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Villalaín C, D'Antonio F, Flacco ME, Gómez-Montes E, Herraiz I, Deiros-Bronte L, Maskatia SA, Phillips AA, Contro E, Fricke K, Bhawna A, Beattie MJ, Moon-Grady AJ, Durand I, Slodki M, Respondek-Liberska M, Patel C, Kawamura H, Rizzo G, Pagani G, Galindo A. Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta-analysis. Ultrasound Obstet Gynecol 2024; 63:446-456. [PMID: 38197327 DOI: 10.1002/uog.27576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA). METHODS An individual participant data meta-analysis was performed to report on the strength of association and diagnostic accuracy of different ultrasound signs in detecting CoA prenatally. MEDLINE, EMBASE and CINAHL were searched for studies published between January 2000 and November 2021. Inclusion criteria were fetuses with suspected isolated CoA, defined as ventricular and/or great vessel disproportion with right dominance on ultrasound assessment. Individual participant-level data were obtained by two leading teams. PRISMA-IPD and PRISMA-DTA guidelines were used for extracting data, and the QUADAS-2 tool was used for assessing quality and applicability. The reference standard was CoA, defined as narrowing of the aortic arch, diagnosed after birth. The most commonly evaluated parameters on ultrasound, both in B-mode and on Doppler, constituted the index test. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and likelihood ratios were computed using the hierarchical summary receiver-operating-characteristics model. RESULTS The initial search yielded 72 studies, of which 25 met the inclusion criteria. Seventeen studies (640 fetuses) were included. On random-effects logistic regression analysis, tricuspid valve/mitral valve diameter ratio > 1.4 and > 1.6, aortic isthmus/arterial duct diameter ratio < 0.7, hypoplastic aortic arch (all P < 0.001), aortic isthmus diameter Z-score of < -2 in the sagittal (P = 0.003) and three-vessel-and-trachea (P < 0.001) views, pulmonary artery/ascending aorta diameter ratio > 1.4 (P = 0.048) and bidirectional flow at the foramen ovale (P = 0.012) were independently associated with CoA. Redundant foramen ovale was inversely associated with CoA (P = 0.037). Regarding diagnostic accuracy, tricuspid valve/mitral valve diameter ratio > 1.4 had a sensitivity of 72.6% (95% CI, 48.2-88.3%), specificity of 65.4% (95% CI, 46.9-80.2%) and DOR of 5.02 (95% CI, 1.82-13.9). The sensitivity and specificity values were, respectively, 75.0% (95% CI, 61.1-86.0%) and 39.7% (95% CI, 27.0-53.4%) for pulmonary artery/ascending aorta diameter ratio > 1.4, 47.8% (95% CI, 14.6-83.0%) and 87.6% (95% CI, 27.3-99.3%) for aortic isthmus diameter Z-score of < -2 in the sagittal view and 74.1% (95% CI, 58.0-85.6%) and 62.0% (95% CI, 41.6-78.9%) for aortic isthmus diameter Z-score of < -2 in the three-vessel-and-trachea view. Hypoplastic aortic arch had a sensitivity of 70.0% (95% CI, 42.0-88.6%), specificity of 91.3% (95% CI, 78.6-96.8%) and DOR of 24.9 (95% CI, 6.18-100). The diagnostic yield of prenatal ultrasound in detecting CoA did not change significantly when considering multiple categorical parameters. Five of the 11 evaluated continuous parameters were independently associated with CoA (all P < 0.001) but all had low-to-moderate diagnostic yield. CONCLUSIONS Several prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combinations of parameters are considered. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Villalaín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - F D'Antonio
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - M E Flacco
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - E Gómez-Montes
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - I Herraiz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - L Deiros-Bronte
- Department of Pediatric Cardiology, La Paz Children's Hospital, Madrid, Spain
| | - S A Maskatia
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - A A Phillips
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - E Contro
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, S. Orsola University Hospital, Bologna, Italy
| | - K Fricke
- Department of Clinical Sciences Lund, Pediatric Cardiology, Lund University, Skane University Hospital, Lund, Sweden
| | - A Bhawna
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - M J Beattie
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - A J Moon-Grady
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - I Durand
- Department of Pediatrics, Rouen University Hospital, Rouen, France
| | - M Slodki
- Medicine Faculty, Mazovian University in Plock, Plock, Poland
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute in Lodz, Lodz, Poland
| | - M Respondek-Liberska
- Department for Diagnosis and Prevention of Congenital Malformations, Medical University of Lodz, Lodz, Poland
- Fetal Cardiology Department Polish Mother's Memorial Hospital, Lodz, Poland
| | - C Patel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - H Kawamura
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - G Pagani
- Department of Obstetrics and Gynecology, ASST-Papa Giovanni XXIII, Maternal Fetal Medicine Unit, Bergamo, Italy
| | - A Galindo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
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Boelman MB, Hansen TVO, Smith MN, Hammer-Hansen S, Christensen AH, Diness BR. Aortic dissection in a young male with persistent ductus arteriosus and a novel variant in MYLK. Am J Med Genet A 2024; 194:e63458. [PMID: 37921548 DOI: 10.1002/ajmg.a.63458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023]
Abstract
Pathogenic variants in several genes involved in the function or regulation of smooth muscle cells (SMC) are known to predispose to congenital heart disease and thoracic aortic aneurysm and dissection (TAAD). Variants in MYLK are primarily known to predispose to TAAD, but a growing body of evidence points toward MYLK also playing an essential role in the regulation of SMC contraction outside the aorta. In this case report, we present a patient with co-occurrence of persistent ductus arteriosus (PDA) and thoracic aortic dissection. Genetic analyses revealed a novel splice acceptor variant (c.3986-1G > A) in MYLK, which segregated with disease in the family. RNA-analyses on fibroblasts showed that the variant induced skipping of exon 24, which resulted in an in-frame deletion of 101 amino acids. These findings suggest that MYLK-associated disease could include a broader phenotypic spectrum than isolated TAAD, including PDA and obstructive pulmonary disease. Genetic analyses could be considered in families with TAAD and PDA or obstructive pulmonary disease.
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Affiliation(s)
| | - Thomas van Overeem Hansen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Birgitte Rode Diness
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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3
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Karmegaraj B. Three- and Four-Dimensional Imaging of Ductus Arteriosus in Fetuses With Pulmonary Atresia and Aortic Arch Abnormalities. J Ultrasound Med 2024; 43:609-616. [PMID: 38050801 DOI: 10.1002/jum.16385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
Advances in fetal echocardiography including newer techniques like 4D spatio-temporal image correlation technology has improved our understanding of fetal cardiac and extracardiac abnormalities. High resolution ultrasound combined with color Doppler and 3D rendering have contributed to an improved understanding of the fetal vascular system and its anomalies. This pictorial essay including ultrasound images and videos alongside their respective clay models, provides precise information of duct anatomy in fetuses with pulmonary atresia and aortic arch abnormalities.
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Affiliation(s)
- Balaganesh Karmegaraj
- Sowmi Pediatric Heart Centre, Swasthik Fetal Heart Unit, Tirunelveli, India
- Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zielinsky P, Sulis NM, Martins CM, Zucatti KP, Bonamigo ER, Vian I. Fetal ductal constriction in the third trimester of pregnancy: a prevalence study. J Perinatol 2024; 44:444-445. [PMID: 38042943 DOI: 10.1038/s41372-023-01844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Paulo Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil.
- Department of Pediatrics, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2400-Santa Cecília/CEP 90035-003, Porto Alegre, Brazil.
| | - Natássia Miranda Sulis
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Cláudia Monster Martins
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Kelly Pozzer Zucatti
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Eduarda Rodrigues Bonamigo
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
| | - Izabele Vian
- Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 370-Santana/CEP 90620-000, Porto Alegre, Brazil
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Li TG, Zheng J, Ma B. Confusion from prenatal diagnosis: Type C persistent fifth aortic arch or right-side ductus arteriosus. Echocardiography 2024; 41:e15729. [PMID: 38113302 DOI: 10.1111/echo.15729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
We described a case of a double aortic arch (DAA) with a subaortic left brachiocephalic vein (LBCV) and right-side ductus arteriosus using high-definition (HD) flow render mode and spatiotemporal image correlation (STIC). We experienced uncertainty regarding this interesting case despite the diagnosis of right-sided ductus arteriosus. The ductus arteriosus originates from the right pulmonary artery (PA) and converges into the descending aorta (DAO), whereas the vessel originated from the PA and converged into the ascending aorta (AAO). Therefore, we assumed that the vessel connecting the PA to AAO may be a type-C persistent fifth aortic arch (PFAA).
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Affiliation(s)
- Tian-Gang Li
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu Province, PR China
- Gansu Provincial Ultrasound Imaging Clinical Medicine Research Center, Lanzhou, Gansu Province, P. R. China
| | - Jiao Zheng
- Department of Ultrasound Diagnosis, Tianshui First People's Hospital, Tianshui, Gansu Province, P. R. China
| | - Bin Ma
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu Province, PR China
- Gansu Provincial Ultrasound Imaging Clinical Medicine Research Center, Lanzhou, Gansu Province, P. R. China
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Peña FL, Emanuelson TW, Todman SH, Jones RC, Mahajan S. Fetal circular shunt in Ebstein's anomaly and non-steroidal anti-inflammatory treatment. J Neonatal Perinatal Med 2024; 17:63-69. [PMID: 38217614 DOI: 10.3233/npm-230040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
A circular shunt is a poor prognostic factor associated with Ebstein's anomaly. Targeting the constriction of the ductus arteriosus (DA) in order to limit or resolve the circular shunt, has been shown to improve fetal outcomes. Prenatal non-steroidal anti-inflammatory drugs (NSAIDs) have been known to constrict the DA. Recently, prenatal NSAIDs have been used for that purpose in the treatment of circular shunt. Limited research shows that it may be an effective treatment leading to improved fetal outcomes. In this article, we did an extensive review of literature to describe this therapy's effectiveness and outcomes. 82% of fetuses were able to achieve ductal constriction with prenatal NSAID therapy. For fetuses who achieved ductal constriction, fetal demise was less likely (6%) when compared to those who were unable to achieve the same (50%). Of all the fetuses with hydrops, 50% had resoluation of hydrops with prenatal NSAID treatment.
