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Oztunc F, Murt NU, Dedeoglu R, Coskun YI, Madazli R. Prenatal Diagnosis of Ductus Arteriosus Anomalies: A Single-Center Study. Pediatr Cardiol 2024; 45:600-604. [PMID: 38099950 DOI: 10.1007/s00246-023-03359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/14/2023] [Indexed: 02/24/2024]
Abstract
To evaluate the fetal ductus arteriosus anomalies diagnosed by fetal echocardiography. The perinatal outcomes and associated cardiac and genetic anomalies are also explored. The fetal echocardiography records of 2366 fetuses were evaluated retrospectively. Thirty-seven pregnancies prenatally diagnosed with ductus arteriosus anomalies and evaluated after delivery were enrolled in the study. Perinatal and obstetric outcomes were analyzed. The incidence of ductus arteriosus anomaly in our series was 1.5% (37/2366). The most frequent ductus arteriosus anomaly detected was right-sided ductus arteriosus followed by aneurysm, constriction and bilateral ductus arteriosus with an incidence of 51.3%, 27.1%, 18.9% and 2.7%, respectively. There were 19 fetuses with right-sided ductus arteriosus, of which 15 had tetralogy of Fallot. There were 2 chromosomal anomalies (22q11 microdeletion) in this group. Of the 7 fetuses with ductus arteriosus constriction, 3 (3/7, 42.9%) died in-utero. There were 2 (2/10, 20%) neonatal deaths due to hypoplastic left heart syndrome in the ductus arteriosus aneurysm group. Various types of ductus arteriosus anomalies can be diagnosed prenatally. Perinatal outcomes mostly dependent on the type of the ductus arteriosus anomaly and accompanying cardiac malformations.
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Affiliation(s)
- Funda Oztunc
- Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | | | | | | | - Riza Madazli
- Istanbul University-Cerrahpasa, Istanbul, Turkey
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2
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Huynh T, Pham T, Ho P, Cam P, Pham V, Vu P. Asymptomatic congenital ductus arteriosus aneurysm in a newborn: Case by approach. Radiol Case Rep 2023; 18:3917-3921. [PMID: 37663558 PMCID: PMC10473969 DOI: 10.1016/j.radcr.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
A ductus arteriosus aneurysm is a rare congenital lesion with a localized saccular or tubular dilation of the ductus arteriosus. This lesion usually appears in all ages. Some case reports suggest the most common age of diagnosis is less than 2 months. We reported a case of an asymptomatic ductus arteriosus aneurysm in neonates. Echocardiography at 2 days of age revealed a tubular dilation of the ductus arteriosus connected to the pulmonary artery. Computed tomography angiogram showed a ductus arteriosus aneurysm with thrombus at the pulmonary end. It resolved spontaneously in the six months of life without serious complications.
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Affiliation(s)
- Thuy Huynh
- Diagnostic Imaging Center, Tam Anh General Hospital, 2B Pho Quang, 2 Ward, Tanbinh District, Hochiminh City, Vietnam
| | - Thuy Pham
- Cardiovascular Center, Tam Anh General Hospital, 2B Pho Quang, 2 Ward, Tanbinh District, Hochiminh City, Vietnam
- Pediatric Department, University of Medicine and Pharmacy, 215 Hong Bang, 11 Ward, 5 District, Hochiminh City, Vietnam
| | - Phuong Ho
- Diagnostic Imaging Center, Tam Anh General Hospital, 2B Pho Quang, 2 Ward, Tanbinh District, Hochiminh City, Vietnam
| | - Phuong Cam
- Neonatal Center, Tam Anh General Hospital, 2B Pho Quang, 2 Ward, Tanbinh District, Hochiminh City, Vietnam
| | - Vinh Pham
- Cardiovascular Center, Tam Anh General Hospital, 2B Pho Quang, 2 Ward, Tanbinh District, Hochiminh City, Vietnam
| | - Phuc Vu
- Cardiovascular Center, Tam Anh General Hospital, 2B Pho Quang, 2 Ward, Tanbinh District, Hochiminh City, Vietnam
- Pediatric Department, University of Medicine and Pharmacy, 215 Hong Bang, 11 Ward, 5 District, Hochiminh City, Vietnam
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3
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Shirozu H, Ichiyama M, Ishimura M, Ayako K, Egami N, Dongchon K, Nakano T, Sagawa K, Ohga S. Ductus Arteriosus Aneurysm and Pulmonary Artery Thromboses in a Protein S-Deficient Newborn. AJP Rep 2023; 13:e44-e48. [PMID: 37484829 PMCID: PMC10361822 DOI: 10.1055/a-2101-7738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/10/2023] [Indexed: 07/25/2023] Open
Abstract
Ductus arteriosus aneurysm (DAA) asymptomatically occurs in newborn infants and resolves spontaneously. High-risk DAA with compression, rupture, and thrombosis requires early surgical intervention. Newborn infants have the highest risk of thrombosis among pediatric patients, but the genetic predisposition is difficult to determine in infancy. We herein report a neonatal case of massive thromboses in DAA and pulmonary artery. Desaturation occurred in an active full-term infant 2 days after birth. Echocardiography and contrast-enhanced computed tomography indicated thrombotic occlusion of the DAA and pulmonary artery thrombus. Urgent thrombectomy and ductus resection were successfully performed. After 6 months of anticoagulant therapy, the dissociated low plasma activity levels of protein S from protein C suggested protein S deficiency. A genetic study of PROS1 identified a heterozygous variant of protein S K196E, a low-risk variant of thrombophilia in Japanese populations. There have been seven reported cases with neonatal-onset symptomatic thromboses of DAA involving the pulmonary artery. All survived without recurrence after surgical intervention in five and anticoagulant therapy alone in two. Two newborns had a heterozygous methylenetetrahydrofolate reductase ( MTHFR ) variant, but information on thrombophilia was not available for any other cases. A genetic predisposition may raise the risk of DAA thrombosis, leading to rapid progression.
