the southern African (SAF) patch has quickly drifted westward at a speed of 0.2-0.3°/a; meanwhile its area has expanded 5 times, and the magnetic flux crossing the area has intensified 30 times. On the other hand, other three patches show little if any change during this 100-year period. Extending upward, each of the reversed polarity patches at the CMB forms a chimney-shaped "reversed polarity column" in the mantle with the bottom at the CMB. The height of the SAF column has grown rapidly from 200km in 1900 to 900km in 2000. If the column grows steadily at the same rate in the future, its top will reach to the ground surface in 600-700 years. And then a reversed polarity patch will be observed at the Earth's surface, which will be an indicator of the beginning of a magnetic field reversal. On the basis of this study, one can describe the process of a geomagnetic polarity reversal, the polarity reversal may be observed firstly in one or several local regions; then the areas of these regions expand, and at the same time, other new reversed polarity regions may appear. Thus several poles may exist during a polarity reversal.

  4. Optimized reversible BCD adder using new reversible logic gates

    CERN Document Server

    Bhagyalakshmi, H R

    2010-01-01

    Reversible logic has received great attention in the recent years due to their ability to reduce the power dissipation which is the main requirement in low power digital design. It has wide applications advanced computing, low power CMOS design, Optical information processing, DNA computing, bio information, quantum computation and nanotechnology. This paper presents an optimized reversible BCD adder using a new reversible gate. A comparative result is presented which shows that the proposed design is more optimized in terms of number of gates, number of garbage outputs and quantum cost than the existing designs.

  5. Ultrasound assessment of the closure time and Z scores of neonatal ductus venosus%超声评估新生儿静脉导管闭合时间及Z值分布

    Institute of Scientific and Technical Information of China (English)

    黄志勇; 瞿国萍; 罗伟权; 吴浩堂; 纪宗萍; 梁键锋

    2016-01-01

    目的 研究新生儿静脉导管闭合时间及其Z值回归方程,探讨新生儿静脉导管闭合时间随胎龄的变化规律.方法 应用彩色多普勒超声探测不同胎龄新生儿静脉导管闭合的具体时间,以胎龄为自变量(X)对所测的静脉导管闭合时间(Y)进行相关性回归分析,建立新生儿静脉导管闭合时间的Z值回归方程(lnY=a+bX+cX2),根据公式Z=(M-Y)/Sx(M为观察值,Y为预测平均值),计算出不同胎龄新生儿静脉导管闭合时间的Z值.结果 共获得432例新生儿静脉导管闭合时间,其随胎龄增加而缩短(r=-0.938,P<0.001),胎龄31~41周新生儿静脉导管闭合时间参考值分别为28.5、26.3、23.7、20.9、18.0、15.2、12.5、10.1、7.9、6.2、4.6天.所获得非线性回归方程式为lnY=-5.228+0.089X-0.000228X2,R2=0.854,Sx=0.214(P<0.001),由各胎龄新生儿静脉导管闭合时间的预测平均值及Sx可计算静脉导管闭合时间任一测定值的Z值,Z=(M-Y)/Sx(其中M为观察值,Y为预测平均值);Z值呈正态分布,无随胎龄变化趋势.结论新生儿静脉导管闭合时间与胎龄存在相关性,采用非线性回归方程可用于计算预测平均值,所获得的Z值呈正态分布.%Objective To study the closure time of neonatal ductus venosus and the Z score regression equation, and to explore the variation of closure time of neonatal ductus venosus with gestationalage.Methods Color doppler ultrasound was applied to detect the closure time of neonatal ductus venosus in normal newborns, Z score regression equation ( lnY =a +bX +cX2 ) for the closure time of neonatal ductus venosus ( Y ) was developed by regression analysis which used gestational age ( X) as an independent variable. The Z scores of the closure time of neonatal ductus venosus in different gestational age were calculated by the formula [ Z = ( M - Y )/S x , M for observation value, Y for predictivevalue].Results There were 432 cases in our study.The closure time of neonatal ductus

  6. NOVEL REVERSIBLE VARIABLE PRECISION MULTIPLIER USING REVERSIBLE LOGIC GATES

    National Research Council Canada - National Science Library

    M. Saravanan; K. Suresh Manic

    2014-01-01

    .... In this study a reversible logic gate based design of variable precision multiplier is proposed which have the greater efficiency in power consumption and speed since the partial products received...

  7. Fluxo no ducto venoso e na veia cava inferior dos fetos em gestações isoimunizadas Assess flow velocity in the ductus venosus and inferior vena cava in fetuses in isoimmunized pregnancies

    Directory of Open Access Journals (Sweden)

    Eura Martins Lage

    2006-10-01

    Full Text Available OBJETIVO: Avaliar a velocidade de fluxo na veia cava inferior e no ducto venoso em fetos, nas gestações isoimunizadas. MÉTODOS: De junho de 1999 a junho de 2004, foram avaliados 61 fetos, entre 27 e 35 semanas, de gestantes portadoras de isoimunização por antígenos eritrocitários. Em todos os fetos foram avaliadas as velocidades de fluxo na veia cava inferior e no ducto venoso. Obteve-se amostra de sangue fetal para determinação dos valores da hemoglobina e calculou-se o déficit da concentração de hemoglobina. Esses fetos foram divididos em quatro grupos, de acordo com o déficit da concentração de hemoglobina: fetos não anêmicos, anêmicos leves, anêmicos moderados e anêmicos graves. Utilizou-se o teste Qui-quadrado para comparar os quatro grupos de fetos quanto à proporção da alteração da velocidade média de fluxo na veia cava inferior e no ducto venoso. RESULTADOS: A velocidade de fluxo na veia cava inferior estava alterada em 3,8% dos fetos não anêmicos, em 3,1% dos fetos com anemia leve, em 40% dos anêmicos moderados e em 76% dos fetos com anemia grave. Já a velocidade de fluxo no ducto venoso estava alterada em 7,7% dos fetos não anêmicos, em 3,1% dos fetos com anemia leve, em 32,5% dos anêmicos moderados e em 68% dos fetos com anemia grave. O valor p foi inferior a 0,001. CONCLUSÃO: Verificou-se aumento da freqüência de alteração da velocidade de fluxo na veia cava inferior e no ducto venoso à medida que a anemia se agravava.OBJECTIVE: Ductus venosus and inferior vena cava flow velocity was assessed in fetuses in isoimmunized pregnancies. METHODS: Examination of 61 fetuses aged 27 to 35 weeks from Rh-erythrocyte antigen isoimmunized women was carried out from June 1999 to June 2004. All fetuses were submitted to the examination of ductus venosus and inferior vena cava flow velocity. Blood samples were collected to determine hemoglobin values and hemoglobin concentration deficits. Accordingly, fetuses

  8. Supercritical fluid reverse micelle separation

    Science.gov (United States)

    Fulton, John L.; Smith, Richard D.

    1993-01-01

    A method of separating solute material from a polar fluid in a first polar fluid phase is provided. The method comprises combining a polar fluid, a second fluid that is a gas at standard temperature and pressure and has a critical density, and a surfactant. The solute material is dissolved in the polar fluid to define the first polar fluid phase. The combined polar and second fluids, surfactant, and solute material dissolved in the polar fluid is maintained under near critical or supercritical temperature and pressure conditions such that the density of the second fluid exceeds the critical density thereof. In this way, a reverse micelle system defining a reverse micelle solvent is formed which comprises a continuous phase in the second fluid and a plurality of reverse micelles dispersed in the continuous phase. The solute material is dissolved in the polar fluid and is in chemical equilibrium with the reverse micelles. The first polar fluid phase and the continuous phase are immiscible. The reverse micelles each comprise a dynamic aggregate of surfactant molecules surrounding a core of the polar fluid. The reverse micelle solvent has a polar fluid-to-surfactant molar ratio W, which can vary over a range having a maximum ratio W.sub.o that determines the maximum size of the reverse micelles. The maximum ratio W.sub.o of the reverse micelle solvent is then varied, and the solute material from the first polar fluid phase is transported into the reverse micelles in the continuous phase at an extraction efficiency determined by the critical or supercritical conditions.

  9. Supercritical fluid reverse micelle separation

    Science.gov (United States)

    Fulton, J.L.; Smith, R.D.

    1993-11-30

    A method of separating solute material from a polar fluid in a first polar fluid phase is provided. The method comprises combining a polar fluid, a second fluid that is a gas at standard temperature and pressure and has a critical density, and a surfactant. The solute material is dissolved in the polar fluid to define the first polar fluid phase. The combined polar and second fluids, surfactant, and solute material dissolved in the polar fluid is maintained under near critical or supercritical temperature and pressure conditions such that the density of the second fluid exceeds the critical density thereof. In this way, a reverse micelle system defining a reverse micelle solvent is formed which comprises a continuous phase in the second fluid and a plurality of reverse micelles dispersed in the continuous phase. The solute material is dissolved in the polar fluid and is in chemical equilibrium with the reverse micelles. The first polar fluid phase and the continuous phase are immiscible. The reverse micelles each comprise a dynamic aggregate of surfactant molecules surrounding a core of the polar fluid. The reverse micelle solvent has a polar fluid-to-surfactant molar ratio W, which can vary over a range having a maximum ratio W[sub o] that determines the maximum size of the reverse micelles. The maximum ratio W[sub o] of the reverse micelle solvent is then varied, and the solute material from the first polar fluid phase is transported into the reverse micelles in the continuous phase at an extraction efficiency determined by the critical or supercritical conditions. 27 figures.

  10. NOVEL REVERSIBLE VARIABLE PRECISION MULTIPLIER USING REVERSIBLE LOGIC GATES

    OpenAIRE

    M. Saravanan; K. Suresh Manic

    2014-01-01

    Multipliers play a vital role in digital systems especially in digital processors. There are many algorithms and designs were proposed in the earlier works, but still there is a need and a greater interest in designing a less complex, low power consuming, fastest multipliers. Reversible logic design became the promising technologies gaining greater interest due to less dissipation of heat and low power consumption. In this study a reversible logic gate based design of variable precision multi...

  11. A Typology of Reverse Innovation

    DEFF Research Database (Denmark)

    von Zedtwitz, Max; Corsi, Simone; Søberg, Peder Veng

    2015-01-01

    taking place in an emerging country. This analytical framework allows recasting of current research at the intersection between innovation and international business. Of the 10 reverse innovation flows, six are new and have not been covered in the literature to date. The study addresses questions......Reverse innovation commonly refers to an innovation initially launched in a developing country and later introduced to an advanced country. Adopting a linear innovation model with the four sequential phases of concept ideation, product development, primary target market introduction, and subsequent......, the paper then introduces a typology of global innovation with 16 different types of innovation flows between advanced and emerging countries, 10 of which are reverse innovation flows. The latter are further differentiated into weak and strong reverse innovation, depending on the number of innovation phases...

  12. Designing the Reverse Supply Chain

    DEFF Research Database (Denmark)

    Gobbi, Chiara

    2011-01-01

    for the reverse supply chain. Design/methodology/approach – In order to identify the relevance of the Fisher model, the model needs to be recast in terms of PRV, which, in this context, is considered the independent variable in the reverse logistics arena. Products defined as innovative in Fisher's taxonomy...... is associated with first-class recovery options (reconditioning and remarketing). When the recovery option is recycling, time is not relevant, the primary objective is cost reduction (efficiency), the chain is centralized, and actors and phases of the reverse chain are determined by the specificity...... of the recycling process. When the recovery option is reconditioning, time is primarily relevant, tradeoffs between costs and time efficiency are necessary, the chain presents a centralized structure, and the presence of other types of actors and phases influences the structure of the reverse supply chain...

