Conservative treatment for patent ductus arteriosus in the preterm

BACKGROUND: A patent ductus arteriosus (PDA) is common among preterms, and prophylactic medical treatment has been advocated as the first-line approach. Conservative treatment may result in similar outcome, but without exposure to the harmful side effects of medication. A retrospective analysis revealed a ductal closure rate of 94% after conservative treatment with adjustment of ventilation (lowering the inspiratory time and increasing positive end expiratory pressure) and fluid restriction. OBJECTIVE: To study prospectively over one year the rate of PDA closure, and morbidity and mortality following conservative treatment. METHOD: Prospective study (1 January 2005 - 31 December 2005) including 30 newborns <or=30 weeks' gestation, all of whom were being ventilated and required surfactant. Echocardiography was performed 48-72 h after birth. Clinically important PDA was conservatively treated as described above. The percentage of children with PDA, ductal ligation and major complications was determined. RESULTS: Ten neonates (33%) developed a clinical important PDA. Following conservative treatment the duct closed in all neonates (100%), and none required ductal ligation or medical treatment. The rates of major complications were no higher than those reported by the Vermont Oxford Network and in the literature. CONCLUSION: The managed care plan resulted in an overall ductal closure rate of 100%. These results suggest that conservative treatment of PDA is a worthy alternative to prophylactic medical treatmen

Automatic mitral annulus tracking in volumetric ultrasound using non-rigid image registration

Analysis of mitral annular dynamics plays an important role in the diagnosis and selection of optimal valve repair strategies, but remains cumbersome and time-consuming if performed manually. In this paper we propose non-rigid image registration to automatically track the annulus in 3D ultrasound images for both normal and pathological valves, and compare the performance against manual tracing. Relevant clinical properties such as annular area, circumference and excursion could be extracted reliably by the tracking algorithm. The root-mean-square error, calculated as the difference between the manually traced landmarks (18 in total) and the automatic tracking, was 1.96 ± 0.46 mm over 10 valves (5 healthy and 5 diseased) which is within the clinically acceptable error range.status: publishe