Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-27T06:28:23.535Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of not having a ductus arteriosus on clinical outcomes in foetuses diagnosed with tetralogy of Fallot

Published online by Cambridge University Press:  28 April 2014

Seth J. Stern Open the ORCID record for Seth J. Stern [Opens in a new window] ,
Neelum Wadekar ,
Luc Mertens ,
Cedric Manlhiot ,
Brian W. McCrindle ,
Edgar T. Jaeggi  and
Lynne E. Nield
Seth J. Stern
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada
Neelum Wadekar
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada
Luc Mertens
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada
Cedric Manlhiot
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada
Brian W. McCrindle
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada
Edgar T. Jaeggi
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada
Lynne E. Nield*
Affiliation:
The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada
*
Correspondence to: L. E. Nield, MD, Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Tel: +416 813 6141; Fax: +416 813 5857; E-mail: lynne.nield@sickkids.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Foetuses with simple tetralogy of Fallot almost universally have a patent ductus arteriosus. Two recently identified cases had an absent patent ductus arteriosus, requiring emergent intervention at birth. The objective of this study was to determine whether foetuses diagnosed with tetralogy of Fallot and no patent ductus arteriosus have poorer outcomes compared with those with tetralogy of Fallot+patent ductus arteriosus. Methods: All foetal cases of tetralogy of Fallot between January, 2000 and 2012 were retrospectively identified from The Hospital for Sick Children (Toronto, Canada) database. Cases – tetralogy of Fallot+no patent ductus arteriosus confirmed on postnatal echo – and controls – tetralogy of Fallot+patent ductus arteriosus, matched for gestational age – were identified from prenatal records, and both clinical and echocardiographic data were reviewed. Optimal outcome was defined as valve-sparing repair with no residual lesions. Student’s t-tests and Fisher’s exact χ2 were used to compare groups. Results: n=115 foetuses were diagnosed with tetralogy of Fallot: 11 (9%) had no patent ductus arteriosus, and were matched to 22 controls – mean gestational age at diagnosis 23.2±4.2 weeks, 23.4±6.6 weeks, respectively. Cases had a higher proportion of right aortic arches (64% versus 14%, p<0.001). Foetal and postnatal echocardiographic data did not reveal significant differences in branch pulmonary artery sizes, pulmonary valve sizes, or ventricular function. No differences were identified for cyanosis at birth (2/10 versus 7/20, p=0.67), or catheter intervention (5/10 versus 4/22, p=0.12). Optimal outcome rates were similar between cases and controls (4/11 (36%) versus 5/21 (24%), p=0.68). Conclusions: The patent ductus arteriosus does not appear to have an impact on clinical outcome in foetuses with tetralogy of Fallot.

