title: Fetal ductus arteriosus constriction and closure: analysis of the causes and perinatal outcome related to 45 consecutive cases.
abstract: OBJECTIVE
  The aim of this study was to analyze the causes and perinatal outcome related to fetal ductus arteriosus constriction or closure at a single center over a 26-year period.
  
  
  METHODS
  This was a retrospective analysis of 45 consecutive cases of constriction (n = 41) and closure (n = 4) from 1987 through 2013. Patients were divided into Group A (maternal use of non-steroidal anti-inflammatory drugs (NSAID), n = 29), Group B (idiopathic, n = 8), and Group C (other drugs not previously described, n = 8).
  
  
  RESULTS
  The median gestational age at diagnosis was 34 weeks (range, 27-38), mean systolic and diastolic velocity in the ductus arteriosus was 2.01 ± 0.66 m/s and 0.71 ± 0.46 m/s, respectively. Among the 29 cases of NSAIDs, 27.5% (8/29) have taken a single day use and 75% multiple days/doses. Right ventricular dilatation was present in 82.2% of the fetuses, tricuspid insufficiency in 86.6%, and heart failure in 22.2%. Neonatal persistent pulmonary hypertension occurred in 17.7% of the patients. Late follow-up showed all 43 survivors alive and healthy with only two deaths from unrelated causes.
  
  
  CONCLUSIONS
  The results of this study indicate that clinically significant ductal constriction may follow maternal exposure to single doses of NSAIDs. Unknown causes or other new substances were also described, such as naphazoline, fluoxetine, isoxsuprine, caffeine and pesticides. Echocardiographic diagnosis of ductal constriction led to an active medical approach that resulted in low morbidity of this group of patients.
authors.affiliation: a Department of Obstetrics and Gynecology and.
authors.forename: Lilian Maria
authors.initials: LM
authors.lastname: Lopes
authors.affiliation: a Department of Obstetrics and Gynecology and.
authors.forename: Milene Carvalho
authors.initials: MC
authors.lastname: Carrilho
authors.affiliation: a Department of Obstetrics and Gynecology and.
authors.forename: Rossana Pulcineli Vieira
authors.initials: RP
authors.lastname: Francisco
authors.affiliation: a Department of Obstetrics and Gynecology and.
authors.forename: Marco Antonio Borges
authors.initials: MA
authors.lastname: Lopes
authors.affiliation: b Department of Pediatrics , University of São Paulo School of Medicine , São Paulo , Brazil.
authors.forename: Vera Lúcia Jornada
authors.initials: VL
authors.lastname: Krebs
authors.affiliation: a Department of Obstetrics and Gynecology and.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001783:Blood Flow Velocity; D002110:Caffeine / Q000009:adverse effects; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000139:chemically induced / Q000000981:diagnostic imaging; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging* / Q000187:drug effects*; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects; D006333:Heart Failure / Q000139:chemically induced / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced; D007556:Isoxsuprine / Q000009:adverse effects; D018811:Maternal Exposure / Q000009:adverse effects*; D008431:Maternal-Fetal Exchange; D009278:Naphazoline / Q000009:adverse effects; D014663:Nasal Decongestants / Q000009:adverse effects; D010575:Pesticides / Q000633:toxicity; D011247:Pregnancy; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects; D014262:Tricuspid Valve Insufficiency / Q000139:chemically induced / Q000000981:diagnostic imaging; D016216:Ultrasonography, Prenatal; D014665:Vasodilator Agents / Q000009:adverse effects; D018497:Ventricular Dysfunction, Right / Q000139:chemically induced / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002110:Caffeine; D000697:Central Nervous System Stimulants; D005473:Fluoxetine; D007556:Isoxsuprine; D009278:Naphazoline; D014663:Nasal Decongestants; D010575:Pesticides; D017367:Selective Serotonin Reuptake Inhibitors; D014665:Vasodilator Agents
keywords: Ductus arteriosus constriction; fetal echocardiography; prenatal diagnosis