Ishida Hidekazu, Inamura Noboru, Kawazu Yukiko, Kayatani Futoshi
Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Congenit Heart Dis. 2011 Jan-Feb;6(1):51-6. doi: 10.1111/j.1747-0803.2010.00411.x.
Prenatal constriction of the ductus arteriosus associated with maternal drug ingestion was reported several decades ago. There are fewer reports of the complete closure of the ductus arteriosus; therefore, the clinical features of the latter are poorly understood. The aim of this study is to clarify the clinical features of complete ductal closure and postnatal pulmonary hypertension by performing echocardiography of the fetus.
We diagnosed four fetuses with complete ductal closure by performing fetal echocardiography and reviewed the prenatal and postnatal medical records of the mother and fetus.
One mother each had bronchial asthma, ulcerative colitis, and idiopathic thrombocytopenic purpura, and they had received nonsteroidal anti-inflammatory drugs and/or corticosteroids during pregnancy. The fourth mother did not have basal disease and had not ingested any drugs. Fetal diagnosis was performed at 32-38 weeks of gestation. All fetuses had right heart dilatation with tricuspid regurgitation in the absence of any cardiac defects, and Doppler echocardiography indicated that the right ventricular pressure was elevated. Two of the fetuses had fetal hydrops, which suggested severe right heart dysfunction. All fetuses were delivered by emergent cesarean delivery. After birth, all the infants developed persistent pulmonary hypertension and required oxygen inhalation. Of these, three required mechanical ventilation, and two, nitric oxide inhalation. All infants improved within 2 weeks, and they had no neurological and cardiac complications after discharge.
Right heart dilatation and severe tricuspid regurgitation in the absence of a cardiac defect in the fetus strongly suggested ductal dysfunction. Careful evaluation of ductal patency and right ventricular function can lead to precise early diagnosis and good prognosis.
几十年前就有报道称产前动脉导管狭窄与母亲药物摄入有关。关于动脉导管完全闭合的报道较少，因此对其临床特征了解甚少。本研究的目的是通过对胎儿进行超声心动图检查来阐明动脉导管完全闭合及产后肺动脉高压的临床特征。
我们通过胎儿超声心动图诊断出4例胎儿动脉导管完全闭合，并回顾了母亲和胎儿的产前及产后医疗记录。
4位母亲中，1位患有支气管哮喘，1位患有溃疡性结肠炎，1位患有特发性血小板减少性紫癜，她们在孕期均接受过非甾体类抗炎药和/或皮质类固醇治疗。第4位母亲无基础疾病，未服用任何药物。胎儿诊断在妊娠32 - 38周进行。所有胎儿均有右心扩大伴三尖瓣反流，无任何心脏缺陷，多普勒超声心动图显示右心室压力升高。其中2例胎儿有胎儿水肿，提示严重右心功能不全。所有胎儿均通过急诊剖宫产分娩。出生后，所有婴儿均出现持续性肺动脉高压，需要吸氧。其中3例需要机械通气，2例需要吸入一氧化氮。所有婴儿在2周内病情好转，出院后无神经和心脏并发症。
胎儿无心脏缺陷但出现右心扩大和严重三尖瓣反流强烈提示导管功能障碍。仔细评估导管通畅情况和右心室功能可实现准确的早期诊断和良好预后。
