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Li T, Han J, Han Y, Liu X, Gu X, Zhang Y, Sun L, Zhao Y, Gao S, Hao X, He Y. Evaluation of changes of cardiac morphology and function in fetuses with ductus arteriosus constriction by Speckle-tracking echocardiography. Front Pediatr 2023; 11:1085352. [PMID: 36816371 PMCID: PMC9932508 DOI: 10.3389/fped.2023.1085352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Premature ductus arteriosus constriction (DA Con) can result in right ventricular enlargement, right ventricular hypertrophy, and tricuspid regurgitation. METHOD This study retrospectively analyzed 34 singleton fetuses that underwent fetal echocardiography with a diagnosis of DA Con (16 cases with mild to moderate, and 18 cases with moderate to severe) and 45 healthy fetuses. The morphology and function parameters of cardiac, as well as the 24-Segment of ventricles, were compared between the DA Con group and controls, and between the mild to moderate and moderate to severe groups, using the fetal heart quantification (FHQ) technology. RESULTS There were no significant difference in left ventricular parameters in DA Con group when compared to controls. Moreover, fetal 4CV-GSI was significantly reduced, as well as the sphericity index (SI), fractional shortening (FS), global longitudinal strain (GS) and fractional area change (FAC) of right ventricle, especially in the basal-middle segments. Compared with the mild to moderate group, LV-FS increased and RV-FS decreased in moderate to severe group. CONCLUSION The results showed that the fetal heart in the DA Con group was different from the controls in morphology and function. FHQ technology provides a comprehensive assessment for the evaluation of cardiac morphological and functional changes in DA Con fetuses.
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Affiliation(s)
- Tianjing Li
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Ultrasound, out-Patient Department, Communication University of China, Beijing, China
| | - Jiancheng Han
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanli Han
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Zhao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Gao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiuxiu Hao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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2
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Battistoni G, Montironi R, Di Giuseppe J, Giannella L, Delli Carpini G, Baldinelli A, Pozzi M, Ciavattini A. Foetal ductus arteriosus constriction unrelated to non-steroidal anti-Inflammatory drugs: a case report and literature review. Ann Med 2021; 53:860-873. [PMID: 34096417 PMCID: PMC8189142 DOI: 10.1080/07853890.2021.1921253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
Foetal ductus arteriosus (DA) constriction can be found in complex foetal heart malformations, but rarely as an isolated defect. Although many cases of DA constriction are usually related to Non-steroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake, other causes remain without an established aetiology and are referred to as idiopathic. Recently, a wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) showed a definitive effect upon the pathway of inflammation, causing DA constriction. We report a case of a premature DA constriction in a woman whose possible risk factor was identified in her maternal occupational exposure to solvents and a comprehensive literature review of 176 cases of NSAID-unrelated DA constriction. A 30-year-old Asian woman was referred to our institution at 33 gestational weeks and 0 days because of suspicion of premature DA constriction. The woman had no history of medication intake, including NSAIDs, alcohol, tobacco or polyphenol-rich-food consumption during pregnancy. A detailed foetal echocardiography revealed a normal cardiac anatomy with hypertrophic, hypokinetic and a dilated right ventricle due to right pressure overload, holosystolic tricuspid regurgitation, and, at the level of the DA, high systolic and diastolic velocities, indicating premature ductal restriction. The right outflow showed dilatation of the pulmonary artery with narrow DA. An urgent caesarean section was performed at 33 gestational weeks and 4 days due to worsening of DA PI and signs of right pressure overload, despite the interruption of exposure to solvents. We assume a relationship exists between premature DA constriction and a maternal occupational exposure to solvents. This hypothesis is reinforced by the presence of associated foetal malformations in in two of the patient's children. Further research is needed to confirm the role of exposure to solvents and toxic chemicals in the pathogenesis of DA constriction, also with experimental animal models.KEY MESSAGESMany cases of DA constriction are usually related to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake.A wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) can cause foetal DA constriction.Further investigation are needed to confirm the role of maternal exposure to solvents in the pathogenesis of DA constriction.
