Scientific Letter
Premature constriction of the ductus arteriosus
Constricción precoz del ductus arterioso
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Ayerza Casas, L. Jiménez Montañés, M. López Ramón, D. Lerma Puertas, M.D. García de la Calzada" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Ayerza Casas" "email" => array:1 [ 0 => "aayerzac@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Jiménez Montañés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "López Ramón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "Lerma Puertas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M.D." "apellidos" => "García de la Calzada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Obstetricia y Ginecología, Diagnóstico Prenatal, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Constricción precoz del ductus arterioso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1128 "Ancho" => 1500 "Tamanyo" => 240047 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Severe premature constriction of the ductus arteriosus. (A) Four-chamber view showing dilatation of the right heart chambers with the foramen ovale flap bulging into the left atrium. (B) Doppler of the ductus arteriosus revealing a continuous blood flow with increased systolic and diastolic flow velocities. (C) Severe tricuspid regurgitation. (D) Three-vessel view showing a reduced ductal diameter.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Severe premature constriction of the foetal ductus arteriosus is a rare condition that may result in serious foetal and neonatal morbidity. Its development is usually associated with maternal exposure to nonsteroidal anti-inflammatory drugs,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> a polyphenol-rich diet<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> or a tortuous ductus arteriosus,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> although there are cases in which the cause is not identified (idiopathic constriction of the ductus arteriosus).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Since this is an important phenomenon, we present the characteristics of the pregnant women diagnosed with premature intrauterine ductus arteriosus constriction in our department.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To that end, we performed a retrospective descriptive study by reviewing the medical records of the pregnant women who received care in the paediatric cardiology department of our hospital in the past three years (2011–2013) in whom echocardiography revealed the presence of premature constriction of the ductus arteriosus, and also of the subsequent evolution of the newborns.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We found evidence of premature constriction of the ductus arteriosus in 7 pregnant women, all of who were diagnosed in the third trimester at a mean gestational age of 35.4 weeks. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the pregnant women. The outcomes were favourable when the triggering factor was removed (5/7). One of the foetuses had a severe restriction of blood flow through the ductus arteriosus with dilation and dysfunction of the right heart chambers and severe tricuspid regurgitation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) that persisted in the neonatal period and was observed to have normalised in subsequent follow-up office visits.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Premature constriction of the foetal ductus arteriosus has been well described in the literature, although there are few published articles on the subject, which may be due to underdiagnosis of this condition. It must be suspected, particularly in the third trimester, if foetal echocardiography reveals dilatation and dysfunction of the right ventricle, tricuspid regurgitation and increased flow velocity in the ductus arteriosus measured by Doppler in the absence of structural heart disease.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Identifying the possible cause of the condition requires taking a detailed history with particular emphasis on the diet of the mother and any medications taken during pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a> In our series, the type of maternal exposure most frequently associated with this condition corresponded to nonsteroidal anti-inflammatory drugs, as described in the literature,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> although we found others such as exposure to hydroxychloroquine, which had not been described until now.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The early diagnosis of premature constriction of the foetal ductus arteriosus and the identification of its aetiology are essential in order to reverse or minimise haemodynamic alterations, as progression of this condition may lead to heart failure and foetal death.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ayerza Casas A, Jiménez Montañés L, López Ramón M, Lerma Puertas D, García de la Calzada MD. Constricción precoz del ductus arterioso. An Pediatr (Barc). 2015;82:193–195.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1128 "Ancho" => 1500 "Tamanyo" => 240047 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Severe premature constriction of the ductus arteriosus. (A) Four-chamber view showing dilatation of the right heart chambers with the foramen ovale flap bulging into the left atrium. (B) Doppler of the ductus arteriosus revealing a continuous blood flow with increased systolic and diastolic flow velocities. (C) Severe tricuspid regurgitation. (D) Three-vessel view showing a reduced ductal diameter.