Keywords

Tetralogy of Fallotductus arteriosusfoetal echocardiographyoutcome
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 684 - 692
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Tennstedt, C, Chaoui, R, Korner, H, Dietel, M. Spectrum of congenital heart defects and extracardiac malformations associated with chromosomal abnormalities: results of a seven year necropsy study. Heart 1999; 82: 34–39.CrossRefGoogle ScholarPubMed
2. Yoo, SJ, Lee, YH, Kim, ES, et al. Tetralogy of Fallot in the fetus: findings at targeted sonography. Ultrasound Obstet Gynecol 1999; 14: 29–37.Google Scholar
3. Hickey, EJ, Veldtman, G, Bradley, TJ, et al. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiovasc Surg 2009; 35: 156–164.CrossRefGoogle ScholarPubMed
4. Apitz, C, Webb, GD, Redington, AN. Tetralogy of Fallot. Lancet 2009; 374: 1462–1471.Google Scholar
5. Hornberger, LK, Sanders, SP, Sahn, DJ, et al. In utero pulmonary artery and aortic growth and potential for progression of pulmonary outflow tract obstruction in tetralogy of Fallot. JACC 1995; 25: 739–745.Google Scholar
6. Hirji, A, Bernasconi, A, McCrindle, BW, et al. Outcomes of prenatally diagnosed tetralogy of Fallot: implications for valve-sparing repair versus transannular patch. Can J Cardiol 2010; 26: e1–e6.Google Scholar
7. Schneider, C, McCrindle, BW, Carvalho, JS, Hornberger, LK, McCarthy, KP, Daubeney, PEF. Development of Z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol 2005; 26: 599–605.Google Scholar
8. Pettersen, MD, Du, W, Skeens, ME, Humes, RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 2008; 21: 922–934.Google Scholar
9. Huhta, JC, Moise, KJ, Fisher, DJ, Sharif, DS, Wasserstrum, N, Martin, C. Detection and quantitation of constriction of the fetal ductus arteriosus by Doppler echocardiography. Circulation 1987; 75: 406–412.Google Scholar
10. Van Arsdell, G, Maharaj, GS, et al. What is the optimal age for repair of Tetralogy of Fallot? Circulation 2000; 102 (Suppl 3): 123–129.Google Scholar
11. Pahl, E, Muster, AJ, Ilbawi, MN, DeLeon, SY. Tetralogy of Fallot with absent ductus arteriosus and absent collateral pulmonary circulation: diagnostic and surgical implications during the neonatal period. Pediatr Cardiol 1988; 9: 45–49.Google Scholar
12. Peres, LC, Bekhit, M, Johki, R. A tetralogy of fallot associated with a stenotic pulmonary valve and agenesis of the ductus arteriosus in a 13-week-old fetus: the role of postmortem examination. Pediatr Dev Path 2012; 15: 240–244.CrossRefGoogle Scholar
13. Rudolph, AM. Congenital Diseases of the Heart. Wiley-Blackwell, Oxford, 2009.CrossRefGoogle Scholar
14. Seed, M, van Amerom, JFP, Al Nafisi, B, et al. Feasibility of quantification of the distribution of blood flow in the normal human fetal circulation using CMR: a cross-sectional study. J Cardiovasc Magnet Res 2012; 14: 79–90.Google Scholar
15. Ettedgui, JA, Sharland, GK, Chita, SK, Cook, A, Fagg, N, Allan, LD. Absent pulmonary valve syndrome with ventricular septal defect: role of the arterial duct. Am J Cardiol 1990; 66: 233–234.Google Scholar
16. Razavi, RS, Sharland, GK, Simpson, JM. Prenatal diagnosis by echocardiogram and outcome of absent pulmonary valve syndrome. Am J Cardiol 2003; 91: 429–432.Google Scholar
17. Galindo, A, Gutiérrez-Larraya, F, Martinez, JM, et al. Prenatal diagnosis and outcome for fetuses with congenital absence of the pulmonary valve. Ultrasound Obstet Gynecol 2006; 28: 32–39.Google Scholar
18. Wertaschnigg, D, Jaeggi, M, Chitayat, D, et al. Prenatal diagnosis and outcome of absent pulmonary valve syndrome: contemporary single-center experience and review of the literature. Ultrasound Obstet Gynecol 2013; 41: 162–167.Google Scholar
19. Kohler, HG. Premature closure of the ductus arteriosus (P.C.D.A.): a possible cause of intrauterine circulatory failure. Early Hum Dev 1978; 2: 15–23.Google Scholar
20. Bergwerff, M, DeRuiter, MC, Gittenberger-de Groot, AC. Comparative anatomy and ontogeny of the ductus arteriosus, a vascular outsider. Anat Embryol 1999; 200: 559–571.Google Scholar
21. Ettedgui, JA, Sharland, GK, Chita, SK, Cook, A, Fagg, N, Allan, LD. Absent pulmonary valve syndrome with ventricular septal defect: role of the arterial duct. Am J Cardiol 1990; 66: 233–234.Google Scholar
22. Becker, R, Schmitz, L, Guschmann, M, Wegner, RD, Stiemer, B, Entezami, M. Prenetal diagnosis of familial absent pulmonary valve syndrome: case report and review of the literature. Ultrasound Obstet Gynecol 2001; 17: 263–267.Google Scholar
23. Tulzer, G, Gudmundsson, S, Sharkey, AM, Wood, DC, Cohen, AW, Huhta, JC. Doppler echocardiography of fetal ductus arteriosus constriction versus increased right ventricular output. JACC 1991; 18: 532–536.Google Scholar
24. Leal, SD, Cavallé-Garrido, T, Ryan, G, Farine, D, Heilbut, M, Smallhorn, JF. Isolated ductal closure in utero diagnosed by fetal echocardiography. Am J Perinatol 1997; 14: 205–210.CrossRefGoogle ScholarPubMed
25. Trevett, TN, Cotton, J. Idiopathic constriction of the fetal ductus arteriosus. Ultrasound Obstet Gynecol 2004; 23: 517–519.CrossRefGoogle ScholarPubMed
26. Waffarn, F, Siassi, B, Cabal, LA, Schmidt, PL. Effect of antenatal glucocorticoids on clinical closure of the ductus arteriosus. Am J Dis Child 1983; 137: 336–338.Google Scholar
27. Moise, KJ, Huhta, JC, Sharif, DS, et al. Indomethacin in the treatment of premature labor: effects on the fetal ductus arteriosus. NEJM 1988; 319: 327–331.Google Scholar
28. Rao, BN, Anderson, RC, Edwards, JE. Anatomic variations in the tetralogy of Fallot. Am Heart J 1971; 81: 361–371.Google Scholar
29. Gentile, R, Stevenson, G, Dooley, T, Franklin, D, Kawabori, I, Pearlman, A. Pulsed Doppler echocardiographic determination of time of ductal closure in normal newborn infants. J Pediatr 1981; 98: 443–448.Google Scholar