Lopes Lilian Maria, Carrilho Milene Carvalho, Francisco Rossana Pulcineli Vieira, Lopes Marco Antonio Borges, Krebs Vera Lúcia Jornada, Zugaib Marcelo
a Department of Obstetrics and Gynecology and.
b Department of Pediatrics , University of São Paulo School of Medicine , São Paulo , Brazil.
J Matern Fetal Neonatal Med. 2016;29(4):638-45. doi: 10.3109/14767058.2015.1015413. Epub 2015 Feb 24.
The aim of this study was to analyze the causes and perinatal outcome related to fetal ductus arteriosus constriction or closure at a single center over a 26-year period.
This was a retrospective analysis of 45 consecutive cases of constriction (n = 41) and closure (n = 4) from 1987 through 2013. Patients were divided into Group A (maternal use of non-steroidal anti-inflammatory drugs (NSAID), n = 29), Group B (idiopathic, n = 8), and Group C (other drugs not previously described, n = 8).
The median gestational age at diagnosis was 34 weeks (range, 27-38), mean systolic and diastolic velocity in the ductus arteriosus was 2.01 ± 0.66 m/s and 0.71 ± 0.46 m/s, respectively. Among the 29 cases of NSAIDs, 27.5% (8/29) have taken a single day use and 75% multiple days/doses. Right ventricular dilatation was present in 82.2% of the fetuses, tricuspid insufficiency in 86.6%, and heart failure in 22.2%. Neonatal persistent pulmonary hypertension occurred in 17.7% of the patients. Late follow-up showed all 43 survivors alive and healthy with only two deaths from unrelated causes.
The results of this study indicate that clinically significant ductal constriction may follow maternal exposure to single doses of NSAIDs. Unknown causes or other new substances were also described, such as naphazoline, fluoxetine, isoxsuprine, caffeine and pesticides. Echocardiographic diagnosis of ductal constriction led to an active medical approach that resulted in low morbidity of this group of patients.
本研究旨在分析某单一中心26年间与胎儿动脉导管狭窄或闭合相关的原因及围产期结局。
这是一项对1987年至2013年间连续45例动脉导管狭窄（n = 41）和闭合（n = 4）病例的回顾性分析。患者分为A组（母亲使用非甾体抗炎药（NSAID），n = 29）、B组（特发性，n = 8）和C组（其他未先前描述的药物，n = 8）。
诊断时的中位孕周为34周（范围27 - 38周），动脉导管的平均收缩期和舒张期速度分别为2.01±0.66 m/s和0.71±0.46 m/s。在29例使用NSAID的病例中，27.5%（8/29）为单日使用，75%为多日/多剂量使用。82.2%的胎儿存在右心室扩张，86.6%存在三尖瓣关闭不全，22.2%存在心力衰竭。17.7%的患者发生新生儿持续性肺动脉高压。后期随访显示，43名幸存者均存活且健康，仅2例死于无关原因。
本研究结果表明，母亲单次接触NSAID可能导致具有临床意义的动脉导管狭窄。还描述了未知原因或其他新物质，如萘甲唑啉、氟西汀、异克舒令、咖啡因和农药。动脉导管狭窄的超声心动图诊断促使采取积极的医学治疗方法，使该组患者的发病率较低。