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Affiliation(s)
- Giovanna Battistoni
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Ramona Montironi
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Luca Giannella
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Baldinelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
| | - Marco Pozzi
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
| | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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3
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Zhang X, Haneishi H, Liu H. Impact of ductus arteriosus constriction and restrictive foramen ovale on global hemodynamics for term fetuses with d-TGA. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3231. [PMID: 31257729 DOI: 10.1002/cnm.3231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 06/09/2023]
Abstract
The ductus arteriosus (DA) constriction and restrictive foramen ovale (FO) are known as the leading cause of compromise and death of fetuses with dextro-transposition of the great arteries (d-TGA). Although the d-TGA fetal hemodynamics is of great importance in making diagnosis and management of the congenital heart defect, it remains poorly understood, particularly in terms of abnormal DA and FO. In this study, we developed a closed-loop 0-1D multiscale model of the fetal cardiovascular system (CVS) specified for the d-TGA circulation and conducted a systematic study of the impact of the DA constriction and restrictive FO on fetal hemodynamics. We found that the DA constriction led to a pronounced increase in the pulmonary artery pressure, pulmonary and mitral valve (PV and MV) regurgitation as well as left heart volume; the restrictive FO was responsible for reducing MV E/A ratio, ie, the ratio of peak early filling and late diastolic filling velocities, and PV peak systolic flow (PSV) but could increase both aortic valve (AV) PSV and aortic isthmus systolic index (ISI). Moreover, the amount of blood flowing through the DA was observed equivalent to that through the FO; the influence of DA constriction on the cerebral and placental perfusions are larger than that of the FO. Our results demonstrate that the proposed fetal cardiovascular model may be a useful tool for studying the underlying mechanisms associated with d-TGA fetal circulation and providing insights into its complex physiology and pathology.
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Affiliation(s)
- Xiancheng Zhang
- Graduate School of Engineering, Chiba University, Inage, Chiba, Japan
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering, Chiba University, Inage, Chiba, Japan
| | - Hao Liu
- Graduate School of Engineering, Chiba University, Inage, Chiba, Japan
- Shanghai Jiao Tong University and Chiba University International Cooperative Research Center (SJTU-CU ICRC), Shanghai, China
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4
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Stephens EH, Dearani JA, Qureshi MY, Segura LG, Arendt KW, Bendel-Stenzel EM, Ruano R. Toward Eliminating Perinatal Comfort Care for Prenatally Diagnosed Severe Congenital Heart Defects: A Vision. Mayo Clin Proc 2021; 96:1276-1287. [PMID: 33958058 DOI: 10.1016/j.mayocp.2020.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/25/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
Over the past 40 years, the medical and surgical management of congenital heart disease has advanced considerably. However, substantial room for improvement remains for certain lesions that have high rates of morbidity and mortality. Although most congenital cardiac conditions are well tolerated during fetal development, certain abnormalities progress in severity over the course of gestation and impair the development of other organs, such as the lungs or airways. It follows that intervention during gestation could potentially slow or reverse elements of disease progression and improve prognosis for certain congenital heart defects. In this review, we detail specific congenital cardiac lesions that may benefit from fetal intervention, some of which already have documented improved outcomes with fetal interventions, and the state-of-the-science in each of these areas. This review includes the most relevant studies from a PubMed database search from 1970 to the present using key words such as fetal cardiac, fetal intervention, fetal surgery, and EXIT procedure. Fetal intervention in congenital cardiac surgery is an exciting frontier that promises further improvement in congenital heart disease outcomes. When fetuses who can benefit from fetal intervention are identified and appropriately referred to centers of excellence in this area, patient care will improve.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Leal G Segura
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ellen M Bendel-Stenzel
- Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN; Division of Neonatal Medicine, Mayo Clinic, Rochester, MN
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN
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5
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Bakas AM, Healy HM, Bell KA, Brown DW, Mullen M, Scheid A. Prenatal duct closure leading to severe pulmonary hypertension in a preterm neonate-a case report. Cardiovasc Diagn Ther 2020; 10:1691-1695. [PMID: 33224782 DOI: 10.21037/cdt-20-123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prenatal closure of the ductus arteriosus (DA) can lead to cardiovascular dysfunction resulting in pulmonary hypertension (PH), progressive right heart failure, fetal hydrops, and fetal or neonatal demise. Supportive therapies-including mechanical ventilation, oxygen, and nitric oxide (NO)-have been employed with variable success among infants born full term, but there is no widely accepted management of prenatal closure of the DA, particularly for preterm infants. We present the case of an infant born at 31 weeks' gestation with right ventricular (RV) dysfunction and PH due to prenatal ductal closure, who was successfully treated with milrinone, resulting in full recovery of cardiac function. Prenatal ductal closure is rare, particularly under 32 weeks gestation, but should be suspected in cases of postnatal hypoxemia in the absence of significant lung disease or structural heart disease. Milrinone may be considered as a therapeutic agent to treat both PH and RV dysfunction in preterm infants status post in utero closure of the DA.
