Changes During Reopening in Premature Constriction or Closure of the Ductus Arteriosus: A Report of Two Cases

Abstract

Although premature constriction or closure of the ductus arteriosus (PCDA) is associated with poor prognosis and early delivery is considered before deterioration occurs, some cases may improve and have a good prognosis, but the changes in fetal Doppler during the reopening of the ductus arteriosus are unclear, as are the factors related to its reopening. We encountered two cases of PCDA. In the first case, right cardiac function and ductus venosus flow normalized in a few days and the ductus arteriosus reopened spontaneously, and became vaginal delivery at 37 weeks of gestation. In the second case, labor induction was performed due to confirmed fetal cardiac stress associated with the closure of the ductus arteriosus at 38 weeks of gestation, and cesarean section was performed due to non-reassuring fetal status. The improvement in the right ventricular myocardial performance index, ductus venosus pulsatility index, the tendency for ductus arteriosus diastolic velocity to decrease, and confirmation of prograde flow into the pulmonary artery within a few days could serve as predictive indicators for the reopening of the ductus arteriosus.

Keywords: closure; constriction; ductus arteriosus diastolic velocity; ductus venosus pulsatility index; reopening of ductus arteriosus; right ventricular myocardial performance index; the ductus arteriosus.

Figure 1. Fetal echocardiographic findings on the day of presentation in Case 1

(A) Enlargement of the ductus arteriosus and pulmonary artery with reduced prograde flow; (B) Narrowing and tortuosity of the ductus arteriosus and acceleration of ductal blood flow velocity (white arrow); (C) Doppler of ductal blood flow velocity (systolic velocity of 3.5 m/second and diastolic velocity of 1.87 m/second) and ductus arteriosus pulsatility index of 0.65. PA, pulmonary artery; Ao, aorta; duct, ductus arteriosus.

Figure 2. Fetal echocardiographic findings on the second day in Case 1

(A) The prograde flow into the pulmonary artery; (B) Doppler of ductal blood flow velocity (systolic velocity of 2.9 m/second and diastolic velocity of 0.88 m/second) and ductus arteriosus pulsatility index of 1.12. PA, pulmonary artery; Ao, aorta

Figure 3. Fetal echocardiographic findings in Case 1 showing ridge of the site of stenosis and tortuosity (white arrow)

PA, pulmonary artery; aA, ascending aorta; dA, descending aorta; duct, ductus arteriosus.

Figure 4. Postnatal echocardiograph in Case 1 showing ridge and tortuosity of the ductus arteriosus (white arrow)

PA, pulmonary artery; Ao, aorta

Figure 5. Fetal echocardiogram in Case 2 showing enlargement of the ductus arteriosus and pulmonary artery, closure of the ductus arteriosus (white arrow)

aA, ascending aorta; dA, descending aorta; duct, ductus arteriosus.

Figure 6. Postnatal echocardiographic findings in Case 2 showing no ductus arteriosus due to closure of the ductus arteriosus, and mild dilatation and hypertrophy of the right ventricle

PA, pulmonary artery; Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.