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Affiliation(s)
- F L Peña
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - T W Emanuelson
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - S H Todman
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - R C Jones
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - S Mahajan
- Louisiana State University Health Shreveport, Shreveport, LA, USA
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Michelitsch M, Wiedemann D, Schermer E, Zimpfer D, Michel-Behnke I. Premature closure of the arterial duct presenting with right heart failure of the fetus and ductal aneurysm postnatally. Cardiol Young 2023; 33:2690-2692. [PMID: 37905342 DOI: 10.1017/s1047951123003359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
In utero idiopathic constriction of the arterial duct is a rare condition with only a handful reported cases. Ductal aneurysms with thrombus formations on the other hand are significantly more common. We report a case of a term infant who presented with right heart failure due to premature ductal closure and postnatal severe respiratory distress. Subsequent diagnostics revealed paresis of left laryngeal nerve and obstruction of the left pulmonary artery secondary to a ductal aneurysm. Consequently, surgical intervention was considered necessary. Post-operatively, right ventricular function and hoarseness resolved slowly.
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Affiliation(s)
- Mathias Michelitsch
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Schermer
- Department of Child and Adolescent Health, Pediatrics III (Pediatric Cardiology, Pulmonology, Allergology and Cystic Fibrosis), Medical University of Innsbruck, Innsbruck, TIR, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
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Abdul Latiff H, Gopal AR, Hidayat ZF, Haranal M, Borhanuddin BK, Alwi M, Samion H. Ductus arteriosus morphology in duct-dependent pulmonary circulation: CT classification and pattern in different ventricular morphology. Cardiol Young 2023; 33:2243-2251. [PMID: 36651340 DOI: 10.1017/s1047951122004218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The objective was to study the ductus arteriosus morphology in duct-dependent pulmonary circulation and its pattern in different ventricle morphology using CT angiography. METHOD From January 2013 to December 2015, patients aged 6 months and below with duct-dependent pulmonary circulation underwent CT angiography to delineate the ductus arteriosus origin, tortuosity, site of insertion, and pulmonary artery anatomy. The ductus arteriosus were classified into type I, IIa, IIb, and III based on its site of origin, either from descending aorta, distal arch, proximal arch, or subclavian artery, respectively. RESULTS A total of 114 patients and 116 ductus arteriosus (two had bilateral ductus arteriosus) were analysed. Type I, IIa, IIb, and III ductus arteriosus were seen in 13 (11.2 %), 71 (61.2%), 21 (18.1%), and 11 (9.5%), respectively. Tortuous ductus arteriosus was found in 38 (32.7%), which was commonly seen in single ventricular lesions. Ipsilateral and bilateral branch pulmonary artery stenosis was seen in 68 (59.6%) and 6 (5.3%) patients, respectively. The majority of patients with pulmonary atresia intact ventricular septum had type I (54.4%) and non-tortuous ductus arteriosus, while those with single and biventricular lesions had type II ductus arteriosus (84.9% and 89.7%, respectively). Type III ductus arteriosus was more common in biventricular lesions (77.8%). CONCLUSIONS Ductus arteriosus in duct-dependent pulmonary circulation has a diverse morphology with a distinct origin and tortuosity pattern in different types of ventricular morphology. CT may serve as an important tool in case selection and pre-procedural planning for ductal stenting.
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Affiliation(s)
- Haifa Abdul Latiff
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Anu Ratha Gopal
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Zul Febrianti Hidayat
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Maruti Haranal
- Department of Cardiac Surgery, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Boekren K Borhanuddin
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Mazeni Alwi
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
| | - Hasri Samion
- PCHC Department, Institut Jantung Negara, 145, Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
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Mariager AF, Hammeken A, Malham M, Raja AA, Sellmer A, Skjellerup SL, Raja RA, Navne J, Sillesen AS, Vejlstrup N, Bundgaard H, Iversen KK, Garne E, Jeppesen DL. Age-Related Prevalence of Open Ductus Arteriosus in Full-Term Newborns. Neonatology 2023; 120:527-531. [PMID: 37285834 DOI: 10.1159/000529842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The ductus arteriosus is part of the fetal circulation. Normally, the vessel closes during the cardiac transition. Delayed closure is associated with complications. The aim of this study was to evaluate the age-related prevalence of open ductus arteriosus in full-term neonates. METHODS Echocardiograms were collected in the population study, the Copenhagen Baby Heart Study. The present study included full-term neonates with an echocardiogram performed within 28 days after birth. All echocardiograms were reviewed to assess ductus arteriosus patency. RESULTS A total of 21,649 neonates were included. In neonates examined at day zero and day seven, an open ductus arteriosus was found in 36% and 0.6%, respectively. Beyond day seven, the prevalence remained stable at 0.6%. CONCLUSION More than one-third of full-term neonates had an open ductus arteriosus on the first day of life, declining rapidly within the first week and stabilizing below 1% after day seven.
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Affiliation(s)
- Anton Friis Mariager
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alberte Hammeken
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Malham
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Centre Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Sellmer
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine Aarhus University Hospital, Aarhus, Denmark
| | - Signe Levring Skjellerup
- Department of Internal Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Raheel Altaf Raja
- Department of Pediatrics and Adolescents, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Johan Navne
- Department of Intensive Care Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Capital Region's Unit of Inherited Cardiac Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ester Garne
- Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Dorthe Lisbeth Jeppesen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Li TG, Ma B, Lan Q, Yao LG, Qi PA. Prenatal diagnosis of double aortic arch with subaortic left brachiocephalic vein and right-side ductus arteriosus using high-definition flow render mode and spatiotemporal image correlation. Echocardiography 2023; 40:295-298. [PMID: 36789919 DOI: 10.1111/echo.15541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/05/2023] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Double aortic arch (DAA) with subaortic left brachiocephalic vein (LBCV) and right-side ductus arteriosus (RDA) was not reported before delivery, only in adults with anatomy course findings. We present a case of fetal DAA with subaortic LBCV and RDA using high-definition (HD) flow render mode and spatiotemporal image correlation (STIC).
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Affiliation(s)
- Tian-Gang Li
- Department of Ultrasound Diagnosis, Lanzhou Gansu Province Gansu Provincial Maternity and Child-care Hospital, P.R. China
- Lanzhou Gansu Province Gansu Provincial Ultrasound Imaging Clinical Medicine Research Center, P.R. China
| | - Bin Ma
- Department of Ultrasound Diagnosis, Lanzhou Gansu Province Gansu Provincial Maternity and Child-care Hospital, P.R. China
- Lanzhou Gansu Province Gansu Provincial Ultrasound Imaging Clinical Medicine Research Center, P.R. China
| | - Qiong Lan
- Department of Ultrasound Diagnosis, Lanzhou Gansu Province Gansu Provincial Maternity and Child-care Hospital, P.R. China
- Lanzhou Gansu Province Gansu Provincial Ultrasound Imaging Clinical Medicine Research Center, P.R. China
| | - Li-Guo Yao
- Department of Medical Imaging Center, Lanzhou Gansu Province Gansu Provincial Maternity and Child-care Hospital, P.R. China
| | - Ping-An Qi
- Department of Ultrasound Diagnosis, Lanzhou Gansu Province Gansu Provincial Maternity and Child-care Hospital, P.R. China
- Lanzhou Gansu Province Gansu Provincial Ultrasound Imaging Clinical Medicine Research Center, P.R. China
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12
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Agudo-Montore P, Guillén-Rodríguez I, Manso-García B, González-Calle A, Coserria-Sánchez F. Sinus-SuperFlex-DS stent collapse in ductus arteriosus of a newborn with type B interrupted aortic arch. Rev Esp Cardiol (Engl Ed) 2022; 75:959-960. [PMID: 35688689 DOI: 10.1016/j.rec.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Pedro Agudo-Montore
- Sección de Cardiología Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain.
| | | | - Begoña Manso-García
- Sección de Cardiología Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio González-Calle
- Sección de Cirugía Cardiaca Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Félix Coserria-Sánchez
- Sección de Cardiología Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain
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13
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Chen L, Xu H, Zhou L, Liu C, Xi J, Wu Y, Yang L, Guo Y. Prenatal diagnosis of ductal origin of distal pulmonary artery: presentation of three cases and literature review. Ultrasound Obstet Gynecol 2022; 60:284-290. [PMID: 34687572 DOI: 10.1002/uog.24799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
Ductal origin of distal pulmonary artery (DODPA) is a rare congenital cardiovascular anomaly, with an incidence of approximately 1 in 200 000 people. It involves the proximal interruption of one pulmonary artery branch, with the distal part arising from the base of the brachiocephalic artery, via the ipsilateral ductus arteriosus (DA) and the intrapulmonary branch of the pulmonary artery is usually intact. If timely treatment is not provided after birth, it is very likely that, due to DA closure, severe hypoplasia will occur in the lung supplied by the abnormal pulmonary artery. Hence, prenatal diagnosis of DODPA is important to enable initiation of prostaglandin treatment and early rehabilitation of the affected lung. Herein, we report three cases of fetal DODPA diagnosed via two-dimensional (2D) ultrasonography combined with four-dimensional (4D) spatiotemporal image correlation. We also present a literature review, and explore the ultrasonographic findings and the importance of 2D and 4D ultrasonography in obtaining an accurate prenatal diagnosis of DODPA. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Chen
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - H Xu
- Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, China
| | - L Zhou
- Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - C Liu
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - J Xi
- Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Y Wu
- Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - L Yang
- Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Y Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
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14
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McClean M, Ngwezi D, Colen T, Mah K, Al-Aklabi M, Hornberger L. Echocardiographic Predictors of Ductal Tissue-Related Branch Pulmonary Artery Stenosis in Pulmonary Atresia. Pediatr Cardiol 2022; 43:878-886. [PMID: 35022807 DOI: 10.1007/s00246-021-02799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
Branch pulmonary artery (PA) stenosis due to ductus arteriosus (DA) tissue (DA-PS) contributes to the morbidity associated with pulmonary atresia (PAtr). We sought to identify preoperative echocardiographic features predictive of DA-PS. Patients consecutively encountered with PAtr and a DA-dependent pulmonary circulation at birth who underwent intervention in our program over a 5-year period were identified and records reviewed. Preoperative echocardiograms were reviewed to identify features that predicted postoperative DA-PS. Seventy patients with PAtr met inclusion criteria and 36 (51%) had DA-PS. At preoperative echocardiography, the proximal diameter of the PA ipsilateral to the DA was smaller in those with versus without DA-PS (Z-score - 4.8 ± 1.7 vs - 1.1 ± 1.7, respectively p < 0.001). PA origins could not be imaged on the same axial plane in 21/36 (58%) with versus 2/34 (6%) without DA-PS. Patients with DA-PS had an obtuse posterior angle of the PA bifurcation compared to those without (128 ± 17° and 87 ± 21°, p < 0.001), and a posterior angle of > 100° best predicted DA-PS with a sensitivity of 97% and specificity of 76%. An abnormal PA relationship and/or an obtuse posterior bifurcation angle had a sensitivity, specificity, positive and negative predictive value for DA-PS of 78%, 94%, 90% and 86%, respectively. Finally, DA insertion was into the ipsilateral PA in 26/36 (72%) of cases with DA-PS. A smaller proximal ipsilateral PA diameter, inability to image the PAs in the same plane, a posterior PA bifurcation angle of > 100°, and insertion of the DA in the ipsilateral PA demonstrated by echo are useful in identifying patients at risk for DA-PS.