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Affiliation(s)
| | - Masako Ichiyama
- Division of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuraoka Ayako
- Division of Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Naoki Egami
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kang Dongchon
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Toshihide Nakano
- Division of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Koichi Sagawa
- Division of Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, Michelfelder E, Morris SA, Peyvandi S, Pinto NM, Pruetz J, Sethi N, Simpson J, Srivastava S, Tian Z. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:679-723. [PMID: 37227365 DOI: 10.1016/j.echo.2023.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Joe Kreeger
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wesley Lee
- Baylor College of Medicine, Houston, Texas
| | | | - Shaine A Morris
- Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas
| | - Shabnam Peyvandi
- University of California, San Francisco, San Francisco, California
| | | | - Jay Pruetz
- Children's Hospital of Los Angeles, Los Angeles, California
| | | | - John Simpson
- Evelina London Children's Hospital, London, United Kingdom
| | | | - Zhiyun Tian
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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5
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Prenatal Diagnosis of Ductus Arteriosus Aneurysm: A Case Report and Literature Review. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-022-00348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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6
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Rapidly growing thrombus from a ductus arteriosus aneurysm in a neonate. J Cardiol Cases 2022; 26:283-285. [DOI: 10.1016/j.jccase.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/23/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022] Open
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Leshen MA, Devanagondi R, Saul D, Chaturvedi A. Physiological fetal vascular shunts and failure to regress: what the radiologist needs to know. Pediatr Radiol 2022; 52:1207-1223. [PMID: 35166890 DOI: 10.1007/s00247-022-05302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/13/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
The fetal circulation is characterized by the presence of three physiological vascular shunts - the ductus arteriosus, the foramen ovale and the ductus venosus. Acting in concert, these shunts preferentially stream blood flow in a pattern that maximizes efficiency of blood oxygenation by the maternofetal unit. Shortly following the transition to extrauterine life, a quick and predetermined succession of events results in closure of these embryological structures with consequent establishment of postnatal vascular flow patterns. While this transition is often seamless, the physiological shunts of the fetus occasionally fail to regress. Such failure to regress can occur in isolation or in association with other congenital malformations. This failed regression challenges the circulatory physiology of the neonate and might have implications for the optimum functioning of several organ systems. When symptomatic, these shunts are treated. Interventions, when undertaken, might be medical, endovascular or surgical. The radiologist's role continues to expand in the assessment of these shunts, in providing a roadmap for treatment and in prompt identification of treatment-related complications. This review is to familiarize radiologists with the embryology, pre- and post-treatment imaging appearances, and associated complications of persistent fetal vascular shunts.
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Affiliation(s)
- Michael A Leshen
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
| | - Rajiv Devanagondi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - David Saul
- Department of Medical Imaging, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Apeksha Chaturvedi
- Pediatric Imaging Section, Department of Imaging Sciences, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
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Nour A, Abdelrazik Y, Huessin S, Kamel H. Safety and efficacy of percutaneous patent ductus arteriosus closure: a multicenter Egyptian experience. Egypt Heart J 2022; 74:14. [PMID: 35244792 PMCID: PMC8897530 DOI: 10.1186/s43044-022-00251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Transcatheter closure of patent ductus arteriosus (PDA) has gained acceptance over the last two decades, replacing the surgery in more than 90% of the cases, so the safety and efficacy of transcather closure of PDA have been evaluated by studying different experiences from different centers in developing countries. The aim is to report our experience with PDA transcather closure, with focus on the adverse events and complications faced during the procedure.
Results Outcome data on PDA transcatheter closure were collected from two different tertiary centers in a multicenter registry. During the period from June 2017 till January 2021, 308 PDA closure were recorded, using device in 197 (64%) and coils in 111 (36%) patients, most of the patients were in pediatric age group from 6 months to 6 years and only 10 patients (3.2%) were adults. Most patients had isolated PDA of 92%, and 9 (2.9%) patients had residual PDAs either post-surgical or transcatheter closure. Median minimum PDA diameter was 2.8 mm (range 1–7.6 mm; IQR 1.8–3.8 mm). The procedure was successful in 293 patients (95%). Complications occurred in 15/308 patients (5%), and only 6 (2%) of them were major complications, but none was life threating. Frequent complications were device embolization (2%), hemolysis (1%), arrhythmia (1%). Younger age, low body weight and longer procedure time were associated with a high complication rate (p < 0.005). Device-related complications were more common than coil-related complications (2.5% versus 0.5%). Conclusions Although transcatheter closure of PDA is considered to be effective procedure with low complications rate, however, complications should be anticipated and managed properly.
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Affiliation(s)
- Amira Nour
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, P.O. 11835, Abbassya, Nargess 3, Fifth Settlement, Cairo, Egypt
| | - Yasmeen Abdelrazik
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, P.O. 11835, Abbassya, Nargess 3, Fifth Settlement, Cairo, Egypt
| | - Safaa Huessin
- Pediatric Department, Sohag University, Sohâg, Egypt
| | - Heba Kamel
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, P.O. 11835, Abbassya, Nargess 3, Fifth Settlement, Cairo, Egypt.
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9
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Fedrigo M, Visentin S, Veronese P, Barison I, Giarraputo A, Cosmi E, Thiene G, Gervasi MT, Basso C, Angelini A. Isolated Dissection of the Ductus Arteriosus Associated with Sudden Unexpected Intrauterine Death. J Cardiovasc Dev Dis 2021; 8:jcdd8080091. [PMID: 34436233 PMCID: PMC8396886 DOI: 10.3390/jcdd8080091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 12/23/2022] Open
Abstract
We report five cases of sudden intrauterine death due to premature closure of the ductus arteriosus. In four cases, this was caused by dissecting the hematoma of the ductus arteriosus with intimal flap and obliteration of the lumen. In one case, the ductus arteriosus was aneurysmatic, with lumen occlusion caused by thrombus stratification. No drug therapy or free medication consumption were reported during pregnancy. The time of stillbirth ranged between 26 and 33 gestational weeks. We performed TUNEL analysis for apoptosis quantification. The dissecting features were intimal tears with flap formation in four of the cases, just above the origin of the ductus arteriosus from the pulmonary artery. The dissecting hematoma of the ductus arteriosus extended downward to the descending aorta and backward to the aortic arch with involvement of the left carotid and left subclavian arteries. TUNEL analysis showed a high number of apoptotic smooth muscle cells in the media in two cases. Abnormal ductal remodeling with absence of subintimal cushions, lacunar spaces rich in glycosaminoglycans (cystic medial necrosis), and smooth muscle cell apoptosis were the pathological substrates accounting for failure of remodeling process and dissection.
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Affiliation(s)
- Marny Fedrigo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (M.F.); (I.B.); (A.G.); (G.T.); (C.B.)
| | - Silvia Visentin
- Department of Woman and Children Health, University of Padua, 35128 Padua, Italy; (S.V.); (P.V.); (E.C.); (M.T.G.)
| | - Paola Veronese
- Department of Woman and Children Health, University of Padua, 35128 Padua, Italy; (S.V.); (P.V.); (E.C.); (M.T.G.)
| | - Ilaria Barison
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (M.F.); (I.B.); (A.G.); (G.T.); (C.B.)
| | - Alessia Giarraputo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (M.F.); (I.B.); (A.G.); (G.T.); (C.B.)
| | - Erich Cosmi
- Department of Woman and Children Health, University of Padua, 35128 Padua, Italy; (S.V.); (P.V.); (E.C.); (M.T.G.)
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (M.F.); (I.B.); (A.G.); (G.T.); (C.B.)
| | - Maria Teresa Gervasi
- Department of Woman and Children Health, University of Padua, 35128 Padua, Italy; (S.V.); (P.V.); (E.C.); (M.T.G.)
