Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-19T11:55:01.672Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficacy of very low-dose prostaglandin E1 in duct-dependent congenital heart disease

Published online by Cambridge University Press:  29 October 2013

Ilker K. Yucel ,
Ayhan Cevik ,
Mustafa O. Bulut ,
Reyhan Dedeoğlu ,
İbrahim H. Demir ,
Abdullah Erdem  and
Ahmet Celebi
Ilker K. Yucel
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey
Ayhan Cevik*
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey
Mustafa O. Bulut
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey
Reyhan Dedeoğlu
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey
İbrahim H. Demir
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey
Abdullah Erdem
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey
Ahmet Celebi
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey
*
Correspondence to: A. Cevik, Department of Pediatric Cardiology, Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital, Istanbul, Turkey, Tıbbiye Caddesi, No. 13, Haydarpaşa, Istanbul, Turkey. Tel: 0905326571042; Fax: 02163125626; E-mail: ayhancevik12@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

The present study aims to define the lowest effective prostaglandin E1 dose in patients with inadequacy of pulmonary blood flow and/or intracardiac blood mixing and those with inadequate systemic blood flow.

Methods

Patients with inadequacy of both pulmonary blood flow and/or blood mixing (Group 1) and those with inadequate systemic blood flow (Group 2) were retrospectively evaluated in two separate groups with regard to the prostaglandin E1 starting dose given in the referring facility, the lowest and the highest dose administered in our centre, treatment duration, adverse effects, and administered treatment.

Results

No difference between the groups could be detected with respect to sex or birth weight (p=0.95 and 0.42, respectively). Group 1 and Group 2 were statistically similar in aspect of prostaglandin treatment duration (9.73±0.81 days versus 11.6±1.05 days, p=0.064). When compared with Group 2, the initial, maintenance and lowest efficient doses of prostaglandin E1 treatment were significantly lower and the titrated dose of prostaglandin E1 was significantly higher in Group 1 (p=0.001 for each).

Conclusion

Our findings indicate that the infusion of prostaglandin at a very low dose (0.003–0.005 mcg/kg/minute) is sufficient to maintain the patency of the ductus arteriosus. A higher dose of prostaglandin E1 may be necessary in patients with inadequate systemic blood flow.

Keywords

Prostaglandin E1congenital heart diseaseefficacyneonatal transport
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 1 , January 2015 , pp. 56 - 62
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Shivananda, S, Kirsh, J, Whyte, HE, Muthalally, K, McNamara, PJ. Accuracy of clinical diagnosis and decision to commence intravenous prostaglandin E1 in neonates presenting with hypoxemia in a transport setting. J Crit Care 2010; 25: 174e1–174e9.CrossRefGoogle Scholar
2. Stone, DM, Frattarelli, DA, Karthikeyan, S, Johnson, YR, Chintala, K. Altered prostaglandin E1 dosage during extracorporeal membrane oxygenation in a newborn with ductal-dependent congenital heart disease. Pediatr Cardiol 2006; 27: 360–363.Google Scholar
3. Condò, M, Evans, N, Bellù, R, Kluckow, M. Echocardiographic assessment of ductal significance: retrospective comparison of two methods. Arch Dis Child Fetal Neonatal Ed 2012; 97: 35–38.Google Scholar
4. Browning Carmo, KA, Barr, P, West, M, Hopper, NW, White, JP, Badawi, N. Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation. Arch Dis Child Fetal Neonatal Ed 2007; 92: 117–119.CrossRefGoogle ScholarPubMed
5. Su, BH, Watanabe, T, Shimizu, M, Yanagisawa, M. Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants. Arch Dis Child Fetal Neonatal Ed 1997; 77: 36–40.CrossRefGoogle ScholarPubMed
6. Su, BH, Peng, CT, Tsai, CH. Echocardiographic flow pattern of patent ductus arteriosus: a guide to indomethacin treatment in premature infants. Arch Dis Child Fetal Neonatal Ed 1999; 81: 197–200.Google Scholar
7. Silove, ED, Roberts, DG, de Giovanni, JV. Evaluation of oral and low dose intravenous prostaglandin E2 in management of ductus dependent congenital heart disease. Arch Dis Child 1985; 60: 1025–1030.Google Scholar
8. Freed, MD, Heymann, MA, Lewis, AB, Roehl, SL, Kensey, RC. Prostaglandin E1 infants with ductus arteriosus-dependent congenital heart disease. Circulation 1981; 64: 899–905.CrossRefGoogle ScholarPubMed
9. Hallidie-Smith, KA. Prostaglandin E1 in suspected ductus dependent cardiac malformation. Arch Dis Child 1984; 59: 1020–1026.Google Scholar
10. Barker, CL, Yates, RW, Kelsall, AW. Prolonged treatment with prostaglandin in an infant born with extremely low weight. Cardiol Young 2005; 15: 425–426.Google Scholar
11. Velaphi, S, Cilliers, A, Beckh-Arnold, E, Mokhachane, M, Mphahlele, R, Pettifor, J. Cortical hyperostosis in an infant on prolonged prostaglandin infusion: case report and literature review. J Perinatol 2004; 24: 263–265.Google Scholar
12. Takeda, N, Hiraishi, S, Misawa, H, et al. Echocardiographic evaluation of the ductal morphology in patients with refractoriness to lipo-prostaglandin E1 therapy. Pediatr Int 2000; 42: 134–138.Google Scholar
13. Ito, T, Harada, K, Tamura, M, Takada, G. Increase in pulmonary arterial diameter under prostaglandin E1 therapy in infants with cyanotic congenital heart disease. Pediatr Cardiol 1998; 19: 404–407.Google Scholar
14. Hiraishi, S, Fujino, N, Saito, K, et al. Responsiveness of the ductus arteriosus to prostaglandin E1 assessed by combined cross sectional and pulsed Doppler echocardiography. Br Heart J 1989; 62: 140–147.CrossRefGoogle ScholarPubMed
15. Joshi, A, Berdon, WE, Brudnicki, A, et al. Gastric thumbprinting: diffuse gastric wall mucosal and submucosal thickening in infants with ductal-dependent cyanotic congenital heart disease maintained on long-term prostaglandin therapy. Pediatr Radiol 2002; 32: 405–408.Google Scholar
16. Graham, TP Jr, Atwood, GF, Boucek, RJ Jr. Pharmacologic dilatation of the ductus arteriosus with prostaglandin E1 in infants with congenital heart disease. South Med J 1978; 71: 1238–1241.Google Scholar
17. Lewis, AB, Freed, MD, Heymann, MA, Roehl, SL, Kensey, RC. Side effects of therapy with prostaglandin E1 in infants with critical congenital heart disease. Circulation 1981; 64: 893–898.Google Scholar
18. Kramer, HH, Sommer, M, Rammos, S, Krogmann, O. Evaluation of low dose prostaglandin E1 treatment for ductus dependent congenital heart disease. Eur J Pediatr 1995; 154: 700–707.Google Scholar