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Affiliation(s)
- Marisha McClean
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Pediatrics, Children's Hospital LHSC, Western University, London, ON, Canada
| | - Deliwe Ngwezi
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Timothy Colen
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kandice Mah
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Mohammed Al-Aklabi
- Division of Cardiac Surgery, Department of Surgery, Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hornberger
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Schrauben EM, Darby JRT, Berry MJ, Saini BS, Quinn M, Holman SL, Bradshaw EL, Lock MC, Perumal SR, Cho SKS, Aujla T, Seed M, Macgowan CK, Morrison JL. Open or closed: Changes in ductus arteriosus flow patterns at birth using 4D flow MRI in newborn piglets. Physiol Rep 2021; 9:e14999. [PMID: 34435462 PMCID: PMC8387787 DOI: 10.14814/phy2.14999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/20/2021] [Indexed: 12/31/2022] Open
Abstract
The ductus arteriosus (DA) functionally closes during the transition from fetal to postnatal life because of lung aeration and corresponding cardiovascular changes. The thorough and explicit measurement and visualization of the right and left heart output during this transition has not been previously accomplished. We combined 4D flow MRI (dynamic volumetric blood flow measurements) and T2 relaxometry (oxygen delivery quantification) in surgically instrumented newborn piglets to assess the DA. This was performed in Large White-Landrace-Duroc piglets (n = 34) spanning four age groups: term-9 days, term-3, term+1, and term+5. Subject's DA status was classified using 4D flow: closed DA, forward DA flow, reversed DA flow, and bidirectional DA flow. Over all states, vessel diameters and flows normalized to body weight increased with age (for example in the ascending aorta flow-term-9: 126.6 ± 45.4; term+5: 260.2 ± 80.0 ml/min per kg; p = 0.0005; ascending aorta diameter-term-9: 5.2 ± 0.8; term+5: 7.7 ± 0.4 mm; p = 0.0004). In subjects with reversed DA blood flow there was lower common carotid artery blood flow (forward: 37.5 ± 9.0; reversed: 20.0 ± 7.4 ml/min per kg; p = 0.032). Linear regression revealed that as net DA flow decreases, common carotid artery flow decreases (R2 = 0.32, p = 0.004), and left (R2 = 0.33, p = 0.003) and right (R2 = 0.34, p = 0.003) pulmonary artery flow increases. Bidirectional DA blood flow changed oxygen saturation as determined by MRI between the ascending and descending aorta (ascending aorta: 90.1% ± 8.4%; descending aorta: 75.6% ± 14.2%; p < 0.05). Expanded use of these techniques in preterm animal models will aid in providing new understandings of normal versus abnormal DA transition, as well as to test the effectiveness of related clinical interventions.
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Affiliation(s)
| | - Jack R. T. Darby
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Mary J. Berry
- Centre for Translational Physiology & Department of Pediatrics and Child HealthUniversity of OtagoWellingtonNew Zealand
| | - Brahmdeep S. Saini
- Heart CentreHospital for Sick ChildrenInstitute of Medical ScienceFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Megan Quinn
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Stacey L. Holman
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Emma L. Bradshaw
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Mitchell C. Lock
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Sunthara R. Perumal
- Preclinical Imaging and Research LaboratoriesSouth Australian Health & Medical Research InstituteAdelaideSAAustralia
| | - Steven K. S. Cho
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
- Department of Physiology, Faculty of MedicineUniversity of TorontoTorontoONCanada
| | - Tanroop Aujla
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
- Department of Physiology, Faculty of MedicineUniversity of TorontoTorontoONCanada
| | - Mike Seed
- Division of CardiologyDepartment of PaediatricsHospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Christopher K. Macgowan
- Translational MedicineHospital for Sick ChildrenTorontoONCanada
- Department of BiophysicsUniversity of TorontoTorontoONCanada
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical InnovationUniSA: Clinical and Health SciencesUniversity of South AustraliaAdelaideSAAustralia
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17
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Ngwezi DP, McClean M, McBrien A, Eckersley L, Abeysekera J, Colen T, Hornberger LK. Prenatal features of ductus arteriosus-related branch pulmonary stenosis in fetal pulmonary atresia. Ultrasound Obstet Gynecol 2021; 58:411-419. [PMID: 33347665 DOI: 10.1002/uog.23576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Ductus arteriosus (DA)-related branch pulmonary stenosis (PS), due to ductal tissue migration into the proximal pulmonary artery (PA) ipsilateral to the DA, is common in newborns with pulmonary atresia (PAtr) and contributes significantly to their mortality and morbidity. We sought to define fetal echocardiographic predictors of DA-PS in PAtr. METHODS This was a study of all neonates diagnosed prenatally with PAtr and a DA-dependent pulmonary circulation, with a DA that joined the underbelly of the arch, who had undergone surgical or catheter intervention in our hospital between 2009 and 2018. The postnatal echocardiograms and clinical records were reviewed to confirm the presence or absence of DA-PS based on the need for angioplasty at initial intervention and/or development of proximal PA stenosis post intervention. Fetal echocardiograms were examined for the features of DA-PS. RESULTS Of 53 fetuses with PAtr, 34 (64%) had analyzable images, including 20/34 (59%) with and 14/34 (41%) without DA-PS. An inability to visualize the branch PAs in the same plane, largely associated with abnormal DA insertion into the ipsilateral PA (85% of cases), had sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of 75%, 100%, 100% and 74%, respectively, for the prediction of postnatal DA-PS. The mean branch PA posterior bifurcation angle was more obtuse in cases with DA-PS compared to cases without DA-PS (117° ± 17° vs 79° ± 17°, P < 0.001), and an angle of > 100°, the preoperative cut-off observed previously in affected newborns, had a sensitivity, specificity, PPV and NPV of 88%, 79%, 82% and 85%, respectively. The receiver-operating-characteristics curve revealed an angle of ≥ 105° to have a sensitivity and specificity of 88% and 93%, respectively, for prenatal prediction of DA-PS. The presence of one or both features (inability to image in the same plane and the posterior bifurcation angle of ≥ 105°) had a sensitivity, specificity, PPV and NPV of 100%, 93%, 95% and 100%, respectively. CONCLUSION An inability to visualize the branch PAs in the same plane, associated with abnormal insertion of the DA in most cases, and/or the presence of a posterior PA bifurcation angle of ≥ 105° are predictive features of postnatal DA-PS in fetuses with PAtr. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D P Ngwezi
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Women's & Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - M McClean
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Women's & Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - A McBrien
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Women's & Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - L Eckersley
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Women's & Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - J Abeysekera
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Women's & Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - T Colen
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Women's & Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - L K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Women's & Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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18
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Santhanam R, Balakrishnan BK, Parasuram MB, Patil SN, Gopinathan KK. Aorto-pulmonary window with absent ductus arteriosus-A case report. J Clin Ultrasound 2021; 49:512-515. [PMID: 33314158 DOI: 10.1002/jcu.22967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/26/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
Aorto-pulmonary window (APW) is a rare congenital heart defect characterized by the connection between the ascending aorta and the pulmonary trunk before its bifurcation, just above the semilunar valves, due to the abnormal development of spiral septum. The short-axis echocardiographic view of the right ventricular outflow track, the three-vessel-view, and the three-vessel-trachea view are the key planes for prenatal diagnosis. We report a case of APW with absent ductus arteriosus in a monochorionic twin, detected by prenatal echocardiography. The diagnosis was confirmed postnatally and corrective surgery was performed at the age of 1 week. Prenatal diagnosis of APW is essential, since surgical correction early after birth is required to prevent congestive heart failure secondary to high pulmonary blood flow.
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Affiliation(s)
- Ramya Santhanam
- High Risk Pregnancy and Perinatology, CIMAR, Edappal Hospital Private Limited, Cochin, India
| | - Bijoy K Balakrishnan
- Department of Feto-Maternal Medicine at CIMAR Cochin and Edappal Hospitals Pvt Ltd, Cochin, India
| | - Meenu Batra Parasuram
- Department of Feto-Maternal Medicine at CIMAR Cochin and Edappal Hospitals Pvt Ltd, Cochin, India
| | - Swapneel N Patil
- Department of Feto-Maternal Medicine at CIMAR Cochin and Edappal Hospitals Pvt Ltd, Cochin, India
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Freud LR, Wilkins-Haug LE, Beroukhim RS, LaFranchi T, Phoon CK, Glickstein JS, Cumbermack KM, Makhoul M, Morris SA, Sun HY, Ferrer Q, Pedra SR, Tworetzky W. Effect of In Utero Non-Steroidal Anti-Inflammatory Drug Therapy for Severe Ebstein Anomaly or Tricuspid Valve Dysplasia (NSAID Therapy for Fetal Ebstein anomaly). Am J Cardiol 2021; 141:106-112. [PMID: 33217351 DOI: 10.1016/j.amjcard.2020.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
Ebstein anomaly (EA) and tricuspid valve dysplasia (TVD) are rare congenital malformations associated with nearly 50% mortality when diagnosed in utero. The diseases often produce severe tricuspid regurgitation (TR) in the fetus and in some cases, pulmonary regurgitation (PR) and circular shunting ensue. Since the ductus arteriosus (DA) plays a critical role in the circular shunt and may be constricted by transplacental nonsteroidal anti-inflammatory drugs (NSAIDs), we sought to assess the effect of NSAIDs on fetuses with EA/TVD. We reviewed mothers of singleton fetuses with EA/TVD and PR, indicative of circular shunting, who were offered NSAIDs at multiple centers from 2010 to 2018. Initial dosing consisted of indomethacin, followed by ibuprofen in most cases. Twenty-one patients at 10 centers were offered therapy at a median gestational age (GA) of 30.0 weeks (range: 20.9 to 34.9). Most (15/21 = 71%) mothers received NSAIDs, and 12 of 15 (80%) achieved DA constriction after a median of 2.0 days (1.0 to 6.0). All fetuses with DA constriction had improved PR; 92% had improved Doppler patterns. Median GA at pregnancy outcome (live-birth or fetal demise) was 36.1 weeks (30.7 to 39.0) in fetuses with DA constriction versus 33 weeks (23.3 to 37.3) in fetuses who did not receive NSAIDs or achieve DA constriction (p = 0.040). Eleven of 12 patients (92%) with DA constriction survived to live-birth, whereas 4 of 9 patients (44%) who did not receive NSAIDs or achieve DA constriction survived (p = 0.046). In conclusion, our findings demonstrate the proof of concept that NSAIDs mitigate circular shunt physiology by DA constriction and improve PR among fetuses with severe EA/TVD. Although the early results are encouraging, further investigation is necessary to determine safety and efficacy.
