Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases.
OBJECTIVE
To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction.


METHODS
Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants.


RESULTS
The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]). Mean gestational age was 32.5 +/- 3.1 (27-38) weeks and maternal age was 28.2 +/- 8.5 (17-42) years. Mean systolic velocity in the ductus was 2.22 +/- 0.34 (1.66-2.81) m/s, diastolic velocity 0.79 +/- 0.28 (0.45-1.5) m/s, and pulsatility index 1.33 +/- 0.36 (0.52-1.83). Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13 +/- 0.33) than in group B (0.68 +/- 0.15) (P=0.008). The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension.


CONCLUSIONS
The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.
Luchese
Stelamaris
S
Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil. pesquisa@cardnet.tche.br
Mânica
João L
JL
Zielinsky
Paulo
P
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001783:Blood Flow Velocity / Q000187:drug effects; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000139:chemically induced / Q000000981:diagnostic imaging; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors