Intravenous Prostaglandin E1 (Alprostadil) Bolus in Ductus Arteriosus-Dependent Congenital Heart Disease: A Case Series.

The use of prostaglandin E1 is well documented in ductus arteriosus-dependent congenital heart disease (CHD) and severe neonatal pulmonary hypertension. Standard therapy involves intravenous infusion, with onset of action typically 30 min to 2 h. We report three patients with ductal-dependent CHD who developed acute ductal spasm during cardiac catheterization. In all cases, a bolus of alprostadil improved ductal spasm, increased pulmonary or systemic flow, stabilized hemodynamics, and allowed successful patent ductus arteriosus (PDA) stent implantation. Transient hypotension was observed in two patients, resolving promptly; one premature infant had a delayed response requiring temporary extracorporeal membrane oxygenation support. No serious complications or neurological sequelae were observed. These findings suggest that intravenous alprostadil bolus may be an effective and relatively safe rescue therapy for acute ductal spasm. Further studies are warranted to better define its role in this critical setting.