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Affiliation(s)
- Anna M Bakas
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Helen M Healy
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katherine A Bell
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary Mullen
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Annette Scheid
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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6
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Abstract
Constriction of the fetal ductus arteriosus is rare and usually attributed to medications or CHD. We describe a 24-year-old multigravida at 33 weeks 5 days gestation with echocardiographic findings of severe ductal constriction, a dilated, hypertrophied and hypocontractile right ventricle, and severe tricuspid regurgitation following BC powder® use. Treatment with Digoxin and oxygen resulted in a progressive 71% reduction in peak systolic ductal gradient, improved right ventricular function, and decreased tricuspid regurgitation.
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7
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Pedra SRFF, Zielinsky P, Binotto CN, Martins CN, Fonseca ESVBD, Guimarães ICB, Corrêa IVDS, Pedrosa KLM, Lopes LM, Nicoloso LHS, Barberato MFA, Zamith MM. Brazilian Fetal Cardiology Guidelines - 2019. Arq Bras Cardiol 2019; 112:600-648. [PMID: 31188968 PMCID: PMC6555576 DOI: 10.5935/abc.20190075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Simone R F Fontes Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.,Hospital do Coração (HCor), São Paulo, SP - Brazil
| | - Paulo Zielinsky
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
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8
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Liu L, Wang HD, Cui CY, Yao HM, Huang L, Li T, Fan TB, Peng BT, Zhang LZ. Investigating the characteristics of echocardiogram, surgical treatment, chromosome and prognosis for fetal right heart enlargement: A STROBE-compliant article. Medicine (Baltimore) 2018; 97:e13307. [PMID: 30508919 PMCID: PMC6283138 DOI: 10.1097/md.0000000000013307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prognosis of right heart enlargement varies according to different etiologies. The purpose of this study was to investigate the characteristics of echocardiogram, surgical treatment, chromosome and prognosis for fetal right heart enlargement.The foetal echocardiogram was performed on 3987 pregnant women, and then 88 fetuses with right heart enlargement were identified. The data about prenatal and postnatal echocardiograms, postnatal cardiac surgical treatment, karyotype analysis and autopsy after induced labor were analyzed in the 88 fetuses.Except the 1111 cases that had loss of follow-up, 2876 cases had complete data. Among the 2876 cases, right heart enlargement was identified in 88 fetuses. Of the 88 fetuses, 15 had total atrioventricular septal defect (unbalanced type: right ventricular dominance), 15 Ebstein's anomaly, 18 fallot tetrad, 14 double outlet right ventricle, 13 total anomalous pulmonary venous drainage, and 13 premature closure of ductus arteriosus. Chromosomal abnormality was found in 12 cases.There are many etiological factors causing right heart enlargement. The prognosis is better in the fetuses with single heart malformation than in the fetuses who have extracardiac malformation or/and chromosomal abnormality besides heart malformation. Fetal echocardiography combined with karyotype analysis can provide important bases for evaluating the prognosis of fetuses with right heart enlargement.
