Severe Coarctation and Acute Heart Failure in This Infant

This infant's presentation with severe coarctation and acute onset of heart failure a few days after birth strongly suggest recent closure of the ductus. Urgent medical therapy is indicated at this time.

Prostaglandin E1 acts directly on the ductus arteriosus, causing dilation of a constricted ductus and opening of a ductus that recently closed. Prostaglandin E1 may open the ductus permitting flow from the main pulmonary artery into the descending aorta, restoring critical systemic blood flow, particularly to the kidneys. This can stabilize the patient prior to proceeding with definitive treatment to relief the obstruction. If not rapidly effective, however, reief of the obstruction must not be delayed.

A diuretic such as furosemide improves heart failure by reducing systemic fluid volume. Digoxin, or other inotropic agent, can improve myocardial contractility. Oxygen can improve respiratory function and blood transfusion can increase oxygen transport. None of these effects is as important as opening the ductus arteriosus.