Fetal ductus arteriosus constriction and closure: analysis of the causes and perinatal outcome related to 45 consecutive cases

• Published in: The journal of maternal-fetal & neonatal medicine 2016-02, Vol.29 (4), p.638-645
• Main Authors: Lopes, Lilian Maria, Carrilho, Milene Carvalho, Francisco, Rossana Pulcineli Vieira, Lopes, Marco Antonio Borges, Krebs, Vera Lúcia Jornada, Zugaib, Marcelo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Blood Flow Velocity; Caffeine - adverse effects; Central Nervous System Stimulants - adverse effects; Constriction, Pathologic - chemically induced; Constriction, Pathologic - diagnostic imaging; Ductus Arteriosus - diagnostic imaging; Ductus Arteriosus - drug effects; Ductus arteriosus constriction; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Female; fetal echocardiography; Fluoxetine - adverse effects; Heart Failure - chemically induced; Heart Failure - diagnostic imaging; Humans; Hypertension, Pulmonary - chemically induced; Isoxsuprine - adverse effects; Maternal Exposure - adverse effects; Maternal-Fetal Exchange; Naphazoline - adverse effects; Nasal Decongestants - adverse effects; Pesticides - toxicity; Pregnancy; prenatal diagnosis; Remission, Spontaneous; Retrospective Studies; Serotonin Uptake Inhibitors - adverse effects; Tricuspid Valve Insufficiency - chemically induced; Tricuspid Valve Insufficiency - diagnostic imaging; Ultrasonography, Prenatal; Vasodilator Agents - adverse effects; Ventricular Dysfunction, Right - chemically induced; Ventricular Dysfunction, Right - diagnostic imaging; Young Adult
• ISSN: 1476-7058; 1476-4954
• DOI: 10.3109/14767058.2015.1015413

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.