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (M.F.); (I.B.); (A.G.); (G.T.); (C.B.)
| | - Annalisa Angelini
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (M.F.); (I.B.); (A.G.); (G.T.); (C.B.)
- Correspondence: ; Tel.: +39-049-8272260
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10
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Yukimoto M, Okuma T, Sohgawa E, Nakano MM, Shimono T, Miki Y. Incidentally identified ductus arteriosus aneurysm in eight adults: a case series. BJR Case Rep 2021; 7:20200097. [PMID: 35047188 PMCID: PMC8749408 DOI: 10.1259/bjrcr.20200097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/05/2022] Open
Abstract
Ductus arteriosus aneurysm (DAA) in adulthood is a rare entity. We retrospectively reviewed our medical records from the past 10 years and identified 8 cases of adult DAA (6 males and 2 females aged between 69 and 89 years; mean, 76 years), using multiplanar reconstruction and three-dimensional reconstruction CT images. The aneurysm was suspected incidentally in all cases based on the results of chest radiographic screening or post-operative follow-up CT for lung or colon cancer. All eight patients were asymptomatic but had a history of or concurrent hypertension (n = 5, 62.5%), diabetes mellitus (n = 3, 37.5%), cerebrovascular disease (n = 3, 37.5%), ischemic heart disease (n = 1, 12.5%), and cardiac failure (n = 1). All patients had no history of trauma (n = 8, 100%). Six had a history of cigarette smoking. The aneurysm size ranged from 2.0 × 4.0 to 6.3 × 5.3 cm (mean, 3 × 5 cm). The surgical procedures used were four cases of total arch replacement and two cases of thoracic endovascular aortic repair. Two patients were not surgically treated. The median follow-up was 14.5 months (range, 2 months to 9 years). In the two patients who were not surgically treated, the aneurysm enlarged in one, and remained unchanged in the other. Of the six surgically managed cases, one was lost to follow-up, and another patient died of an unrelated cause. The remaining four cases had no enlargement of the aneurysm. No ruptures were reported in any of the cases. DAA should be considered when a saccular aneurysm is located in the minor curvature of the aortic arch and extending toward the left pulmonary trunk in adult patients. Differentiating adult DAA is important, because it is associated with a high risk of rupture due to the fragile nature of true aneurysms.
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Affiliation(s)
- Mayo Yukimoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan 1-4-3 Asahimachi, Abenoku, Osaka, Japan 545-8585
| | - Tomohisa Okuma
- Department of Diagnostic Radiology, Osaka City General Hospital, Osaka Japan 2-13-22 Miyakojima-hondori, Miyakojima-ku Osaka, Japan 534-0021
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan 1-4-3 Asahimachi, Abenoku, Osaka, Japan 545-8585
| | - Mariko M Nakano
- Department of Radiology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan 2-1 Kidohigashi-cho, Kawachinagano, Osaka, Japan 586-8521
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan 1-4-3 Asahimachi, Abenoku, Osaka, Japan 545-8585
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan 1-4-3 Asahimachi, Abenoku, Osaka, Japan 545-8585
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Bannan B, Aly S, Yoo SJ, Seed M, Lam CZ. The Many Faces of Neonatal Ductus Arteriosus Aneurysms: Multimodality Imaging with an Emphasis on CT and MRI Appearance. Radiol Cardiothorac Imaging 2021; 3:e210017. [PMID: 34235446 DOI: 10.1148/ryct.2021210017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/17/2022]
Abstract
Neonatal ductus arteriosus aneurysm (DAA) is a rare abnormality that is typically diagnosed at fetal third trimester or early postnatal echocardiography. While echocardiography is usually adequate for diagnosis and clinical decision-making, cross-sectional imaging, including CT or cardiac MRI, may be necessary to clarify the diagnosis or delineate associated complications. Severe complications include thromboembolism, infection, compression of adjacent structures, airway erosion, and aneurysm rupture. This imaging essay reviews the pathophysiology and depicts the spectrum of cross-sectional imaging appearances of neonatal DAAs. Most neonatal DAAs will spontaneously regress and can be managed conservatively. Keywords: CT, MRI, Cardiac, Aneurysms, Congenital Supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Badr Bannan
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Safwat Aly
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Mike Seed
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
| | - Christopher Z Lam
- Department of Diagnostic Imaging (B.B., S.J.Y., C.Z.L.) and Labatt Family Heart Centre, Department of Paediatrics (S.A., M.S.), The Hospital for Sick Children, and Department of Medical Imaging (B.B., S.J.Y., C.Z.L.), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8
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12
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Takajo D, Kobayashi D. Ductus arteriosus aneurysm with left pulmonary artery obstruction. Echocardiography 2021; 38:1128-1130. [PMID: 33998041 DOI: 10.1111/echo.15070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/06/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
The echogenic mass in the pulmonary artery is a rare finding in newborns. Differential diagnoses include pulmonary artery thrombosis, ductal aneurysm, and malignant tumor. We report a newborn case who presented with mild desaturation and was found to have a large echogenic mass at the pulmonary bifurcation on echocardiography, which caused partial flow obstruction in the proximal left pulmonary artery. Along with the findings of cardiac computed tomography and magnetic resonance imaging, the diagnosis of ductus arteriosus aneurysm (DAA) was made. This DAA spontaneously regressed without any intervention at 4 months follow-up.
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Affiliation(s)
- Daiji Takajo
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Daisuke Kobayashi
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, USA
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13
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Doğan V, Aksoy ÖN, Sayıcı İU, Çitli R. Thrombosis of isolated ductus arteriosus aneurysm in a newborn. Echocardiography 2021; 38:716-717. [PMID: 33677831 DOI: 10.1111/echo.15017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
Congenital aneurysm of the ductus arteriosus is reported in 0.8% in neonatal autopsies; however, true incidence is unknown because of high rate of asymptomatic cases and spontaneous regression. Possible complications in symptomatic cases are thromboembolism, spontaneous rupture, erosion, infection, compression of airways, and death. In this report, we present a newborn with giant ductus arteriosus aneurysm (DAA) diagnosed in first day of life, surgically treated after thrombosis of aneurysm.
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Affiliation(s)
- Vehbi Doğan
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ömer Nuri Aksoy
- Department of Pediatric Cardiovascular Surgery, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İlker Ufuk Sayıcı
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Rümeysa Çitli
- Department of Neonatology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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14
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Antenatal occlusion of a ductal arteriosus aneurysm: a potential postnatal surgical emergency. Case report and literature review. Cardiol Young 2020; 30:1750-1752. [PMID: 32880253 DOI: 10.1017/s1047951120002711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Symptomatic presentation of ductal arteriosus aneurysm is usually a consequence of associated complications, including thromboembolism, infection, and compression of adjacent structures. In this case report, we present a thrombosed ductal aneurysm that developed antenatally with further postnatal progression of the thrombus and complete occlusion of the left pulmonary artery. Urgent surgical thrombectomy was successful and the post-operative course was uneventful.
