title: Assessment of the ductus arteriosus in fetuses with tetralogy of Fallot and the implication for postnatal management.
abstract: OBJECTIVE
  To describe the antenatal and neonatal echocardiographic morphology and flow pattern of the ductus arteriosus in patients with tetralogy of Fallot.
  
  
  METHODS
  We included patients with a prenatal diagnosis of tetralogy of Fallot between January 2006 and December 2012.
  
  
  RESULTS
  Among the 52 fetuses with tetralogy of Fallot the severity of right ventricular outflow obstruction was considered mild in 32, moderate in 14, and severe in 6. In the mild right ventricular outflow obstruction group (n = 32) all had normal ductal morphology and flow pattern, eight (25%) elected for termination of pregnancy and two died in the neonatal period from extracardiac causes. In the moderate right ventricular outflow obstruction group (n = 14) the fetuses had a small ductus arteriosus with antegrade but abnormal flow velocity, one (7%) elected for termination of pregnancy. Immediately after birth the ductus arteriosus was very small or already closed at echocardiographic examination. Two out of 13 patients (15%) developed severe hypoxic spells and underwent modified Blalock-Taussig shunt during the neonatal period. Six fetuses were considered to have severe right ventricular outflow obstruction with flow reversal in the ductus arteriosus, three (50%) of whom elected for termination of pregnancy. The other three newborns underwent modified Blalock-Taussig shunt.
  
  
  CONCLUSIONS
  In fetuses with tetralogy of Fallot, ductal diameter can be reduced even up to prenatal closure. Prenatal ductal morphology assessment may be useful for improving management of patients with moderate right ventricular outflow obstruction and small ductus arteriosus who may become cyanotic at birth.
authors.affiliation: Department of Pediatric Cardiology and Cardiac Surgery, Giannina Gaslini Institute, Genova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Tuo
authors.forename: Paolo
authors.initials: P
authors.lastname: Volpe
authors.forename: Davide
authors.initials: D
authors.lastname: Buffi
authors.forename: Valentina
authors.initials: V
authors.lastname: De Robertis
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marasini
mesh_terms: D000015:Abnormalities, Multiple; D000028:Abortion, Induced; D058366:Blalock-Taussig Procedure; D003490:Cyanosis / Q000209:etiology / Q000628:therapy; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005318:Fetal Heart / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology
keywords: Ductus Arteriosus; Fetal Echocardiography; Prenatal Diagnosis; Tetralogy of Fallot