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gestational age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Possible trigger \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Impact on foetal haemodynamics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maternal disease \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ethnicity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Disease in the newborn \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">At diagnosis</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>35.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grapes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>35.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Paracetamol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>32.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acetylsalicylic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Antiphospholipid syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>35.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydroxychloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lupus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Latin American \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>35.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diclofenac and ibuprofen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Low back pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dilatation of right heart chambers and tricuspid regurgitation ++ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>35.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arabic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>36.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab752226.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics of mothers and babies born with restricted blood flow through the ductus arteriosus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal diclofenac medication in pregnancy causing in utero closure of the fetal ductus arteriosus and hydrops" "autores" => array:1 [ 0 => 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Shastri" 1 => "D. Abdulkarim" 2 => "P. Clarke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00246-012-0461-y" "Revista" => array:6 [ "tituloSerie" => "Pediatr Cardiol" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "1925" "paginaFinal" => "1927" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22872018" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ductal flow dynamics and right ventricular size are influenced by maternal ingestion of polyphenol-rich common beverages in normal pregnancies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Zielinsky" 1 => "J.L. Manica" 2 => "A. Piccoli Jr." 3 => "L.H. Nicoloso" 4 => "R. Frajndlich" 5 => "H.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 14 | 25 |
| 2024 October | 125 | 37 | 162 |
| 2024 September | 77 | 23 | 100 |
| 2024 August | 115 | 56 | 171 |
| 2024 July | 125 | 32 | 157 |
| 2024 June | 152 | 41 | 193 |
| 2024 May | 92 | 42 | 134 |
| 2024 April | 73 | 32 | 105 |
| 2024 March | 78 | 38 | 116 |
| 2024 February | 89 | 34 | 123 |
| 2024 January | 99 | 27 | 126 |
| 2023 December | 122 | 21 | 143 |
| 2023 November | 96 | 36 | 132 |
| 2023 October | 88 | 17 | 105 |
| 2023 September | 92 | 25 | 117 |
| 2023 August | 69 | 21 | 90 |
| 2023 July | 66 | 29 | 95 |
| 2023 June | 84 | 27 | 111 |
| 2023 May | 126 | 28 | 154 |
| 2023 April | 70 | 22 | 92 |
| 2023 March | 79 | 30 | 109 |
| 2023 February | 73 | 16 | 89 |
| 2023 January | 81 | 21 | 102 |
| 2022 December | 109 | 29 | 138 |
| 2022 November | 105 | 30 | 135 |
| 2022 October | 84 | 48 | 132 |
| 2022 September | 103 | 33 | 136 |
| 2022 August | 110 | 48 | 158 |
| 2022 July | 62 | 68 | 130 |
| 2022 June | 73 | 36 | 109 |
| 2022 May | 94 | 48 | 142 |
| 2022 April | 127 | 35 | 162 |
| 2022 March | 159 | 49 | 208 |
| 2022 February | 159 | 33 | 192 |
| 2022 January | 154 | 37 | 191 |
| 2021 December | 98 | 46 | 144 |
| 2021 November | 127 | 51 | 178 |
| 2021 October | 132 | 55 | 187 |
| 2021 September | 96 | 62 | 158 |
| 2021 August | 119 | 51 | 170 |
| 2021 July | 123 | 33 | 156 |
| 2021 June | 120 | 28 | 148 |
| 2021 May | 130 | 50 | 180 |
| 2021 April | 234 | 79 | 313 |
| 2021 March | 112 | 15 | 127 |
| 2021 February | 87 | 17 | 104 |
| 2021 January | 96 | 14 | 110 |
| 2020 December | 199 | 21 | 220 |
| 2020 November | 61 | 18 | 79 |
| 2020 October | 83 | 16 | 99 |
| 2020 September | 75 | 18 | 93 |
| 2020 August | 96 | 14 | 110 |
| 2020 July | 104 | 20 | 124 |
| 2020 June | 76 | 13 | 89 |
| 2020 May | 104 | 28 | 132 |
| 2020 April | 91 | 19 | 110 |
| 2020 March | 71 | 29 | 100 |
| 2020 February | 61 | 13 | 74 |
| 2020 January | 59 | 18 | 77 |
| 2019 December | 84 | 28 | 112 |
| 2019 November | 56 | 22 | 78 |
| 2019 October | 69 | 17 | 86 |
| 2019 September | 62 | 13 | 75 |
| 2019 August | 58 | 16 | 74 |
| 2019 July | 86 | 19 | 105 |
| 2019 June | 64 | 19 | 83 |
| 2019 May | 123 | 56 | 179 |
| 2019 April | 118 | 44 | 162 |
| 2019 March | 41 | 13 | 54 |
| 2019 February | 51 | 18 | 69 |
| 2019 January | 46 | 14 | 60 |
| 2018 December | 50 | 31 | 81 |
| 2018 November | 61 | 29 | 90 |
| 2018 October | 74 | 18 | 92 |
| 2018 September | 36 | 16 | 52 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 2 | 0 | 2 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 37 | 0 | 37 |
| 2018 March | 33 | 0 | 33 |
| 2018 February | 18 | 0 | 18 |
| 2018 January | 13 | 0 | 13 |
| 2017 December | 20 | 0 | 20 |
| 2017 November | 9 | 0 | 9 |
| 2017 October | 12 | 0 | 12 |
| 2017 September | 27 | 0 | 27 |
| 2017 August | 10 | 0 | 10 |
| 2017 July | 29 | 1 | 30 |
| 2017 June | 47 | 8 | 55 |
| 2017 May | 29 | 9 | 38 |
| 2017 April | 20 | 5 | 25 |
| 2017 March | 9 | 1 | 10 |
| 2017 February | 57 | 4 | 61 |
| 2017 January | 14 | 1 | 15 |
| 2016 December | 51 | 11 | 62 |
| 2016 November | 49 | 6 | 55 |
| 2016 October | 67 | 8 | 75 |
| 2016 September | 76 | 4 | 80 |
| 2016 August | 50 | 2 | 52 |
| 2016 July | 21 | 2 | 23 |
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