Patent ductus arteriosus and high altitude∗

Alzamora-Castro, Victor; Battilana, Guido; Abugattas, Ricardo; Sialer, Salvador

doi:10.1016/0002-9149(60)90052-7

Cited by 69 publications

(20 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is hypothesized that the mild hypoxia of high altitude would result in 'physiologic band ing' of the pulmonary vascular bed, leading to a reduction of failure. However, the inci dence of patent ductus arteriosus has been found to be 6 times higher at high altitudes [30], Dilated cardiomyopathy was found in 10.6% of patients in this series. This condi tion is not fully understood [31].…”

Section: Discussionmentioning

confidence: 47%

Pattern of Heart Disease in Ethiopia as Seen in a Cardiology Referral Clinic

Hodes¹

1988

Cardiology

View full text Add to dashboard Cite

385 patients were seen in the cardiology clinic of Tikur Anbessa Hospital, Addis Ababa, Ethiopia over 20 months. Of 338 with defined pathology, 152 had rheumatic heart disease, 47 were hypertensive, 39 had cardiomyopathy, 36 had congenital heart disease and 24 arrhythmia. Average age of rheumatics was 25.5, 78% were ≤30, male:female = 58:94. The mitral valve was affected in 91 %; 18% of rheumatics had pure mitral stenosis and 56% only mitral involvement. Average age of cardiomyopathy patients was 52, 90% had dilated cardiomyopathy. In congenital cases, mitral valve prolapse was most common (25%), followed by ventricular septal defect (19%), and patent ductus arteriosus (19%). Comparison is made with Ethiopian and other African data. Clearly, rheumatic fever is the main cause of cardiac pathology in Ethiopia, and deserves greatly increased attention.

show abstract

Section: Discussionmentioning

confidence: 47%

Pattern of Heart Disease in Ethiopia as Seen in a Cardiology Referral Clinic

Hodes¹

1988

Cardiology

View full text Add to dashboard Cite

show abstract

“…57 There is also a greater frequency of symptomatic pulmonary hypertension (subacute infantile mountain sickness), persistent patent ductus arteriosus, and PFO later in childhood at high than at low altitude. 37,41,[66][67][68][69][70][71][72] While several reports indicate that population ancestry influences resting P pa and the pulmonary vasoconstrictor response to hypoxia during adulthood (Fig. 1B), little is known concerning population variation in P pa during infancy or childhood.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Oxygenation, Pulmonary Hypertension, and Evolutionary Adaptation to High Altitude (2013 Grover Conference series)

Niermeyer

Andrade-M²,

Vargas

et al. 2015

Pulm. circ.

View full text Add to dashboard Cite

Andeans and Tibetans have less altitude reduction in birth weight than do shorter-resident groups, but only Tibetans are protected from pulmonary hypertension and chronic mountain sickness (CMS). We hypothesized that differences in neonatal oxygenation were involved, with arterial O 2 saturation (SaO 2 ) being highest in Tibetans, intermediate in Andeans, and lowest in Han or Europeans, and that improved oxygenation in Andeans relative to Europeans was accompanied by a greater postnatal decline in systolic pulmonary arterial pressures (P pa sys ). We studied 41 healthy (36 Andeans, 5 Europeans) and 9 sick infants at 3,600 m in Bolivia. The SaO 2 in healthy babies was highest at 6-24 hours of postnatal age and then declined, whereas sick babies showed the opposite pattern. Compared to that of 30 Tibetan or Han infants studied previously at 3,600 m, SaO 2 was higher in Tibetans than in Han or Andeans during wakefulness and active or quiet sleep. Tibetans, as well as Andeans, had higher values than Han while feeding. The SaO 2 's of healthy Andeans and Europeans were similar and, like those of Tibetans, remained at 85% or above, whereas Han values dipped below 70%. Andean and European P pa sys values were above sea-level norms and higher in sick than in healthy babies, but right heart pressure decreased across 4-6 months in all groups. We concluded that Tibetans had better neonatal oxygenation than Andeans at 3,600 m but that, counter to our hypothesis, neither was SaO 2 higher nor P pa lower in Andean than in European infants. Further, longitudinal studies in these 4 groups are warranted to determine whether neonatal oxygenation influences susceptibility to high-altitude pulmonary hypertension and CMS later in life.Keywords: Andean, cardiopulmonary transition, Ethiopian, European, genetic adaptation, Han, hypoxia, Tibet. Studies at high altitude have long provided a useful model for persons interested in the pulmonary circulation. [1][2][3][4] While pulmonary arterial pressures (P pa 's) are generally elevated at high altitude, there is considerable population variation in both P pa and pulmonary circulation-related disorders such as chronic mountain sickness (CMS; Fig. 1A) 11,36 and subacute infantile mountain sickness. 37 Specifically, directly measured P pa and hypoxic pulmonary vasoconstrictor responses are lowest in Tibetans, intermediate in Andeans, and highest in European-derived residents of Colorado (Fig. 1B). Recent estimates using echocardiography also suggest intermediate values in Ethiopians. 15 While multiple factors contribute to the etiology of CMS and no well-controlled comparative epidemiological studies exist, a reduced prevalence among Tibetans is consistent with the lower hemoglobin levels seen in Tibetans, relative to Andeans, in multiple reports. [38][39][40] Tibetans are also protected, relative to Han, from subacute infantile mountain sickness, a syndrome characterized by severe pulmonary hypertension in 4-6-month-old infants that has also been reported in European-derived popul...

