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Fetal Ductus Arteriosus: The Good, The Bad, and The Ugly

Fetal Ductus Arteriosus: The Good, The Bad, and The Ugly. James C. Huhta , M.D. Perinatal Cardiology JHM-All Children’s Hospital 5th Phoenix Fetal Cardiology Symposium Sat. April 26, 2014, 11-11:30 AM. Fetal Ductal Constriction. Fetal Ductal Constriction Etiology:

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Fetal Ductus Arteriosus: The Good, The Bad, and The Ugly

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  1. Fetal Ductus Arteriosus: The Good, The Bad, and The Ugly James C. Huhta, M.D. Perinatal Cardiology JHM-All Children’s Hospital 5th Phoenix Fetal Cardiology Symposium Sat. April 26, 2014, 11-11:30 AM

  2. Fetal Ductal Constriction • Fetal Ductal Constriction • Etiology: • Maternal medications (such as nonsteroidalantinflammatory drugs like indomethacin) can cause constriction of the fetal ductus or it can occur spontaneously.

  3. Fetal Ductal Constriction

  4. MECHANISM OF ACTION OF ANTIINFLAMMATORY DRUGS X STEROIDS X NSAD Phospholipids A2Phospholipase A2phospholipase Arachdonic Acid Non-hormonal anti-inflammatory drugs Cycloxygenase Prostaglandin G2 Isomerase Thromboxane Prostacyclin Prostaglandin E , F ,D a 2 2 2 Macones et al ; Am J Obstet Gynecol ; 2001;184:264-72.

  5. PATENCY OF DUCTUS ARTERIOSUS CIRCULATING PGs DURING 3rd TRIMESTER INHIBITION OF PGs PA AO RA CONSTRICTIVE EFFECT ON DA LA LV RV DUCTAL CONSTRICTION

  6. Momma et al Constriction of fetal ductus arteriosus by nonsteroidal antiinflammatory drugs. Adv Prostaglandin Thromboxane Leukot Res. 1983;12:499-504. Mushiake K et al Severe heart failure due to ductal constriction caused by maternal indomethacin. Pediatr Int. 2002 Apr;44(2):174-6. Momma et al In vivo constriction of the fetal and neonatal ductus arteriosus by a prostanoid EP4-receptor antagonist in rats. Pediatr Res. 2005 Nov;58(5):971-5. DUCTAL CONSTRICTION CAUSED BY NSAD Toyoshima K et al Constriction of the ductus arteriosus by selective inhibition of cyclooxygenase-1 and -2 in near-term and preterm fetal rats. Prostaglandins Other Lipid Mediat. 2006 Mar;79(1-2):34-42.

  7. Turbulent ductal flow IV septal bulging RV/LV ratio > 1.3 Tricuspid regurgitation CONSTRICTION OF DUCTUS ARTERIOSUS DIAGNOSIS • Systolic velocity > 1.4 m/s • Diastolic velocity > 0.3 m/s • Pulsatility index < 1.9 (2.2) Huhta JC. Circulation, 1987 Feb;75(2):406-12.

  8. SYST VEL = 2.70 m/s DIAST VEL = 0.70 m/s PI = 1.5

  9. Fetal Ductus Arteriosus Constriction results in pressure gradient from the PAto the descending aorta Moise KJ, Huhta JC, Sharif DS, Ou CN, Kirshon B, Wasserstrum N, Cano L, Indomethacin in the treatment of premature labor: Effects on the fetal ductus arteriosus. NEJM 319:327-331, 1988

  10. Fetal Ductal Constriction

  11. Fetal Ductus Normal

  12. Fetal Ductal Constriction

  13. Fetal Ductus Arteriosus First diagnosis of ductal constriction

  14. Intracardiac findings

  15. Fetal Ductal Constriction

  16. Fetal Ductal Constriction • Fetal ductal constriction due to indomethacin in the management of preterm labor. • Tricuspid regurgitation associated

  17. Fetal Ductal ConstrictionAnimal modelFetal Lamb

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