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Affiliation(s)
- Lindsay R Freud
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork-Presbyterian, Columbia University Medical Center, New York, New York.
| | - Louise E Wilkins-Haug
- Department of Obstetrics, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
| | - Rebecca S Beroukhim
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Terra LaFranchi
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colin K Phoon
- Department of Pediatrics, Division of Pediatric Cardiology, Hassenfeld Children's Hospital, New York University, New York, New York
| | - Julie S Glickstein
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork-Presbyterian, Columbia University Medical Center, New York, New York
| | - Kristopher M Cumbermack
- Department of Pediatrics, Division of Pediatric Cardiology, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
| | - Majd Makhoul
- Department of Pediatrics, Division of Pediatric Cardiology, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
| | - Shaine A Morris
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Heather Y Sun
- Department of Pediatrics, Division of Pediatric Cardiology, Rady Children's Hospital, University of California-San Diego, San Diego, California
| | - Queralt Ferrer
- Department of Pediatrics, Division of Pediatric Cardiology, University Hospital Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Simone R Pedra
- Department of Pediatrics, Division of Pediatric Cardiology, Instituto Dante Pazzanese de Cardiologia/Hospital do Coracao da Associacao Sanatorio Sirio, Sao Paulo, Brazil
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Kardasevic M, Mesihovic-Dinarevic S, Kecalovic AH. Therapeutic Modalities in the Treatment of Persistent Ductus Arteriosus in Premature Babies: Report of Two Cases. Med Arch 2021; 75:467-470. [PMID: 35169376 PMCID: PMC8802680 DOI: 10.5455/medarh.2021.75.467-470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/11/2021] [Indexed: 11/07/2022] Open
Abstract
Background: Persistent Ductus Arteriosus (PDA) is a vascular structure that connects the pulmonary artery and the descending aorta. It plays an important role in the fetal blood flow pattern. Objective: The aim of this paper is to present two cases from Neonatology of Cantonal hospital in Bihac, with hemodynamically significant ductus, different “timing” of treatment and different therapeutic options. Results and Discussion: The ductus closes functionally within the first 72 to 96 hours after the birth. Its anatomical closure follows in the next 14 days. If it remains open after the third month of life, it is treated as a congenital heart anomaly with a left-right shunt. Approximately 10% of all congenital heart defects are PDA with an incidence of 2-4 per 1000 live births. It has been clinically proven that PDA is present in 45% of premature babies with a birth weight of less than 1750 g and in about 80% of premature babies with a birth weight below 1200 g. As criteria for the application of drug therapy (in this case we use Paracetamol) for ductal closure, we took into account clinical parameters and echo parameters that indicated that it was a hemodynamically significant ductal shunt. Prerequisites for treatment were normal liver function confirmed by laboratory tests, normal platelet count, no intracranial hemorrhage, normal gastrointestinal function, normal coagulation parameters, normal renal function, calm parameters of inflammation. Conclusion: The diagnosis of PDA in the early, asymptomatic phase, in premature babies, is made by early echocardiographic examination. The decision on treatment should be based on clinical and echocardiographic criteria. Paracetamol is an alternative in the treatment of this cardiac problem of premature infants and could be more effective if used in early, presymptomatic phase.
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Yang SH, He GD, Liang MF, Qin GC, Pang YL, Li XQ, Li XY, Wei HW, Wang YF. Vascular ring and sling in a fetus who developed esophageal and airway compression after birth. Echocardiography 2020; 37:2152-2154. [PMID: 33107081 DOI: 10.1111/echo.14907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
Vascular ring and sling are congenital anomalies of the vascular structure in the thorax with a prevalence of 2.4/10,000 live births. Double aortic arch (DAA), right aortic arch with left ductus arteriosus and aberrant left subclavian artery (RAA-ALSA), and pulmonary artery sling (PAS) are the three common types of vascular ring and sling. These anomalies can be isolated or accompanied by intracardiac malformation. The presence of both vascular ring and PAS is extremely rare. Here, we report a fetus who was prenatally diagnosed with PAS and RAA-ALS, and developed symptoms due to esophageal and airway compression after birth.
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Affiliation(s)
- Shui-Hua Yang
- Department of Ultrasound, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Gui-Dan He
- Department of Ultrasound, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Meng-Feng Liang
- Department of Ultrasound, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Gui-Chan Qin
- Department of Ultrasound, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu-Lan Pang
- Department of Ultrasound, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xue-Qin Li
- Department of Ultrasound, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xin-Yan Li
- Department of Ultrasound, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hong-Wei Wei
- Department of Obstetrics, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ying-Fei Wang
- Department of Radiology, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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23
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Kelleher MA, Lee JY, Roberts VHJ, Novak CM, Baschat AA, Morgan TK, Novy MJ, Räsänen JP, Frias AE, Burd I. Maternal azithromycin therapy for Ureaplasma parvum intraamniotic infection improves fetal hemodynamics in a nonhuman primate model. Am J Obstet Gynecol 2020; 223:578.e1-578.e11. [PMID: 32343954 PMCID: PMC7591241 DOI: 10.1016/j.ajog.2020.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/09/2020] [Accepted: 04/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ureaplasma parvum infection is a prevalent cause of intrauterine infection associated with preterm birth, preterm premature rupture of membranes, fetal inflammatory response syndrome, and adverse postnatal sequelae. Elucidation of diagnostic and treatment strategies for infection-associated preterm labor may improve perinatal and long-term outcomes for these cases. OBJECTIVE This study assessed the effect of intraamniotic Ureaplasma infection on fetal hemodynamic and cardiac function and the effect of maternal antibiotic treatment on these outcomes. STUDY DESIGN Chronically catheterized pregnant rhesus monkeys were assigned to control (n=6), intraamniotic inoculation with Ureaplasma parvum (107 colony-forming units/mL, n=15), and intraamniotic infection plus azithromycin treatment (12.5 mg/kg twice a day intravenously, n=8) groups. At approximately 135 days' gestation (term=165 days), pulsed and color Doppler ultrasonography was used to obtain measurements of fetal hemodynamics (pulsatility index of umbilical artery, ductus venosus, descending aorta, ductus arteriosus, aortic isthmus, right pulmonary artery, middle cerebral artery and cerebroplacental ratio, and left and right ventricular cardiac outputs) and cardiac function (ratio of peak early vs late transmitral flow velocity [marker of ventricular function], Tei index [myocardial performance index]). These indices were stratified by amniotic fluid proinflammatory mediator levels and cardiac histology. RESULTS Umbilical and fetal pulmonary artery vascular impedances were significantly increased in animals from the intraamniotic inoculation with Ureaplasma parvum group (P<.05). Azithromycin treatment restored values to control levels. Amniotic fluid prostaglandin F2 alpha levels were significantly higher in animals with abnormal umbilical artery pulsatility index (>1.1) than in those with normal blood flow (P<.05; Spearman ρ=0.6, P<.05). In the intraamniotic inoculation with Ureaplasma parvum group, left ventricular cardiac output was significantly decreased (P<.001), and more animals had abnormal right-to-left ventricular cardiac output ratios (defined as >1.6, P<.05). Amniotic fluid interleukin-6 concentrations were elevated in cases of abnormal right-to-left ventricular cardiac output ratios compared with those in normal cases (P<.05). CONCLUSION Fetal hemodynamic alterations were associated with intraamniotic Ureaplasma infection and ameliorated after maternal antibiotic treatment. Doppler ultrasonographic measurements merit continuing investigation as a diagnostic method to identify fetal cardiovascular and hemodynamic compromise associated with intrauterine infection or inflammation and in the evaluation of therapeutic interventions or clinical management of preterm labor.