  13. Towards a reversible functional language

    DEFF Research Database (Denmark)

    Yokoyama, Tetsuo; Axelsen, Holger Bock; Glück, Robert

    2012-01-01

    first-match policy for case expressions, we can write overlapping patterns in case branches, as is customary in ordinary functional languages, and also in leaf expressions, unlike existing inverse interpreter methods, which enables concise programs. In patterns, the use of a duplication......We identify concepts of reversibility for a functional language by means of a set of semantic rules with specific properties. These properties include injectivity along with local backward determinism, an important operational property for an efficient reversible language. We define a concise...... reversible first-order functional language in which access to the backward semantics is provided to the programmer by inverse function calls. Reversibility guarantees that in this language a backward run (inverse interpretation) is as fast as the corresponding forward run itself. By adopting a symmetric...

  14. An Overview of Reverse Logistics

    Institute of Scientific and Technical Information of China (English)

    WANG Jia-xiang; HE Xin

    2005-01-01

    Until recently, investment in logistics has focused mainly on the flows from companies to markets. Growing concerns for the environment and conserving resources have created new logistical approaches to more effectively manage the distribution function, and make better use of the resources available to an organization. One such approach is reverse logistics, which uses various methods to give scope for a back-load of finished products, components, waste, reusable packing, etc. from consumer to manufacturer. Back-loads allow manufacturers to reduce costs by using the distribution vehicle's return journey to create income or added value. This basic concept is now being developed to create novel solutions to the problems of reducing pollution, costs and vehicle movements, whilst maintaining high customer service levels. In this paper, the idea of reverse logistics is presented; motivations for it are analyzed, several successful practices are demonstrated and some important truths regarding successful reverse logistics are identified, trend of reverse logistics is provided.

  15. CONCEPTUAL ISSUES REGARDING REVERSE LOGISTICS

    National Research Council Canada - National Science Library

    Ioana Olariu

    2014-01-01

    ... of reverse logistics in companies. Many firms attracted by the value available in the flow, have proactively participated in handling returned products at the end of their usefulness or from other parts of the product life cycle...

  16. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients.......A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients....

  17. REVERSE LOGISTICS RETAIL LEVEL RETURN

    Directory of Open Access Journals (Sweden)

    Ivona Bajor

    2014-06-01

    Full Text Available Conducting scientific research regarding reverse logistics systems includes certain difficulties. Developed logistics systems are aimed at analysing reverse logistics issues and tend to continuously detect differences and oscillations in the flow of returned products and their characteristics. Developing logistics systems, as Croatian, find reverse logistics issues, regarding product returns, significantly complex and very often these issues are not observed as issues of priority. As distributive flow, reverse logistics systems fundaments should be also based on detailed analysis. Analysis in this flow presents amounts, reasons, process flows and quality of returned items. Because of complex product evaluation on individual level, reverse logistics procedures should be implemented as a methodology individually developed for every supply chain subject. This paper presents a research of retail level returns on the Croatian market, where the analysis implicated that the majority of products in return for this level is directed from final consumers and presents noncurrent inventories of distribution chain. The paper will present conducted research regarding characteristics of returns and routing these products from the retail level.

  18. Cylindrical air flow reversal barrier

    Energy Technology Data Exchange (ETDEWEB)

    Woznica, C.; Rodziewicz, M.

    1988-06-01

    Describes an innovative design introduced in the ZMP mine in Zory for quick reversal of ventilation air flow. Geologic mining conditions at the 705 m deep horizon, where the barrier was built, are described. According to the design used until now, a reversal system consisted of safety barriers, ventilation air locks, a ventilation bridge and stopping needed in case of a fire when air flow direction must be reversed. Nine air locks and an expensive concrete ventilation bridge were needed and the air locks had to be operated at 8 points of the region to effect reversal. The new design consists of a 2-storey cylindrical barrier which also fulfills the function of a ventilation bridge. It can be manually or remotely operated by a mechanical or pneumatic system. Tests showed that the new barrier permits immediate air flow reversal while retaining 60% of the original air, which is important in the case of fire and methane hazards. It permits improved seam panelling and splitting of pillars and brings an economy of about 40 million zlotys in construction cost. Design and operation of the barrier is illustrated and ventilation air circulation is explained. 7 figs.

  19. Are all reversible computations tidy?

    CERN Document Server

    Maroney, O J E

    2004-01-01

    It has long been known that to minimise the heat emitted by a deterministic computer during it's operation it is necessary to make the computation act in a logically reversible manner\\cite{Lan61}. Such logically reversible operations require a number of auxiliary bits to be stored, maintaining a history of the computation, and which allows the initial state to be reconstructed by running the computation in reverse. These auxiliary bits are wasteful of resources and may require a dissipation of energy for them to be reused. A simple procedure due to Bennett\\cite{Ben73} allows these auxiliary bits to be "tidied", without dissipating energy, on a classical computer. All reversible classical computations can be made tidy in this way. However, this procedure depends upon a classical operation ("cloning") that cannot be generalised to quantum computers\\cite{WZ82}. Quantum computations must be logically reversible, and therefore produce auxiliary qbits during their operation. We show that there are classes of quantu...

  20. Low Cost Reversible Signed Comparator

    Directory of Open Access Journals (Sweden)

    Farah Sharmin

    2013-10-01

    Full Text Available Nowadays exponential advancement in reversible comp utation has lead to better fabrication and integration process. It has become very popular ove r the last few years since reversible logic circuit s dramatically reduce energy loss. It consumes less p ower by recovering bit loss from its unique input-o utput mapping. This paper presents two new gates called RC-I and RC-II to design an n-bit signed binary comparator where simulation results show that the p roposed circuit works correctly and gives significa ntly better performance than the existing counterparts. An algorithm has been presented in this paper for constructing an optimized reversible n-bit signed c omparator circuit. Moreover some lower bounds have been proposed on the quantum cost, the numbers of g ates used and the number of garbage outputs generated for designing a low cost reversible sign ed comparator. The comparative study shows that the proposed design exhibits superior performance consi dering all the efficiency parameters of reversible logic design which includes number of gates used, quantum cost, garbage output and constant inputs. This proposed design has certainly outperformed all the other existing approaches.

  1. Vasectomy reversal: a clinical update

    Directory of Open Access Journals (Sweden)

    Abhishek P Patel

    2016-01-01

    Full Text Available Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.

  2. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    INTRODUCTION: A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients. MATERIAL AND METHODS: The medical records...... of all patients who underwent reversal of a colostomy after a primary Hartmann's procedure during the period May 2005 to December 2008 were reviewed retrospectively in a case-control study. RESULTS: A total of 43 patients were included. Twenty-one had a laparoscopic and 22 an open procedure. The two...

  3. Reversible Switching of Cooperating Replicators

    Science.gov (United States)

    Urtel, Georg C.; Rind, Thomas; Braun, Dieter

    2017-02-01

    How can molecules with short lifetimes preserve their information over millions of years? For evolution to occur, information-carrying molecules have to replicate before they degrade. Our experiments reveal a robust, reversible cooperation mechanism in oligonucleotide replication. Two inherently slow replicating hairpin molecules can transfer their information to fast crossbreed replicators that outgrow the hairpins. The reverse is also possible. When one replication initiation site is missing, single hairpins reemerge from the crossbreed. With this mechanism, interacting replicators can switch between the hairpin and crossbreed mode, revealing a flexible adaptation to different boundary conditions.

  4. Marburg Virus Reverse Genetics Systems.

    Science.gov (United States)

    Schmidt, Kristina Maria; Mühlberger, Elke

    2016-06-22

    The highly pathogenic Marburg virus (MARV) is a member of the Filoviridae family and belongs to the group of nonsegmented negative-strand RNA viruses. Reverse genetics systems established for MARV have been used to study various aspects of the viral replication cycle, analyze host responses, image viral infection, and screen for antivirals. This article provides an overview of the currently established MARV reverse genetic systems based on minigenomes, infectious virus-like particles and full-length clones, and the research that has been conducted using these systems.

  5. Marburg Virus Reverse Genetics Systems

    Directory of Open Access Journals (Sweden)

    Kristina Maria Schmidt

    2016-06-01

    Full Text Available The highly pathogenic Marburg virus (MARV is a member of the Filoviridae family and belongs to the group of nonsegmented negative-strand RNA viruses. Reverse genetics systems established for MARV have been used to study various aspects of the viral replication cycle, analyze host responses, image viral infection, and screen for antivirals. This article provides an overview of the currently established MARV reverse genetic systems based on minigenomes, infectious virus-like particles and full-length clones, and the research that has been conducted using these systems.

  6. Dopplerfluxometria de ducto venoso: identificação não invasiva da acidemia em fetos prematuros centralizados Ductus venosus velocimetry: noninvasive identification of fetal acidemia in preterm fetuses with brain sparing reflex

    Directory of Open Access Journals (Sweden)

    Renato Augusto Moreira de Sá

    2004-06-01

    Full Text Available OBJETIVO: estabelecer o ponto de corte a partir do qual seja possível identificar fetos prematuros com centralização do fluxo sangüíneo que apresentem gasometria anormal. MÉTODO: foi realizado estudo observacional transversal, cuja população consistia de 60 gestantes com fetos centralizados (relação umbílico-cerebral maior que 1, com idade gestacional entre 25 e 33 semanas. O ducto venoso foi identificado com auxílio da dopplerfluxometria colorida e obtida a relação S/A a partir do sonograma (relação entre a velocidade de pico da sístole ventricular e a velocidade de pico da sístole atrial. Imediatamente após a cesariana foi colhida amostra de sangue da veia umbilical para gasometria. Os conceptos foram classificados de acordo com a análise gasométrica e considerados anormais quando pH OBJECTIVE: to assess through Dopllerfluxometry the S/A ratio of the ductus venosus and determine the cut-off point to identify preterm fetuses with the 'brain sparing phenomenon". METHOD: a cross-sectional study was performed in 60 pregnant women that presented the "brain sparing phenomenon" (umbilical cerebral ratio >1 and gestational age between 25 and 33 weeks. The following parameters were studied: S/A ratio of the ductus venosus, pH and base excess (BE of a fetal blood sample collected from the umbilical vein immediately after birth. The fetuses were classified according to the gas analysis result. They were considered abnormal when pH <7.20 and BE < -6 mmol/l. A receiver operator characteristic (ROC curve analysis was performed to examine the relationship between S/A ratio and fetal acidemia. RESULTS: sixty pregnant women in the period of January 1998 to January 2003 were selected. In the moment of the study the gestational age varied from 25 to 33 weeks, with an average of 29.7 weeks (±1.8 weeks. All of the fetuses presented the "brain sparing phenomenon". Among them 14 presented abnormal gas analysis at birth and 46 presented normal

  7. Minimally invasive per-catheter occlusion and dilation procedures for congenital cardiovascular abnormalities in dogs.

    Science.gov (United States)

    Tobias, Anthony H; Stauthammer, Christopher D

    2010-07-01

    With ever-increasing sophistication of veterinary cardiology, minimally invasive per-catheter occlusion and dilation procedures for the treatment of various congenital cardiovascular abnormalities in dogs have become not only available, but mainstream. Much new information about minimally invasive per-catheter patent ductus arteriosus occlusion has been published and presented during the past few years. Consequently, patent ductus arteriosus occlusion is the primary focus of this article. Occlusion of other less common congenital cardiac defects is also briefly reviewed. Balloon dilation of pulmonic stenosis, as well as other congenital obstructive cardiovascular abnormalities is discussed in the latter part of the article.

  8. Nickel-hydrogen cell reversal characteristics

    Science.gov (United States)

    Lurie, Charles

    1994-01-01

    Nickel-hydrogen cell reversal characteristics are being studied as part of a TRW program directed towards development of a high current battery cell bypass switch. The following are discussed: cell bypass switch; nickel-hydrogen cell reversal characteristics; and nickel-hydrogen cell chemistry: discharge/reversal and overdischarge (reversal) with nickel and hydrogen precharge.

  9. Reversible logic gate using adiabatic superconducting devices

    Science.gov (United States)

    Takeuchi, N.; Yamanashi, Y.; Yoshikawa, N.