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15
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Siddiqui S, Polanco A, DiLorenzo MP, Shah A, Snyder M, Dietz H, Bacha E, Farooqi KM. Massive ductal aneurysm in an asymptomatic child with Loeys-Dietz syndrome. Ann Pediatr Cardiol 2020; 14:113-115. [PMID: 33679075 PMCID: PMC7918009 DOI: 10.4103/apc.apc_85_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/20/2020] [Accepted: 08/04/2020] [Indexed: 11/04/2022] Open
Abstract
An asymptomatic 3-year-old with Loeys-Dietz Syndrome (LDS) followed for a small patent ductus arteriosus and dilated aorta was found to have a massive ductal aneurysm on routine surveillance cardiac magnetic resonance. The aneurysm was successfully resected. Serial advanced imaging tools are useful in surveillance, diagnosis, and management in patients with LDS.
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Affiliation(s)
- Saira Siddiqui
- Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, USA
| | - Antonio Polanco
- Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael P DiLorenzo
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amee Shah
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Snyder
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Harry Dietz
- Mckusick-Nathans Department of Genetic Medicine, Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emile Bacha
- Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kanwal Majeed Farooqi
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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16
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Ritter M, Franz C, Germund-Maiwald I, Graupner O, Enzensberger C. Ductus-arteriosus-Aneurysma. Z Geburtshilfe Neonatol 2020; 224:227-229. [PMID: 32838450 DOI: 10.1055/a-1173-5344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Monica Ritter
- Klinik für Gynäkologie und Geburtsmedizin der Uniklinik RWTH Aachen
| | - Cordula Franz
- Klinik für Gynäkologie und Geburtsmedizin der Uniklinik RWTH Aachen
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17
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Jeong LE, Na JY, Huh J, Kang IS, Yang JH, Jun TG, Song JY. Echogenic Mass Lesion within the Main Pulmonary Artery in a Neonate. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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18
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Goswami A, Das A. A spontaneous partially thrombosed ductal aneurysm presenting with left recurrent laryngeal nerve palsy. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2020. [DOI: 10.1080/23772484.2020.1725388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Abhilasha Goswami
- Department of Otorhinolaryngology, Gauhati Medical College, Guwahati, Assam, India
| | - Anandita Das
- Department of Otorhinolaryngology, Gauhati Medical College, Guwahati, Assam, India
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Abstract
Congenital ductus arteriosus aneurysms develop in the third trimester of fetal life, possibly due to abnormal intimal cushion formation or elastin expression in the ductal wall. It is often diagnosed in infants before 2 months of age. Most have a benign course and resolve spontaneously. However, life-threatening complications have been reported. We report a case of large ductal aneurysm diagnosed incidentally in a neonate, in whom there was a novel mutation in the smooth muscle myosin protein gene-MYH11.
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20
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van den Berg G, Helbing WA, van Beynum I, Krasemann TB. Development of a Ductal Aneurysm in a Patient with Williams Syndrome, and Subsequent Interventional Closure. Pediatr Cardiol 2020; 41:213-214. [PMID: 31535182 DOI: 10.1007/s00246-019-02211-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022]
Abstract
Whilst stenosis of systemic and pulmonary arteries in Williams syndrome is frequently described, aneurysm formation is uncommon. We provide the first description of a Williams patient with development of an aneurysm of the arterial duct. This aneurysm developed concomitantly with supravalvar aortic, and peripheral pulmonary stenosis. The duct was closed interventionally to reduce the risk of rupture.
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Affiliation(s)
- Gert van den Berg
- Department of Pediatrics, Division of Pediatric Cardiology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ingrid van Beynum
- Department of Pediatrics, Division of Pediatric Cardiology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Thomas B Krasemann
- Department of Pediatrics, Division of Pediatric Cardiology, Sophia Children's Hospital, Rotterdam, The Netherlands. .,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Room SP-2428, PO box 2060, 3000 CB, Rotterdam, The Netherlands.
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Anton T, Sklansky MS, Perez M, Pretorius DH. The Fetal 3-Vessel Views: An Illustrative Case-Based Tutorial. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3335-3347. [PMID: 31206762 DOI: 10.1002/jum.15067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
In 2018, the American Institute of Ultrasound in Medicine revised its obstetric Practice Parameter for the second-trimester fetal anatomic survey. The 2018 Practice Parameter recommends incorporation of the 3-vessel view and 3-vessel and trachea view "if technically feasible." Sonographers and other medical providers may require additional training and education to develop greater proficiency in obtaining and interpreting these views. This pictorial essay, including ultrasound images alongside their respective schematic diagrams, provides an up-to-date, practical, and clinically oriented review of the 3-vessel view and 3-vessel and trachea view and their most common presentations in the context of congenital heart disease.
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Affiliation(s)
- Tracy Anton
- University of California, San Diego, Maternal-Fetal Care and Genetics, La Jolla, California, USA
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
| | - Mark S Sklansky
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Mishella Perez
- University of California, San Diego, Maternal-Fetal Care and Genetics, La Jolla, California, USA
| | - Dolores H Pretorius
- University of California, San Diego, Maternal-Fetal Care and Genetics, La Jolla, California, USA
- Department of Radiology, University of California, San Diego, San Diego, California, USA
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An Unusual Cardiac Cause of Unilateral Neonatal Wheezing. Case Rep Pediatr 2019; 2019:9638518. [PMID: 31179149 PMCID: PMC6501233 DOI: 10.1155/2019/9638518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/28/2019] [Indexed: 11/17/2022] Open
Abstract
A neonate presented three days after birth with left-sided unilateral inspiratory wheezing, intermittent respiratory distress, and desaturations. She was found to have a large ductus arteriosus aneurysm that caused compression of her left mainstem bronchus and left pulmonary artery. This lesion was not identified prior to birth on routine prenatal screening, which included fetal ultrasonography. Diagnosis was made on day of life (DOL) 5 by a computed tomography with angiography scan. On DOL 7, she underwent cardiac surgery which included resection of the ductal aneurysm, patch reconstruction of the transverse aortic arch and descending aorta, patent ductus arteriosus excision, and atrial secundum septal defect repair. There were no postoperative complications, and she has been asymptomatic since.