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Affiliation(s)
- Meredith A Kelleher
- Division of Reproductive and Development Sciences, Oregon National Primate Research Center, Beaverton, OR.
| | - Ji Yeon Lee
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victoria H J Roberts
- Division of Reproductive and Development Sciences, Oregon National Primate Research Center, Beaverton, OR
| | - Christopher M Novak
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmet A Baschat
- Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Terry K Morgan
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Miles J Novy
- Division of Reproductive and Development Sciences, Oregon National Primate Research Center, Beaverton, OR
| | - Juha P Räsänen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR; University of Helsinki, Helsinki, Finland
| | - Antonio E Frias
- Division of Reproductive and Development Sciences, Oregon National Primate Research Center, Beaverton, OR; Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Irina Burd
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Casati D, Pellegrino M, Cortinovis I, Spada E, Lanna M, Faiola S, Cetin I, Rustico MA. Longitudinal Doppler references for monochorionic twins and comparison with singletons. PLoS One 2019; 14:e0226090. [PMID: 31809530 PMCID: PMC6897428 DOI: 10.1371/journal.pone.0226090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To construct monochorionic (MC) twin-specific longitudinal Doppler references for umbilical artery pulsatility index (UA-PI), middle cerebral artery (MCA) PI and peak systolic velocity (PSV) and ductus venosus (DV) PI derived from a strictly selected cohort of uncomplicated MC twins. The secondary aim of the study was to compare our findings with singleton reference charts. METHODS A retrospective evaluation was made of all consecutive uncomplicated MC twin pregnancies referred to our Unit from 2010 to 2018. Fortnightly serial examinations were performed of UA-PI, MCA-PI, MCA-PSV and DV-PI, according with the clinical protocol, from 20 to 37 weeks of gestation. We included cases with at least four ultrasound examinations, delivery at our hospital and complete neonatal follow up. A two-step method was used to trace the estimated centile curves: estimation of the median was performed with appropriate fractional polynomials by a multilevel model and estimation of the external centiles through the residuals (quantile regression). The comparison with singletons was made by plotting the references derived from the present study on the referred charts commonly used for singletons. RESULTS The study group comprised 150 uncomplicated MC twin pairs. Estimated centiles (3rd, 5th, 10th, 50th, 90th, 95th, 97th) of UA-PI, MCA-PI, MCA-PSV and DV-PI in function of the gestational age are presented. The comparison with singletons showed substantial differences, with higher UA-PI and lower MCA-PI and PSV median values in MC twins. Median DV PI values were similar to the values for singletons, while the upper centiles were higher in MC twins. CONCLUSIONS This study sets out MC twin-specific longitudinal references for UA-PI, MCA-PI, MCA-PSV and DV-PI derived from the largest series of uncomplicated MC twin pregnancies presently available. The comparison with singleton reference values underscores the deviation from physiology that is intrinsic to these unique pregnancies and supports the need for MC twin-specific charts.
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Affiliation(s)
- Daniela Casati
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- * E-mail:
| | - Marcella Pellegrino
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Ivan Cortinovis
- Laboratory G.A. Maccacaro, Department of Clinical Sciences and Community Health, University of Milan Milan, Italy
| | - Elena Spada
- Neonatal Unit, University of Turin, City of Health and Science of Turin, Turin, Italy
| | - Mariano Lanna
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Stefano Faiola
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Maria Angela Rustico
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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Jhaveri S, Komarlu R. Prenatal diagnosis of right-sided cervical aortic arch with aberrant left subclavian artery and absent ductus arteriosus in tetralogy of Fallot. Ultrasound Obstet Gynecol 2019; 54:414-416. [PMID: 30338597 DOI: 10.1002/uog.20151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Jhaveri
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - R Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
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Campanale CM, Pasquini L, Santangelo TP, Iorio FS, Bagolan P, Sanders SP, Toscano A. Prenatal echocardiographic assessment of right aortic arch. Ultrasound Obstet Gynecol 2019; 54:96-102. [PMID: 30125417 DOI: 10.1002/uog.20098] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To report our experience with fetal diagnosis of right aortic arch (RAA) variants based on the ductus arteriosus (DA) anatomy and brachiocephalic vessel branching pattern in relation to the trachea, and to establish whether the echocardiographic 'V-shaped' or 'U-shaped' appearance of the junction between the DA and aortic arch (AA) in the fetal upper mediastinal view is sufficiently accurate for assessment of fetal AA anatomy. METHODS This was a retrospective study of pregnancies with a prenatal diagnosis of fetal RAA that had postnatal confirmation of AA anatomy, referred to our tertiary center during 2011-2017. Prenatal and postnatal medical records, including echocardiographic and computed tomography (CT)/magnetic resonance imaging (MRI) scan reports, were reviewed, and cardiac and extracardiac abnormalities and the results of genetic testing were recorded. RESULTS Of 55 consecutive pregnancies with a prenatal diagnosis of fetal RAA, six were lost to follow-up, one was terminated and three were excluded due to lack of postnatal confirmation of AA anatomy. Of the remaining 45 pregnancies, AA anatomy was assessed postnatally by CT in 39, by MRI in one and by direct examination at cardiac surgery in five. A U-shaped appearance was found in 37/45 (82.2%) patients, all of which had a complete vascular ring (CVR). Of these 37 patients, on postnatal confirmation, 21 (56.8%) had RAA with Kommerell's diverticulum, left posterior ductus arteriosus (LPDA) and aberrant left subclavian artery (ALSA) (RAA/LPDA/ALSA), 11 (29.7%) had a double AA (DAA), four (10.8%) had RAA with Kommerell's diverticulum, LPDA and mirror-image (MI) branching (RAA/LPDA/MI), and one (2.7%) had RAA with Kommerell's diverticulum, LPDA and aberrant left innominate artery (ALIA) (RAA/LPDA/ALIA). A V-shaped appearance was found in 3/45 (6.7%) patients, all of which had RAA with right DA not forming a CVR and MI branching. In the 5/45 (11.1%) fetuses with neither U- nor V-shaped appearance, RAA with left anterior DA arising from the left innominate artery and MI branching, not forming a CVR, was found. Twelve (26.7%) fetuses had a congenital heart defect (CHD). RAA forming a CVR (U-shaped appearance) was associated with a septal defect in 6/37 (16.2%) fetuses, while RAA not forming a CVR (V-shaped appearance or no U- or V-shaped appearance) was associated with major CHD in 6/8 (75.0%) fetuses. CONCLUSIONS In fetuses with RAA, V-shaped appearance of the junction between the DA and AA indicates only that the transverse AA and DA run together on the same side of the thorax (trachea) while a U-shaped appearance is always a sign of a CVR. Among fetuses with a CVR, RAA/LPDA/MI is more frequent than described previously. Finally, RAA forming a CVR is not usually associated with complex CHD, as opposed to RAA not forming a CVR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C M Campanale
- Division of Perinatal Cardiology, Department of Medical and Surgical Neonatology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - L Pasquini
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - T P Santangelo
- Department of Radiology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - F S Iorio
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - P Bagolan
- Division of Neonatal Surgery, Department of Medical and Surgical Neonatology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
| | - S P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - A Toscano
- Division of Perinatal Cardiology, Department of Medical and Surgical Neonatology, Ospedale Pediatrico 'Bambino Gesù', Rome, Italy
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Han J, Yu S, Hao X, Gao S, Weng Z, He Y. Prenatal Diagnosis of Bilateral Ductus Arteriosi and an Anomalous Origin of the Right Pulmonary Artery From the Right-Sided Duct. J Ultrasound Med 2018; 37:2961-2962. [PMID: 29689596 DOI: 10.1002/jum.14655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Jiancheng Han
- Department of Ultrasound, Beijing Anzhen Hospital Capital Medical University, Beijing, China
| | - Shaomei Yu
- Department of Ultrasound, Beijing Anzhen Hospital Capital Medical University, Beijing, China
| | - Xiaoyan Hao
- Department of Ultrasound, Beijing Anzhen Hospital Capital Medical University, Beijing, China
| | - Shuang Gao
- Department of Ultrasound, Beijing Anzhen Hospital Capital Medical University, Beijing, China
| | - Zongjie Weng
- 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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fouron JC, McNeal-Davidson A, Abadir S, Fournier A, Bigras JL, Boutin C, Brassard M, Raboisson MJ, van Doesburg N, Berger A, Brisebois S, Gendron R. Prenatal diagnosis and prognosis of accelerated idioventricular rhythm. Ultrasound Obstet Gynecol 2017; 50:624-631. [PMID: 27943499 DOI: 10.1002/uog.17382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia. METHODS We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M-mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014. RESULTS Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M-mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a-waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in central venous pressure in all and hydrops fetalis in two cases without evidence of ventricular dysfunction. CONCLUSIONS Echocardiographic criteria required for postnatal diagnosis of AIVR can be documented in utero using specific ultrasonographic approaches. During fetal life, AIVR may not be a benign entity. Hydrops fetalis is frequently associated with AIVR because of increase in central venous pressure related to simultaneous atrioventricular contractions; thus, the ultrasonographic investigation protocol of fetuses with unexplained hydrops fetalis should aim at ruling out AIVR and include Doppler flow recordings in SVC/Ao, DV, AoI, DA and umbilical vein. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J-C Fouron
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - A McNeal-Davidson
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - S Abadir
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Electrophysiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - A Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Electrophysiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - J-L Bigras
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - C Boutin
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - M Brassard
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - M-J Raboisson
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - N van Doesburg
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - A Berger
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - S Brisebois
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
| | - R Gendron
- Fetal Cardiology Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Québec, Canada
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Baik N, Urlesberger B, Schwaberger B, Schmölzer GM, Köstenberger M, Avian A, Pichler G. Foramen ovale (FO) - The underestimated sibling of ductus arteriosus (DA): Relevance during neonatal transition. Early Hum Dev 2016; 103:137-140. [PMID: 27648971 DOI: 10.1016/j.earlhumdev.2016.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 07/11/2016] [Accepted: 08/24/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Nariae Baik
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Austria
| | - Georg M Schmölzer
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria; Department of Pediatrics, University of Alberta, Edmonton, Canada; Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada
| | - Martin Köstenberger
- Division of pediatric Cardiology, Department of Paediatrics, Medical University of Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Gerhard Pichler
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Austria; Department of Pediatrics, University of Alberta, Edmonton, Canada; Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada.
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Talemal L, Donofrio MT. Hemodynamic consequences of a restrictive ductus arteriosus and foramen ovale in fetal transposition of the great arteries. J Neonatal Perinatal Med 2016; 9:317-320. [PMID: 27589547 DOI: 10.3233/npm-16915122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
D-transposition of the great arteries (D-TGA) is the most commonly diagnosed cyanotic congenital heart disease presenting in the neonatal period. The survival after an arterial switch operation, with freedom from adverse cardiovascular events, has been reported to be as high as 93% at 25 years. However, despite excellent surgical outcomes, there continues to be significant preoperative morbidity and potential mortality due to compromise in the delivery room from foramen ovale closure requiring urgent balloon atrial septostomy for stabilization in the first minutes of life. The prenatal diagnosis of D-TGA using fetal echocardiography has aided in the perinatal management and delivery planning of these infants, lowering preoperative morbidity and mortality and preventing delivery room compromise. Fetuses with D-TGA have more highly oxygenated blood supplying the pulmonary arteries and ductus arteriosus which likely results in ductal constriction and increased pulmonary blood flow. This may be the cause of foramen ovale restriction or closure in-utero, which then increases the risk for postnatal compromise at delivery. Theories regarding the cause of the abnormal pulmonary vasculature that may be seen in D-TGA, including aorto-pulmonary collateral formation, have been proposed but to our knowledge, observation of the ultrasound findings throughout mid and late gestation describing the progression of the abnormal fetal physiology have not been previously described. We present a case of D-TGA in which serial assessment using fetal echocardiography enabled observation of the in-utero progression of disease, predicting postnatal compromise and facilitating the planning of life-saving specialized delivery room care and intervention.
