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High incidence of ductal closure or narrowing at birth in patients with right ventricular outflow tract obstruction with normal orientation of the ductus arteriosus

Published online by Cambridge University Press:  24 October 2018

Hazumu Nagata ,
Eiko Terashi ,
Mamoru Muraoka ,
Kiyoshi Uike ,
Yuichiro Hirata ,
Hideki Tatewaki ,
Yasuyuki Fujita ,
Kenichiro Yamamura  and
Shouichi Ohga
Hazumu Nagata*
Affiliation:
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Eiko Terashi
Affiliation:
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Mamoru Muraoka
Affiliation:
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Kiyoshi Uike
Affiliation:
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Yuichiro Hirata
Affiliation:
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Hideki Tatewaki
Affiliation:
Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Yasuyuki Fujita
Affiliation:
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Kenichiro Yamamura
Affiliation:
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Shouichi Ohga
Affiliation:
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
*
Author for correspondence: H. Nagata, MD, PhD, Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Tel: +81-92-642-5421; Fax: +81-92-642-35; E-mail: dadan@pediatr.med.kyushu-u.ac.jp
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Abstract

Background

Ductal patency is mandatory to manage patients with ductal-dependent pulmonary circulation. The aim of this study is to elucidate the morphological and haemodynamic features of ductus arteriosus with right ventricular outflow tract obstruction, and investigate the appropriate perinatal management.

Patients and methods

Patients with prenatal diagnosis of right ventricular outflow tract obstruction at our institution between 2010 and 2015 were included in the study. Reverse orientation of the ductus arteriosus is defined as an inferior angle of <90° at the aortic junction, and normal orientation of the ductus arteriosus as an angle of >90°. We retrospectively reviewed the shape and flow pattern of ductus arteriosus and the clinical characteristics of the cases.

Results

A total of 39 patients were enrolled. The shape was divided into normal orientation (n=15) and reverse orientation (n=24) of the ductus arteriosus. There was no significant difference in the type of oxygen saturation at birth and age at shunt operation between both the groups. However, the median narrowest diameter of ductus arteriosus in the normal orientation group was significantly smaller than that in the reverse orientation group (2.0 [1.0–5.4] versus 3.0 [1.3–4.4] mm, p<0.05). In two patients of the normal orientation group, ductus arteriosus had closed at birth, and one of whom died because of severe cyanosis.

Conclusions

Normal orientation pattern might have high incidence of an early narrowing or closure of ductus arteriosus at birth. The critical patients need careful evaluation by repeated foetal echocardiography and further maternal interventions.

Keywords

Right ventricular outflow tract obstructionductus arteriosusductal narrowing
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 1 , January 2019 , pp. 54 - 58
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Nagata H, Terashi E, Muraoka M, Uike K, Hirata Y, Tatewaki H, Fujita Y, Yamamura K, Ohga S. (2018). High incidence of ductal closure or narrowing at birth in patients with right ventricular outflow tract obstruction with normal orientation of the ductus arteriosus. Cardiology in the Young29: 54–58. doi: 10.1017/S1047951118001798

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