Spontaneous aneurysm of the ductus arteriosus

Cruickshank, Bruce; Marquis, R. M.

doi:10.1016/0002-9343(58)90287-0

Cited by 63 publications

(16 citation statements)

References 29 publications

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“…49 The true incidence is unclear because the definition of ductus arteriosus aneurysm is not precise and because many incidentally discovered ductus arteriosus aneurysms detected by fetal or neonatal echocardiography resolve spontaneously with ductal closure and thrombosis, without clinically apparent sequelae. 50 Ductal aneurysm most commonly presents in infancy 49 -51 but has also been reported in adults 52 and may develop after infective endarteritis, surgical closure, or transcatheter coil occlusion. [53][54][55] In approximately one fourth of patients, an underlying disorder such as trisomy 21, trisomy 13, Smith-LemliOpitz syndrome, type IV Ehlers-Danlos syndrome, or Marfan's syndrome is present.…”

Section: Aneurysm Of Ductus Arteriosusmentioning

confidence: 99%

Patent Ductus Arteriosus

2006

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T he patent ductus arteriosus (PDA) is a vascular structure that connects the proximal descending aorta to the roof of the main pulmonary artery near the origin of the left branch pulmonary artery. This essential fetal structure normally closes spontaneously after birth. After the first few weeks of life, persistence of ductal patency is abnormal. The physiological impact and clinical significance of the PDA depend largely on its size and the underlying cardiovascular status of the patient. The PDA may be "silent" (not evident clinically but diagnosed incidentally by echocardiography done for a different reason), small, moderate, or large. Regardless of the size, complications may arise, and it is important for both pediatric and adult cardiologists to have an understanding of the pathophysiology, clinical implications, and management of PDA. EmbryologyThe ductus arteriosus is a normal and essential fetal structure that becomes abnormal if it remains patent after the neonatal period. In normal cardiovascular development, the proximal portions of the sixth pair of embryonic aortic arches persist as the proximal branch pulmonary arteries, and the distal portion of the left sixth arch persists as the ductus arteriosus, connecting the left pulmonary artery with the left dorsal aorta (Figure 1). Normally, the distal right sixth aortic arch loses its connection to the dorsal aorta and degenerates. This transformation is complete by 8 weeks of fetal life. Normal Physiology Fetal CirculationWhereas Ϸ65% of the fetal cardiac output is from the right ventricle, only 5% to 10% passes through the lungs. 1,2 The preponderance of right ventricular output passes through the ductus arteriosus into the descending aorta. The fetal ductus arteriosus is thus an important structure that is essential for normal fetal development, permitting right ventricular output to be diverted away from the high-resistance pulmonary circulation. Premature constriction or closure may lead to right heart failure, resulting in fetal hydrops. 3 Histology and Mechanisms of Normal ClosureGrossly, the constitution of the fetal ductus arteriosus appears to be similar to the contiguous main pulmonary artery and descending aorta; there are important histological differences, however. 4 -9 Whereas the mediae of surrounding aorta and pulmonary artery are composed mainly of circumferentially arranged layers of elastic fibers, the media of the ductus arteriosus is composed of longitudinally and spirally arranged layers of smooth muscle fibers within loose, concentric layers of elastic tissue. The intima of the ductus arteriosus is thickened and irregular, with abundant mucoid material, sometimes referred to as intimal cushions.Fetal patency of the ductus arteriosus is controlled by many factors, the most important of which are relatively low fetal oxygen tension 10 and cyclooxygenase-mediated products of arachidonic acid metabolism (primarily prostaglandin [PGE 2 ] and prostacyclin [PGI 2 ]). 11 Locally produced and circulating PGE 2 and PGI 2 in the fetus cau...

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Section: Aneurysm Of Ductus Arteriosusmentioning

confidence: 99%

Patent Ductus Arteriosus

2006

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“…Cruickshank and Marquis (1958) were able to trace 51 cases of aneurysmal dilatation of the ductus arteriosus in infants, 28 of which were thrombosed. The same authors found only 9 cases of aneurysm of the ductus arteriosus occurring in adults.…”

Section: Casementioning

confidence: 99%

“…Case 5 is an example of thrombosis of the ductus arteriosus without embolic complication. Cruickshank and Marquis (1958) postulated that the presence of a thrombus, usually at the aortic end of the ductus arteriosus, may be due to continuing patency at the aortic end after closure of the pulmonary arterial end. The naturally thin and by this time degenerate wall of the ductus is exposed to the force of the aortic blood stream until thrombosis occurs.…”

Section: Casementioning

confidence: 99%

See 1 more Smart Citation

Anomalous Ductus Arteriosus with Aneurysm and Thrombosis

Niwayama¹,

Vadakan

1972

Tohoku J. Exp. Med.

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“…A significant PDA that is not closed, may lead to sequelae such as congestive heart failure, pulmonary hypertension, pulmonary vascular obstructive disease, recurrent chest infection, ductal aneurism and an increased risk of infective endocarditis. (4)(5)(6). Echocardiography is a noninvasive diagnostic method that provides the information about hemodynamics of PDA.…”

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confidence: 99%