N. Takeda et al., Echocardiographic evaluation of the ductal morphology in patients with refractoriness to lipo-prostaglandin E-1 therapy, PEDIATR INT, 42(2), 2000, pp. 134-138
Background: Lipo-prostaglandin (PG)E-1 is effective at lower doses and has
fewer side effects than PGE(1)-cyclodextrin (CD). Previous studies, however
, have suggested that some patients show refractoriness to lipo-PGE(1) in t
he course of treatment. The present paper examines: (i) whether such cases
can be predicted by examining the ductal morphology before and 24 h after t
he start of lipo-PGE(1) infusion; and (ii) whether PGE(1)-CD dilates the du
ctus arteriosus in patients with refractoriness to lipo-PGE(1).
Methods: The ductal morphology was evaluated with two echo indices, such as
minimal and minimal plus maximal intraluminal diameters of the ductus. Two
-dimensional echocardiography was performed in 24 patients with ductus-depe
ndent congenital heart disease. The two echo indices were measured before a
nd 24 h after lipo-PGE(1) infusion and also at least twice per week until s
urgery.
Results: In 19 of 24 patients, ductal patency was maintained until surgical
treatment (group A). The remaining five patients (21%) showed ductal closu
re during the course of the lipo-PGE(1) therapy (group B). There were no si
gnificant differences between the two groups, in either the maximal or mini
mal diameters, which were examined before and 24 h after treatment. In the
five patients of group B, lipo-PGE(1) was replaced with a relatively high d
osage of PGE(1)-CD (50-100 ng/kg per min), resulting in good ductal patency
until surgery.
Conclusions: Patients with refractoriness to lipo-PGE(1) therapy could not
be predicted from initial intraluminal diameters of the ductus using echoca
rdiography. Therefore, serial echocardiographic examinations are important
to detect early findings of ductal closure. In addition, PGE(1)-CD is still
useful as back-up therapy in such patients.