Closure of the ductus arteriosus in the newborn infant

Moss, Arthur J.; Emmanouilides, George C.; Duffie, Edward R.

doi:10.1097/00006199-196401320-00069

Cited by 31 publications

(39 citation statements)

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“…There is good qualitative evidence that bidirectional shunts occur in all these sites [12,17,251. During the first 24-48 hours of life, the pulmonary artery pressure is close to systemic levels and falls steadily during this time [5]; nevertheless, R + L shunting through the ductus has been demonstrated in normal newborn babies at this age [4,16,191. In the hypoxic neonate with RDS, the pulmonary artery pressure is likely to rise and closure of the ductus will be delayed [2,13,15,231 ; both these factors will increase the likelihood of a R + L shunt occurring through the ductus arteriosus.…”

Section: Introductionmentioning

confidence: 96%

Ductus Arteriosus Shunts in the Respiratory Distress Syndrome

Roberton

Dahlenburg

1969

Pediatr Res

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ExtractThe arterial blood gas tensions in the right radial artery and the lower abdominal aorta were compared in 2 1 infants suffering from respiratory distress syndrome. Simultaneous sampling was carried out using a radial artery catheter inserted by a cut-down technique and an umbilical arterial catheter inserted into the abdominal aorta. One hundred thirty-nine simultaneous blood samples were analysed for paO,, pH, and pCO,. In no case was there any significant difference in p H and pCO, values in samples of blood drawn from the two sites. Differences in paO, were observed but owing to inherent errors in measurement, only differences of greater than 10 mm Hg were regarded as significant. In 27 out of the 139 determinations, paO, from the right radial artery exceeded that from the abdominal aorta by more than 10 mm Hg. The babies studied were divided into the following groups : Group 1, 6 babies with no significant paO, difference between the two sampling sites. Group 2(a), 6 babies with significantly higher oxygen tensions in blood drawn from the radial artery but only at aortic paO, levels of more than 140 mm Hg. I n this group there were no significant differences when the abdominal aorta paO, was less than 140 mm Hg. Group 2(b), 3 babies with slightly higher radial artery oxygen tensions only when they were being ventilated with a positive pressure respirator. Group 2(c), 6 babies with significantly higher paO, levels in the radial artery at arterial oxygen tensions of less than 100 mm Hg. I n two of these babies, the right radial paO, (and therefore presumably the retinal artery paO,) would have exceeded 160 mm Hg had the ambient oxygen concentration been raised sufficiently to produce an aorta paO, of 100 mm Hg and had the total shunt and the proportion passing through the ductus arteriosus remained constant. I n two of these babies, however, increasing ambient oxygen concentration decreased the total shunt and the proportion of the shunt passing through the ductus. In the remaining four babies in Group 2(c), the severity of the disease was such that it was impossible to raise the aorta paO, to 100 mm Hg.From these data it seems that most of the R -L shunt in respiratory distress syndrome must pass through the foramen ovale or the lungs. Only rarely does more than 15 % of the R -L shunt pass through the ductus arteriosus.The final quantitative differentiation between shunting in the lungs and through the foramen ovale is most likely to be made by dye dilution studies from peripheral vein or right atrial injections.

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Section: Introductionmentioning

confidence: 96%

Ductus Arteriosus Shunts in the Respiratory Distress Syndrome

Roberton

Dahlenburg

1969

Pediatr Res

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“…At birth, with the initiation of ventilation, pulmonary vascular resistance decreases markedly (14). Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome characterized by abnormal pulmonary vascular tone, reactivity, and structure, leading to persistent elevation of pulmonary vascular resistance and severe hypoxemia at birth (15,16).…”

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confidence: 99%

Changes in Expression of Vascular Endothelial Growth Factor and Its Receptors in Neonatal Hypoxia-Induced Pulmonary Hypertension

et al. 2005

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“…As part of the transition from fetal to neonatal life, these central blood flow patterns change abruptly. The right to left shunts through the foramen ovale (2) and through the ductus arteriosus (3) cease rapidly, and a transient left to right shunt occurs until the ductus arteriosus closes fully within a few hours after birth (3,4). The two ventricles eject the same volumes once the ductus arteriosus does close.…”

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confidence: 99%

Effects of Birth-Related Events on Central Blood Flow Patterns

1987

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ABSTRACT. We determined the effects of three components of the birth process on central blood flow patterns in fetal sheep. We instrumented 16 fetal sheep at 133.0 f 1.2 days gestation, inserting various intravascular catheters, intubating the trachea, and placing an inflatable balloon around the umbilical cord. After 2-3 days, we determined central blood flow patterns using radionuclidelabeled microspheres under control conditions, during positive pressure ventilation without oxygenation, during ventilation with 100% Oz, and after umbilical cord occlusion. The foramen ovale right to left shunt was essentially abolished, decreasing from 102 f 48 to 66 f 40 ml/min/ kg with ventilation, and to only 13 f 10 ml/min/kg with oxygenation. The ductus arteriosus right to left shunt decreased progressively, from a control level of 224 2 64 to 6 f 10 ml/min/kg after umbilical cord occlusion. A ductus arteriosus left to right shunt appeared with oxygenation (41 f 26 ml/min/kg) and increased to 65 f 43 ml/ min/kg after cord occlusion. Left ventricular output increased progressively a s a percentage of combined ventricular output (from a control value of 34.8 to 59.5% after cord occlusion), and increased absolutely with ventilation (from 134 f 44 to 211 f 87 ml/min/kg). However, right ventricular output decreased (from a control value of 258 f 75 to 144 f 36 ml/min/kg after cord occlusion) so that combined ventricular output did not change. Although the transition from the fetal to neonatal circulatory pattern was accomplished by simulating these three components of the birth process, none is alone responsible for the large increase in combined ventricular output normally seen a t birth. The adaptation of the fetus to extrauterine life involves numerous processes that occur rapidly. Paramount among these is the change in the pattern of circulation of blood. The fetal circulation is characterized by the presence of central shunts that direct systemic venous return to the systemic arterial circulation ( Fig. 1): the foramen ovale directs the more highly oxygenated umbilical venous blood from the right atrium to the left heart to supply oxygen to the heart, brain, and other organs, and the ductus arteriosus directs the less oxygenated right ventricular output via the descending aorta to the placenta for oxygen uptake. The right ventricle ejects about 50% more blood than the left ventricle in the sheep fetus (1). As part of the transition from fetal to neonatal life, these central blood flow patterns change abruptly. The right to left shunts through the foramen ovale (2) and through the ductus arteriosus (3) cease rapidly, and a transient left to right shunt occurs until the ductus arteriosus closes fully within a few hours after birth (3,4). The two ventricles eject the same volumes once the ductus arteriosus does close. Associated with the increased oxygen requirements after birth, left ventricular output increases 2-to 21/2-fold (5, 6).The specific factors that cause this dramatic change in central blood flow patterns and thei...

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Closure of the ductus arteriosus in the newborn infant

Cited by 31 publications

References 0 publications

Ductus Arteriosus Shunts in the Respiratory Distress Syndrome

Ductus Arteriosus Shunts in the Respiratory Distress Syndrome

Changes in Expression of Vascular Endothelial Growth Factor and Its Receptors in Neonatal Hypoxia-Induced Pulmonary Hypertension

Effects of Birth-Related Events on Central Blood Flow Patterns

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