    2014-09-01

    Reversible computing has been studied since Rolf Landauer advanced the argument that has come to be known as Landauer's principle. This principle states that there is no minimum energy dissipation for logic operations in reversible computing, because it is not accompanied by reductions in information entropy. However, until now, no practical reversible logic gates have been demonstrated. One of the problems is that reversible logic gates must be built by using extremely energy-efficient logic devices. Another difficulty is that reversible logic gates must be both logically and physically reversible. Here we propose the first practical reversible logic gate using adiabatic superconducting devices and experimentally demonstrate the logical and physical reversibility of the gate. Additionally, we estimate the energy dissipation of the gate, and discuss the minimum energy dissipation required for reversible logic operations. It is expected that the results of this study will enable reversible computing to move from the theoretical stage into practical usage.

  10. Vasectomy reversal : a clinical update

    NARCIS (Netherlands)

    A.P. Patel (Abhishek); R.P. Smith (Ryan)

    2016-01-01

    textabstractVasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage,

  11. CAPSULE REPORT: REVERSE OSMOSIS PROCESS

    Science.gov (United States)

    A failure analysis has been completed for the reverse osmosis (RO) process. The focus was on process failures that result in releases of liquids and vapors to the environment. The report includes the following: 1) A description of RO and coverage of the principles behind the proc...

  12. CAPSULE REPORT: REVERSE OSMOSIS PROCESS

    Science.gov (United States)

    A failure analysis has been completed for the reverse osmosis (RO) process. The focus was on process failures that result in releases of liquids and vapors to the environment. The report includes the following: 1) A description of RO and coverage of the principles behind the proc...

  13. A Framework for Reverse Logistics

    NARCIS (Netherlands)

    M.P. de Brito (Marisa); R. Dekker (Rommert)

    2003-01-01

    textabstractReverse Logistics has been stretching out worldwide, involving all the layers of supply chains in various industry sectors. While some actors in the chain have been forced to take products back, others have pro-actively done so, attracted by the value in used products One way or the othe

  14. Time-reversible Hamiltonian systems

    NARCIS (Netherlands)

    Schaft, Arjan van der

    1982-01-01

    It is shown that transfer matrices satisfying G(-s) = G(s) = G^T(-s) have a minimal Hamiltonian realization with an energy which is the sum of potential and kinetic energy, yielding the time reversibility of the equations. Furthermore connections are made with an associated gradient system. The

  15. Reversible colour change in Arthropoda.

    Science.gov (United States)

    Umbers, Kate D L; Fabricant, Scott A; Gawryszewski, Felipe M; Seago, Ainsley E; Herberstein, Marie E

    2014-11-01

    The mechanisms and functions of reversible colour change in arthropods are highly diverse despite, or perhaps due to, the presence of an exoskeleton. Physiological colour changes, which have been recorded in 90 arthropod species, are rapid and are the result of changes in the positioning of microstructures or pigments, or in the refractive index of layers in the integument. By contrast, morphological colour changes, documented in 31 species, involve the anabolism or catabolism of components (e.g. pigments) directly related to the observable colour. In this review we highlight the diversity of mechanisms by which reversible colour change occurs and the evolutionary context and diversity of arthropod taxa in which it has been observed. Further, we discuss the functions of reversible colour change so far proposed, review the limited behavioural and ecological data, and argue that the field requires phylogenetically controlled approaches to understanding the evolution of reversible colour change. Finally, we encourage biologists to explore new model systems for colour change and to engage scientists from other disciplines; continued cross-disciplinary collaboration is the most promising approach to this nexus of biology, physics, and chemistry.

  16. Reverse Knowledge Transfer in MNEs

    DEFF Research Database (Denmark)

    Mudambi, Ram; Piscitello, Lucia; Rabbiosi, Larissa

    2014-01-01

    , and that the curvilinearity is greater for greenfield entries relative to acquisition entries. The U-shaped relationship between subsidiary innovativeness and reverse knowledge transfers, as well as the sensitivity of this result to entry mode are important new findings in the literature on the role of subsidiaries...

  17. A reversible nanoconfined chemical reaction.

    Science.gov (United States)

    Nielsen, Thomas K; Bösenberg, Ulrike; Gosalawit, Rapee; Dornheim, Martin; Cerenius, Yngve; Besenbacher, Flemming; Jensen, Torben R

    2010-07-27

    Hydrogen is recognized as a potential, extremely interesting energy carrier system, which can facilitate efficient utilization of unevenly distributed renewable energy. A major challenge in a future "hydrogen economy" is the development of a safe, compact, robust, and efficient means of hydrogen storage, in particular, for mobile applications. Here we report on a new concept for hydrogen storage using nanoconfined reversible chemical reactions. LiBH4 and MgH2 nanoparticles are embedded in a nanoporous carbon aerogel scaffold with pore size Dmax approximately 21 nm and react during release of hydrogen and form MgB2. The hydrogen desorption kinetics is significantly improved compared to bulk conditions, and the nanoconfined system has a high degree of reversibility and stability and possibly also improved thermodynamic properties. This new scheme of nanoconfined chemistry may have a wide range of interesting applications in the future, for example, within the merging area of chemical storage of renewable energy.

  18. Reverse osmosis water purification system

    Science.gov (United States)

    Ahlstrom, H. G.; Hames, P. S.; Menninger, F. J.

    1986-01-01

    A reverse osmosis water purification system, which uses a programmable controller (PC) as the control system, was designed and built to maintain the cleanliness and level of water for various systems of a 64-m antenna. The installation operates with other equipment of the antenna at the Goldstone Deep Space Communication Complex. The reverse osmosis system was designed to be fully automatic; with the PC, many complex sequential and timed logic networks were easily implemented and are modified. The PC monitors water levels, pressures, flows, control panel requests, and set points on analog meters; with this information various processes are initiated, monitored, modified, halted, or eliminated as required by the equipment being supplied pure water.

  19. Reversible Watermarking Using Statistical Information

    Directory of Open Access Journals (Sweden)

    Kurugollu Fatih

    2010-01-01

    Full Text Available In most reversible watermarking methods, a compressed location map is exploited in order to ensure reversibility. Besides, in some methods, a header containing critical information is appended to the payload for the extraction and recovery process. Such schemes have a highly fragile nature; that is, changing a single bit in watermarked data may prohibit recovery of the original host as well as the embedded watermark. In this paper, we propose a new scheme in which utilizing a compressed location map is completely removed. In addition, the amount of auxiliary data is decreased by employing the adjacent pixels information. Therefore, in addition to quality improvement, independent authentication of different regions of a watermarked image is possible.

  20. Molecular Simulation of Reverse Micelles

    Science.gov (United States)

    Chowdhary, Janamejaya; Ladanyi, Branka

    2009-03-01

    Reverse micelles (RM) are surfactant assemblies containing a nanosized water pool dissolved in a hydrophobic solvent. Understanding their properties is crucial for insight into the effect of confinement on aqueous structure, dynamics as well as physical processes associated with solutes in confinement. We perform molecular dynamics simulations for the RM formed by the surfactant Aerosol-OT (AOT) in isooctane (2,2,4-trimethyl pentane) in order to study the effect of reverse micelle size on the aqueous phase. The structure of the RM is quantified in terms of the radial and pair density distributions. Dynamics are studied in terms of the mean squared displacements and various orientational time correlation functions in different parts of the RM so as to understand the effect of proximity to the interface on aqueous dynamics. Shape fluctuations of the RM are also analyzed.

  1. Reversal agents in anaesthesia and critical care

    Directory of Open Access Journals (Sweden)

    Nibedita Pani

    2015-01-01

    Full Text Available Despite the advent of short and ultra-short acting drugs, an in-depth knowledge of the reversal agents used is a necessity for any anaesthesiologist. Reversal agents are defined as any drug used to reverse the effects of anaesthetics, narcotics or potentially toxic agents. The controversy on the routine reversal of neuromuscular blockade still exists. The advent of newer reversal agents like sugammadex have made the use of steroidal neuromuscular blockers like rocuronium feasible in rapid sequence induction situations. We made a review of the older reversal agents and those still under investigation for drugs that are regularly used in our anaesthesia practice.

  2. CONCEPTUAL ISSUES REGARDING REVERSE LOGISTICS

    Directory of Open Access Journals (Sweden)

    Ioana Olariu

    2014-01-01

    Full Text Available As the power of consumers is growing, the product return for customer service and customer retention has become a common practice in the competitive market, which propels the recent practice of reverse logistics in companies. Many firms attracted by the value available in the flow, have proactively participated in handling returned products at the end of their usefulness or from other parts of the product life cycle. Reverse logistics is the flow and management of products, packaging, components and information from the point of consumption to the point of origin. It is a collection of practices similar to those of supply chain management, but in the opposite direction, from downstream to upstream. It involves activities such as reuse, repair, remanufacture, refurbish, reclaim and recycle. For the conventional forward logistics systems, the flow starts upstream as raw materials, later as manufactured parts and components to be assembled and continues downstream to reach customers as final products to be disposed once they reach their economic or useful lives. In reverse logistics, the disposed products are pushed upstream to be repaired, remanufactured, refurbished, and disassembled into components to be reused or as raw material to be recycled for later use.

  3. Reversible Simulations of Elastic Collisions

    CERN Document Server

    Perumalla, Kalyan S

    2013-01-01

    Consider a system of N identical hard spherical particles moving in a d-dimensional box and undergoing elastic, possibly multi-particle, collisions. We develop a new algorithm that recovers the pre-collision state from the post-collision state of the system, across a series of consecutive collisions, with essentially no memory overhead. The challenge in achieving reversibility for an n-particle collision (where, n << N) arises from the presence of nd-d-1 degrees of freedom during each collision, and from the complex geometrical constraints placed on the colliding particles. To reverse the collisions in a traditional simulation setting, all of the particular realizations of these degrees of freedom during the forward simulation must be saved. This limitation is addressed here by first performing a pseudo-randomization of angles, ensuring determinism in the reverse path for any values of n and d. To address the more difficult problem of geometrical and dynamic constraints, a new approach is developed whic...

  4. Reversible Oxidative Addition at Carbon.

    Science.gov (United States)

    Eichhorn, Antonius F; Fuchs, Sonja; Flock, Marco; Marder, Todd B; Radius, Udo

    2017-04-07

    The reactivity of N-heterocyclic carbenes (NHCs) and cyclic alkyl amino carbenes (cAACs) with arylboronate esters is reported. The reaction with NHCs leads to the reversible formation of thermally stable Lewis acid/base adducts Ar-B(OR)2 ⋅NHC (Add1-Add6). Addition of cAAC(Me) to the catecholboronate esters 4-R-C6 H4 -Bcat (R=Me, OMe) also afforded the adducts 4-R-C6 H4 Bcat⋅cAAC(Me) (Add7, R=Me and Add8, R=OMe), which react further at room temperature to give the cAAC(Me) ring-expanded products RER1 and RER2. The boronate esters Ar-B(OR)2 of pinacol, neopentylglycol, and ethyleneglycol react with cAAC at RT via reversible B-C oxidative addition to the carbene carbon atom to afford cAAC(Me) (B{OR}2 )(Ar) (BCA1-BCA6). NMR studies of cAAC(Me) (Bneop)(4-Me-C6 H4 ) (BCA4) demonstrate the reversible nature of this oxidative addition process.

  5. Garbageless reversible implementation of integer linear transformations

    DEFF Research Database (Denmark)

    Burignat, Stéphane; Vermeirsch, Kenneth; De Vos, Alexis;

    2013-01-01

    Discrete linear transformations are important tools in information processing. Many such transforms are injective and therefore prime candidates for a physically reversible implementation into hardware. We present here reversible digital implementations of different integer transformations on fou...

  6. Ancient Magnetic Reversals: Clues to the Geodynamo.

    Science.gov (United States)

    Hoffman, Kenneth A.

    1988-01-01

    Discusses the question posed by some that the earth's magnetic field may reverse. States that rocks magnetized by ancient fields may offer clues to the underlying reversal mechanism in the earth's core. (TW)

  7. Reversible logic gate using adiabatic superconducting devices

    National Research Council Canada - National Science Library

    Takeuchi, N; Yamanashi, Y; Yoshikawa, N

    2014-01-01

    .... However, until now, no practical reversible logic gates have been demonstrated. One of the problems is that reversible logic gates must be built by using extremely energy-efficient logic devices...

