The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 907-911, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Combined prostaglandin therapy and ductal formalin infiltration in neonatal pulmonary oligemia
JE Larson, WH Fleming, LB Sarafian, WC Rogler, PJ Hofschire and BM McManus
Prostaglandins and ductal formalin infiltration, singly and together, have
been used in efforts to improve pulmonary flow in very ill newborn infants
with right ventricular outflow tract obstruction. To evaluate the efficacy
of concurrent use of prostaglandins and ductal formalin infiltration, we
have reviewed our experience with 25 infants with right ventricular outflow
tract obstruction and prostaglandin-ductal formalin infiltration therapy.
Prostaglandin therapy was begun 22 +/- 21 hours (range 20 to 93 hours)
before and was continued 20 +/- 18 hours (range 0 to 62 hours) following
ductal formalin infiltration; prostaglandin administration was initiated at
a dose of 0.05 to 0.1 microgram/kg/min and tapered postoperatively.
Clinical cyanosis was diminished in 20 of 25 infants (80%) postoperatively.
Systemic arterial pH and oxygen saturation both improved following
prostaglandin-ductal formalin infiltration therapy from 7.35 to 7.41 (p
less than 0.001) and from 35.7 to 50.3 (p less than 0.001), respectively.
Persistent ductal patency (mean 219 +/- 191 days) was observed in 17
survivors of the early postoperative period (more than 14 days). Two of
five infants who died within 14 days of operation had a widely patent
ductus with resultant progressive congestive heart failure. The other three
infants died as a result of operative technical problems, dysrhythmias, and
thrombotic ductal closure, respectively. No correlation was observed
between duration of ductus patency and operatively determined size of
ductus, total prostaglandin dose, or duration of prostaglandin infusion.
Secondary operative intervention was delayed by 92 +/- 74 days with
prostaglandin-ductal formalin infiltration therapy; thus
prostaglandin-ductal formalin infiltration therapy may have a role in
selected neonates with right ventricular outflow tract obstruction.
