Premature Closure of the Ductus Arteriosus in an Otherwise Healthy Fetus

Operle, Michaela; Anderson, Sharlette

doi:10.1177/8756479318824315

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…The most consistently reported risk of using indomethacin is its countereffect on the patency of the fetal DA. A constricted DA can lead to pulmonary hypertension and if untreated fetal death ( 27 ). The diameter of the ductus arteriosus varies at different gestational weeks, however, generally, the mean values range from 1.34 mm at week 15–3.49 mm at week 34 ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Balancing Benefits and Risks of Indomethacin in the Management of Antenatal Bartter Syndrome: A Case Report

et al. 2022

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BackgroundBartter syndrome, a very rare inherited renal tubular disorder, characterized by urinary salt wastage, hypokalemia, polyuria, and metabolic alkalosis, may manifest antenatally as severe isolated polyhydramnios. Indomethacin is known to reduce salt wastage and subsequent polyhydramnios during pregnancy; however, it reduces the Ductus Arteriosus diameter among other potential complications, such as inhibition of gastrointestinal perfusion and increasing the risk of renal toxicity.CaseA 36-year-old multigravida presented with severe isolated polyhydramnios at 30 weeks of gestation. Based on a history of a previous pregnancy affected with Bartter syndrome, indomethacin was initiated. Amniotic fluid volume and Ductus Arteriosus diameter were monitored. As evidence lacks on optimal dose and duration of indomethacin, multiple-dose adjustments were made to reduce the amniotic fluid volume while maintaining normal Ductus Arteriosus diameter. Progressive polyhydramnios led to Cesarean section at 34+ weeks of gestation resulting in a healthy fetus diagnosed with Bartter syndrome in the early neonatal period.ConclusionWe share our experience in the adjustment of the dose and duration of Indomethacin therapy in the treatment of severe polyhydramnios associated with antenatal Bartter syndrome. Amniotic fluid index, Ductus Arteriosus diameter, and umbilical artery doppler work together as key indicators to guide the success and safety of the therapy.

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Section: Discussionmentioning

confidence: 99%

Balancing Benefits and Risks of Indomethacin in the Management of Antenatal Bartter Syndrome: A Case Report

et al. 2022

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“…When respiration begins after birth, the DA closes functionally by vasoconstriction and anatomically by intimal thickening 1 . Before birth, in contrast, maintenance of the DA patency is important because DA premature constriction or closure can lead to various anomalies such as persistent pulmonary hypertension, progressive right heart dysfunction with tricuspid regurgitation, congestive heart failure, fetal hydrops, and intrauterine death 2,3 …”

Section: Introductionmentioning

confidence: 99%

“…1 Before birth, in contrast, maintenance of the DA patency is important because DA premature constriction or closure can lead to various anomalies such as persistent pulmonary hypertension, progressive right heart dysfunction with tricuspid regurgitation, congestive heart failure, fetal hydrops, and intrauterine death. 2,3 NO produced by eNOS and PGE2 produced by COX-2 are critical DA patency regulators during late pregnancy. eNOS is expressed in DA and a NOS inhibitor causes DA constriction.…”

Section: Introductionmentioning

confidence: 99%

Complementary mRNA expression of enzymes producing nitric oxide and prostaglandin in ductus arteriosus with respect to their role in maintaining patency

Yamana

Kadota

Ishii

et al. 2023

Congenital Anomalies

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mRNA expression of molecules related to the activity of nitric oxide or prostaglandin E2, the critical regulators maintaining the ductus arteriosus patency, was examined in rat ductus arteriosus at preterm (days 18.5 and 19.5 of pregnancy) and near term (days 20.5 and 21.5). The endothelial nitric oxide synthase mRNA level increased transiently at preterm and then decreased at near term. The cyclooxygenase 2 mRNA increased gradually from near-term to the term complementary to the reduced endothelial nitric oxide synthase mRNA. These results suggest that the role shift between nitric oxide and prostaglandin E2 in maintaining ductus arteriosus patency at preterm and near term may be due to complementary expression changes of endothelial nitric oxide synthase and cyclooxygenase 2 at the transcriptional level.

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“…Premature closure of the ductus arteriosus is a rare condition, which is difficult to diagnose. The incidence is not well defined [4][5][6][7][8]. Since 2013, our center has acted as a tertiary referral center in Northeast Italy for sudden unexpected intrauterine death.…”

Section: Introductionmentioning

confidence: 99%

Isolated Dissection of the Ductus Arteriosus Associated with Sudden Unexpected Intrauterine Death

Fedrigo

Visentin

Veronese

et al. 2021

JCDD

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We report five cases of sudden intrauterine death due to premature closure of the ductus arteriosus. In four cases, this was caused by dissecting the hematoma of the ductus arteriosus with intimal flap and obliteration of the lumen. In one case, the ductus arteriosus was aneurysmatic, with lumen occlusion caused by thrombus stratification. No drug therapy or free medication consumption were reported during pregnancy. The time of stillbirth ranged between 26 and 33 gestational weeks. We performed TUNEL analysis for apoptosis quantification. The dissecting features were intimal tears with flap formation in four of the cases, just above the origin of the ductus arteriosus from the pulmonary artery. The dissecting hematoma of the ductus arteriosus extended downward to the descending aorta and backward to the aortic arch with involvement of the left carotid and left subclavian arteries. TUNEL analysis showed a high number of apoptotic smooth muscle cells in the media in two cases. Abnormal ductal remodeling with absence of subintimal cushions, lacunar spaces rich in glycosaminoglycans (cystic medial necrosis), and smooth muscle cell apoptosis were the pathological substrates accounting for failure of remodeling process and dissection.

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Premature Closure of the Ductus Arteriosus in an Otherwise Healthy Fetus

Cited by 6 publications

References 6 publications

Balancing Benefits and Risks of Indomethacin in the Management of Antenatal Bartter Syndrome: A Case Report

Balancing Benefits and Risks of Indomethacin in the Management of Antenatal Bartter Syndrome: A Case Report

Complementary mRNA expression of enzymes producing nitric oxide and prostaglandin in ductus arteriosus with respect to their role in maintaining patency

Isolated Dissection of the Ductus Arteriosus Associated with Sudden Unexpected Intrauterine Death

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