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In-utero idiopathic ductal constriction: a prenatal manifestation of Alagille and Williams syndrome arteriopathy. J Perinatol 2018; 38:1453-1456. [PMID: 30202046 DOI: 10.1038/s41372-018-0221-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/15/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Williams and Alagille syndromes are genetic disorders associated with pathologic arterial narrowing. We hypothesized that fetal idiopathic ductus arteriosus (DA) constriction may represent a prenatal manifestation of the arteriopathy associated with these syndromes. METHODS Multi-institutional case series review of the pre- and postnatal medical records, echocardiograms, and genetic test results of fetuses presenting with idiopathic DA constriction. RESULTS We identified four cases of idiopathic fetal DA constriction at 21-36 weeks of gestation. All had right ventricular hypertension, dilation, hypertrophy, and dysfunction and either DA constriction or absence. All demonstrated progressive peripheral pulmonary artery stenosis after birth. Three met clinical diagnostic criteria for Alagille syndrome; two tested had confirmatory JAG1 mutations. One also developed supravalvar aortic stenosis after birth and was positive for 7q11.23 deletion (Williams syndrome). CONCLUSION This is the first case series to suggest that idiopathic fetal DA constriction may be a prenatal manifestation of genetic arteriopathy.
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Alvarez SGV, McBrien A. Ductus arteriosus and fetal echocardiography: Implications for practice. Semin Fetal Neonatal Med 2018. [PMID: 29530740 DOI: 10.1016/j.siny.2018.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The ductus arteriosus (DA) is a crucial part of the fetal circulation, both in the normal fetus and in critical congenital heart disease (CHD). It allows shunting between the pulmonary and systemic circulations. In physiological prenatal conditions, the DA lets the majority of right ventricular output bypass the fluid-filled, high-resistance lungs. The DA can cause hemodynamic compromise in the fetus and neonate when constricted or absent (in isolation or in patients with CHD) and may lead to pre- or postnatal sequelae within other systems when forming part of a vascular ring. In CHD, the DA can be interrogated by fetal echocardiography to infer information regarding severity of pulmonary outflow tract obstruction, adequacy of the sub-pulmonary ventricle to supply pulmonary blood flow, and to predict the likelihood of atrial septum restriction in transposition of the great arteries. A good understanding of the DA is crucial for fetal cardiologists.
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Affiliation(s)
- Silvia G V Alvarez
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada; Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Angela McBrien
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Closure time of ductus arteriosus after birth based on survival analysis. Early Hum Dev 2018; 121:37-43. [PMID: 29754023 DOI: 10.1016/j.earlhumdev.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/15/2018] [Accepted: 05/06/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The correct ductus arteriosus (DA) closure time is somewhere between the opening and closing time confirmed on echo, not on examination. We investigated DA closure time and factors affecting DA closure time using interval censoring analysis. METHODS This was an observational, retrospective study including 2611 healthy neonates. Echo was performed every 12-24 h after birth until DA closure. We investigated the DA closure time using interval censoring analysis. If the DA was closed on echo, we assumed that the DA was open at birth. We evaluated clinical factors affecting DA closure time. RESULTS Median DA closure time was 13.5 h (range, 7.7-18.7 h) after birth. DA closure time was associated with primipara status, maternal prostaglandin E2 (PGE2) administration, <2500 g birth weight, and diagnosis of congenital ductus arteriosus aneurysm (DAA). Using proportional hazards regression models, the interval-censored data (primipara, hazard ratio [HR] = 1.099, P = 0.04; PGE2, HR = 0.823, P = 0.03; <2500 g, HR = 1.413, P < 0.01; DAA, HR = 0.570, P < 0.01) were found to be significantly associated with DA closure time. CONCLUSIONS Estimation of DA closure time by interval censoring analysis is helpful to determine the optimal time to perform echo and to predict risk factors for patent DA.
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26
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Xu E, Delpey JG, Finel E, Pennanéach A. Ductus arteriosus aneurysm: Case report and review of the literature. Arch Pediatr 2018; 25:283-285. [PMID: 29656824 DOI: 10.1016/j.arcped.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/25/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022]
Abstract
We report the case of an infant boy born at 39 weeks and 5 days who presented a cleft lip and palate. During the assessment to detect associated malformations, cardiac auscultation revealed a systolic heart murmur. Echocardiography and subsequent thoracic computed tomography angiography identified an aneurysm of the ductus arteriosus. Ductus arteriosus aneurysm, a complicated form of patent ductus arteriosus, may not be as rare as once considered. A clear majority of ductus arteriosus aneurysms are asymptomatic and physiologically resolve after birth. Nevertheless, severe complications can occur, primarily during the postnatal period.
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Affiliation(s)
- E Xu
- Department of radiology, university hospital Cavale-Blanche, boulevard Tanguy-Prigent, 29200 Brest, France; Department of radiology, hospital Laennec, 14, bis avenue Yves-Thépot, 29000 Quimper, France.
| | - J-G Delpey
- Department of pediatry, university hospital Morvan, 2, avenue Maréchal-Foch, 29200 Brest, France
| | - E Finel
- Department of pediatry, hospital Laennec, 14, bis avenue Yves-Thépot, 29000 Quimper, France
| | - A Pennanéach
- Department of radiology, hospital Laennec, 14, bis avenue Yves-Thépot, 29000 Quimper, France
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27
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Peiró Molina E, Sánchez Andrés A, Carrasco Moreno JI. Aneurisma del ductus arterioso: diagnóstico prenatal y evolución. An Pediatr (Barc) 2017; 87:359-361. [DOI: 10.1016/j.anpedi.2016.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/19/2016] [Accepted: 10/22/2016] [Indexed: 11/16/2022] Open
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28
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Gewillig M, Brown SC, Roggen M, Eyskens B, Heying R, Givron P, Cools B, de Catte L. Dysfunction of the foetal arterial duct results in a wide spectrum of cardiovascular pathology. Acta Cardiol 2017; 72:625-635. [PMID: 28745124 DOI: 10.1080/00015385.2017.1314876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Foetal ductal problems may have various cardiopulmonary consequences. This study aimed to identify the spectrum of ductus arteriosus (DA) dysfunction (closure, constriction, kinking, aneurysm and thrombosis) and the resultant clinical and echocardiographic presentation in foetuses and neonates. METHODS AND RESULTS This is a retrospective analysis of serial pre- and post-natal data of 27 cases of foetal ductal dysfunction diagnosed at a median gestational age of 33 weeks (range 20-39). The most common abnormalities observed were premature closure of the DA in 56% (15/27) and constriction in 29% (8/27). Right ventricular hypertrophy was present in 75% (n = 11/15) of foetuses with premature DA closure, while ventricular dilation (4/7, 57%) was a more common feature in foetuses with ductal constriction. After birth, 63% (17/27) of new borns presented with cyanosis and pulmonary hypertension that required active treatment. Three infants died after birth. Abnormalities resolved spontaneously after birth in about 50% of patients. In some children, pulmonary valve stenosis and regurgitation was progressive and required further treatment. CONCLUSIONS An abnormal right heart on foetal four-chamber ultrasound view should alert the sonographer to the possible presence of foetal ductal dysfunction. Ductal occlusion, transient or fixed constriction, kinking and aneurysm formation are associated with foetal cardiopulmonary sequelae. Symptoms and pathology is probably related to the type, foetal age, rapidity of progression and duration of intrauterine ductal dysfunction. Correspondingly, clinical outcomes vary ranging from little or no symptoms to severe respiratory distress and even foetal or neonatal death.
