Clinical features of the complete closure of the ductus arteriosus prenatally.
OBJECTIVE
Prenatal constriction of the ductus arteriosus associated with maternal drug ingestion was reported several decades ago. There are fewer reports of the complete closure of the ductus arteriosus; therefore, the clinical features of the latter are poorly understood. The aim of this study is to clarify the clinical features of complete ductal closure and postnatal pulmonary hypertension by performing echocardiography of the fetus.


METHODS
We diagnosed four fetuses with complete ductal closure by performing fetal echocardiography and reviewed the prenatal and postnatal medical records of the mother and fetus.


RESULTS
One mother each had bronchial asthma, ulcerative colitis, and idiopathic thrombocytopenic purpura, and they had received nonsteroidal anti-inflammatory drugs and/or corticosteroids during pregnancy. The fourth mother did not have basal disease and had not ingested any drugs. Fetal diagnosis was performed at 32-38 weeks of gestation. All fetuses had right heart dilatation with tricuspid regurgitation in the absence of any cardiac defects, and Doppler echocardiography indicated that the right ventricular pressure was elevated. Two of the fetuses had fetal hydrops, which suggested severe right heart dysfunction. All fetuses were delivered by emergent cesarean delivery. After birth, all the infants developed persistent pulmonary hypertension and required oxygen inhalation. Of these, three required mechanical ventilation, and two, nitric oxide inhalation. All infants improved within 2 weeks, and they had no neurological and cardiac complications after discharge.


CONCLUSIONS
Right heart dilatation and severe tricuspid regurgitation in the absence of a cardiac defect in the fetus strongly suggested ductal dysfunction. Careful evaluation of ductal patency and right ventricular function can lead to precise early diagnosis and good prognosis.
Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. hidehide@fb4.so-net.ne.jp
Hidekazu
H
Ishida
Noboru
N
Inamura
Yukiko
Y
Kawazu
Futoshi
F
Kayatani
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002585:Cesarean Section; D003251:Constriction, Pathologic; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000196:embryology; D015150:Echocardiography, Doppler; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000187:drug effects*; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy; D017380:Hypertrophy, Right Ventricular / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000196:embryology / Q000628:therapy; D007231:Infant, Newborn; D018811:Maternal Exposure; D010547:Persistent Fetal Circulation Syndrome / Q000139:chemically induced / Q000628:therapy; D011247:Pregnancy; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000196:embryology / Q000628:therapy; D016216:Ultrasonography, Prenatal; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal