Leal S D, Cavallé-Garrido T, Ryan G, Farine D, Heilbut M, Smallhorn J F
Division of Cardiology, Hospital for Sick Children, Toronto, Canada.
Am J Perinatol. 1997 Apr;14(4):205-10. doi: 10.1055/s-2007-994128.
In utero isolated ductal closure is uncommon and can lead to fetal hydrops and death if not recognized. Five fetuses were diagnosed prenatally by echocardiography. The reasons for referral were hydrops (2), cardiomegaly (1), polyhydramnios and choroid plexus cyst (1), and polyhydramnios and teratoma of the neck (1). Gestational age was median 32, range 18-41 weeks. Two mothers received indomethacin for polyhydramnios, with the echocardiogram performed 5 and 3 days after the last dose. Three had a negative history of drug ingestion. Fetal echocardiograms showed absent flow in the ductus arteriosus, dilated right ventricle with decreased function, and mild or moderate tricuspid and pulmonary insufficiency in all. The left ventricle was hypercontractile, with significantly increased left ventricular stroke output when compared to the right. Four fetuses were delivered by cesarean section and had an uneventful course. One fetus died shortly after birth due to airway obstruction from a large teratoma. Autopsy showed ductal constriction. Postnatal echocardiograms showed absent ductal flow and dilated right ventricle. On follow-up, survivors remained asymptomatic with cardiac size returning to normal. Premature closure of the ductus arteriosus should be considered in hydrops of unknown etiology, right ventricular dysfunction, and following indomethacin therapy. Urgent delivery results in an excellent prognosis.
胎儿期孤立性动脉导管闭合并不常见，若未被识别可导致胎儿水肿和死亡。5例胎儿通过超声心动图在产前得到诊断。转诊原因分别为水肿（2例）、心脏扩大（1例）、羊水过多合并脉络丛囊肿（1例）以及羊水过多合并颈部畸胎瘤（1例）。孕周中位数为32周，范围为18 - 41周。2例母亲因羊水过多接受了吲哚美辛治疗，超声心动图检查在最后一剂用药后5天和3天进行。3例无药物摄入史。胎儿超声心动图显示动脉导管内无血流，右心室扩张且功能降低，所有病例均有轻度或中度三尖瓣和肺动脉瓣关闭不全。左心室收缩增强，与右心室相比左心室每搏输出量显著增加。4例胎儿通过剖宫产分娩，过程顺利。1例胎儿出生后不久因巨大畸胎瘤导致气道阻塞死亡。尸检显示动脉导管狭窄。产后超声心动图显示动脉导管无血流及右心室扩张。随访发现，存活者无症状，心脏大小恢复正常。对于病因不明的水肿、右心室功能障碍以及吲哚美辛治疗后，应考虑动脉导管过早闭合。紧急分娩预后良好。
