Patent ductus arteriosus (PDA) is defined as a persistent communication between the pulmonary artery and the aorta that normally closes before birth. While the ductus arteriosus is an essential vascular shunt for a developing fetus, its failure to close can become pathologic. Most PDAs are repaired during infancy; however, some remain patent into adulthood, with presentations varying in clinical severity. Untreated PDA can lead to significant morbidity, with complications including left-heart volume overload, arrhythmia, pulmonary hypertension, and possible Eisenmenger syndrome. This review covers the management of PDA in adults, highlighting the pathophysiology, morphological classification, clinical presentation, and current approaches to closure. Transcatheter closure is currently the preferred approach, although surgical methods may be used in patients with distinct anatomy or other concomitant intracardiac pathology. While both methods come with different risk profiles, closure in adults has proven to be effective, resulting in considerable hemodynamic and clinical improvements.
Anthony J. Kaywood, Alishah Ahmadi, W. Frishman· Cardiology in Review· 0 citations
We evaluated the efficacy and safety of baxdrostat in adults with uncontrolled or resistant hypertension. We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to January 2026. We included randomized controlled trials that involved hypertension patients with resistance type and compared baxdrostat versus placebo. The primary outcomes were the changes in mean seated systolic blood pressure and diastolic blood pressure. Secondary outcomes included changes in estimated glomerular filtration rate (eGFR), serum potassium, and serum aldosterone. Three randomized controlled trials were finally included, comprising 1264 patients were followed for 12-24 weeks. Compared with placebo, baxdrostat reduced seated systolic blood pressure by 8.62 mm Hg [mean difference (MD) = -8.62, 95% confidence interval (CI), -10.55 to -6.70, P < 0.001] and seated diastolic blood pressure by 3.55 mm Hg (MD = -3.55, 95% CI, -4.81 to -2.28, P < 0.001). Baxdrostat lowered serum aldosterone by 4.03 ng/dL, reduced eGFR by 5.49 mL/min/1.73 m2, and increased serum potassium by 0.39 mmol/L. However, baxdrostat was associated with higher adverse events compared with the placebo. Baxdrostat lowers blood pressure and aldosterone levels in uncontrolled and resistant hypertension but increases potassium and modestly reduces eGFR, supporting careful laboratory monitoring and longer trials to evaluate long-term clinical outcomes.
A. Gadelmawla, A. W. Hageen, R. Rateb et al.· Cardiology in Review· 0 citations
Patent ductus arteriosus (PDA) is a common congenital heart defect. PDA disproportionately affects low-birth-weight infants, resulting in an incidence of 21% among preterm births as compared to 0.05% in the general population. The ductus arteriosus remains patent in the fetus, allowing maternal blood to directly enter fetal systemic circulation, bypassing the fetal lungs. This is mediated through the mechanisms of nitric oxide and prostaglandins. At birth, increased partial pressure and decreased prostaglandin levels facilitate functional closure of the ductus arteriosus. Further migration of contractile smooth muscle cells and tissue remodeling results in fibrosis and anatomical closure of the ductus. Underdevelopment of contractile smooth muscle cells, the intimal layer in blood vessels, and vasa vasorum have been theorized as the mechanisms behind PDA in preterm-birth neonates. PDA creates a left-to-right shunt, sending oxygenated blood from the aorta to the lungs via the pulmonary artery, often manifesting with symptoms of pulmonary hypertension and edema. As the symptoms progress, the shunt is often reversed, resulting in cyanosis in a condition known as Eisenmenger syndrome. While most affected patients present with distinguishing clinical findings, many also remain asymptomatic, and the defect goes undetected for years.
Rithvik Swamynathan, L. Dolan, W. Frishman et al.· Cardiology in Review· 0 citations
Integration of echocardiography, computed tomography, CMR, and emerging positron emission tomography and artificial intelligence-based approaches can help address diagnostic uncertainty in aortic stenosis.
H. Itani, M. Moumneh, Ahmed A. Zayed et al.· Cardiology in Review· 0 citations
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