  8. 14 CFR 33.97 - Thrust reversers.

    Science.gov (United States)

    2010-01-01

    ... Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: AIRCRAFT ENGINES Block Tests; Turbine Aircraft Engines § 33.97 Thrust reversers. (a) If the engine incorporates a reverser, the endurance calibration, operation, and vibration tests prescribed...

  9. SELECTED PROBLEMS OF REVERSE LOGISTICS IN POLAND

    OpenAIRE

    Agata Mesjasz-Lech

    2009-01-01

    This paper presents the essence of reverse logistics and directions of physical and information flows between logistic network partners. It also analyses effects of implementation of the principles of reverse logistics in Poland in the years 2004-2007

  10. Design of a High Performance Reversible Multiplier

    Directory of Open Access Journals (Sweden)

    Md.Belayet Ali

    2011-11-01

    Full Text Available Reversible logic circuits are increasingly used in power minimization having applications such as low power CMOS design, optical information processing, DNA computing, bioinformatics, quantum computing and nanotechnology. The problem of minimizing the number of garbage outputs is an important issue in reversible logic design. In this paper we propose a new 44 universal reversible logic gate. The proposed reversible gate can be used to synthesize any given Boolean functions. The proposed reversible gate also can be used as a full adder circuit. In this paper we have used Peres gate and the proposed Modified HNG (MHNG gate to construct the reversible fault tolerant multiplier circuit. We show that the proposed 44 reversible multiplier circuit has lower hardware complexity and it is much better and optimized in terms of number of reversible gates and number of garbage outputs with compared to the existing counterparts.

  11. Design of High speed Low Power Reversible Vedic multiplier and Reversible Divider

    Directory of Open Access Journals (Sweden)

    Srikanth G Department of Electronics & Communication Engineerig, Indur Institute of Engineering & Technology, Siddipet, Medak, JNTUH University, Telangana, India.

    2014-09-01

    Full Text Available This paper bring out a 32X32 bit reversible Vedic multiplier using "Urdhva Tiryakabhayam" sutra meaning vertical and crosswise, is designed using reversible logic gates, which is the first of its kind. Also in this paper we propose a new reversible unsigned division circuit. This circuit is designed using reversible components like reversible parallel adder, reversible left-shift register, reversible multiplexer, reversible n-bit register with parallel load line. The reversible vedic multiplier and reversible divider modules have been written in Verilog HDL and then synthesized and simulated using Xilinx ISE 9.2i. This reversible vedic multiplier results shows less delay and less power consumption by comparing with array multiplier.

  12. Statistical Learning, Letter Reversals, and Reading

    Science.gov (United States)

    Treiman, Rebecca; Gordon, Jessica; Boada, Richard; Peterson, Robin L.; Pennington, Bruce F.

    2014-01-01

    Reversal errors play a prominent role in theories of reading disability. We examined reversal errors in the writing of letters by 5- to 6-year-old children. Of the 130 children, 92 had a history of difficulty in producing speech sounds, a risk factor for reading problems. Children were more likely to reverse letter forms that face left, such as…

  13. Garbage collection for reversible functional languages

    DEFF Research Database (Denmark)

    Mogensen, Torben Ægidius

    2015-01-01

    Reversible languages are programming languages where all programs can run both forwards and backwards. Reversible functional languages have been proposed that use symmetric pattern matching and data construction. To be reversible, these languages require linearity: Every variable must be used exa...

  14. A functional language for describing reversible logic

    DEFF Research Database (Denmark)

    Thomsen, Michael Kirkedal

    2012-01-01

    . Reversibility of descriptions is guaranteed with a type system based on linear types. The language is applied to three examples of reversible computations (ALU, linear cosine transformation, and binary adder). The paper also outlines a design flow that ensures garbage- free translation to reversible logic...

  15. THEORETICAL FRAMES FOR DESIGNING REVERSE LOGISTICS PROCESSES

    OpenAIRE

    Grabara, Janusz K.; Sebastian Kot

    2009-01-01

    Logistics processes of return flow became more and more important in present business practice. Because of better customer satisfaction, environmental and financial aspects many enterprises deal with reverse logistics performance. The paper is a literature review focused on the design principles of reverse logistics processes Keywords: reverse logistics, designing.

  16. Dynamic Reverse Code Generation for Backward Execution

    DEFF Research Database (Denmark)

    Lee, Jooyong

    2007-01-01

    . In this paper, we present a method to generate reverse code, so that backtracking can be performed by executing reverse code. The novelty of our work is that we generate reverse code on-the-fly, while running a debugger, which makes it possible to apply the method even to debugging multi-threaded programs....

  17. Cleaning Our World through Reverse Graffiti

    Science.gov (United States)

    Randazzo, Gabe; LaJevic, Lisa

    2013-01-01

    Over the last decade artists have begun to experiment with "reverse pollution" techniques, such as reverse graffiti, which focuses on cleaning environmental surfaces. Having recently been introduced to the works of Moose, the artist known for inventing the reverse graffiti technique, the authors decided to design a curriculum to increase…

  18. REVERSE ENGINEERING AND ITS REALISTIC APPLICATIONS

    OpenAIRE

    Nikita Bakshi; Shruti Gujral

    2014-01-01

    Reverse-engineering is used for many purposes like as a learning tool, as a way to make compatible products that are cheaper than what is currently on the market. This paper discusses what is software, its type, reverse engineering, applications of reverse engineering and their tools.

  19. REVERSE ENGINEERING AND ITS REALISTIC APPLICATIONS

    Directory of Open Access Journals (Sweden)

    Nikita Bakshi

    2014-06-01

    Full Text Available Reverse-engineering is used for many purposes like as a learning tool, as a way to make compatible products that are cheaper than what is currently on the market. This paper discusses what is software, its type, reverse engineering, applications of reverse engineering and their tools.

  20. Remote Whispering Applying Time Reversal

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Brian Eric [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-07-16

    The purpose of this project was to explore the use of time reversal technologies as a means for communication to a targeted individual or location. The idea is to have the privacy of whispering in one’s ear, but to do this remotely from loudspeakers not located near the target. Applications of this work include communicating with hostages and survivors in rescue operations, communicating imaging and operational conditions in deep drilling operations, monitoring storage of spent nuclear fuel in storage casks without wires, or clandestine activities requiring signaling between specific points. This technology provides a solution in any application where wires and radio communications are not possible or not desired. It also may be configured to self calibrate on a regular basis to adjust for changing conditions. These communications allow two people to converse with one another in real time, converse in an inaudible frequency range or medium (i.e. using ultrasonic frequencies and/or sending vibrations through a structure), or send information for a system to interpret (even allowing remote control of a system using sound). The time reversal process allows one to focus energy to a specific location in space and to send a clean transmission of a selected signal only to that location. In order for the time reversal process to work, a calibration signal must be obtained. This signal may be obtained experimentally using an impulsive sound, a known chirp signal, or other known signals. It may also be determined from a numerical model of a known environment in which the focusing is desired or from passive listening over time to ambient noise.

  1. Reverse Triangle Inequalities for Potentials

    OpenAIRE

    Pritsker, I. E.; Saff, E. B.

    2013-01-01

    We study the reverse triangle inequalities for suprema of logarithmic potentials on compact sets of the plane. This research is motivated by the inequalities for products of supremum norms of polynomials. We find sharp additive constants in the inequalities for potentials, and give applications of our results to the generalized polynomials. We also obtain sharp inequalities for products of norms of the weighted polynomials $w^nP_n, deg(P_n)\\le n,$ and for sums of suprema of potentials with ex...

  2. Presbycusis: reversible with anesthesia drugs?

    Science.gov (United States)

    Kocher, Carl A

    2009-02-01

    Age-related hearing impairment, or presbycusis, is a degenerative condition not currently treatable by medication. It is therefore significant that the author, as a patient, experienced a reversal of high-frequency hearing loss during a 2-day period following abdominal surgery with general anesthesia. This report documents the surgery and the subsequent restoration of hearing, which was bilateral and is estimated to have exceeded 50dB at 4kHz. A possible role is noted for anesthetic agents such as lidocaine, propofol, or fentanyl. This experience may hold a clue for research toward the development of medical treatments for presbycusis.

  3. How to play Reverse Hex

    DEFF Research Database (Denmark)

    Toft, Bjarne; Hayward, Ryan B.; Henderson, Philip

    2012-01-01

    We present new results on how to play Reverse Hex, also known as Rex, or Misère Hex, on n × n boards. We give new proofs – and strengthened versions – of Lagarias and Sleator’s theorem (for n × n boards, each player can prolong the game until the board is full, so the first/second player can always......, we find second-player winning replies. Finally, in response to comments by Martin Gardner, for each n ≤ 5, we give a simple winning strategy for the n × n board....

  4. Efeitos da tela de polipropileno no testículo, epidídimo e ducto deferente de cães Effects of the polypropilene mesh in the testicle, epididimus and ductus deferens of dogs

    Directory of Open Access Journals (Sweden)

    Alberto Goldenberg

    2001-12-01

    Full Text Available Objetivo: Investigar os efeitos da tela sintética sobre o testículo, epidídimo e ducto deferente de cães. Métodos: Foram utilizados 10 cães, machos, adultos, pesando entre 9 e 12 kg. Os animais, após realizada anestesia, foram submetidos à laparoscopia com formação de pneumoperitônio por incisão em linha mediana. Era então fixada tela de polipropileno, de dimensões 2,5X3,5 cm² na região inguinal esquerda do cão em contato direto com o funículo espermático, com o uso de grampos metálicos, sem dissecar a região. O lado direito, sem colocação de tela, serviu de controle. O procedimento tinha duração de 15 minutos. Após observação pós-operatória de 30 dias, os animais eram novamente anestesiados e reoperados sendo o testículo e ducto deferente retirados e enviados para análise histológica. Análise estatística foi realizada com os dados obtidos desta análise. Resultados: No lado esquerdo, as secções histológicas de testículo revelaram focalmente, diminuição da espermatogênese e processo degenerativo em 20% dos animais. No epidídimo, observou-se inflamação crônica e dilatação dos túbulos seminíferos em 70%. No ducto deferente foi observado processo inflamatório crônico em 60% dos cães. Não foram verificadas alterações histológicas no lado contralateral. Conclusão: A tela de polipropileno em contato com o funículo espermático de cães provoca alterações histológicas com discreta redução da espermatogênese.The aim of this study was to investigate the effects of the synthetic mesh on the ductus deferens and testicle of dogs. Ten adult male dogs were anesthetized and a 2,5X3,5 cm² polypropilene mesh was fixed in the inguinal region in direct contact with the ductus deferens, using metallic staples without dissection of the region and therefore, without manipulation. The right side, with no mesh was the control. . The operative time was 15 minutes. The animals were observed for 30 days and

  5. Optimized reversible binary-coded decimal adders

    DEFF Research Database (Denmark)

    Thomsen, Michael Kirkedal; Glück, Robert

    2008-01-01

    their design. The optimized 1-decimal BCD full-adder, a 13 × 13 reversible logic circuit, is faster, and has lower circuit cost and less garbage bits. It can be used to build a fast reversible m-decimal BCD full-adder that has a delay of only m + 17 low-power reversible CMOS gates. For a 32-decimal (128-bit...... in reversible logic design by drastically reducing the number of garbage bits. Specialized designs benefit from support by reversible logic synthesis. All circuit components required for optimizing the original design could also be synthesized successfully by an implementation of an existing synthesis algorithm...

