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Krcho P, Derco J, Juhas M, Donn S. Multiple vascular malformations in a newborn. J Neonatal Perinatal Med 2023; 16:731-734. [PMID: 38043022 PMCID: PMC10789358 DOI: 10.3233/npm-230097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/26/2023] [Indexed: 12/04/2023]
Abstract
We describe the case of a term newborn who presented with congenital testicular torsion at 10 hours of age. During the evaluation of this problem, additional malformations were encountered. Diagnostic and therapeutic considerations are addressed.
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Affiliation(s)
- P. Krcho
- Department of Pediatrics (Neonatology), Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - J. Derco
- Department of Pediatrics (Neonatology), Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - M. Juhas
- Center for Fetal and Gynecological Diagnostics, JUHAMED, Košice, Slovak Republic
| | - S.M. Donn
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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2
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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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3
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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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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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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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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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Ardhanari M, Colin A, Tekin M, Infante JC, Swaminathan S. Aneurysmal Dilatation of Ductus Arteriosus and Pulmonary Artery in Association With ACTA2 Mutation. World J Pediatr Congenit Heart Surg 2020; 11:NP498-NP500. [PMID: 32452246 DOI: 10.1177/2150135120902120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Actin α2 (ACTA2) is a protein crucial for proper functioning of contractile apparatus in smooth muscles. A specific mutation resulting in substitution of arginine at position 179 by histidine (p.R179 H) in ACTA2 has been shown to be associated with multisystemic smooth muscle dysfunction syndrome. Characteristic features include aneurysmal arterial disease. Due to rarity of this disease, we report a nine-year-old girl with this rare genetic variant in whom cardiovascular manifestations were identified in fetal life and who needed neonatal cardiac surgical intervention.
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Affiliation(s)
- Mohanageetha Ardhanari
- Division of Pediatric Cardiology, Department of Pediatrics, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Andrew Colin
- Division of Pediatric Pulmonology, Department of Pediatrics, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Mustafa Tekin
- Dr. John T. MacDonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Juan C Infante
- Department of Radiology, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sethuraman Swaminathan
- Division of Pediatric Cardiology, Department of Pediatrics, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Miami, FL, USA
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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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Karmegaraj B, Rajeshkannan R, Kappanayil M, Vaidyanathan B. Fetal descending aortic tortuosity with ductal aneurysm. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:142-144. [PMID: 31021025 DOI: 10.1002/uog.20303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- B Karmegaraj
- Division of Fetal Cardiology, Department of Pediatric Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - R Rajeshkannan
- Department of Radiodiagnosis, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - M Kappanayil
- Division of Fetal Cardiology, Department of Pediatric Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - B Vaidyanathan
- Division of Fetal Cardiology, Department of Pediatric Cardiology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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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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11
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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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12
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Walker JC, Dikkers R, Halmos GB, Berger RMF, du Marchie Sarvaas GJ. Ductus arteriosus aneurysm and vocal cord paralysis. Circulation 2015; 131:1713-4. [PMID: 25964282 DOI: 10.1161/circulationaha.114.013568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer C Walker
- From the Departments of Pediatric Cardiology (J.C.W., R.M.F.B., G.J.d.M.S.), Radiology (R.D.), and Otolaryngology, Head and Neck Surgery (G.B.H.), University Medical Center Groningen, University of Groningen, The Netherlands, Center for Congenital Heart Diseases, Beatrix Children's Hospital
| | - Riksta Dikkers
- From the Departments of Pediatric Cardiology (J.C.W., R.M.F.B., G.J.d.M.S.), Radiology (R.D.), and Otolaryngology, Head and Neck Surgery (G.B.H.), University Medical Center Groningen, University of Groningen, The Netherlands, Center for Congenital Heart Diseases, Beatrix Children's Hospital
| | - Gyorgy B Halmos
- From the Departments of Pediatric Cardiology (J.C.W., R.M.F.B., G.J.d.M.S.), Radiology (R.D.), and Otolaryngology, Head and Neck Surgery (G.B.H.), University Medical Center Groningen, University of Groningen, The Netherlands, Center for Congenital Heart Diseases, Beatrix Children's Hospital
| | - Rolf M F Berger
- From the Departments of Pediatric Cardiology (J.C.W., R.M.F.B., G.J.d.M.S.), Radiology (R.D.), and Otolaryngology, Head and Neck Surgery (G.B.H.), University Medical Center Groningen, University of Groningen, The Netherlands, Center for Congenital Heart Diseases, Beatrix Children's Hospital
| | - Gideon J du Marchie Sarvaas
- From the Departments of Pediatric Cardiology (J.C.W., R.M.F.B., G.J.d.M.S.), Radiology (R.D.), and Otolaryngology, Head and Neck Surgery (G.B.H.), University Medical Center Groningen, University of Groningen, The Netherlands, Center for Congenital Heart Diseases, Beatrix Children's Hospital.
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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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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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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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Oh SJ, Jeung IC. A case of isolated congenital ductus arteriosus aneurysm detected by fetal echocardiography at 38 weeks of gestation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:530-533. [PMID: 21647917 DOI: 10.1002/jcu.20840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 03/31/2011] [Indexed: 05/30/2023]
Abstract
A 30 year-old pregnant woman (G1P0) was diagnosed with fetal ductus arteriosus aneurysm (DAA) at 38 weeks of gestation. The three-vessel view of the heart and the sagittal view of the ductal arch showed a 12-mm fusiform dilatation of the ductus arteriosus. Turbulent flow was detected in it by color Doppler. DAA was confirmed by postnatal echocardiography within 24 hours after birth and it spontaneously closed in the neonatal period. Congenital DAA, usually developed in the third trimester, is potentially fatal due to the possible complications such as spontaneous rupture, dissection, and thromboembolism.