show abstract

“…However, the role of relative hypoxemia in ductal closure has long been recognized as several studies have found that the incidence of PDA is higher in high altitude where PaO 2 in the air is lower than at sea level. [15][16][17] However, to our knowledge, this is the first report on the effects of lower oxygen saturation limits on the incidence and closure of the PDA. In this study, we found that by targeting arterial oxygen saturation in the 83 to 89% range, the incidence of PDA but not the need for ductal ligation was increased.…”

Section: Discussionmentioning

confidence: 99%

Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants

et al. 2009

View full text Add to dashboard Cite

Objective: Postnatal increase in oxygen promotes constriction of the patent ductus arteriosus (PDA). According to the findings of prospective observational studies, the clinical practice of targeting lower fractional oxygen saturation between 70 and 90% has been associated with a reduced incidence of severe retinopathy of prematurity (ROP) without affecting survival or neurodevelopmental disability at 1 year of age. Our objective was to investigate the impact of the use of a lower oxygen saturation target range on the incidence of early hemodynamically significant PDA (hsPDA) and the need for ductal ligation in extremely low birth weight (ELBW, <1000 g) infants.Study Design: In this retrospective study, we analyzed data from 263 ELBW infants managed 4 years before (episode I: target oxygen saturation 89 to 94%) and after (episode II: target oxygen saturation 83 to 89%) implementation of the use of lower oxygen saturation limits in two neonatal intensive care units. Infants with a birth weight of 1000 to 1500 g were managed with the same oxygen saturation target range (89 to 94%) during both episodes, and they served as controls. Parametric and nonparametric tests were used as appropriate and multivariate logistic regression models were used to correct for confounders.Results: There was an increase in the incidence of hsPDA (63.2 vs 74.8%, P ¼ 0.043), without an increase in the need for surgical ligation (24.2 vs 29.9%, P ¼ 0.3) after implementation of the lower oxygen saturation target range policy. After adjusting for confounders, there was an increase in the odds of having an hsPDA (odds ratio (OR) 1.77, 95% confidence interval (CI) (1.03 to 3.06), P ¼ 0.04) but the odds for ductal ligation did not change in episode II (OR 1.25, 95% CI (0.70 to 2.25), P ¼ 0.4). The incidence of ROPXstage III (50.7 vs 15.7%; P<0.0001) and the need for laser ablation (33.8% vs 8.7%; P<0.0001) were significantly reduced. There was no change in the incidence of hsPDA or ductal ligation in the control group. Conclusion:Targeting lower oxygen saturation limits to minimize periods of hyperoxemia in ELBW infants reduced the incidence of severe ROP and the need for laser ablation. The incidence of early hsPDA was increased; however, final closure rate and the incidence of surgical ligation of the ductus arteriosus were not affected.

show abstract

Patent ductus arteriosus and high altitude∗

Cited by 69 publications

References 5 publications

Pattern of Heart Disease in Ethiopia as Seen in a Cardiology Referral Clinic

Pattern of Heart Disease in Ethiopia as Seen in a Cardiology Referral Clinic

Neonatal Oxygenation, Pulmonary Hypertension, and Evolutionary Adaptation to High Altitude (2013 Grover Conference series)

Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants

Contact Info

Product

Resources

About