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Affiliation(s)
- Lin Liu
- Department of Cardiovascular Ultrasound, Henan Provincial People's Hospital, China
| | - Hong-Dan Wang
- Institute of Medical Genetics, Henan Provincial People's Hospital, China
| | - Cun-Ying Cui
- Department of Cardiovascular Ultrasound, Henan Provincial People's Hospital, China
| | - Hui-Mei Yao
- Department of Ultrasound, the Seventh People's Hospital, China
| | - Lei Huang
- Department of Ultrasound, the Seventh People's Hospital, China
| | - Tao Li
- Institute of Medical Genetics, Henan Provincial People's Hospital, China
| | - Tai-Bing Fan
- Children's Heart Center, Henan Provincial People's Hospital, China
| | - Bang-Tian Peng
- Children's Heart Center, Henan Provincial People's Hospital, China
| | - Lian-Zhong Zhang
- Department of Cardiovascular Ultrasound, Henan Provincial People's Hospital, China
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9
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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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10
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Abstract
This article reports a rare but potentially serious complication of ductus arteriosus closure resulting from second‐trimester indomethacin exposure. Serial echocardiograms are indicated to monitor for development of right heart dysfunction and to ensure delivery prior to the onset of right heart failure and hydrops fetalis.
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Affiliation(s)
- Jeanette I Beaute
- Boston Children's Hospital Boston Massachusetts 02115.,University of Massachusetts Medical School Worcester Massachusetts
| | - Kevin G Friedman
- Boston Children's Hospital Boston Massachusetts 02115.,Harvard Medical School Boston Massachusetts 02115
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11
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Tanaka S, Kanagawa T, Momma K, Hori S, Satoh H, Nagamatsu T, Fujii T, Kimura T, Sawada Y. Prediction of sustained fetal toxicity induced by ketoprofen based on PK/PD analysis using human placental perfusion and rat toxicity data. Br J Clin Pharmacol 2017. [PMID: 28635050 DOI: 10.1111/bcp.13352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM We encountered a case of fetal toxicity due to ductus arteriosus (DA) constriction in a 36-week pregnant woman who had applied multiple ketoprofen patches. The aim of the present study was to present the case and develop a model to predict quantitatively the fetal toxicity risk of transdermal administration of ketoprofen. METHODS Human placenta perfusion studies were conducted to estimate transplacental pharmacokinetic (PK) parameters. Using a developed model and these parameters, human fetal plasma concentration profiles of ketoprofen administered to mothers were simulated. Using pregnant rats, DA constriction and fetal plasma drug concentration after ketoprofen administration were measured, fitted to an Emax model, and extrapolated to humans. RESULTS Transplacental transfer value at the steady state of ketoprofen was 4.82%, which was approximately half that of antipyrine (passive marker). The model and PK parameters predicted almost equivalent mother and fetus drug concentrations at steady state after transdermal ketoprofen administration in humans. Maximum DA constriction and maximum plasma concentration of ketoprofen after administration to rat dams were observed at different times: 4 h and 1 h, respectively. The model accurately described the delay in DA constriction with respect to the fetal ketoprofen concentration profile. The model with effect compartment and the obtained parameters predicted that use of multiple ketoprofen patches could potentially cause severe DA constriction in the human fetus, and that fetal toxicity might persist after ketoprofen discontinuation by the mother, as observed in our case. CONCLUSION The present approach successfully described the sustained fetal toxicity after discontinuing the transdermal administration of ketoprofen.
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Affiliation(s)
- Shingo Tanaka
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
| | - Takeshi Kanagawa
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Kazuo Momma
- Department of Pediatric Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Satoko Hori
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
| | - Hiroki Satoh
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasufumi Sawada
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
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12
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Abstract
BACKGROUND A number of case reports show various outcomes of premature closure of the ductus arteriosus in utero, including persistent pulmonary hypertension of the newborn and fetal or neonatal death; however, no study clarifies the clinical observations that are related to their prognoses. We aimed to clarify the prognostic factors of intrauterine ductal closure by a systematic literature review. Data sources We searched PubMed database (1975-2014) to identify case reports and studies on intrauterine closure of the ductus arteriosus, including maternal, fetal, and neonatal clinical information and their prognoses. RESULTS We analysed the data of 116 patients from 39 articles. Of these, 12 (10.3%) died after birth or in utero. Fetal or neonatal death was significantly correlated with fetal hydrops (odds ratio=39.6, 95% confidence interval=4.6-47.8) and complete closure of the ductus arteriosus (odds ratio=5.5, 95% confidence interval=1.2-15.1). Persistent pulmonary hypertension was observed in 33 cases (28.4%), and was also correlated with fetal hydrops (odds ratio=4.2, 95% confidence interval=1.3-4.6) and complete closure of the ductus arteriosus (odds ratio=5.5, 95% confidence interval=1.6-6.0). Interestingly, maternal drug administration was not correlated with the risk of death and persistent pulmonary hypertension. CONCLUSIONS Fetal hydrops and complete ductal closure are significant risk factors for both death and persistent pulmonary hypertension. Cardiac or neurological prognoses could be favourable if the patients overcome right heart failure during the perinatal period.