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Affiliation(s)
- Sae Jeong Oh
- Department of Obstetrics and Gynecology, Cheong Wha Women's Medical Center, Seoul, Korea
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Diagnosis of ductal aneurysm using three-dimensional CT reconstruction. Pediatr Cardiol 2010; 31:301-2. [PMID: 20012033 DOI: 10.1007/s00246-009-9569-0] [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: 08/26/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
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Scott CK, Meyer D, Phoon CK, Srichai MB. Ductal Arteriosus Aneurysm, Right Aortic Arch, and Isolated Left Subclavian Artery in a Neonate. CONGENIT HEART DIS 2009; 4:187-9. [DOI: 10.1111/j.1747-0803.2008.00235.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Franklin RCG, Slavik Z. Real time three-dimensional echocardiography moves towards clinically useful neonatal cardiovascular imaging. Int J Cardiol 2005; 105:306-7. [PMID: 16274773 DOI: 10.1016/j.ijcard.2005.03.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 03/25/2005] [Indexed: 11/30/2022]
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Tseng JJ, Jan SL. Fetal echocardiographic diagnosis of isolated ductus arteriosus aneurysm: a longitudinal study from 32 weeks of gestation to term. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:50-6. [PMID: 15926189 DOI: 10.1002/uog.1859] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To investigate the echocardiographic characteristics of isolated fetal ductus arteriosus aneurysm (DAA) and the factors influencing its development. METHODS Fetal echocardiograms for 509 low-risk singleton pregnancies were performed longitudinally from 32 weeks of gestation. The ventricular outflow tracts and great vessels were visualized, focusing on changes in the ductus arteriosus (DA), and fetuses with DAA or ductus arteriosus dilatation (DAD) were identified. Prenatal and perinatal findings were compared between those infants diagnosed postnatally with and those without neonatal DAA. RESULTS Forty-one of the 509 fetuses (8.1%) studied had neonatal DAA; 2.2% (11/509) had DAA and 5.9% (30/509) DAD before delivery. The mean gestational age at the time of diagnosis of fetal DAA/DAD was 36.9 +/- 1.7 weeks. The mean maximal internal diameter of DAA/DAD was 8.0 +/- 0.8 mm at initial diagnosis, increasing to 10.8 +/- 1.6 mm before delivery. All cases originated from the aortic end of the DA. Compared with fetuses without neonatal DAA, the affected cases had a markedly more curved DA prior to diagnosis, and higher peak velocities at the aortic end of the DA (P < 0.05). Newborns with fetal DAA/DAD had a larger placental weight to birth body weight (BBW) ratio and were less likely to have a BBW appropriate for gestational age (P < 0.05). All cases of fetal DAA/DAD regressed spontaneously. CONCLUSION Isolated neonatal DAA is a continuity of fetal DAA/DAD. The development of fetal DAA/DAD is likely to be related to the higher peak velocities in the more markedly curved DA occurring in the latter part of the third trimester. Fetal DAA/DAD usually initiates at the aortic end of the DA, followed by progression towards the pulmonary end.
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Affiliation(s)
- J J Tseng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Jackson CM, Sandor GGS, Lim K, Duncan WJ, Potts JE. Diagnosis of fetal ductus arteriosus aneurysm: importance of the three-vessel view. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:57-62. [PMID: 15971287 DOI: 10.1002/uog.1927] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To present four cases of ductus arteriosus aneurysm (DAA) detected by fetal echocardiography and highlight the value of the three-vessel view in the diagnosis of DAA. METHODS In addition to the standard fetal echocardiographic views, we examined the three-vessel view in four cases of DAA. The three-vessel view was achieved by sliding the transducer cranially from the four-chamber plane toward the fetal upper mediastinum to demonstrate cross-sections of the main pulmonary artery, the ascending aorta and superior vena cava arranged in a straight line from the left anterior to the right posterior aspect of the mediastinum. DAA was diagnosed when there was a tortuous ductus arteriosus with a dilation that protruded leftward of the aortic arch. CASE SERIES In the first case, an insulin-dependent diabetic woman underwent fetal ultrasound examination at 36 weeks' gestation showing right-to-left cardiac disproportion and bidirectional flow in the aorta and main pulmonary artery (PA). The three-vessel view showed a dilated ductus arteriosus (DA) which was stenosed at its distal end. In the second case, a woman had fetal ultrasound scans at 38 and 39 weeks' gestation for suspected intrauterine growth restriction and oligohydramnios. The scans identified an abnormal aortic arch and the three-vessel view showed an elongated vascular structure at the distal end of the PA, which was the DAA. In the third case, a woman with a high-risk obstetric history had multiple scans showing an abnormal PA to aorta relationship, with an apparent 'kink' in the PA. The three-vessel view clarified that this was the DAA. In the fourth case, a woman was scanned because of a 3-kg weight gain in 1 week. The fetal ultrasound scan showed moderate polyhydramnios with normal fetal growth and normal intracardiac anatomy and flow, and the three-vessel view demonstrated a large DA. In each of these cases, the DAA appeared to have occurred in isolation with non-specific clinical findings. CONCLUSION We advocate the use of the three-vessel view, in conjunction with the standard echocardiography views currently employed, to assist in the diagnosis of DAA.
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Affiliation(s)
- C M Jackson
- Division of Cardiology, Department of Paediatrics, Children's and Women's Health Centre of British Columbia and The University of British Columbia, Vancouver, B.C., Canada
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