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Hashima JN, Rogers V, Langley SM, Ashraf M, Sahn DJ, Ohtonen P, Davis LE, Hohimer AR, Rasanen J. Fetal ventricular interactions and wall mechanics during ductus arteriosus occlusion in a sheep model. Ultrasound Med Biol 2015; 41:1020-1028. [PMID: 25701524 PMCID: PMC4407698 DOI: 10.1016/j.ultrasmedbio.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 06/04/2023]
Abstract
We investigated the effect of fetal sheep ductus arteriosus occlusion (DO) on the distribution of cardiac output and left and right ventricular function by tissue and pulsed Doppler at baseline; after 15 and 60 min of DO induced with a vascular occluder; and 15 min after release of DO. Ductal occlusion decreased fetal pO2. Mean left ventricular output increased (p < 0.001) from 725 to 1013 mL/min, and right ventricular (1185 mL/min vs. 552 mL/min) and systemic (1757 mL/min vs. 1013 mL/min) cardiac outputs fell (p < 0.001) after 15 min of DO, compared with baseline. Pulmonary vascular impedance decreased and volume blood flow increased more than threefold during DO, whereas foramen ovale volume blood flow remained unchanged. Left ventricular systolic function was unaffected, whereas isovolumic relaxation velocity deceleration decreased. Right ventricular functional indices remained unchanged. We conclude that DO increased pulmonary volume blood flow, not foramen ovale volume blood flow. Left ventricular output increased, although not as much as right ventricular output fell, resulting in decreased systemic cardiac output. During DO, left ventricular function exhibited diminished relaxation.
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Affiliation(s)
- Jason N Hashima
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Vanessa Rogers
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephen M Langley
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Muhammed Ashraf
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Sahn
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Pasi Ohtonen
- Department of Anesthesiology and Surgery, Oulu University Hospital, Oulu, Finland
| | - Lowell E Davis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - A Roger Hohimer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Juha Rasanen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA; Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
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Krzeszowski W, Wilczyński J, Grzesiak M, Nowakowska D. Prenatal sonographic diagnosis of premature constriction of the fetal ductus arteriosus after maternal self-medication with benzydamine hydrochloride: report of 3 cases and review of the literature. J Ultrasound Med 2015; 34:531-535. [PMID: 25715374 DOI: 10.7863/ultra.34.3.531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report 3 cases of prenatal diagnosis of premature constriction of the ductus arteriosus after maternal benzydamine hydrochloride therapy (3-mg lozenges) in third-trimester pregnancies. In each case, fetal echocardiography revealed a dilated, hypocontractile right ventricle with severe tricuspid regurgitation and constriction of the ductus arteriosus. Although the effect of indomethacin and other nonsteroidal anti-inflammatory drugs on prenatal ductal constriction is well known, readily available over-the-counter nonsteroidal anti-inflammatory drugs such as benzydamine can have an equally deleterious effect and are best avoided in the third trimester of pregnancy.
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Affiliation(s)
- Waldemar Krzeszowski
- Third Chair of Gynecology and Obstetrics, Department of Fetal-Maternal Medicine and Gynecology, Medical University, Lodz, Poland
| | - Jan Wilczyński
- Third Chair of Gynecology and Obstetrics, Department of Fetal-Maternal Medicine and Gynecology, Medical University, Lodz, Poland
| | - Mariusz Grzesiak
- Third Chair of Gynecology and Obstetrics, Department of Fetal-Maternal Medicine and Gynecology, Medical University, Lodz, Poland
| | - Dorota Nowakowska
- Third Chair of Gynecology and Obstetrics, Department of Fetal-Maternal Medicine and Gynecology, Medical University, Lodz, Poland.
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Inamura N, Kubota A, Ishii R, Ishii Y, Kawazu Y, Hamamichi Y, Yoneda A, Kawahara H, Okuyama H, Kayatani F. Efficacy of the circulatory management of an antenatally diagnosed congenital diaphragmatic hernia: outcomes of the proposed strategy. Pediatr Surg Int 2014; 30:889-94. [PMID: 25106889 DOI: 10.1007/s00383-014-3574-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
Abstract
OBJECT The purpose of this study is to evaluate the outcome of our therapeutic strategy for antenatally diagnosed congenital diaphragmatic hernia (ADCDH). METHODS We treated 61 cases of ADCDH according to our strategy. Prostaglandin E1 was required to be maintained the patency of the ductus arteriosus (PDA) in 39 cases (Group I) while it was not administered in 22 cases (Group II). Left ventricular end-diastolic dimension (LVDD) and Tei index were measured with echocardiography on days 0, 2, and 7 after birth. Radical surgery was performed on all cases by day 2. RESULTS On day 0, Group I showed smaller LVDD and Tei index than those in Group II. Between day 0 and day 2, these parameters increased significantly in Group I, but not in Group II. On day 7, no significant difference in these parameters was observed between the two groups. Five patients died of cardiac and respiratory failure, resulting in a survival rate of 92 %. CONCLUSION Our therapeutic strategy improves the clinical outcome of ADCDH. This can be attributed to two factors: earlier surgery resulting in improved LV function. The latter attenuates pulmonary hypertension and maintains PDA with a consequent decrease in right ventricular afterload to compensate for the low cardiac output resulting from PDA.
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Affiliation(s)
- Noboru Inamura
- Department of Pediatric Cardiology, and Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan,
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Chabaneix J, Fouron JC, Sosa-Olavarria A, Gendron R, Dahdah N, Berger A, Brisebois S. Profiling left and right ventricular proportional output during fetal life with a novel systolic index in the aortic isthmus. Ultrasound Obstet Gynecol 2014; 44:176-181. [PMID: 24585706 DOI: 10.1002/uog.13345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 01/07/2014] [Accepted: 02/14/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Left ventricular ejection causes forward flow in the fetal aortic isthmus while the right ventricle has a retrograde influence. The aim of this study was to create reference values for an isthmic systolic index (ISI) reflecting the changing influence of right and left ventricular performance on Doppler flow velocity waveforms of the aortic isthmus throughout normal pregnancy. METHODS Doppler recordings of 260 normal fetuses with a gestational age of 18-37 weeks were reviewed. Peak systolic velocity (PSV) and end-systolic velocity (or systolic nadir; Ns) were measured on all aortic isthmus waveforms. An ISI was derived from the ratio Ns/PSV. Left and right ventricular outputs were also calculated. RESULTS Up to 22-23 weeks' gestation, the mean ISI is stable at around 0.2. At about 28 weeks, a brief end-systolic deceleration wave is observed on the aortic isthmus waveforms, progressing steadily with gestation and causing a fall of ISI towards a mean value of zero between 30 and 31 weeks. This trend continues thereafter and a mean value of -0.4 was observed at the end of pregnancy. An inverse correlation was found between right ventricular output and Ns (r = -0.334, P = 0.001). Simultaneous recordings of the isthmus and the ductus arteriosus Doppler waveforms demonstrated that the primary cause of the end-systolic deceleration and ultimate reversal of flow at the isthmus is the increasingly dominant flow from the right ventricle. CONCLUSION The transitional changes of the respective right and left ventricular outputs throughout pregnancy are well profiled by the ISI. This index highlights the physiological increase in fetal right ventricle flow preponderance as pregnancy progresses. Alteration of the ISI profile could be expected in clinical conditions associated with unbalanced alteration of the fetal ventricular outputs.
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Affiliation(s)
- J Chabaneix
- Fetal Cardiology Unit, Pediatric Cardiology Division, CHU Sainte-Justine, University of Montreal, Quebec, Canada
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Rychik J. Re: Profiling left and right ventricular proportional output during fetal life with a novel systolic index in the aortic isthmus. J. Chabaneix, J. C. Fouron, A. Sosa-Olavarria, R. Gendron, N. Dahdah, A. Berger and S. Brisebois. Ultrasound Obstet Gynecol 2014; 44: 176-181. Ultrasound Obstet Gynecol 2014; 44:136. [PMID: 25088512 DOI: 10.1002/uog.13452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- J Rychik
- Fetal Heart Program, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Broadhouse KM, Finnemore AE, Price AN, Durighel G, Cox DJ, Edwards AD, Hajnal JV, Groves AM. Cardiovascular magnetic resonance of cardiac function and myocardial mass in preterm infants: a preliminary study of the impact of patent ductus arteriosus. J Cardiovasc Magn Reson 2014; 16:54. [PMID: 25160730 PMCID: PMC4145259 DOI: 10.1186/s12968-014-0054-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/08/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Many pathologies seen in the preterm population are associated with abnormal blood supply, yet robust evaluation of preterm cardiac function is scarce and consequently normative ranges in this population are limited. The aim of this study was to quantify and validate left ventricular dimension and function in preterm infants using cardiovascular magnetic resonance (CMR). An initial investigation of the impact of the common congenital defect patent ductus arteriosus (PDA) was then carried out. METHODS Steady State Free Procession short axis stacks were acquired. Normative ranges of left ventricular end diastolic volume (EDV), stroke volume (SV), left ventricular output (LVO), ejection fraction (EF), left ventricular (LV) mass, wall thickness and fractional thickening were determined in "healthy" (control) neonates. Left ventricular parameters were then investigated in PDA infants. Unpaired student t-tests compared the 2 groups. Multiple linear regression analysis assessed impact of shunt volume in PDA infants, p-value ≤ 0.05 being significant. RESULTS 29 control infants median (range) corrected gestational age at scan 34+6(31+1-39+3) weeks were scanned. EDV, SV, LVO, LV mass normalized by weight and EF were shown to decrease with increasing corrected gestational age (cGA) in controls. In 16 PDA infants (cGA 30+3(27+3-36+1) weeks) left ventricular dimension and output were significantly increased, yet there was no significant difference in ejection fraction and fractional thickening between the two groups. A significant association between shunt volume and increased left ventricular mass correcting for postnatal age and corrected gestational age existed. CONCLUSION CMR assessment of left ventricular function has been validated in neonates, providing more robust normative ranges of left ventricular dimension and function in this population. Initial investigation of PDA infants would suggest that function is relatively maintained.
