title: Flow patterns in the ductus arteriosus during open fetal myelomeningocele repair.
abstract: OBJECTIVE
  The objective of this study is to perform a longitudinal evaluation of blood flow patterns in the ductus arteriosus (DA) during the perioperative period in fetal myelomeningocele (MMC) surgical patients.
  
  
  METHODS
  Serial fetal echocardiograms were reviewed in 10 MMC cases where mothers received indomethacin and intravenous and inhaled anesthesia. One-way analysis of variance was utilized to evaluate for differences in peak systolic velocity, end-diastolic velocity (EDV), time-averaged mean velocity (TAMV), and Pulsatility Index (PI) throughout the monitoring period. Regression analysis was performed to evaluate the relationship between PI and maternal hemodynamics and medications.
  
  
  RESULTS
  The DA TAMV and EDV increased between baseline and inhaled anesthesia and decreased between inhaled anesthesia and postoperative day 2. PI decreased to a nadir during inhaled anesthesia and then increased through postoperative day 2. Three distinct ductal flow patterns, characterizing degree of ductal constriction, were observed. Two fetuses exhibited a severely constricted ductal flow pattern with concurrent moderate tricuspid insufficiency and right ventricular dysfunction during inhaled anesthesia.
  
  
  CONCLUSIONS
  Abnormal DA flow patterns culminating in significant DA constriction occurred during fetal MMC repair. Limiting maternal exposure to indomethacin, supplemental oxygen, and inhaled anesthesia may reduce the incidence and severity of DA constriction and perhaps reduce fetal cardiac dysfunction during open fetal surgery.
authors: Department of Pediatric Cardiology, The Fetal Heart Program, Colorado Fetal Care Center, Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
authors: Lisa
authors: http://orcid.org/0000-0001-5902-6959
authors: L
authors: Howley
authors: Department of Anesthesiology, Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
authors: Cristina
authors: C
authors: Wood
authors: Department of Pediatric Cardiology, The Fetal Heart Program, Colorado Fetal Care Center, Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
authors: Sonali S
authors: SS
authors: Patel
authors: Department of Maternal-Fetal Medicine, Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.|Department of Fetal Surgery, Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
authors: Michael V
authors: MV
authors: Zaretsky
authors: Department of Fetal Surgery, Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
authors: Timothy
authors: T
authors: Crombleholme
authors: Department of Pediatric Cardiology, The Fetal Heart Program, Colorado Fetal Care Center, Colorado Institute for Maternal Fetal Health, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
authors: Bettina
authors: B
authors: Cuneo
mesh_terms: D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D015331:Cohort Studies; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D046128:Fetal Therapies; D006439:Hemodynamics; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D017078:Laser-Doppler Flowmetry; D008137:Longitudinal Studies; D008591:Meningomyelocele / Q000601:surgery*; D010102:Oxygen Inhalation Therapy; D059035:Perioperative Period; D011247:Pregnancy; D011673:Pulsatile Flow; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin