CIRCULATORY CHANGES FOLLOWING INTRAUTERINE CLOSURE OF THE DUCTUS-ARTERIOSUS IN THE HUMAN FETUS AND NEWBORN

Prenatal detection of intrauterine closure of the ductus arteriosus un related to maternal administration of non-steroidal anti-inflammatory drugs or glucocorticoids made it possible to study the circulation in this condition in the human fetus and newborn by pre- and postnatal ec hocardiography and neonatal cardiac catheterization. At 38 weeks, the fetus presented intrauterine ductal closure associated with right vent ricular dilatation and marked hypertrophy of the right ventricle and t he interventricular septum, as well as severely diminished right ventr icular fractional shortening and diminished pulmonary blood flow. Bloo d how redistribution was characterized by reduced blood how through th e right heart and increased right-to-left shunting across the dilated foramen ovale. Pathological Doppler waveforms of the inferior vena cav a and the ductus venosus were found, although the cardiotocogram was n ormal. Following unsuccessful induction of labour a Caesarean section was performed. Postnatal echocardiography confirmed the prenatal findi ngs. Cardiac catheterization, performed because of persistent dependen ce on additional oxygen administration, revealed increased pulmonary v ascular resistance, reduced pulmonary blood flow, and prolonged right- to-left shunt across the foramen ovale. Reduced peripheral pulmonary a rtery diameters were shown angiographically. Follow-up examinations re vealed regression of right ventricular hypertrophy and recovery of rig ht ventricular and pulmonary function. The findings confirm results fr om haemodynamic studies in animal experiments. (C) 1998 John Wiley & S ons, Ltd.