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[Effects of PGE1 in neonatal aortic coarctation]
C Cheliakine-Chamboux1, A Chantepie, F Godde
1Unité de Réanimation Pédiatrique, Hôpital G. de Clocheville, Tours.
Insights
Prostaglandin E1 (PGE1) effectively improved femoral pulses in neonates with coarctation of the aorta (CoAo) and pulmonary hypertension. However, PGE1 did not directly dilate the aortic obstruction itself.
Area of Science:
- Cardiology
- Neonatal Medicine
- Pharmacology
Context:
- Coarctation of the aorta (CoAo) is a critical congenital heart defect.
- Neonates with CoAo often present with heart failure.
- Pulmonary hypertension can complicate the management of CoAo.
Purpose:
- To evaluate the efficacy of Prostaglandin E1 (PGE1) in dilating aortic obstructions in neonates with CoAo.
- To assess the clinical and echocardiographical effects of PGE1 on CoAo.
- To determine if PGE1 directly impacts the aortic isthmus diameter.
Summary:
- Sixteen neonates with heart failure due to CoAo were studied, with 5 having isolated CoAo and 11 with intracardiac shunts (7 with pulmonary hypertension).
- PGE1 (0.05 microgram/kg/min) was administered on day 6 of life alongside standard heart failure treatment.
- While PGE1 improved post-ductal perfusion via a right-to-left shunt in neonates with pulmonary hypertension, it did not alter CoAo diameter.
Impact:
- PGE1 enhances post-ductal perfusion in neonates with CoAo and pulmonary hypertension by facilitating ductal shunting.
- PGE1 does not demonstrate a direct vasodilatory effect on the aortic isthmus in CoAo.
- Findings suggest PGE1's benefit is primarily through improving perfusion in specific CoAo subpopulations.
Abstract:
In order to estimate the efficacity of prostaglandine E1 (PGE1) to dilate the obstruction in coarctation of the aorta (CoAo), we studied 16 full term neonates with heart failure. Over the 16 neonates, there was 5 with isolated CoAo and 11 with an intracardiac shunt. Over the 11 neonates, 7 had pulmonary hypertension. PGE1, at a dose of 0.05 microgram/kg/min associated to the classical treatment of heart failure were given on the 6 day of life. Effects of PGE1 were evaluated on clinical basis (presence of femoral pulse, blood pressure), echocardiographical basis (ductus arteriosus and aortic isthmus diameter) and morphological basis. In 15 neonates, the ductus arteriosus was open, in all cases CoAo diameter was the same. In 7 neonates with pulmonary hypertension, femoral pulse appeared. In conclusion, PGE1 increases post ductal perfusion by a right to left shunt through the ductus arteriosus, only in cases where pulmonary hypertension is present. No direct action on the aortic isthmus was observed.