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MESH Headings
- Case-Control Studies
- Ductus Arteriosus/diagnostic imaging
- Ductus Arteriosus/pathology
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/pathology
- Ductus Arteriosus, Patent/physiopathology
- Echocardiography, Doppler, Color
- Gestational Age
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Humans
- Image Interpretation, Computer-Assisted
- Infant, Newborn
- Infant, Premature
- Linear Models
- Magnetic Resonance Imaging
- Models, Cardiovascular
- Myocardium/pathology
- Observer Variation
- Predictive Value of Tests
- Reproducibility of Results
- Stroke Volume
- Ventricular Function, Left
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Affiliation(s)
- Kathryn M Broadhouse
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
- The Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Anna E Finnemore
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
- The Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Anthony N Price
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
- The Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Giuliana Durighel
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
| | - David J Cox
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
- The Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Anthony David Edwards
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
- The Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Joseph V Hajnal
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
- The Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Alan M Groves
- Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London, UK
- The Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London SE1 7EH, UK
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Braulio R, Gelape CL, Araújo FDDR, Brandão KN, Abreu LDG, Costa PHN, Capanema FD. Indicators of surgical treatment of patent ductus arteriosus in preterm neonates in the first week of life. Braz J Cardiovasc Surg 2014; 28:504-8. [PMID: 24598956 PMCID: PMC4389417 DOI: 10.5935/1678-9741.20130082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/08/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify clinical and echocardiographic indicators of the necessity for early surgical closure of patent ductus arteriosus in preterm neonates. METHODS The prospective study was conducted at the Neonatal Unit of Hospital Municipal Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm neonates diagnosed with patent ductus arteriosus in the first week after birth, of whom 55 (group S) were submitted to clinical and or surgical closure and 60 (group NS) received non-surgical treatment. The parameters analyzed were birth weight, diameter of the ductus arteriosus (DAD), left atrial-to-aortic root diameter ratio (LA:Ao), the quotient of DAD² and birth weight (mm²/kg), and ductal shunting. RESULTS The study population comprised 58 males and 57 females. The average birth weight of group S (924 ± 224.3 g) was significantly (P=0.049) lower than that of group NS (1012.3 ± 242.8 g). The probability of the preterm neonates being submitted to surgical closure was 62.1% (P=0.006) when the DAD2/birth weight index was > 5 mm²/kg, 72.2% (P=0.001) when the LA:Ao ratio was > 1.5, and 61.2% when ductal shunting was high (P=0.025). CONCLUSION The parameters DAD²/birth weight index > 5 mm²/kg, LA:Ao ratio > 1.5 and high ductal shunting were statistically significant indicators (P<0.05) of the need for surgical closure of patent ductus arteriosus in low birth weight preterm neonates. Moreover, when an LA:Ao ratio > 1.5 was associated with the occurrence of shock, the probability of surgical closure increased to 78.4%.
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Affiliation(s)
- Renato Braulio
- Federal University of Minas Gerais, School of Mediciney, Belo
Horizonte, MG, Brazil
- Correspondence address: Renato Braulio, Hospital das Clínicas da UFMG,
Av. Prof. Alfredo Balena, 110 - 5º andar - Santa Efigênia - Belo Horizonte, MG,
Brazil - Zip code: 30130-100. E-mail:
| | - Cláudio Léo Gelape
- Federal University of Minas Gerais, School of Mediciney, Belo
Horizonte, MG, Brazil
| | | | - Kelly Nascimento Brandão
- Hospital Municipal Odilon Behrens, Department of Pediatrics, Belo
Horizonte, Minas Gerais, Brazil
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Peyvandi S, Rychik J, McCann M, Soffer D, Tian Z, Szwast A. Pulmonary artery blood flow patterns in fetuses with pulmonary outflow tract obstruction. Ultrasound Obstet Gynecol 2014; 43:297-302. [PMID: 23554091 PMCID: PMC4527155 DOI: 10.1002/uog.12472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/06/2013] [Accepted: 03/18/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Fetuses with pulmonary outflow tract obstruction (POTO) have altered blood flow to the pulmonary vasculature. We sought to determine whether pulmonary vascular impedance, as assessed by the pulsatility index (PI), is different in fetuses with POTO compared with normal controls. METHODS Branch pulmonary artery PI was evaluated in age-matched normal control fetuses (n=22) and 20 POTO fetuses (pulmonary stenosis n=15, pulmonary atresia n=5). Pulsed-wave Doppler was performed in the proximal (PA1), mid (PA2) and distal (PA3) branch pulmonary artery. The direction of flow in the ductus arteriosus was noted. The study and control groups were compared with Student's t-test and ANOVA. A linear mixed model evaluated the relationship between PI and ductus arteriosus flow patterns. RESULTS There was no difference in PI between control, pulmonary stenosis and pulmonary atresia subjects at PA1 and PA2; however, there was a significant difference at PA3. Subjects with pulmonary atresia had a lower PI at PA3 than did controls (P=0.003) and pulmonary stenosis subjects (P=0.003). Subjects with retrograde flow in the ductus arteriosus had lower PIs in PA2 and PA3 than did those with antegrade flow (P=0.01 and 0.005, respectively). The PI in PA3 was lower in fetuses that required prostaglandin postnatally than in those that did not (P=0.008). CONCLUSIONS Fetuses with pulmonary atresia or severe pulmonary stenosis with retrograde flow in the ductus arteriosus have decreased PI in the distal pulmonary vasculature. Our findings indicate the capacity of the fetal pulmonary vasculature to vasodilate in response to anatomical obstruction of flow.
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Affiliation(s)
- Shabnam Peyvandi
- Fetal Heart Program at the Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jack Rychik
- Fetal Heart Program at the Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Margaret McCann
- Fetal Heart Program at the Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Debbra Soffer
- Fetal Heart Program at the Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Zhiyun Tian
- Fetal Heart Program at the Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Anita Szwast
- Fetal Heart Program at the Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Batlivala SP, McElhinney DB, Pigula FA, Marshall AC. Isolated pulmonary artery arising from a duct: a single-center review of diagnostic and therapeutic strategies. J Thorac Cardiovasc Surg 2013; 148:2245-52. [PMID: 24521948 DOI: 10.1016/j.jtcvs.2013.11.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/07/2013] [Accepted: 11/22/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Isolated pulmonary artery of ductal origin (IPADO) is a rare disease with diverse presentations. Diagnostic and therapeutic approaches vary widely given the low incidence. Reporting additional cases may help inform medical decision making. METHODS We reviewed diagnostic data--including echocardiography, catheterization, and MRI--and outcomes for all patients with IPADO at our institution. RESULTS Thirty-seven patients who met inclusion criteria were identified. The mean age at diagnosis was 3 months (range, 1 day-45 years). In 11 patients, the duct supplying the IPADO was patent (ie, patent ductus arteriosis [PDA]); the duct had closed (ligamentum) in the other 26 patients. When performed, catheterization delineated the anatomy in 90% (100% if PDA) versus 54% with magnetic resonance imaging. Patients with a PDA were more likely to undergo intervention (100% vs 58%, P=.02) and had earlier first intervention (1 vs 20 months; P<.001). Patients diagnosed at age≤6 months were more likely to undergo intervention (86% vs 50%; P=.03) and unifocalization (81% vs 44%; P=.04), and had greater IPADO flow at follow-up (40% vs 14%; P<.001). Patients who underwent any intervention had greater IPADO flow than those without intervention (38% vs 0%). CONCLUSIONS Early IPADO diagnosis is important in long-term outcome. However, successful interventions can be performed on older patients. Diagnosis relies on angiography but magnetic resonance imaging may play an increasingly important role. Although initial intervention depends on individual factors, the ultimate goal should be early unifocalization.
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Affiliation(s)
- Sarosh P Batlivala
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Pediatric Cardiology, Batson Children's Hospital, Jackson, Miss; Department of Pediatrics, University of Mississippi Medical Center, Jackson, Miss.
| | - Doff B McElhinney
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Frank A Pigula
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - Audrey C Marshall
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
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Zielinsky P, Piccoli AL, Vian I, Zílio AM, Naujorks AA, Nicoloso LH, Barbisan CW, Busato S, Lopes M, Klein C. Maternal restriction of polyphenols and fetal ductal dynamics in normal pregnancy: an open clinical trial. Arq Bras Cardiol 2013; 101:217-25. [PMID: 23949325 PMCID: PMC4032301 DOI: 10.5935/abc.20130166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 06/20/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We have recently demonstrated reversal of fetal ductal constriction after dietary maternal restriction of polyphenol-rich foods (PRF), due to its inhibitory action on prostaglandin synthesis. OBJECTIVE To test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols. METHODS Open clinical trial with 46 fetuses with gestational age (GA) > 28 weeks submitted to 2 Doppler echocardiographic studies with an interval of at least 2 weeks, being the examiners blinded to maternal dietary habits. A validated food frequency questionnaire was applied and a diet based on polyphenol-poor foods (<30 mg/100 mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples. RESULTS Mean GA was 33 ± 2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277 mg, decreasing to 126 mg after dietary orientation (p=0.0001). Significant decreases in systolic (SDV) and diastolic (DDV) ductal velocities, and RV/LV diameters ratio, as well as increase in ductal PI were observed [DSV = 1.2 ± 0.4 m/s (0.7-1.6) to 0.9 ± 0.3 m/s (0.6-1.3) (p = 0.018); DDV = 0.21 ± 0.09 m/s (0.15-0.32) to 0.18 ± 0.06 m/s (0.11-0.25) (p = 0.016); RV/LV ratio = 1.3 ± 0.2 (0.9-1.4) to 1.1 ± 0.2 (0.8-1.3) (p=0.004); ductal PI = 2.2 ± 0.03 (2.0-2.7) to 2.4 ± 0.4(2.2-2.9) (p = 0.04)]. In the control group, with GA of 32 ± 4 weeks, there were no significant differences in DMPI, mean SDV, DDV, PI and RV/LV ratio. CONCLUSION The oriented restriction of third trimester maternal ingestion of polyphenol-rich foods for a period of 2 weeks or more improve fetal ductus arteriosus flow dynamics and right ventricular dimensions.