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Affiliation(s)
- Marc Gewillig
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephen C. Brown
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Cardiology, University of the Free State, Bloemfontein, South Africa
| | - Mieke Roggen
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Benedicte Eyskens
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Patrice Givron
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Luc de Catte
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
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Leriche V, Dubois A, Vaksmann G. Acute respiratory distress revealing massive pulmonary embolism in a neonate. Pediatr Neonatol 2017; 58:467-468. [PMID: 28533115 DOI: 10.1016/j.pedneo.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/13/2016] [Accepted: 10/26/2016] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Angelina Dubois
- Department of Neonatology, Centre Hospitalier de Calais, France
| | - Guy Vaksmann
- Department of Neonatology, Centre Hospitalier de Calais, France; Department of Pediatric Cardiology, Hôpital Privé de La Louvière, Lille, France.
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30
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Tashima Y, Kimura N, Tamai K, Sato K, Yuri K, Matsumoto H, Yamaguchi A, Adachi H, Kobinata T. Pulmonary Stenosis Caused by Ductus Arteriosus Aneurysm: A Case Report. Ann Vasc Dis 2017; 10. [PMID: 29147152 PMCID: PMC5684151 DOI: 10.3400/avd.cr.16-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 76-year-old woman with a 2-week history of dyspnea on exertion was admitted to our hospital. A computed tomography scan showed a 70-mm diameter aortic arch aneurysm containing a large thrombus that was compressing the pulmonary artery. Echocardiography showed severe pulmonary stenosis and no shunt flow. Operative findings revealed an aneurysmal thrombus protruding into the lumen of the pulmonary artery through a foramen. A ductus arteriosus aneurysm was diagnosed. After the thrombus removal, arch replacement and ductus closure with a prosthetic patch were performed. Histological examination showed that the thrombus had no vascular components. The patient’s symptoms were relieved, and she was discharged.
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Affiliation(s)
- Yasushi Tashima
- Department of Cardiovascular Surgery, Kasukabe Chuo General Hospital,Kasukabe, Saitama, Japan.,Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Koichi Tamai
- Department of Cardiovascular Surgery, Kasukabe Chuo General Hospital,Kasukabe, Saitama, Japan
| | - Kenichiro Sato
- Department of Cardiovascular Surgery, Kasukabe Chuo General Hospital,Kasukabe, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Harunobu Matsumoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Toshiyuki Kobinata
- Department of Cardiovascular Surgery, Kasukabe Chuo General Hospital,Kasukabe, Saitama, Japan
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Behera DR, Nair KKM, Sasidharan B. Ductal aneurysm with postsubclavian coarctation of aorta in an adult. Ann Pediatr Cardiol 2017; 10:310-311. [PMID: 28928624 PMCID: PMC5594949 DOI: 10.4103/apc.apc_165_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe a case of ductal aneurysm in an adult patient with post subclavian coarctation of aorta, which is a very rare association.
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Affiliation(s)
- Dibya Ranjan Behera
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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32
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McArdle DJT, Paterson FLJ, Morris LL. Ductus Arteriosus Aneurysm Thrombosis with Mass Effect Causing Pulmonary Hypertension in the First Week of Life. J Pediatr 2017; 180:289-289.e1. [PMID: 27720408 DOI: 10.1016/j.jpeds.2016.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Affiliation(s)
- David J T McArdle
- Department of General Medicine Royal Hobart Hospital Tasmania, Australia
| | - Felix L J Paterson
- Department of Radiology Women's and Children's Hospital Adelaide, Australia
| | - Lloyd L Morris
- Department of Radiology Women's and Children's Hospital Adelaide, Australia
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33
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Murana G, Cefarelli M, Kloppenburg G, Morshuis WJ, Heijmen RH. Surgical exclusion of a saccular aneurysm within a patent ductus arteriosus in an adult patient with Ortner's syndrome. Future Cardiol 2016; 12:613-616. [PMID: 27759427 DOI: 10.2217/fca-2016-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In adult the patent ductus arteriosus is a rare condition associated sometimes with lethal complications. We describe the case of a 44-year-old woman with a history of systemic lupus erythematosus admitted to our hospital with hoarseness and severe dyspnea. Clinical imaging examinations indicated a saccular aneurysm within a persistent ductus arteriosus with signs of impending rupture. Patient was not considered suitable for transcatheter closure and therefore she underwent open aortic repair. The procedure was uneventful and any significant complications occurred during postoperative course.
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Affiliation(s)
- Giacomo Murana
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Geoffrey Kloppenburg
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Wim J Morshuis
- Department of Cardiac Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
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34
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Tsai HD, Chen K, Lee ML, Lee CH, Chen TH, Lin WH, Chen M. Late onset of large benign ductus arteriosus aneurysm presented with increased nuchal translucency and cystic hygroma at first trimester Down syndrome screening. Taiwan J Obstet Gynecol 2016; 55:427-9. [PMID: 27343329 DOI: 10.1016/j.tjog.2016.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Fetal ductus arteriosus aneurysm (DAA) is a rare but potentially risky congenital heart disease. It is often not diagnosed until the third trimester because of its asymptomatic nature and late onset. In rare occasions, DAA may result in serious complications; therefore, prenatal diagnosis is helpful. CASE REPORT Herein, we report the case of a foetus with cystic hygroma and increased nuchal translucency in the first trimester (but regressed at 20-week anomalous scan). Karyotyping indicated a 46 XY genotype. A large vascular mass was noted at the apex of the left lung by Doppler ultrasound at 38 weeks of gestation, with a diameter of 12.5 mm. After birth, echocardiography showed a patent ductus arteriosus with aneurysmal dilatation (17 mm as the largest diameter); thus, DAA was impressed. Chest computed tomography and three-dimensional angiography confirmed the large aneurysmal dilatation of the ductus arteriosus with a closed end at the pulmonary arterial side. CONCLUSION The male infant survived, but presented mild respiratory distress at birth. He was discharged at 24 days of age. At that time, DAA had regressed partially (diameter of 8.5 mm and much less blood flow), and it fully regressed at 40 days of age.
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Affiliation(s)
- Horng-Der Tsai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuanting Chen
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Meng-Luen Lee
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Cheng-Han Lee
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Tze-Ho Chen
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Hsiang Lin
- Department of Genomic Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming Chen
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan; Department of Genomic Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.