  6. Reversing invasion in bistable systems.

    Science.gov (United States)

    Alzahrani, Ebraheem O; Davidson, Fordyce A; Dodds, Niall

    2012-12-01

    In this paper, we discuss a class of bistable reaction-diffusion systems used to model the competitive interaction of two species. The interactions are assumed to be of classic "Lotka-Volterra" type and we will consider a particular problem with relevance to applications in population dynamics: essentially, we study under what conditions the interplay of relative motility (diffusion) and competitive strength can cause waves of invasion to be halted and reversed. By establishing rigorous results concerning related degenerate and near-degenerate systems, we build a picture of the dependence of the wave speed on system parameters. Our results lead us to conjecture that this class of competition model has three "zones of response". In the central zone, varying the motility can slow, halt and reverse invasion. However, in the two outer zones, the direction of invasion is independent of the relative motility and is entirely determined by the relative competitive strengths. Furthermore, we conjecture that for a large class of competition models of the type studied here, the wave speed is an increasing function of the relative motility.

  7. Reverse Genetic Approaches in Zebrafish

    Institute of Scientific and Technical Information of China (English)

    Peng Huang; Zuoyan Zhu; Shuo Lin; Bo Zhang

    2012-01-01

    Zebrafish (Danio rerio) is a well-established vertebrate animal model.A comprehensive collection of reverse genetics tools has been developed for studying gene function in this useful organism.Morpholino is the most widely used reagent to knock down target gene expression post-transcriptionally.For a long time,targeted genome modification has been heavily relied on large-scale traditional forward genetic screens,such as ENU (N-ethyl-N-nitrosourea) mutagenesis derived TILLING (Targeting Induced Local Lesions IN Genomes)strategy and pseudo-typed retrovirus mediated insertional mutagenesis.Recently,engineered endonucleases,including ZFNs (zinc finger nucleases) and TALENs (transcription activator-like effector nucleases),provide new and efficient strategies to directly generate sitespecific indel mutations by inducing double strand breaks in target genes.Here we summarize the major reverse genetic approaches for loss-of-function studies used and emerging in zebrafish,including strategies based on genome-wide mutagenesis and methods for sitespecific gene targeting.Future directions and expectations will also be discussed.

  8. Online Testable Decoder using Reversible Logic

    Directory of Open Access Journals (Sweden)

    Hemalatha. K. N. Manjula B. B. Girija. S

    2012-02-01

    Full Text Available The project proposes to design and test 2 to 4 reversible Decoder circuit with arbitrary number of gates to an online testable reversible one and is independent of the type of reversible gate used. The constructed circuit can detect any single bit errors and to convert a decoder circuit that is designed by reversible gates to an online testable reversible decoder circuit. Conventional digital circuits dissipate a significant amount of energy because bits of information are erased during the logic operations. Thus if logic gates are designed such that the information bits are not destroyed, the power consumption can be reduced. The information bits are not lost in case of a reversible computation. Reversible logic can be used to implement any Boolean logic function.

  9. Dopplerfluxometria do ducto venoso: relação com a gasometria em fetos prematuros com centralização de fluxo sangüíneo Ductus venosus velocimetry: relationship with fetal blood gases in preterm fetuses presenting brain sparing reflex

    Directory of Open Access Journals (Sweden)

    Renato Augusto Moreira de Sá

    2003-05-01

    Full Text Available OBJETIVO: avaliar o desempenho da dopplerfluxometria do ducto venoso (DV na detecção da acidemia em fetos prematuros apresentando centralização de fluxo sangüíneo. MÉTODOS: estudo observacional transversal. A população em estudo consistiu de 48 gestantes entre a 25ª e a 33ª semana de gestação, que apresentavam centralização de fluxo sangüíneo fetal (relação umbílico/cerebral >1. O tempo decorrido entre o diagnóstico de centralização fetal e o nascimento (cesariana sob anestesia peridural foi de até cinco horas. Os seguintes parâmetros foram estudados: relação sístole ventricular atrial (S/A do ducto venoso, pH e base excess (BE de amostra de sangue da veia umbilical colhida imediatamente após o nascimento. A relação S/A do DV foi considerada anormal quando maior que 3,6. Os conceptos foram classificados quanto ao resultado da gasometria, sendo considerada gasometria anormal quando pH PURPOSE: to evaluate Doppler velocimetry of the ductus venosus as a noninvasive test of abnormal pH and gas analysis in preterm fetuses with "brain sparing reflex". METHODS: a cross-sectional study was performed. The studied population consisted of 48 pregnant women between the 25th and the 33rd week of gestation, whose fetuses presented brain sparing reflex (umbilical/cerebral ratio >1. The time elapsed between Doppler velocimetry and the birth (cesarean section under peridural anesthesia was of up to 5 h. The following parameters were studied: S/A ratio of the ductus venosus, pH and base excess (BE of fetal blood sample (collected from the umbilical vein immediately after birth. The S/A ratio of the ductus venosus was considered abnormal when superior to 3.6. The fetuses were classified according to the gas analysis result. They were considered abnormal when pH <7.26 and BE £ 6 mMol/L. Fisher's test was used for statistical analysis and considered significant when p £ 0.05. RESULTS: there was a significant correlation between

  10. Right juxtaposition of the atrial appendages.

    Science.gov (United States)

    Mathew, R; Replogle, R; Thilenius, O G; Arcilla, R A

    1975-04-01

    We present an infant with right-sided juxtaposition of atrial appendages who had open heart surgery for ventricular septal defect and patent ductus arteriosus. Of 12 cases thus far reported, ventricular d-loop was observed in nine, and normal position of great vessels in four. Contrary to previous views, this condition may not be accompanied by severe conotruncal anomalies.

  11. Left thoracic sympathectomy in a premature infant with long QT syndrome and heart failure.

    Science.gov (United States)

    Surendran, Sushitha; Kumar, Thittamaranahalli K S; Knott-Craig, Christopher J

    2017-01-01

    Left thoracic sympathectomy has been shown to be an effective treatment for adults with long QT syndrome who are refractory to medical therapy. We report the successful use of left thoracic sympathectomy for the management of a 10-week-old premature baby with long QT syndrome and heart failure from a large ventricular septal defect and patent ductus arteriosus.

  12. Diverticulum of the brachiocephalic trunk - angiography and embryological explanation

    Energy Technology Data Exchange (ETDEWEB)

    Pfefferkorn, J.R.; Lunkenheimer, A.; Loeser, H.; Hilgenberg, F.

    1983-03-01

    A diverticulum of the brachiocephalic trunk is described in 5 children with unilateral absence of the pulmonary artery, in a child with tetralogy of Fallot, and in an other child with Bland-White-Garland syndrome. The diverticulum is a remnant of a contralateral ductus arteriosus, which closed after birth and represents the origin of the distal part of the sixth aortic arch.

  13. How Do We Define Congenital Heart Defects for Scientific Studies?

    DEFF Research Database (Denmark)

    Garne, Ester; Olsen, Morten Smærup; Johnsen, Søren Paaske

    2011-01-01

    of echocardiography in neonatal intensive care, a patent ductus arteriosus (PDA) or flow over the atrial septum will often be visible. These findings may be coded as CHD at discharge and in this way falsely increase the CHD prevalence in the population. There are several purposes for which population-based data...

  14. Satelliting streptococci in an adult male with foetal heart

    Directory of Open Access Journals (Sweden)

    Jayakeerthi S

    2002-01-01

    Full Text Available Prior to the days of surgical correction and antibiotics, endocarditis was one of the leading causes of death in adults with patent ductus arteriosus (PDA. Satelliting Streptococcus is an important cause of "culture negative endocarditis". There are no earlier reports of this organism causing endocarditis in a case of PDA. Such a unique association, first of its kind, is reported here.

  15. Anterior urethral diverticulum: A rare presentation

    Directory of Open Access Journals (Sweden)

    Annavarupu Gopalkrishna

    2016-01-01

    Full Text Available Congenital anomalies of the urogenital tract are the most common anomalies found in the foetus, neonates and infants, but anterior urethral valves and diverticula are rare. Here, we present a case with congenital anterior urethral diverticulum associated with patent ductus arteriosus and polydactyly.

  16. Disease: H00547 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL Noninherited risk factors and congenital c...ductus arteriosus. Am J Med Genet 97:304-9 (2000) PMID:17519397 (env_factor) Jenkins KJ, Correa A, Feinstein

  17. Left Pulmonary Artery Thrombosis in a Neonate with Left Lung Hypoplasia

    Directory of Open Access Journals (Sweden)

    Matthias P. van Schendel

    2012-01-01

    Full Text Available Thrombotic events in neonates may origin from fetal life. A 4-day-old newborn infant with a family history of heterozygous type 1 protein C deficiency was diagnosed with left lung hypoplasia and left pulmonary artery thrombosis. Its source was prenatally closed ductus arteriosus. Surgical removal of the thrombus was performed.

  18. Postnatal development of epididymis and ductus deferens in the rat. A correlation between the ultrastructure of the epithelium and tubule wall, and the fluorescence-microscopic distribution of actin, myosin, fibronectin, and basement membrane.

    Science.gov (United States)

    Francavilla, S; Moscardelli, S; Properzi, G; De Matteis, M A; Scorza Barcellona, P; Natali, P G; De Martino, C

    1987-08-01

    The postnatal maturation of regions of the epididymis and intragonadal segment of the deferens duct was studied in the rat by light- and transmission electron microscopy. Maturation of the genital duct starts in the distal cauda epididymidis and ductus deferens after one week of life, and one week later, in the more cranial segments of the epididymis. Epithelial principal cells and peritubular contractile cells are structurally mature 35 days after birth. The synchronous changes of these cells indicate that the same factors control their postnatal maturation. The epithelial principal cells obtain an endocytotic apparatus and long stereocilia, whereas peritubular cells acquire contractile features. These changes are associated with a progressive increase in the immunoreaction for smooth muscle actin in both cell types. Smooth muscle myosin is detected in the apical region of the epithelial cells and the peritubular cell cytoplasm by day one of postnatal development. The differentiation of contractile cells in the wall is accompanied by progressive organization of the pericellular matrix into a continuous basement membrane. Although fibronectin is visible at birth, it is gradually removed from the tubule wall.

  19. Principles of a reversible programming language

    DEFF Research Database (Denmark)

    Yokoyama, Tetsuo; Axelsen, Holger Bock; Glück, Robert

    2008-01-01

    The principles of reversible programming languages are explicated and illustrated with reference to the design of a high-level imperative language, Janus. The fundamental properties for such languages include backward as well as forward determinism and reversible updates of data. The unique design...... features of the language include explicit post-condition assertions, direct access to an inverse semantics and the possibility of clean (i.e., garbage-free) computation of injective functions. We suggest the clean simulation of reversible Turing machines as a criterion for computing strength of reversible...... languages, and demonstrate this for Janus. We show the practicality of the language by implementation of a reversible fast Fourier transform. Our results indicate that the reversible programming paradigm has fundamental properties that are relevant to many different areas of computer science....

  20. Securing Biometric Images using Reversible Watermarking

    CERN Document Server

    Thampi, Sabu M

    2011-01-01

    Biometric security is a fast growing area. Protecting biometric data is very important since it can be misused by attackers. In order to increase security of biometric data there are different methods in which watermarking is widely accepted. A more acceptable, new important development in this area is reversible watermarking in which the original image can be completely restored and the watermark can be retrieved. But reversible watermarking in biometrics is an understudied area. Reversible watermarking maintains high quality of biometric data. This paper proposes Rotational Replacement of LSB as a reversible watermarking scheme for biometric images. PSNR is the regular method used for quality measurement of biometric data. In this paper we also show that SSIM Index is a better alternate for effective quality assessment for reversible watermarked biometric data by comparing with the well known reversible watermarking scheme using Difference Expansion.

  1. Reverse-symmetry waveguides: Theory and fabrication

    DEFF Research Database (Denmark)

    Horvath, R.; Lindvold, Lars René; Larsen, N.B.

    2002-01-01

    We present an extensive theoretical analysis of reverse-symmetry waveguides with special focus on their potential application as sensor components in aqueous media and demonstrate a novel method for fabrication of such waveguides. The principle of reverse symmetry is based on making the refractiv...... has the advantage of deeper penetration of the evanescent electromagnetic field into the cover medium, theoretically permitting higher sensitivity to analytes compared to traditional waveguide designs. We present calculated sensitivities and probing depths of conventional and reverse...