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Affiliation(s)
- Paulo Zielinsky
- Mailing Address: Paulo Zielinsky, Av. Princesa Isabel, 370, Santana.
Postal Code 90620-000, Porto Alegre, RS - Brazil. E-mail:
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Tapia-Rombo CA, González-Arenas M, Carpio-Hernández JC, Santiago-Romo JE. [An index internal diameter ductus arteriosus/body surface area as a need for closure of duct in the preterm newborn]. Rev Invest Clin 2013; 65:12-23. [PMID: 23745440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine a rate of internal diameter (ID), the narrowest of ductus arteriosus (DA)/body surface area (BSA) in preterm newborns (PTNB) for need for closure of DA either medically or surgically. MATERIAL AND METHODS Prospective (cohort), held in a Neonatology Service in February 2010 to January 2011. Inclusion criteria were PTNB from 28 to 36 weeks of gestation from 0 to 28 days after birth, which confirmed diagnosis of patent ductus arteriosus (PDA) by echocardiogram, taking the narrowest ID, who did not present heart complex congenital or other major malformations in other systems without pulmonary arterial hypertension, that had not received drug treatment with prostaglandin inhibitors to close the DA. The exclusion criteria for complications of mechanical ventilation (air leaks, atelectasis, etc.) before measurements. BSA was determined based on their weight and height. There were two comparison groups during its evolution, those who finally merited either closure medical or surgical closure or was indicated but the poor conditions of the patient by the same PDA mainly, the procedure was not carried out (Group A) and Group B, those that are not operated or not medically closed DA not being hemodynamically significant [corrected]. Statistical analysis was performed using descriptive statistics and inferential. Significance levels were set at p < 0.05. RESULTS The study population consisted of 32 patients who were divided into two groups: group A of 13 patients and group B with 19 patients. The study population characteristics between the two groups showed significant difference only in the Apgar Score for the Group B. In multivariate analysis found statistically significant as need for closure of DA only a index ID DA/ BSA when it was > 14. CONCLUSIONS It is important to take into account a number of known ways to assess whether the DA is hemodynamically significant and therefore should be closed medically or surgically and according to this study, a parameter to requiring its closure is an index ID DA/BSA with a value > 14.
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MESH Headings
- Anthropometry
- Body Surface Area
- Comorbidity
- Ductus Arteriosus/diagnostic imaging
- Ductus Arteriosus/pathology
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/pathology
- Ductus Arteriosus, Patent/surgery
- Female
- Gestational Age
- Hemodynamics
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/pathology
- Infant, Premature, Diseases/surgery
- Ligation/statistics & numerical data
- Male
- Postoperative Complications/epidemiology
- Predictive Value of Tests
- Prospective Studies
- Sensitivity and Specificity
- Treatment Outcome
- Ultrasonography
- Unnecessary Procedures
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Affiliation(s)
- Carlos Antonio Tapia-Rombo
- Servicio de Neonatologia, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, IMSS.
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Enzensberger C, Wienhard J, Weichert J, Kawecki A, Degenhardt J, Vogel M, Axt-Fliedner R. Idiopathic constriction of the fetal ductus arteriosus: three cases and review of the literature. J Ultrasound Med 2012; 31:1285-1291. [PMID: 22837295 DOI: 10.7863/jum.2012.31.8.1285] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Premature constriction or closure of the ductus arteriosus can occur during fetal life. It is a rare phenomenon and has been described secondary to medication or structural lesions or as idiopathic constriction. Premature closure of the ductus arteriosus can lead to progressive right heart dysfunction with tricuspid regurgitation, congestive heart failure, fetal hydrops, and intrauterine death. This series describes diagnosis of fetal ductus arteriosus constriction of unknown etiology in 3 cases, prenatal management, and outcomes. Constriction of the ductus arteriosus can be diagnosed prenatally with careful interrogation of the ductal arch using pulsed Doppler sonography and complete fetal echocardiography. Close monitoring is mandatory to rule out development of right heart failure and to determine the intervention time.
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Affiliation(s)
- Christian Enzensberger
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University of Giessen and Marburg, Giessen, Germany
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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. J Clin Ultrasound 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
OBJECTIVES Trisomy 21 is associated with an increased nuchal translucency thickness (NT), abnormal ductus venosus (DV) flow at 11-14 weeks' gestation and congenital heart defects (CHD), and cardiac dysfunction has been hypothesized as the link between them. We therefore aimed to investigate whether cardiac function is altered in trisomy 21 fetuses. METHODS Between December 2003 and June 2009, we performed echocardiography on 46 trisomy 21 fetuses (28 with structurally normal heart and 18 with CHD) and on 191 chromosomally/phenotypically normal fetuses with a confirmed normal heart (87 with normal NT and 104 with NT ≥ 95(th) percentile), between 11 and 35 weeks' gestation. Measurements included: E- and A-wave peak velocity, E/A velocity ratio and E/time velocity integral (TVI) ratio over atrioventricular valves; myocardial performance index (MPI); semilunar valve peak velocity and acceleration time; stroke volume (SV); cardiac output; and DV pulsatility index for veins (PIV) at 11-14 weeks' gestation. Data were categorized into three different age groups for analysis (11 to 13 + 6, 14 to 21 + 6 and 22 to 35 weeks' gestation). RESULTS The tricuspid valve (TV) A-wave velocity and aortic valve peak velocity were significantly reduced in trisomy 21 compared with normal fetuses. Other highly significant differences found in trisomy 21 fetuses at 11-14 weeks' were increased TV-E/A ratio and DV-PIV, and decreased pulmonary valve peak velocity. We also observed evidence of left ventricular (LV) systolic dysfunction, reduced SV and increased MPI. After 14 weeks' gestation, the mitral valve A-wave peak velocity and E/TVI ratio were significantly reduced in the trisomy 21 fetuses with normal hearts compared with the controls with increased NT. CONCLUSIONS In comparison with controls with normal or increased NT, cardiac function in trisomy 21 fetuses is abnormal irrespective of the presence of CHD. Evidence for cardiac loading (increased preload and afterload) and LV systolic (in the first trimester) and later diastolic dysfunction was observed.
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Affiliation(s)
- S A B Clur
- Department of Pediatric Cardiology of the Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
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Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. Ultrasound Obstet Gynecol 2010; 36:93-111. [PMID: 20205158 DOI: 10.1002/uog.7622] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The human fetal venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise.
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Affiliation(s)
- S Yagel
- Obstetrics and Gynecology Ultrasound Center, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Baś-Budecka E, Perenc M, Sieroszewski P. [The role of fetal nuchal translucency (NT) and ductus venosus blood flow (DV) in the detection of congenital heart defects]. Ginekol Pol 2010; 81:272-276. [PMID: 20476599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
UNLABELLED Cardiac defects, the most common forms of congenital defects, are found in 3-8 of every 1000 pregnancies. Currently only 15-30% of CHD in newborns is detected prenatally. There are different strategies to increase the prenatal detection of cardiac abnormalities. Nuchal translucency screening and ductus venosus blood flow have been suggested to be useful methods of identifying cardiac anomalies in chromosomally normal fetuses. OBJECTIVE To examine the association between nuchal translucency thickness and ductus venosus blood flow between 11-13.6 week of pregnancy and CHD in chromosomally normal fetuses. MATERIAL AND METHODS Patients with singleton pregnancies at 11 to 13.6 weeks of gestation were recruited to undergo nuchal translucency sonography. The prevalence of major cardiac defects was determined and the utility of screening for nuchal translucency thickness including sensitivity, specificity, and positive and negative predictive values, were calculated for the NT thickness cut off points of the 95th and 99th centile for CRL. Ductus venosus Doppler ultrasound blood flow velocity waveforms were obtained at 10-13.6 weeks gestation. RESULTS 4720 gestations were analyzed, of which 13 newborn infants had CHD. The incidence of major CHD increased with increasing NT. Sensitivity specificity and positive predictive values were 45.4%, 92% and 1.5% at 99.8th percentile, and 25%, 98.5%, 3.2% and 99.8% at 99th percentile. Reverse or absent flow during atrial contraction was observed in 8 out of the 13 (61.5%) chromosomally normal fetuses with CHD. CONCLUSION Measurement of fetal nuchal translucency thickness and ductus venosus blood flow at 11-13.6 weeks of pregnancy is a sensitive method of screening for CHD. The prevalence of CHD increases with increasing fetal NT and abnormal ductus venosus blood flow. Increased NT or abnormal ductus venosus blood flow is a strong indication for fetal echocardiography.
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Affiliation(s)
- Elzbieta Baś-Budecka
- Klinika Medycyny Płodu i Ginekologii, I Katedra Ginekologii i Połoznictwa, Uniwersytetu Medycznego w Łodzi.
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Meng XC, Cai HB, Li ZC, Wang T, Zhang Q, Zhang ZW. [A modified management of the transcatheter occlusion of patent ductus arteriosus: using angiography combined with transthoracic echocardiography]. Zhongguo Dang Dai Er Ke Za Zhi 2010; 12:103-105. [PMID: 20199722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the feasibility of angiography combined with transthoracic echocardiography (TEE) as a modified management of the transcatheter occlusion of patent ductus arteriosus (PDA). METHODS Forty children with PDA were randomly divided into two groups (n=20 each): observed and control. The control group accepted traditional transcatheter occlusion, and the observed group received a modified management (angiography combined with TEE). The children in the observed group were monitored by realtime TTE. RESULTS A complete occlusion was acquired by one occlusion operation in each child in the observed group. The TTE demonstrated that the occlusion device was in place, and that the blood flow velocities in the left and right pulmonary artery and the descending aorta were in normal ranges. There were shorter X-ray exposure time, shorter recovering time and less ICU stay time in the observed group than in the control group. The complications associated with blood vessel puncturation occurred in four children from the control group, but none of the observed group had the complications. The total hospitalization cost in the observed group was less than in the control group. CONCLUSIONS Angiography combined with TEE as a modified management of the transcatheter occlusion of PDA is recommended.
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Affiliation(s)
- Xiang-Chun Meng
- Pediatric Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong 518026, China.
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