Aneurysm of the ductus arteriosus: A congenital lesion

The objective of this study was to evaluate the clinical, radiological, and echocardiographic findings in 11 neonates with aneurysm of ductus arterios us presented in our institutions between 1993 and 1996, and to postulate a new theory for the pathogenesis of this lesion. Medical records, radiograph ic studies, and echocardiograms were reviewed. All infants underwent follow -up echocardiograms every 2 to 3 days until the aneurysm spontaneously reso lved or surgery was performed. The infants were predominantly term males; s ix had evidence of fetal distress, two were diagnosed prenatally by fetal e chocardiogram, chest X ray evidenced mediastinal mass in six patients. The first echocardiogram showed structurally normal heart with an aneurysmal pa tent ductus arteriosus. In eight patients the aneurysm completely resolved by 5 to 10 days. One infant underwent surgical resection of the aneurysm af ter observation for 11 days with no change in size. Thrombosis of the aneur ysm was noted in two patients; both underwent surgery. Increasing reports o f ductal aneurysms in infants may reflect the availability of high-resoluti on echocardiography and more frequent use of echocardiography in the neonat al intensive care unit. Spontaneous resolution occurred in the majority of cases as in previous reports. We postulate that, at least in some cases, an eurysm of the ductus arteriosus is a congenital lesion that may represent p oststenotic dilation of the ductus due to turbulent flow through a stenotic segment at its pulmonary artery end during fetal life. The presence of ane urysm of the ductus arteriosus should be excluded in selected cases of feta l distress, by fetal echocardiography.