Use of prostaglandin E<sub>1</sub> for emergency palliation of symptomatic coarctation of the aorta

Graham, T.P.; Atwood, Gerald F.; Boucek, Robert J.

doi:10.1002/ccd.1810040114

Cited by 20 publications

(2 citation statements)

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“…1-16 More recently, prostaglandin has been used for aortic arch anomalies and coarctation, where part of the systemic circulation may depend on patency of the ductus arteriosus. '-4 17 The aim here is to prevent or alleviate the consequences of ductal closure such as low cardiac output, renal failure, and metabolic acidosis. This study suggests that the benefits of prostaglandin 657 infusion are sufficient in this regard to justify delayed surgical intervention in some patients, thereby significantly reducing operative mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of prostaglandin on early surgical mortality in obstructive lesions of the systemic circulation.

Leoni¹,

Huhta²,

Douglas³

et al. 1984

Heart

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SUMMARY To examine the effect of preoperative prostaglandin infusion on surgical mortality the records of all patients aged <28 days operated between January 1979 and December 1981 for obstructive lesions of the systemic circulation were reviewed. Forty patients had coarctation of the aorta, five interrupted aortic arch, and seven critical aortic stenosis. Fourteen patients received intravenous prostaglandin before operation. Among preoperative variables low cardiac output was identified as a possible risk factor for hospital death, whereas the presence of a raised blood urea concentration was possibly significantly associated with hospital mortality only in patients not treated with prostaglandin. The preoperative administration of prostaglandin had a strongly favourable influence: 11 out of 38 (29.0%) patients who did not receive prostaglandin died compared with none of 14 treated with prostaglandin. The two groups were otherwise comparable with respect to the incidence of coagulopathy, urgency of operation, associated anomalies, and other medical treatment. Mean age at operation was younger and mean admission blood urea concentration higher in the group treated with prostaglandin, whereas the incidence of preoperative low cardiac output was probably higher.It is concluded that short term preoperative infusion of prostaglandin is associated with a significant reduction in early surgical mortality in this high risk group of infants.Congenital malformations that obstruct the systemic circulation often present with low cardiac output and severe heart failure during the first weeks of life. Closure of the ductus artenosus probably plays an important role in their natural history, and the maintenance of ductal patency by prostaglandin infusion has been reported to improve the clinical condition of some infants with coarctation of the aorta, interrupted aortic arch, and critical aortic stenosis. -4 Although early surgical relief of the obstruction is mandatory, this is associated with a significant mortality. To determine if preoperative prostaglandin infusion might decrease operative mortality, we reviewed our preliminary experience with its use in the management of critically ill infants with obstructive lesions of the systemic circulation.Requests for reprints to Mr J Stark, FRCS, Thoracic Unit, The

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Section: Discussionmentioning

confidence: 99%

Effect of prostaglandin on early surgical mortality in obstructive lesions of the systemic circulation.

Leoni¹,

Huhta²,

Douglas³

et al. 1984

Heart

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“…Once the diagnosis is reached in a neonate, prostaglandin E 1 (PGE) can be administered to re-open or enlarge the PDA and alleviate the obstruction prior to surgical repair. [1]…”

Section: Introductionmentioning

confidence: 99%

A Clinical Prediction Model to Estimate the Risk for Coarctation of the Aorta in the Presence of a Patent Ductus Arteriosus

Soslow

Kavanaugh‐McHugh

Wang

et al. 2013

Journal of the American Society of Echocardiography

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Objective To create a model to help identify coarctation of the aorta (CoA) in neonates with a patent ductus arteriosus (PDA). Background Diagnosing CoA in the presence of a PDA may require observation until PDA closure. We created a model incorporating previously published indices to estimate the probability of neonatal CoA in the presence of a PDA. Methods A retrospective “investigation” cohort of 80 neonates was divided into two groups: (1) neonates with PDA and suspicion for CoA requiring observation to confirm the presence or absence of CoA and (2) neonates with PDA and confirmed diagnosis of either CoA or unobstructed aortic arch. Multivariable logistic regression was used to create the coarctation probability model (CPM), which calculates a neonate’s probability of CoA. The CPM was validated internally using bootstrapping and subsequently validated prospectively using a “validation” cohort of 74 neonates with PDA. Results The CPM had an area under the ROC curve of 0.96 and demonstrated good clinical significance in risk stratification of neonates with a PDA and CoA. No neonate with a CPM probability of <15% had CoA after PDA closure. We classify neonates with CPM <15% as low-risk, between 15–60% as moderate-risk, and > 60% as high-risk for CoA. Conclusion Based on our study results, we recommend measurement of the CPM in all neonates with PDA. Those with CPM <15% no longer require observation, which could decrease observation in as many as half of neonates with unobstructed aortic arch; those with CPM between 15–60% require follow up imaging while those with CPM >60% risk should be observed as inpatients until PDA closure.

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Emergency Palliation of Critical Valvular Aortic Stenosis

Artman¹

1983

Am J Dis Child

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Use of prostaglandin E₁ for emergency palliation of symptomatic coarctation of the aorta

Cited by 20 publications

References 14 publications

Effect of prostaglandin on early surgical mortality in obstructive lesions of the systemic circulation.

Effect of prostaglandin on early surgical mortality in obstructive lesions of the systemic circulation.

A Clinical Prediction Model to Estimate the Risk for Coarctation of the Aorta in the Presence of a Patent Ductus Arteriosus

Emergency Palliation of Critical Valvular Aortic Stenosis

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Use of prostaglandin E1 for emergency palliation of symptomatic coarctation of the aorta

Cited by 20 publications

References 14 publications

Effect of prostaglandin on early surgical mortality in obstructive lesions of the systemic circulation.

Effect of prostaglandin on early surgical mortality in obstructive lesions of the systemic circulation.

A Clinical Prediction Model to Estimate the Risk for Coarctation of the Aorta in the Presence of a Patent Ductus Arteriosus

Emergency Palliation of Critical Valvular Aortic Stenosis

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Use of prostaglandin E₁ for emergency palliation of symptomatic coarctation of the aorta