  2. Reverse polarization in conjugated heterocycle polythiophene

    Institute of Scientific and Technical Information of China (English)

    王鹿霞; 刘德胜; 张大成; 解士杰; 韩圣浩; 梅良模

    2005-01-01

    Reverse polarization in polythiophene under an applied electric field has been studied in the framework of the tightbinding model. It is found that the applied electronic field has a great influence on the excited states of polythiophene.The effect of the heteroatoms on the polarization has been calculated and analysed carefully. It is indicated that a reverse polarization of biexcitons in polythiophene will be observed more easily. The heteroatoms increase this reversed polarization strength apparently.

  3. Magnetic field reversals and galactic dynamos

    OpenAIRE

    2012-01-01

    We argue that global magnetic field reversals similar to those observed in the Milky Way occur quite frequently in mean-field galactic dynamo models that have relatively strong, random, seed magnetic fields that are localized in discrete regions. The number of reversals decreases to zero with reduction of the seed strength, efficiency of the galactic dynamo and size of the spots of the seed field. A systematic observational search for magnetic field reversals in a representative sample of spi...

  4. Reverse polarization in conjugated heterocycle polythiophene

    Science.gov (United States)

    Wang, Lu-Xia; Liu, De-Sheng; Zhang, Da-Cheng; Xie, Shi-Jie; Han, Sheng-Hao; Mei, Liang-Mo

    2005-01-01

    Reverse polarization in polythiophene under an applied electric field has been studied in the framework of the tight-binding model. It is found that the applied electronic field has a great influence on the excited states of polythiophene. The effect of the heteroatoms on the polarization has been calculated and analysed carefully. It is indicated that a reverse polarization of biexcitons in polythiophene will be observed more easily. The heteroatoms increase this reversed polarization strength apparently.

  5. Reversibility of Sympathectomy for Primary Hyperhidrosis.

    Science.gov (United States)

    Hynes, Conor F; Marshall, M Blair

    2016-11-01

    Endoscopic thoracic sympathectomy (ETS) is an effective treatment of primary hyperhidrosis of the face, upper extremities, and axillae. The major limitation is the side effect of compensatory sweating severe enough that patients request reversal in up to 10% of cases. When ETS is performed by cutting the sympathetic chain, reversal requires nerve grafting. However, for ETS done with clips, reversal is a simple thoracoscopic outpatient procedure of removing the clips. Subsequent reversal of the sympathectomy, ie, nerve regeneration, is successful in many cases. However, follow-up is short. Factors contributing to success rates require further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Delay Reduction in Optimized Reversible Multiplier Circuit

    Directory of Open Access Journals (Sweden)

    Mohammad Assarian

    2012-01-01

    Full Text Available In this study a novel reversible multiplier is presented. Reversible logic can play a significant role in computer domain. This logic can be applied in quantum computing, optical computing processing, DNA computing, and nanotechnology. One condition for reversibility of a computable model is that the number of input equate with the output. Reversible multiplier circuits are the circuits used frequently in computer system. For this reason, optimization in one reversible multiplier circuit can reduce its volume of hardware on one hand and increases the speed in a reversible system on the other hand. One of the important parameters that optimize a reversible circuit is reduction of delays in performance of the circuit. This paper investigates the performance characteristics of the gates, the circuits and methods of optimizing the performance of reversible multiplier circuits. Results showed that reduction of the reversible circuit layers has lead to improved performance due to the reduction of the propagation delay between input and output period. All the designs are in the nanometric scales.

  7. Combining or Separating Forward and Reverse Logistics

    DEFF Research Database (Denmark)

    Herbert-Hansen, Zaza Nadja Lee; Larsen, Samuel; Nielsen, Anders

    2017-01-01

    Purpose – While forward logistics handles and manages the flow of goods downstream in the supply chain from suppliers to customers, reverse logistics (RL) manages the flow of returned goods upstream. A firm can combine reverse logistics with forward logistics, keep the flows separated, or choose......-research addresses intra-RL issues while the relationship between forward and reverse logistics is under-researched. This paper contributes to RL-theory by identifying the contextual factors that determine the most advantageous relationship between forward and reverse logistics, and proposes a novel decision making...

  8. THRUST REVERSER PERFORMANCE AND THE INGESTION PROBLEM,

    Science.gov (United States)

    THRUST REVERSAL, INGESTION ), (*JET TRANSPORT PLANE, THRUST), (*TURBOJET ENGINES, INGESTION ), JET TRANSPORT PLANES, PELLETS, ROCK (GEOLOGY), PARTICLES, DESIGN, MODEL, INSTALLATION, EFFECTIVENESS, COMMERICAL.

  9. Reverse genetics in ecological research.

    Directory of Open Access Journals (Sweden)

    Jens Schwachtje

    Full Text Available By precisely manipulating the expression of individual genetic elements thought to be important for ecological performance, reverse genetics has the potential to revolutionize plant ecology. However, untested concerns about possible side-effects of the transformation technique, caused by Agrobacterium infection and tissue culture, on plant performance have stymied research by requiring onerous sample sizes. We compare 5 independently transformed Nicotiana attenuata lines harboring empty vector control (EVC T-DNA lacking silencing information with isogenic wild types (WT, and measured a battery of ecologically relevant traits, known to be important in plant-herbivore interactions: phytohormones, secondary metabolites, growth and fitness parameters under stringent competitive conditions, and transcriptional regulation with microarrays. As a positive control, we included a line silenced in trypsin proteinase inhibitor gene (TPI expression, a potent anti-herbivore defense known to exact fitness costs in its expression, in the analysis. The experiment was conducted twice, with 10 and 20 biological replicates per genotype. For all parameters, we detected no difference between any EVC and WT lines, but could readily detect a fitness benefit of silencing TPI production. A statistical power analyses revealed that the minimum sample sizes required for detecting significant fitness differences between EVC and WT was 2-3 orders of magnitude larger than the 10 replicates required to detect a fitness effect of TPI silencing. We conclude that possible side-effects of transformation are far too low to obfuscate the study of ecologically relevant phenotypes.

  10. Reversible hypothyroidism and Whipple's disease

    Directory of Open Access Journals (Sweden)

    Tran Huy A

    2006-05-01

    Full Text Available Abstract Background The major cause of primary hypothyroidism is autoimmune mediated with progressive and permanent destruction of the thyroid gland resulting in life-long replacement therapy. Treatable and reversible hypothyroidism is unusual and here forth is such a case due to infection of the thyroid gland with Tropheryma whippleii, Whipple disease. Case presentation A 45 year-old female presented with symptoms and signs consistent with primary hypothyroidism, which was also confirmed biochemically. Her response to thyroxine replacement therapy was poor however, requiring a significantly elevated amount. Further investigation revealed the presence of Whipple's disease involving the gastrointestinal trace and possibly the thyroid gland. Her thyroxine requirement decreased drastically following appropriate antimicrobial therapy for Whipple's disease to the extent that it was ceased. Thyrotropin releasing hormone testing in the steady state suggested there was diminished thyroid reserve due to Whipple's disease. Conclusion This is the first ante-mortem case report studying the possible involvement of the thyroid gland by Whipple's disease. Despite the normalization of her thyroid function test biochemically after antibiotic therapy, there is diminished thyroid reserve thus requiring close and regular monitoring.

  11. Reverse Engineering Adverse Outcome Pathways

    Energy Technology Data Exchange (ETDEWEB)

    Perkins, Edward; Chipman, J.K.; Edwards, Stephen; Habib, Tanwir; Falciani, Francesco; Taylor, Ronald C.; Van Aggelen, Graham; Vulpe, Chris; Antczak, Philipp; Loguinov, Alexandre

    2011-01-30

    The toxicological effects of many stressors are mediated through unknown, or poorly characterized, mechanisms of action. We describe the application of reverse engineering complex interaction networks from high dimensional omics data (gene, protein, metabolic, signaling) to characterize adverse outcome pathways (AOPs) for chemicals that disrupt the hypothalamus-pituitary-gonadal endocrine axis in fathead minnows. Gene expression changes in fathead minnow ovaries in response to 7 different chemicals, over different times, doses, and in vivo versus in vitro conditions were captured in a large data set of 868 arrays. We examined potential AOPs of the antiandrogen flutamide using two mutual information theory methods, ARACNE and CLR to infer gene regulatory networks and potential adverse outcome pathways. Representative networks from these studies were used to predict a network path from stressor to adverse outcome as a candidate AOP. The relationship of individual chemicals to an adverse outcome can be determined by following perturbations through the network in response to chemical treatment leading to the nodes associated with the adverse outcome. Identification of candidate pathways allows for formation of testable hypotheses about key biologic processes, biomarkers or alternative endpoints, which could be used to monitor an adverse outcome pathway. Finally, we identify the unique challenges facing the application of this approach in ecotoxicology, and attempt to provide a road map for the utilization of these tools. Key Words: mechanism of action, toxicology, microarray, network inference

  12. Solution to reverse refraction problem

    Science.gov (United States)

    Pavelyev, A. G.

    1985-04-01

    The reverse refraction problem (determination of radial profile of refractive index in planetary atmospheres, such as Earth, from radio probe measurements) is formulated as a bistatic radar problem for a spherically symmetric medium. The modified refractive index n(r)r (a-radius at which the refraction angle as function of relative distance is measured) is assumed to reach extreme values at the upper boundary r sub 1 or at observation level. Before the corresponding Fredholm equation of the first kind can be solved, it must be well-conditioned in the Tikhonov sense. This is done here by two quasi-optimum integral transformation variants with respect to the measurement function and subsequent simplified regularization. The first method is two successive Fourier cosine transformations followed by an Abel transformation, with the possibility of discrete Fourier transformations and numerical Abel transformation. The second method is twofold discrete Fourier transformation. Both yield solutions readily evaluated by simple algorithms. Regularization is effected by approximating functions satisfying the two fundamental conditions for convergence required of the measurement function.

  13. 静脉导管血流检测对妊娠高血压疾病胎儿右心舒张功能的评价%Ductus venosus blood flow detection for fetal right ventricular diastolic function evaluation in hypertensive disorders of pregnancy

    Institute of Scientific and Technical Information of China (English)

    李天刚; 车岩; 童明辉; 聂芳; 叶娜

    2013-01-01

    目的 通过检测胎儿静脉导管血流参数,了解妊娠高血压疾病对胎儿右心舒张功能的影响.方法 92 例妊娠高血压疾病孕妇,其中重度子痫前期组14 例,轻度子痫前期组26 例,妊娠高血压组52 例,60 例与其孕龄匹配且血压正常孕妇为对照组,彩色多普勒超声测量其胎儿静脉导管的搏动指数、阻力指数、静脉前负荷指数(PLI)及心室收缩峰值流速与心房收缩最大流速比值(S/A).于治疗后24 h 及72 h,监测重度子痫前期组胎儿静脉导管各项参数.结果 对照组、轻度子痫前期组和重度子痫前期组的搏动指数、阻力指数、S/A 及PLI 依次增高,组间两两比较差异均有统计学意义(P﹤0.05);治疗后24 h 及72 h,重度子痫前期组胎儿静脉导管各项参数较治疗前均减低(P﹤0.05);与轻度子痫前期组比较,重度子痫前期组三尖瓣反流和静脉导管反向波发生率增高(P﹤0.05).结论 通过胎儿静脉导管检测可以定性或定量判断胎儿右心舒张功能改变,为临床提供治疗及预后依据.%Objective To investigate the effect, of hypertensive disorders in pregnancy on fetal right, ventricular diastolic function by detecting the blood flow parameter of fetal duct.us venosus. Methods Ninety—two cases of pregnant women with hypertension were enrolled including 14 cases of severe preeciampsia ,26 cases of mild preeclampsia,52 cases of gestationai hypertension,and 60 cases of normotensive pregnant, women at gestationai age were taken as the control. The parameters including pulsatility index, resistance index, pre-load index (PLI) and S/A ratio of ductus venosus in fetus were measured by dolor Dopier. The blood flow parameters in fetal ductus venosus in the severe preeciampsia group were monitored 24 h and 72 h after treatment. Results Compared with the control group, pulsatilily index, resistance index. PLI and S/A of ductus venosus in fetus in mild and severe preeciampsia group were

  14. Reversible temperature exchange upon thermal contact

    Science.gov (United States)

    Mishchenko, Eugene G.; Pshenichka, Paul F.

