Closure of the ductus arteriosus and development of pulmonary branch stenosis in babies of less than 32 weeks gestation.
OBJECTIVE
To define how often transient pulmonary branch stenosis (PBS) develops after closure of a patent ductus arteriosus (PDA) in babies born at less than 32 weeks gestation; to describe the natural history of PBS and the relation between PBS and a cardiac murmur.


METHODS
Fifty three preterm infants born at a gestational age less than 32 weeks and who had PDA diagnosed on echocardiography were recruited. An echocardiogram was performed on alternate days until the ductus arteriosus closed. If PBS was diagnosed, the baby was followed up until PBS resolved.


RESULTS
In 59%, PBS developed in one or both branches after closure of the PDA. In 21%, both pulmonary branches were affected. In 79%, the left pulmonary artery alone was involved but the right side was never affected alone. PBS had resolved in 74% by the time the infants reached 40 weeks, in 95% at a corrected age of 6 weeks, and in 100% at a corrected age of 3 months. There is a better correlation between a cardiac murmur and PBS than between a murmur and PDA.


CONCLUSIONS
PBS in preterm infants is usually not present at birth but develops after closure of a PDA. PBS resolves by a corrected age of 3 months. The presence of a murmur after closure of a PDA is usually related to PBS and not to reopening of the ductus arteriosus.
Arlettaz
R
R
Neonatal Unit, University Hospital, Zürich, Switzerland.
Archer
N
N
Wilkinson
A R
AR
D002317:Cardiovascular Agents / Q000627:therapeutic use; D018450:Disease Progression; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D006337:Heart Murmurs / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods
D002317:Cardiovascular Agents; D007213:Indomethacin