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13
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Ndour DD. [Maternal use of non-steroidal antiinflammatory drugs and closure of the ductus arteriosus]. Pan Afr Med J 2017; 25:251. [PMID: 28293367 PMCID: PMC5337287 DOI: 10.11604/pamj.2016.25.251.10317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/02/2016] [Indexed: 11/11/2022] Open
Abstract
Nous rapportons un cas de fermeture prématurée in utero du canal artériel diagnostiqué chez un fœtus en état d’anasarque avec insuffisance cardiaque majeure après prise d’anti-inflammatoire non stéroïdiens (AINS) par la mère. Une échographie obstétricale au deuxième trimestre a permis la découverte d’une asymétrie des cavités cardiaques. L’indication de césarienne a été posée à 30 semaines d’aménorrhées devant un fœtus en état d’anasarque avec insuffisance cardiaque majeure sur une fermeture anténatale du canal artériel. A partir de ce cas nous nous proposons de réaliser une revue de la littérature pour illustrer les complications fœtales et néonatales potentielles résultant de la fermeture précoce du canal artériel secondaire à la prise d’AINS pendant la grossesse.
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Affiliation(s)
- Daouda Diamane Ndour
- Service de Néonatologie et Réanimation Néonatale, Centre Hospitalier Universitaire Albert Royer Dakar, Université Cheikh Anta Diop de Dakar BP: 5005 Dakar-Fann, Sénégal
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14
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Maternal diclofenac medication in pregnancy causing in utero closure of the fetal ductus arteriosus and hydrops. Pediatr Cardiol 2014; 34:1925-7. [PMID: 22872018 DOI: 10.1007/s00246-012-0461-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
Abstract
This report describes a case of premature closure in utero of the ductus arteriosus (DA) diagnosed postnatally in a baby with hydrops and cardiac failure. An echocardiogram 6 h postnatally showed marked dilation of the right atrium and right ventricle with marked hypertrophy and impaired function, elevated pulmonary pressures, a small pericardial effusion, and no flow through the DA. The mother was unaware of her pregnancy until she presented in labor, and she had taken diclofenac medication in the preceding months. This case and the accompanying literature review illustrate the potential fetal and neonatal complications resulting from antenatal closure of the DA due to maternal diclofenac medication during pregnancy.
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15
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Choi EY, Li M, Choi CW, Park KH, Choi JY. A case of progressive ductal constriction in a fetus. Korean Circ J 2013; 43:774-81. [PMID: 24363755 PMCID: PMC3866319 DOI: 10.4070/kcj.2013.43.11.774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/05/2013] [Accepted: 07/17/2013] [Indexed: 11/11/2022] Open
Abstract
The ductus arteriosus is a normal and essential structure in fetal circulation. Since the introduction of fetal echocardiography, there have been reports of ductal constriction, many of which were related to maternal use of some medications. However, there have been some reports of idiopathic ductal constriction, which usually present in later gestation. Recently we experienced a case, which initially showed an S-shaped ductus with mild narrowing at 23 weeks and 27 weeks gestation and developed severe ductal constriction at 33 weeks. Soon after birth, ductus was searched for but no ductus was found in 2-D and color images. The neonate required mechanical ventilation with supplemental oxygen for 3 days. All echocardiographic abnormalities were normalized in 7 months. We report progressive ductal constriction in an S-shaped ductus and emphasize the importance of continuous follow up extending to the third trimester and even immediately after birth.
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Affiliation(s)
- Eun Young Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Meihua Li
- Department of Pediatric Cardiology, Harbin Children's Hospital, Harbin, China
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Yun Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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