    2017-01-01

    According to a well-known principle of thermodynamics, the transfer of heat between two bodies is reversible when their temperatures are infinitesimally close. As we demonstrate, a little-known alternative exists: two bodies with temperatures different by an arbitrary amount can completely exchange their temperatures in a reversible way if split into infinitesimal parts that are brought into thermal contact sequentially.

  15. Magnetic reversals from planetary dynamo waves.

    Science.gov (United States)

    Sheyko, Andrey; Finlay, Christopher C; Jackson, Andrew

    2016-11-24

    A striking feature of many natural dynamos is their ability to undergo polarity reversals. The best documented example is Earth's magnetic field, which has reversed hundreds of times during its history. The origin of geomagnetic polarity reversals lies in a magnetohydrodynamic process that takes place in Earth's core, but the precise mechanism is debated. The majority of numerical geodynamo simulations that exhibit reversals operate in a regime in which the viscosity of the fluid remains important, and in which the dynamo mechanism primarily involves stretching and twisting of field lines by columnar convection. Here we present an example of another class of reversing-geodynamo model, which operates in a regime of comparatively low viscosity and high magnetic diffusivity. This class does not fit into the paradigm of reversal regimes that are dictated by the value of the local Rossby number (the ratio of advection to Coriolis force). Instead, stretching of the magnetic field by a strong shear in the east-west flow near the imaginary cylinder just touching the inner core and parallel to the axis of rotation is crucial to the reversal mechanism in our models, which involves a process akin to kinematic dynamo waves. Because our results are relevant in a regime of low viscosity and high magnetic diffusivity, and with geophysically appropriate boundary conditions, this form of dynamo wave may also be involved in geomagnetic reversals.

  16. Online Reverse Auctions for Procurement of Services

    NARCIS (Netherlands)

    U.L. Radkevitch (Uladzimir)

    2008-01-01

    textabstractOnline reverse auctions, in which a buyer seeks to select a supplier and suppliers compete for contracts by bidding online, revolutionized corporate procurement early this century. Shortly after they had been pioneered by General Electric, many companies rushed to adopt reverse auctions

  17. Szilard engine reversibility as quantum gate function

    Science.gov (United States)

    Mihelic, F. Matthew

    2012-06-01

    A quantum gate is a logically and thermodynamically reversible situation that effects a unitary transformation of qubits of superimposed information, and essentially constitutes a situation for a reversible quantum decision. A quantum decision is a symmetry break, and the effect of the function of a Szilard engine is a symmetry break. A quantum gate is a situation in which a reversible quantum decision can be made, and so if a logically and thermodynamically reversible Szilard engine can be theoretically constructed then it would function as a quantum gate. While the traditionally theorized Szilard engine is not thermodynamically reversible, if one of the bounding walls of a Szilard engine were to be constructed out of the physical information by which it functions in such a manner as to make that information available to both sides of the wall simultaneously, then such a Szilard engine would be both logically and thermodynamically reversible, and thus capable of function as a quantum gate. A theoretical model of the special case of a reversible Szilard engine functioning as a quantum gate is presented and discussed, and since a quantum decision is made when the shutter of a Szilard engine closes, the coherence of linked reversible Szilard engines should be considered as a state during which all of the shutters of linked Szilard engines are open simultaneously.

  18. Multiple reversal olfactory learning in honeybees

    Directory of Open Access Journals (Sweden)

    Theo Mota

    2010-07-01

    Full Text Available In multiple reversal learning, animals trained to discriminate a reinforced from a non-reinforced stimulus are subjected to various, successive reversals of stimulus contingencies (e.g. A+ vs. B-, A- vs. B+, A+ vs. B-. This protocol is useful to determine whether or not animals learn to learn and solve successive discriminations faster (or with fewer errors with increasing reversal experience. Here we used the olfactory conditioning of proboscis extension reflex to study how honeybees Apis mellifera perform in a multiple reversal task. Our experiment contemplated four consecutive differential conditioning phases involving the same odors (A+ vs. B- to A- vs. B+ to A+ vs. B- to A- vs. B+. We show that bees in which the weight of reinforced or non-reinforced stimuli was similar mastered the multiple olfactory reversals. Bees which failed the task exhibited asymmetric responses to reinforced and non-reinforced stimuli, thus being unable to rapidly reverse stimulus contingencies. Efficient reversers did not improve their successive discriminations but rather tended to generalize their choice to both odors at the end of conditioning. As a consequence, both discrimination and reversal efficiency decreasedalong experimental phases. This result invalidates a learning-to-learn effect and indicates that bees do not only respond to the actual stimulus contingencies but rather combine these with an average of past experiences with the same stimuli.  

  19. Online Reverse Auctions for Procurement of Services

    NARCIS (Netherlands)

    U.L. Radkevitch (Uladzimir)

    2008-01-01

    textabstractOnline reverse auctions, in which a buyer seeks to select a supplier and suppliers compete for contracts by bidding online, revolutionized corporate procurement early this century. Shortly after they had been pioneered by General Electric, many companies rushed to adopt reverse auctions

  20. Reversible logic gates on Physarum Polycephalum

    Energy Technology Data Exchange (ETDEWEB)

    Schumann, Andrew [University of Information Technology and Management, Sucharskiego 2, Rzeszow, 35-225 (Poland)

    2015-03-10

    In this paper, we consider possibilities how to implement asynchronous sequential logic gates and quantum-style reversible logic gates on Physarum polycephalum motions. We show that in asynchronous sequential logic gates we can erase information because of uncertainty in the direction of plasmodium propagation. Therefore quantum-style reversible logic gates are more preferable for designing logic circuits on Physarum polycephalum.

  1. Reversal of laryngotracheal separation in paediatric patients.

    LENUS (Irish Health Repository)

    Young, Orla

    2012-02-01

    OBJECTIVE: Laryngotracheal separation (LTS) is an effective and reliable definitive treatment for intractable aspiration. A major advantage of this treatment for intractable aspiration is its\\' potential reversibility. Should the underlying disorder improve, a reversal of the procedure may be attempted. This has been successfully achieved in the adult population. To our knowledge, no previous cases have been reported of successful reversal of LTS in children. METHODS: A retrospective review from 2003 to 2010 identified four cases of intractable aspiration treated with LTS in our department. Two of these patients displayed objective evidence of sufficient recovery of their underlying aspiration to consider reversal. Patient selection for reversal was dependent upon successful oral intake for 9 months along with videofluoroscopic evidence of normal or minimally impaired swallow. RESULTS: Two children who were successfully treated for intractable aspiration with LTS demonstrated objective evidence of recovery sufficient to attempt reversal. Both children underwent successful surgical reversal of LTS using a cricotracheal resection with end-to-end anastamosis, similar to that used in treatment of subglottic stenosis. Both children can now tolerate oral diet and their speech and language development is in line with their overall developmental level. CONCLUSIONS: Laryngotracheal separation is an effective and reliable definitive treatment for intractable aspiration facilitating protection of the airway and allowing safe swallowing with unimpeded respiration, but with the major drawback of loss of phonation. To our knowledge, we document the first two cases of successful LTS reversal in children.

  2. Parallelization of Reversible Ripple-carry Adders

    DEFF Research Database (Denmark)

    Thomsen, Michael Kirkedal; Axelsen, Holger Bock

    2009-01-01

    The design of fast arithmetic logic circuits is an important research topic for reversible and quantum computing. A special challenge in this setting is the computation of standard arithmetical functions without the generation of \\emph{garbage}. Here, we present a novel parallelization scheme...... wherein $m$ parallel $k$-bit reversible ripple-carry adders are combined to form a reversible $mk$-bit \\emph{ripple-block carry adder} with logic depth $\\mathcal{O}(m+k)$ for a \\emph{minimal} logic depth $\\mathcal{O}(\\sqrt{mk})$, thus improving on the $mk$-bit ripple-carry adder logic depth $\\mathcal......{O}(m\\cdot k)$. The underlying mechanisms of the parallelization scheme are formally proven correct. We also show designs for garbage-less reversible comparison circuits. We compare the circuit costs of the resulting ripple-block carry adder with known optimized reversible ripple-carry adders in measures...

  3. Design of Digital Adder Using Reversible Logic

    Directory of Open Access Journals (Sweden)

    Gowthami P

    2016-02-01

    Full Text Available Reversible logic circuits have promising applications in Quantum computing, Low power VLSI design, Nanotechnology, optical computing, DNA computing and Quantum dot cellular automata. In spite of them another main prominent application of reversible logic is Quantum computers where the quantum devices are essential which are ideally operated at ultra high speed with less power dissipation must be built from reversible logic components. This makes the reversible logic as a one of the most promising research areas in the past few decades. In VLSI design the delay is the one of the major issue along with area and power. This paper presents the implementation of Ripple Carry Adder (RCA circuits using reversible logic gates are discussed.

  4. Synthesis of Fault Tolerant Reversible Logic Circuits

    CERN Document Server

    Islam, Md Saiful; Begum, Zerina; Hafiz, Mohd Zulfiquar; Mahmud, Abdullah Al; 10.1109/CAS-ICTD.2009.4960883

    2010-01-01

    Reversible logic is emerging as an important research area having its application in diverse fields such as low power CMOS design, digital signal processing, cryptography, quantum computing and optical information processing. This paper presents a new 4*4 universal reversible logic gate, IG. It is a parity preserving reversible logic gate, that is, the parity of the inputs matches the parity of the outputs. The proposed parity preserving reversible gate can be used to synthesize any arbitrary Boolean function. It allows any fault that affects no more than a single signal readily detectable at the circuit's primary outputs. Finally, it is shown how a fault tolerant reversible full adder circuit can be realized using only two IGs. It has also been demonstrated that the proposed design offers less hardware complexity and is efficient in terms of gate count, garbage outputs and constant inputs than the existing counterparts.

  5. Estimation and uncertainty of reversible Markov models

    CERN Document Server

    Trendelkamp-Schroer, Benjamin; Paul, Fabian; Noé, Frank

    2015-01-01

    Reversibility is a key concept in the theory of Markov models, simplified kinetic models for the conforma- tion dynamics of molecules. The analysis and interpretation of the transition matrix encoding the kinetic properties of the model relies heavily on the reversibility property. The estimation of a reversible transition matrix from simulation data is therefore crucial to the successful application of the previously developed theory. In this work we discuss methods for the maximum likelihood estimation of transition matrices from finite simulation data and present a new algorithm for the estimation if reversibility with respect to a given stationary vector is desired. We also develop new methods for the Bayesian posterior inference of reversible transition matrices with and without given stationary vector taking into account the need for a suitable prior distribution preserving the meta-stable features of the observed process during posterior inference.

  6. Flow reversals in thermally driven turbulence

    CERN Document Server

    Sugiyama, Kazuyasu; Stevens, Richard J A M; Chan, Tak Shing; Zhou, Sheng-Qi; Xi, Heng-Dong; Sun, Chao; Grossmann, Siegfried; Xia, Ke-Qing; Lohse, Detlef; 10.1103/PhysRevLett.105.034503

    2011-01-01

    We analyze the reversals of the large scale flow in Rayleigh-B\\'enard convection both through particle image velocimetry flow visualization and direct numerical simulations (DNS) of the underlying Boussinesq equations in a (quasi) two-dimensional, rectangular geometry of aspect ratio 1. For medium Prandtl number there is a diagonal large scale convection roll and two smaller secondary rolls in the two remaining corners diagonally opposing each other. These corner flow rolls play a crucial role for the large scale wind reversal: They grow in kinetic energy and thus also in size thanks to plume detachments from the boundary layers up to the time that they take over the main, large scale diagonal flow, thus leading to reversal. Based on this mechanism we identify a typical time scale for the reversals. We map out the Rayleigh number vs Prandtl number phase space and find that the occurrence of reversals very sensitively depends on these parameters.