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De Freitas S, Connolly C, Neary C, Sultan S. Ductus arteriosus aneurysm presenting as hoarseness: successful repair with an endovascular approach. J Surg Case Rep 2016; 2016:rjw060. [PMID: 27141045 PMCID: PMC4852955 DOI: 10.1093/jscr/rjw060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An aneurysm of the ductus arteriosus is a rare finding, particularly in the adult population. These saccular aneurysms arise at the site of an incompletely obliterated ductus arteriosus along the lesser curvature of the aortic arch. Left untreated, it is associated with a high risk of potentially life-threatening complications including rupture, infection and thromboembolism. As a result, surgical correction is recommended. Previously, options were limited to open repair but as endovascular experience grows, novel techniques afford safer and less invasive alternatives. In contrast, neonatal ductus arteriosus aneurysms may regress spontaneously and expectant treatment can be justified. We present the case of a 74-year-old woman who presented with hoarseness secondary to a ductus arteriosus aneurysm; a diagnosis consistent with Ortner's syndrome. The patient underwent an uncomplicated endovascular repair using the chimney-graft technique.
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Affiliation(s)
- Simon De Freitas
- School of Medicine Nursing and Health Sciences, Department of Surgery, National University of Ireland, Galway, Republic of Ireland,
| | - Caoilfhionn Connolly
- School of Medicine Nursing and Health Sciences, Department of Surgery, National University of Ireland, Galway, Republic of Ireland
| | - Colm Neary
- Western Vascular Institute, University Hospital Galway, Galway, Republic of Ireland
| | - Sherif Sultan
- Western Vascular Institute, University Hospital Galway, Galway, Republic of Ireland
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Masood SA, Bokowski JW, Kazmouz S, Amin Z. Ductus arteriosus aneurysm with organized thrombus in a neonate: echocardiograms from diagnosis to resolution. Tex Heart Inst J 2015; 42:298-9. [PMID: 26175654 DOI: 10.14503/thij-14-4128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ganesan S, Hutchinson DP, Sampson AJ. Prenatal diagnosis of ductus arteriosus aneurysm. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2015; 23:251-3. [PMID: 27433265 DOI: 10.1177/1742271x15587931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/04/2015] [Indexed: 11/16/2022]
Abstract
The ductus arteriosus holds major functional importance within the fetal circulation, and anomalies within the ductus arteriosus may interfere with the integrity of the fetal circulation. Ductus arteriosus aneurysm, previously considered a rare lesion, is now a well-reported finding in infancy with some reports describing this finding in the prenatal period. Postnatally, most ductus arteriosus aneurysms resolve spontaneously; however, a small group of infants show complications such as connective-tissue disorders, thrombo-embolism, compression of surrounding thoracic structures and life-threatening spontaneous rupture requiring surgical correction. As such, postnatal assessment in this group is recommended.
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Affiliation(s)
- S Ganesan
- Pauline Gandel Imaging Centre, Royal Women's Hospital, Parkville, Australia
| | - D P Hutchinson
- Pauline Gandel Imaging Centre, Royal Women's Hospital, Parkville, Australia; Department of Paediatric Cardiology, Royal Children's Hospital, Parkville, Australia
| | - A J Sampson
- Department of Paediatric Cardiology, Royal Children's Hospital, Parkville, Australia
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Murki S, Deshbhatla SK, Sharma D, Rao N, Verma S. Congenital ductus arteriosus aneurysm: an unusual cause of transient neonatal hypertension. BMJ Case Rep 2014; 2014:bcr-2014-203853. [PMID: 24798362 DOI: 10.1136/bcr-2014-203853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Case 1: A term male child was re-admitted on day 10 of life due to acute onset of respiratory distress. Physical examination revealed tachypnoea, tachycardia and blood pressure (BP) above the 95th centile in all four limbs. Cardiovascular examination revealed a short systolic murmur on the sternal border. Abdomen showed hepatomegaly of 3 cm below the costal margin. Chest X-ray showed a cardiothoracic ratio of 0.65 with normal vascularity. Ultrasound and Doppler of the kidneys and brain were normal. The high parasternal view showed a large ductus arteriosus aneurysm (DAA) of 2.0 × 2.5 cm. The baby was managed with inotropes and antihypertensives. CT angiogram showed 1.6 × 0.6 cm thrombosed DAA, which was extending from the posterior descending aorta to the ampulla. With the resolution of aneurysm BPs normalised and antihypertensives were stopped at 6 weeks of age. Case 2: A premature male neonate weighing 1.2 kg was admitted to the neonatal intensive care unit for respiratory distress syndrome. On the 4th day of life during routine measurement of vitals, the BP was consistently above 95th centile in all four limbs. Blood tests revealed thrombocytopenia that persisted inspite of single donor transfusions. The evaluation for sepsis was negative. The ultrasound and Dopplers of the kidneys and brain were all normal. A transthoracic echocardiogram showed a large DAA measuring 5 × 1.8 mm. Hypertension was managed with antihypertensives. Serial transthoracic echocardiogram showed organising DAA. CT angiogram showed 6 mm × 2 mm thrombosed DAA. As the arterial BP normalised, antihypertensives were stopped on day 15 of life. The baby was discharged on day 29 of life and on follow-up BP remained normal.
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Affiliation(s)
- Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
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Gil-Sales J, Lachat M, Rancic Z, Mayer D, Pfammatter T, Chaykovska L. A hybrid open and endovascular repair for treatment of bovine aortic arch aneurysm accompanied by aneurysm of patent ductus arteriosus with deployment of Amplatzer duct occluder. Ann Vasc Surg 2014; 28:1565.e1-4. [PMID: 24509370 DOI: 10.1016/j.avsg.2013.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/15/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
A rare case of bovine aortic arch aneurysm accompanied by patent ductus Botalli aneurysm was treated using an off-pump hybrid procedure including supraaortic debranching combined with aortic stent grafting and oversewing of pulmonary artery end of the aneurysm. Postoperative computed tomography angiography showed persistent perfusion of the ductus Botalli aneurysm from pulmonary artery, which was successfully closed with an Amplatzer duct occluder. Twenty-two months of follow-up showed good general state of the patient's health status. This less invasive procedure is an alternative to aortic replacement under circulatory arrest and may be the only salvage option for patients in poor general condition.
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Affiliation(s)
- Jose Gil-Sales
- Servicio de Cirugía Vascular, Complejo Hospitalario de Toledo, Hospital Virgen de la Salud, Toledo, Spain
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Zoran Rancic
- Clinic for Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Dieter Mayer
- Clinic for Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Lyubov Chaykovska
- Clinic for Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland.
