Regan E. Giesinger¹, Adrianne R. Bischoff³, Patrick J. McNamara^1,2

Congenital Heart Disease, Vol.14, No.2, pp. 311-316, 2019, DOI:10.1111/chd.12738

Abstract Ligation of a hemodynamically significant ductus arteriosus results in significant changes in loading conditions which have predictable consequences. Postligation cardiac syndrome, defined as hypotension requiring inotropic support and failure of oxygenation and ventilation, may occur 6‐12 hours following ligation due to left ven‐ tricular systolic and diastolic failure, respectively. Afterload is the primary driver of this decompensation. In this review, we describe the pathophysiological changes in loading conditions associated with postligation cardiac syndrome and other contrib‐ utors to cardiovascular dysfunction following ductal ligation. We present strategies for perioperative optimization and a physiology‐based algorithm for postoperative management guided by targeted neonatal… More >

Shyam Sathanandam¹, Stephanie Whiting¹, Jorden Cunningham¹, David Zurakowski², Leah Apalodimas¹, B. Rush Waller¹, Ranjit Philip¹, Athar M. Qureshi³

Congenital Heart Disease, Vol.14, No.1, pp. 6-14, 2019, DOI:10.1111/chd.12729

Abstract Background: Patent ductus arteriosus (PDA) is highly prevalent in extremely low birth weight (ELBW), preterm infants. There are diverse management approaches for the PDA in ELBW infants. The objectives of this research were to identify current PDA management practices among cardiologists and neonatologists in the United States, describe any significant differences in management, and describe areas where practices align.
Methods: A survey of 10 questions based on the management of PDA in ELBW infants was conducted among 100 prominent neonatologists from 74 centers and 103 prominent cardiologists from 75 centers. Among the cardiologists, approximately 50% were interventionists who perform transcatheter… More >

Jason Nathaniel Johnson^1,2, Shyam Sathanandam¹, Ronak Naik¹, Ranjit Philip¹

Congenital Heart Disease, Vol.14, No.1, pp. 74-78, 2019, DOI:10.1111/chd.12725

Abstract Echocardiographic imaging provides real‐time guidance during transcatheter patent ductus arteriosus (PDA) closure in extremely low birth weight (ELBW) infants. Transthoracic echocardiogram provides detailed assessment of the PDA and sur‐ rounding structures prior to, during, and after transcatheter closure. This article aims to review the different echocardiographic techniques and concepts utilized during transcatheter PDA closure in ELBW infants. More >

Anthony Merlocco

Congenital Heart Disease, Vol.14, No.1, pp. 100-104, 2019, DOI:10.1111/chd.12719

Abstract The ductus arteriosus (DA) has been studied since Galen. Initially after birth in neo‐ nates with obstruction to pulmonary blood flow, DA patency is integral to ensure out‐ put and oxygenation. While DA stenting dates back 25 years, there is emerging interest in better understanding how and when to utilize this strategy as an alternative to surgi‐ cal shunt placement or ongoing prostaglandin administration. Understanding the nor‐ mal fetal circulation and the perturbations that affect flow and oxygenation is integral to comprehending how normal DA anatomy and morphology may change and how this may influence technical and clinical considerations. In… More >

John M. Ferguson

Congenital Heart Disease, Vol.14, No.1, pp. 52-56, 2019, DOI:10.1111/chd.12715

Abstract Even though up to 60% of premature infants less than 28 weeks gestation develop persistent patent ductus arteriosus (PDA), there remains controversy regarding if, when, and how to close the PDA. Failure to close the PDA has been associated with significant morbidity but no cause‐and‐effect has been proven for short‐term or long‐term outcomes in modern times. Surgical closure has the advantage of eliminating the PDA, but short‐term complications and long‐term adverse outcomes are worrisome. Intravenous indomethacin has been the “gold standard” for pharmacologic treatment over the past 40 years with high closure rates and decreased incidence of severe intraventricular hemorrhage… More >

Stacey L. Crockett, Courtney D. Berger, Elaine L. Shelton, Jeff Reese

Congenital Heart Disease, Vol.14, No.1, pp. 15-20, 2019, DOI:10.1111/chd.12714

Abstract Regulation of the ductus arteriosus, an essential fetal vessel connecting the pulmo‐ nary artery and aorta, is complex. Failure of this vessel to close after birth may result in a persistent left‐to‐right shunt through the patent ductus arteriosus, a condition associated with significant morbidities. Numerous factors contribute to the shift from fetal ductus patency to postnatal closure, requiring precise coordination of molecular cues with biomechanical forces and underlying genetic influences. Despite significant advances, questions remain regarding signaling dynamics and the natural time course of ductus closure, particularly in preterm neonates. This review highlights the contri‐ butions of early investigators and… More >

Myriam Almeida‐Jones^1,2, Nai Yu Tang^1,2, Aneela Reddy³, Evan Zahn^1,2

Congenital Heart Disease, Vol.14, No.1, pp. 60-64, 2019, DOI:10.1111/chd.12712

Abstract Clinically significant patent ductus arteriosus (PDA) has been associated with signifi‐ cant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a compre‐ hensive review of this emerging procedure. More >

Ruth Seaton, Chandler Williams, Julia Peredo

Congenital Heart Disease, Vol.14, No.1, pp. 65-68, 2019, DOI:10.1111/chd.12711

Abstract The ductus arteriosus is a lifeline for the developing fetus prior to delivery, allowing the circulation of oxygen‐rich blood from the placenta to bypass the lungs and per‐ fuse the body. However, when the ductus fails to close after birth, the pressures can cause blood to shunt from the aorta back into the lungs, causing pulmonary edema. This is called a left‐to‐right shunt. The patent ductus arteriosus (PDA) can also shunt blood from the pulmonary arteries to the aorta, bypassing the lungs and causing oxy‐ gen‐poor blood to mix with the oxygen‐rich blood circulating to the body. This is called… More >

Varun Aggarwal¹, Christopher J. Petit², Andrew C. Glatz^3，4, Bryan H. Goldstein⁵, Athar M. Qureshi¹

Congenital Heart Disease, Vol.14, No.1, pp. 110-115, 2019, DOI:10.1111/chd.12709

Abstract The use of prostaglandin‐E1 immediately after birth and subsequent surgical crea‐ tion of the modified Blalock‐Taussig shunt (BTS) shunt have remarkably improved the prognosis and survival of children with congenital heart disease and ductal‐depend‐ ent pulmonary blood flow (PBF). Despite the advancement in surgical techniques, bypass strategies, and postoperative management, significant morbidity and mortal‐ ity after BTS still remain. Patent ductus arteriosus stenting has been shown to be as an acceptable alternative to BTS placement in select infants with ductal‐dependent PBF. Newer procedural techniques and equipment, along with operator experience have all contributed to procedural refinement associated with improved outcomes… More >

Meera N. Sankar, Shazia Bhombal, William E. Benitz

Congenital Heart Disease, Vol.14, No.1, pp. 46-51, 2019, DOI:10.1111/chd.12708

Abstract Management of patent ductus arteriosus in extremely preterm infants remains a topic of debate. Treatment to produce ductal closure was widely practiced until the past decade, despite lack of evidence that it decreases morbidities or mortality. Meta‐analyses of trials using nonsteroidal anti‐inflammatory drugs have shown ef‐ fectiveness in accelerating ductal closure, but no reduction in neonatal morbidities, regardless of agent used, indication, timing, gestational age, or route of administra‐ tion. Surgical ligation closes the ductus but is associated with adverse effects. Recent experience with conservative approaches to treatment suggest improved neonatal outcomes and a high rate of spontaneous ductal closure… More >