Korean Circ J.  2013 Nov;43(11):774-781. 10.4070/kcj.2013.43.11.774.

A Case of Progressive Ductal Constriction in a Fetus

• Choi EY
• Li M
• Choi CW
• Park KH
• Choi JY

• KMID: 2224811
• DOI: http://doi.org/10.4070/kcj.2013.43.11.774

Abstract

The ductus arteriosus is a normal and essential structure in fetal circulation. Since the introduction of fetal echocardiography, there have been reports of ductal constriction, many of which were related to maternal use of some medications. However, there have been some reports of idiopathic ductal constriction, which usually present in later gestation. Recently we experienced a case, which initially showed an S-shaped ductus with mild narrowing at 23 weeks and 27 weeks gestation and developed severe ductal constriction at 33 weeks. Soon after birth, ductus was searched for but no ductus was found in 2-D and color images. The neonate required mechanical ventilation with supplemental oxygen for 3 days. All echocardiographic abnormalities were normalized in 7 months. We report progressive ductal constriction in an S-shaped ductus and emphasize the importance of continuous follow up extending to the third trimester and even immediately after birth.

Keyword

Ductus arteriosus; Constriction, patholoic; Ultrasonography, prenatal; Echocardiography; Prenatal diagnosis

MeSH Terms

Constriction*
Ductus Arteriosus
Echocardiography
Female
Fetus*
Follow-Up Studies
Humans
Infant, Newborn
Oxygen
Parturition
Pregnancy
Pregnancy Trimester, Third
Prenatal Diagnosis
Respiration, Artificial
Ultrasonography, Prenatal
Oxygen

Figure

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  Fig. 1 The fetal echocardiography was done at 23 weeks of gestation. A: the four chamber view shows normal ventricular size and wall thickness. B: aortic arch was normal in size and location, but the ductal arch which connected with the main pulmonary artery (MPA) was not visualized. C: the main pulmonary artery bifurcated into the left pulmonary artery (LPA) and the right pulmonary artery (RPA) but it had no visible continuity with the ductus arteriosus (DA). D: only the color Doppler examination showed the tortuous S shaped DA (arrow). E: the ductus joined the descending aorta at an obtuse angle. F: color aliasing occurred through the DA (arrow).

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  Fig. 2 Follow-up echocardiography at 27 weeks showed significant changes in right ventricular morphology and function. A: the right ventricle had become small and thick and its endocardial lining was very bright. B: color Doppler examination showed a moderate amount of tricuspid regurgitation (TR). C: measured TR velocity was 4.5 m/sec.

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  Fig. 3 Post-natal echocardiography was performed within few hours after birth. A: four chamber view showed a hypertrophied RV and hyperechoic chordae of the tricuspid valve. B: the patient had a moderate amount of TR. C: TR velocity was slightly decreased compared to the previous examination during fetal life. D: hypertrophied RV and moderator band are apparent in the short axis view. E: there was no visible flow in the ductus arteriosus. F: shunt direction through the foramen ovale was mainly right to left (arrow). RV: right ventricle, TR: tricuspid regurgitation.

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