ABSTRACT
In utero isolated ductal closure is uncommon and can lead to fetal hydrops and death
if not recognized. Five fetuses were diagnosed prenatally by echocardiography. The
reasons for referral were hydrops (2), cardiomegaly (1), polyhydramnios and choroid
plexus cyst (1), and polyhydramnios and teratoma of the neck (1). Gestational age
was median 32, range 18-41 weeks. Two mothers received indomethacin for polyhydramnios,
with the echocardiogram performed 5 and 3 days after the last dose. Three had a negative
history of drug ingestion. Fetal echocardiograms showed absent flow in the ductus
arteriosus, dilated right ventricle with decreased function, and mild or moderate
tricuspid and pulmonary insufficiency in all. The left ventricle was hypercontrac-tile,
with significantly increased left ventricular stroke output when compared to the right.
Four fetuses were delivered by cesarean section and had an uneventful course. One
fetus died shortly after birth due to airway obstruction from a large teratoma. Autopsy
showed ductal constriction. Postnatal echocardiograms showed absent ductal flow and
dilated right ventricle. On follow-up, survivors remained asymptomatic with cardiac
size returning to normal. Premature closure of the ductus arteriosus should be considered
in hydrops of unknown etiology, right ventricular dysfunction, and following indomethacin
therapy. Urgent delivery results in an excellent prognosis.
Keywords
Patent ductus arteriosus - echocardiography - indomethacin
