Aneurysm of the ductus arteriosus A review of the literature and the surgical implications

Abstract

One hundred and forty-four cases of aneurysms of the ductus arteriosus (DAA) have been reported in the literature of which 106 appeared spontaneously and 38 followed surgical treatment of a patent ductus arteriosus (PDA). Within the last few years there has been an increasing number of reported spontaneous DAA. However, the real incidence is presumably still underestimated. Aortography is a well established diagnostic method. In neonates, transthoracic echocardiography has shown convincing potential, whereas in older children and adults, transoesophageal echocardiography has yielded very promising results. Serious complications following spontaneous DAA are rupture, erosion, infection and thromboembolism. In infants younger than 2 months of age, the complication rate is 31%, in children between 2 months and 15 years, 66%, in adults, 47%. The rate of complications following postoperative DAA is even higher: 91% of the unoperated cases died due to rupture or infection. The operative mortality in children older than 2 months and adults is low. In the neonate group, 2 of 8 died during operation. The operative mortality in patients with postoperative DAA was 26%. Based on information from the literature, we suggest prompt surgical treatment of all spontaneous DAA in patients older than 2 months of age, and in all patients with postoperative DAA. In infants, a DAA should be closely followed with echocardiography, as spontaneous regression has been reported in this age group. If no regression is seen within a few days, it should be surgically corrected.

Bilateral Pleural Effusion and Pulmonary Edema Caused by a Fistulous Aneurysm of the Ductus Arteriosus.

“…Specific symptoms of DAAare few in adults, but the aneurysm maycause hoarseness, cough, anorexia and thoracic pain due to local effects on adjacent organs and nerves (8). When the DAAis patent at the pulmonary end, a continuous murmur may be audible, and dyspnea and peripheral edema will be dominant due to pulmonary hypertension and overload from the large volume of blood shunted from the systemic to the pulmonary circulation (8).…”

“…When the DAAis patent at the pulmonary end, a continuous murmur may be audible, and dyspnea and peripheral edema will be dominant due to pulmonary hypertension and overload from the large volume of blood shunted from the systemic to the pulmonary circulation (8). Serious complications following spontaneous DAAare rupture, erosion into the adjacent organs (bronchi, esophagus), infection (arteritis, endocarditis) and thromboembolism.…”

“…Contrast-enhanced CT (9,10) and aortography are essential for making a diagnosis. In neonates, transthoracic echocardiography has shownconvincing potential, whereas in older children and adults, transesophageal echocardiography has yielded very promising results (8).…”

Aneurysmal changes in silent patent ductus arteriosus in a child (year time follow-up)

“…It can be either congenital or acquired as a complication of surgical closure of PDA or after a ductal infection [3,4]. Their time of presentation can be divided in two three groups according to the age at diagnosis: infantile < 2 months, childhood (2 months to 15 years) and adult [5]. DAA has been considered as a rare congenital anomaly with potential fatal complications [5][6][7][8], although the exact incidence of DAA is unclear, but it can be ranged between 0.8-8% among fetuses and neonates [6,9], and approximately 5.2% of all adult thoracic aneurysm [10], with some reported childhood cases [3,11,12].…”

“…Their time of presentation can be divided in two three groups according to the age at diagnosis: infantile < 2 months, childhood (2 months to 15 years) and adult [5]. DAA has been considered as a rare congenital anomaly with potential fatal complications [5][6][7][8], although the exact incidence of DAA is unclear, but it can be ranged between 0.8-8% among fetuses and neonates [6,9], and approximately 5.2% of all adult thoracic aneurysm [10], with some reported childhood cases [3,11,12]. Some authors believe that neonatal DAA is resulted from transient widening of the ductus arteriosus prior to spontaneous obliteration and are not true aneurysm [5,13,14].…”