Prostaglandin in aortic coarctation and closed arterial duct—treatment beyond ductal re-opening

Abstract A 2-week-old girl was transferred to PICU following cardiopulmonary resuscitation locally. Echocardiogram showed severe aortic coarctation and closed ductus arteriosus. She was commenced on infusion of prostaglandin E1 at 10 ng/kg/min increased to 50 ng/kg/min as the ductus arteriosus remained closed. She was referred to cardiac centre for further management. Echocardiogram confirmed juxta-ductal aortic coarctation with reduced peak systolic gradient, no diastolic blood flow continuation on Doppler assessment of blood flow in descending aorta, and a very small ductus arteriosus with bidirectional shunt. Serum lactate gradually reduced to less than 1 mmol/L from 11 mmol/L recorded before transfer. The use of high dose prostaglandin E is warranted in critically ill neonates with aortic coarctation and closed arterial duct unresponsive to conventional doses. Beneficial effect of high doses of prostaglandin E goes in this indication beyond primary arterial ductal reopening.