  7. Reversible machine code and its abstract processor architecture

    DEFF Research Database (Denmark)

    Axelsen, Holger Bock; Glück, Robert; Yokoyama, Tetsuo

    2007-01-01

    A reversible abstract machine architecture and its reversible machine code are presented and formalized. For machine code to be reversible, both the underlying control logic and each instruction must be reversible. A general class of machine instruction sets was proven to be reversible, building ...... on our concept of reversible updates. The presentation is abstract and can serve as a guideline for a family of reversible processor designs. By example, we illustrate programming principles for the abstract machine architecture formalized in this paper....

  8. Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia.

    Science.gov (United States)

    Stressig, R; Fimmers, R; Schaible, T; Degenhardt, J; Axt-Fliedner, R; Gembruch, U; Kohl, T

    2013-12-01

    Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present. We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared. 62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002). Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO. © Georg Thieme Verlag KG Stuttgart · New York.

  9. First-trimester screening for chromosomal abnormalities by integrated application of nuchal translucency, nasal bone, tricuspid regurgitation and ductus venosus flow combined with maternal serum free β-hCG and PAPP-A: a 5-year prospective study.

    Science.gov (United States)

    Ghaffari, S R; Tahmasebpour, A R; Jamal, A; Hantoushzadeh, S; Eslamian, L; Marsoosi, V; Fattahi, F; Rajaei, M; Niroomanesh, S; Borna, S; Beigi, A; Khazardoost, S; Saleh-Gargari, S; Rahimi-Sharbaf, F; Farrokhi, B; Bayani, N; Tehrani, S E; Shahsavan, K; Farzan, S; Moossavi, S; Ramezanzadeh, F; Dastan, J; Rafati, M

    2012-05-01

    To investigate the performance of first-trimester screening for chromosomal abnormalities by integrated application of nuchal translucency thickness (NT), nasal bone (NB), tricuspid regurgitation (TR) and ductus venosus (DV) flow combined with maternal serum free β-human chorionic gonadotropin (fβ-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at a one-stop clinic for assessment of risk (OSCAR). In total, 13,706 fetuses in 13,437 pregnancies were screened for chromosomal abnormalities during a period of 5 years. Maternal serum biochemical markers and maternal age were evaluated in combination with NT, NT + NB, NT + NB + TR, and NT + NB + TR + DV flow data in 8581, 242, 236 and 4647 fetuses, respectively. In total, 51 chromosomal abnormalities were identified in the study population, including 33 cases of trisomy 21, eight of trisomy 18, six of sex chromosome abnormality, one of triploidy and three of other unbalanced abnormalities. The detection rate and false-positive rate (FPR) for trisomy 21 were 93.8% and 4.84%, respectively, using biochemical markers and NT, and 100% and 3.4%, respectively, using biochemical markers, NT, NB, TR and DV flow. While risk assessment using combined biochemical markers and NT measurement has an acceptable screening performance, it can be improved by the integrated evaluation of secondary ultrasound markers of NB, TR and DV flow. This enhanced approach would decrease the FPR from 4.8 % to 3.4 %, leading to a lower number of unnecessary invasive diagnostic tests and subsequent complications, while maintaining the maximum level of detection rate. Pre- and post-test genetic counseling is of paramount importance in either approach. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

  10. Reverse Transcriptase and Cellular Factors: Regulators of HIV-1 Reverse Transcription

    Directory of Open Access Journals (Sweden)

    David Harrich

    2009-11-01

    Full Text Available There is ample evidence that synthesis of HIV-1 proviral DNA from the viral RNA genome during reverse transcription requires host factors. However, only a few cellular proteins have been described in detail that affect reverse transcription and interact with reverse transcriptase (RT. HIV-1 integrase is an RT binding protein and a number of IN-binding proteins including INI1, components of the Sin3a complex, and Gemin2 affect reverse transcription. In addition, recent studies implicate the cellular proteins HuR, AKAP149, and DNA topoisomerase I in reverse transcription through an interaction with RT. In this review we will consider interactions of reverse transcription complex with viral and cellular factors and how they affect the reverse transcription process.

  11. Novel Designs of Quantum Reversible Counters

    Science.gov (United States)

    Qi, Xuemei; Zhu, Haihong; Chen, Fulong; Zhu, Junru; Zhang, Ziyang

    2016-11-01

    Reversible logic, as an interesting and important issue, has been widely used in designing combinational and sequential circuits for low-power and high-speed computation. Though a significant number of works have been done on reversible combinational logic, the realization of reversible sequential circuit is still at premature stage. Reversible counter is not only an important part of the sequential circuit but also an essential part of the quantum circuit system. In this paper, we designed two kinds of novel reversible counters. In order to construct counter, the innovative reversible T Flip-flop Gate (TFG), T Flip-flop block (T_FF) and JK flip-flop block (JK_FF) are proposed. Based on the above blocks and some existing reversible gates, the 4-bit binary-coded decimal (BCD) counter and controlled Up/Down synchronous counter are designed. With the help of Verilog hardware description language (Verilog HDL), these counters above have been modeled and confirmed. According to the simulation results, our circuits' logic structures are validated. Compared to the existing ones in terms of quantum cost (QC), delay (DL) and garbage outputs (GBO), it can be concluded that our designs perform better than the others. There is no doubt that they can be used as a kind of important storage components to be applied in future low-power computing systems.

  12. Chemical reactions in reverse micelle systems

    Science.gov (United States)

    Matson, Dean W.; Fulton, John L.; Smith, Richard D.; Consani, Keith A.

    1993-08-24

    This invention is directed to conducting chemical reactions in reverse micelle or microemulsion systems comprising a substantially discontinuous phase including a polar fluid, typically an aqueous fluid, and a microemulsion promoter, typically a surfactant, for facilitating the formation of reverse micelles in the system. The system further includes a substantially continuous phase including a non-polar or low-polarity fluid material which is a gas under standard temperature and pressure and has a critical density, and which is generally a water-insoluble fluid in a near critical or supercritical state. Thus, the microemulsion system is maintained at a pressure and temperature such that the density of the non-polar or low-polarity fluid exceeds the critical density thereof. The method of carrying out chemical reactions generally comprises forming a first reverse micelle system including an aqueous fluid including reverse micelles in a water-insoluble fluid in the supercritical state. Then, a first reactant is introduced into the first reverse micelle system, and a chemical reaction is carried out with the first reactant to form a reaction product. In general, the first reactant can be incorporated into, and the product formed in, the reverse micelles. A second reactant can also be incorporated in the first reverse micelle system which is capable of reacting with the first reactant to form a product.

  13. Reverse triple I method of fuzzy reasoning

    Institute of Scientific and Technical Information of China (English)

    宋士吉; 吴澄

    2002-01-01

    A theory of reverse triple I method with sustention degree is presented by using the implication operator R0 in every step of the fuzzy reasoning. Its computation formulas of supremum for fuzzy modus ponens and infimum for fuzzy modus tollens are given respectively. Moreover, through the generalization of this problem, the corresponding formulas of ?-reverse triple I method with sustention degree are also obtained. In addition, the theory of reverse triple I method with restriction degree is proposed as well by using the operator R0, and the computation formulas of infimum for fuzzy modus ponens and supremum for fuzzy modus tollens are shown.

  14. Magnetic reversals from planetary dynamo waves

    DEFF Research Database (Denmark)

    Sheyko, Andrey; Finlay, Chris; Jackson, Andrew

    2016-01-01

    place in Earth's core, but the precise mechanism is debated. The majority of numerical geodynamo simulations that exhibit reversals operate in a regime in which the viscosity of the fluid remains important, and in which the dynamo mechanism primarily involves stretching and twisting of field lines...... by columnar convection. Here we present an example of another class of reversing-geodynamo model, which operates in a regime of comparatively low viscosity and high magnetic diffusivity. This class does not fit into the paradigm of reversal regimes that are dictated by the value of the local Rossby number...

  15. Time reversibility, computer simulation, and chaos

    CERN Document Server

    Hoover, William Graham

    1999-01-01

    A small army of physicists, chemists, mathematicians, and engineers has joined forces to attack a classic problem, the "reversibility paradox", with modern tools. This book describes their work from the perspective of computer simulation, emphasizing the author's approach to the problem of understanding the compatibility, and even inevitability, of the irreversible second law of thermodynamics with an underlying time-reversible mechanics. Computer simulation has made it possible to probe reversibility from a variety of directions and "chaos theory" or "nonlinear dynamics" has supplied a useful

  16. Reverse logistics in the Brazilian construction industry.

    Science.gov (United States)

    Nunes, K R A; Mahler, C F; Valle, R A

    2009-09-01

    In Brazil most Construction and Demolition Waste (C&D waste) is not recycled. This situation is expected to change significantly, since new federal regulations oblige municipalities to create and implement sustainable C&D waste management plans which assign an important role to recycling activities. The recycling organizational network and its flows and components are fundamental to C&D waste recycling feasibility. Organizational networks, flows and components involve reverse logistics. The aim of this work is to introduce the concepts of reverse logistics and reverse distribution channel networks and to study the Brazilian C&D waste case.

  17. Kinetic Line Voronoi Operations and Their Reversibility

    DEFF Research Database (Denmark)

    Mioc, Darka; Anton, François; Gold, Christopher

    2010-01-01

    In Geographic Information Systems the reversibility of map update operations has not been explored yet. In this paper we are using the Voronoi based Quad-edge data structure to define reversible map update operations. The reversibility of the map operations has been formalised at the lowest level...... explanation using the finite field of residual classes of integers modulo 5: F 5 = ℤ/5ℤ. We show also an isomorphism between the set of complex operations on the kinetic Voronoi diagram of points and open oriented line segments and the set of differences of new and deleted Quad-Edge edges induced...

  18. An insightful approach for understanding solvatochromic reversal

    Science.gov (United States)

    Manzoni, Vinicius; Coutinho, Kaline; Canuto, Sylvio

    2016-07-01

    Several studies have shown that organic dyes may show solvatochromic reversal with respect to the solvent polarity. This controversial non-monotonic behavior is still not well understood. This has been analyzed here using the merocyanine of Brooker as the working example. Associating a continuous variable to model the solvent polarity a solvatochromic reversal is obtained with a single solute without aggregation. This reversal is in excellent agreement with the experimental results and is shown to be the outcome of a competition between structural change and intramolecular charge transfer.

  19. Time reversibility in the quantum frame

    Energy Technology Data Exchange (ETDEWEB)

    Masot-Conde, Fátima [Escuela Superior Ingenieros, Dpt. Física Aplicada III, Universidad de Sevilla Isla Mágica, 41092- Sevilla (Spain)

    2014-12-04

    Classic Mechanics and Electromagnetism, conventionally taken as time-reversible, share the same concept of motion (either of mass or charge) as the basis of the time reversibility in their own fields. This paper focuses on the relationship between mobile geometry and motion reversibility. The goal is to extrapolate the conclusions to the quantum frame, where matter and radiation behave just as elementary mobiles. The possibility that the asymmetry of Time (Time’s arrow) is an effect of a fundamental quantum asymmetry of elementary particles, turns out to be a consequence of the discussion.

  20. Performance of the reverse Helmbold universal portfolio

    Science.gov (United States)

    Tan, Choon Peng; Kuang, Kee Seng; Lee, Yap Jia

    2017-04-01

    The universal portfolio is an important investment strategy in a stock market where no stochastic model is assumed for the stock prices. The zero-gradient set of the objective function estimating the next-day portfolio which contains the reverse Kullback-Leibler order-alpha divergence is considered. From the zero-gradient set, the explicit, reverse Helmbold universal portfolio is obtained. The performance of the explicit, reverse Helmbold universal portfolio is studied by running them on some stock-price data sets from the local stock exchange. It is possible to increase the wealth of the investor by using these portfolios in investment.