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Eine seltene kardiale Anomalie als Ursache einer schweren Gerinnungsstörung im Neugeborenenalter. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-3017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Chung BHY, Bradley T, Grosse-Wortmann L, Blaser S, Dirks P, Hinek A, Chitayat D. Hand and fibrillin-1 deposition abnormalities in Loeys-Dietz syndrome--expanding the clinical spectrum. Am J Med Genet A 2013; 164A:461-6. [PMID: 24194458 DOI: 10.1002/ajmg.a.36246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 08/21/2013] [Indexed: 11/06/2022]
Abstract
Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder characterized by hypertelorism, bifid uvula, cleft palate and arterial tortuosity. We report on a patient with LDS, bearing mutation in the TGFβR2 gene, whose prenatal examination demonstrated clenched fists and club feet, suggesting arthrogryposis multiplex congenita. Postnatal assessment showed digital abnormalities, including brachydactyly, camptodactyly, partial syndactyly and absent distal phalanges. With the lack of fibrillin-1 microfibril deposition as well as impaired and inadequate elastic fiber assembly in our patient's fibroblasts, we speculate that the skeletal abnormalities seen in this patient with LDS are the result of lack of these components in embryonal perichondrium and in blood vessels. We suggest that LDS should be included in the differential diagnosis of joint contractures seen pre and postnatally. Prenatal diagnosis of LDS would be important in parental counseling and early post natal diagnosis could prompt treatment before the development of detrimental vascular complications.
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Affiliation(s)
- Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, Centre for Reproduction, Growth and Development, The University of Hong Kong, Hong Kong, Hong Kong
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Jan SL, Fu YC, Chan SC, Lin MC. Ductus arteriosus aneurysm with persistent left superior vena cava in a neonate: A “Four-star sign” on echocardiography. Int J Cardiol 2013; 167:e49-50. [DOI: 10.1016/j.ijcard.2013.03.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 03/29/2013] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Fetal echocardiography plays a critical role in the diagnosis and management of structural, functional and rhythm-related fetal cardiovascular disease. OBJECTIVES/METHODS This article reviews the history of fetal echocardiography and the prenatal diagnosis of fetal cardiovascular disease as well as the evolution of the field of fetal cardiology. The clinical application of fetal echocardiography, including indications for referral, timing of referral and considerations in the diagnosis and serial assessment of fetal cardiovascular disease, is presented. CONCLUSIONS Newer directions in the field of fetal cardiology, including first trimester diagnoses and fetal intervention, will continue to expand its role in the evaluation and treatment of affected pregnancies in the future; however, equally as important are efforts to continue to improve prenatal detection rates.
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Affiliation(s)
- Lisa K Hornberger
- Professor of Pediatrics University of Alberta William C McKenzie Health Centre, Director of the Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics & Obstetrics, 4C2.23, 8440 112th Street, Edmonton, Alberta T6G2B7, Canada +1 780 407 3952 ; +1 780 407 3954 ;
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Jacques F, Grosse-Wortmann L, Hickey EJ, Chitayat D, Van Arsdell GS, Bradley TJ. Unexpected Contained Rupture of a Ductus Arteriosus Aneurysm Found at Surgical Repair in an Infant With Loeys-Dietz Syndrome. Ann Thorac Surg 2013; 95:710-1. [DOI: 10.1016/j.athoracsur.2012.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/11/2012] [Accepted: 06/21/2012] [Indexed: 10/27/2022]
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Morgan GJ, Yim DLS, Hayes AM, Martin RP, Hamilton MCK, Stuart G. Imaging and percutaneous occlusion of a large aneurysm of the ductus arteriosus in an infant with Loeys-Dietz syndrome. CONGENIT HEART DIS 2013; 8:E192-5. [PMID: 23350955 DOI: 10.1111/chd.12041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 11/28/2022]
Abstract
Loeys-Dietz is a multisystem congenital syndrome that comprises craniofacial and cutaneous abnormalities as well as structural cardiac defects. One of its key pathological features is an aggressive widespread vasculopathy that can manifest as aortic or cerebral aneurysms, which is prone to dissection and rupture. We report a case of a large aneurysm of the ductus arteriosus in a patient with Loeys-Dietz syndrome, successfully occluded by interventional catheterization.
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Affiliation(s)
- Gareth J Morgan
- Department of Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
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Abstract
Four neonates presented within 24 hours of birth with stridor, respiratory distress and a weak cry. Clinical examination of the cardiovascular system revealed no abnormality. The transthoracic echocardiogram showed large aneurysm of ductus arteriosus at the aortic isthmus, tapering to a small tortuous channel at the site of pulmonary artery insertion. Computerized tomography scan performed in two of the neonates demonstrated considerable compression of adjacent thoracic structures. One required surgical excision due to persistence of symptoms. Serial echocardiograms in the remaining three babies showed transition through various stages of resolution over a period of 6 weeks to 3 months, resulting in the obliteration of the aneurysm. All babies are doing well during the follow-up.
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Affiliation(s)
- Nageswara R Koneti
- Department of Pediatric Cardiology, CARE Institute of Medical Sciences, Hyderabad, India
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Suzue M, Mori K, Hayabuchi Y. Congenital ductus arteriosus aneurysm. J Echocardiogr 2012; 10:112-4. [PMID: 27278213 DOI: 10.1007/s12574-012-0137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 03/15/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Masashi Suzue
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1 Chome, 10-3 Kuramoto-cho, Tokushima, 770-8539, Japan.
| | - Kazuhiro Mori
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1 Chome, 10-3 Kuramoto-cho, Tokushima, 770-8539, Japan
| | - Yasunobu Hayabuchi
- Department of Pediatrics, School of Medicine, University of Tokushima, Tokushima, Japan
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Abstract
During fetal life, the ductus arteriosus is a normal and essential structure that connects the pulmonary artery to the distal aortic arch, permitting right ventricular ejection into the aorta. After birth, with commencement of pulmonary blood flow and a 2-ventricle circulation, a variety of physiological and biochemical signals normally result in complete closure of the ductus. Persistent patency of the ductus arteriosus may impair systemic cardiac output and result in deleterious effects on the cardiovascular system and lungs. Although surgery is still the treatment of choice for most premature infants with patent ductus arteriosus (PDA), transcatheter techniques have largely supplanted surgery for closure of PDA in children and adults. This article is a review of the PDA in term infants, children, and adults, with focus on the clinical manifestations and management.
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Affiliation(s)
- Douglas J Schneider
- Division of Pediatric Cardiology, Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA.
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Sheridan RM, Michelfelder EC, Choe KA, Divanovic A, Liu C, Ware S, Stanek J. Ductus arteriosus aneurysm with massive thrombosis of pulmonary artery and fetal hydrops. Pediatr Dev Pathol 2012; 15:79-85. [PMID: 21875340 DOI: 10.2350/11-02-0991-cr.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ductus arteriosus aneurysm (DAA) is a rare cardiovascular lesion usually diagnosed within the first 2 months of life, or less frequently in the 3rd trimester, by antenatal sonography. The true in utero incidence of DAA is unknown, as most affected fetuses are asymptomatic at birth. Potential complications include thromboembolism, rupture, and death. We report a unique lethal case of a large DAA detected by mid-2nd trimester fetal echocardiography, complicated by stricture and massive occlusive thrombosis extending into the pulmonary artery branches. Stricture and thrombosis of the DAA led to interruption of fetal circulation, cardiac failure, and fetal hydrops, ultimately resulting in fetal demise.
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Affiliation(s)
- Rachel M Sheridan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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