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G420(P) Case report: Idiopathic premature closure of fetal ductus arteriosus
  1. EJV Musgrave,
  2. P Nair
  1. Paediatrics, Bedford Hospital, Bedford, UK

Abstract

Introduction Premature closure of the ductus arteriosus (DA) is a rare event associated with maternal NSAID use and structural lesions. Idiopathic cases have also been described. The sequelae of premature closure of the DA can be potentially devastating. This case report highlights the importance of considering this differential in infants found to have right ventricular hypertrophy (RVH) on echocardiogram.

Case Report A male infant born by caesarean section at 39+3 weeks gestation to a 25 year old (gravida 2, para 2) mother weighing 2470 grams. No resuscitation was required at birth. There was premature rupture of membranes but aside from this the pregnancy and family history were otherwise uneventful. His mother took no medication in pregnancy. He developed signs of respiratory distress at 5 hours of age, with saturations of 78%. Nasal cannulae oxygen was required to maintain saturations; no murmur was heard and no significant pre/post ductal difference. Chest x-ray showed enlarged cardiac shadow with clear lung fields. Along with; partial septic screen, IV antibiotics and IV fluids, a prostin infusion was commenced and day 1 echocardiogram performed. This showed moderate RVH with echogenic tricuspid valve papillary muscles. The DA was closed with no right ventricular outflow tract gradient. He required oxygen until day 7 and was discharged on day 10. On follow-up the RVH was improving.

Discussion In fetal life, DA allows most of the blood to bypass the pulmonary circulation. Usually DA begins to close almost immediately after birth but will remain patent for several hours to days following delivery. Prostaglandin antagonism (e.g. maternal NSAID use) and some cardiac structural lesions increase the risk of fetal closure of the DA. In utero, it may cause congestive heart failure, fetal hydrops and intrauterine death. However, the range of clinical manifestations may range from mild symptomology to complete respiratory failure. This event can be diagnosed antenatally with fetal echocardiography and pulsed wave dopplers. Disproportionate RVH is the most common finding associated with premature closure of the DA. Therefore this diagnosis should be considered in infants found to have disproportionate RVH.

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