title: Isolated ductus arteriosus aneurysm in the fetus and infant: a multi-institutional experience.
abstract: OBJECTIVE
  The purpose of this study was to describe the clinical characteristics and outcome and to elucidate the pathogenesis of ductus arteriosus aneurysm (DAA).
  
  
  BACKGROUND
  Ductus arteriosus aneurysm is a rare lesion that can be associated with severe complications including thromboembolism, rupture and death.
  
  
  METHODS
  We reviewed the clinical records, diagnostic imaging studies and available histology of 24 cases of DAA, diagnosed postnatally (PD) in 15 and antenatally (AD) in 9 encountered in five institutions.
  
  
  RESULTS
  Of PD cases, 13 presented at <2 months, and all AD cases were detected incidentally after 33 weeks of gestation during a late trimester fetal ultrasound study. Of the 24, only 4 had DAA-related symptoms and 6 had associated syndromes: Marfan, Smith-Lemli-Opitz, trisomies 21 and 13 and one possible Ehlers-Danlos. Three had complications related to the DAA: thrombus extension into the pulmonary artery, spontaneous rupture, and asymptomatic cerebral infarction. Six underwent uncomplicated DAA resection for ductal patency, DAA size or extension of thrombus. In the four examined, there was histologic evidence of reduced intimal cushions in two and abnormal elastin expression in two. Five of the 24 died, with only one death due to DAA. Of 19 survivors, all but one remain clinically asymptomatic at a median follow-up of 35 months; however, two have developed other cardiac lesions that suggest Marfan syndrome. A review of 200 consecutive third trimester fetal ultrasounds suggests an incidence of DAA of 1.5%.
  
  
  CONCLUSIONS
  Ductus arteriosus aneurysm likely develops in the third trimester perhaps due to abnormal intimal cushion formation or elastin expression. Although it can be associated with syndromes and severe complications, many affected infants have a benign course. Given the potential for development of other cardiac lesions associated with connective tissue disease, follow-up is warranted.
authors.affiliation: Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: U
authors.initials: U
authors.lastname: Dyamenahalli
authors.forename: J F
authors.initials: JF
authors.lastname: Smallhorn
authors.forename: T
authors.initials: T
authors.lastname: Geva
authors.forename: J C
authors.initials: JC
authors.lastname: Fouron
authors.forename: P
authors.initials: P
authors.lastname: Cairns
authors.forename: L
authors.initials: L
authors.lastname: Jutras
authors.forename: V
authors.initials: V
authors.lastname: Hughes
authors.forename: M
authors.initials: M
authors.lastname: Rabinovitch
authors.forename: C A
authors.initials: CA
authors.lastname: Mason
authors.forename: L K
authors.initials: LK
authors.lastname: Hornberger
mesh_terms: D000783:Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016216:Ultrasonography, Prenatal