Closure of the ductus arteriosus: Determinant factor in the appearance of transient peripheral pulmonary stenosis of the neonate

Maroto, Enrique E.; Fouron, Jean‐Claude; Aké, Evelyne; Doesburg, Nicolaas H. van; Cartwright, David; Teyssier, G; Bard, Harry

doi:10.1016/s0022-3476(05)83055-0

Cited by 23 publications

(21 citation statements)

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“…Using the definition of peripheral pulmonary stenosis proposed by Maroto and colleagues [9], a velocity in the branch artery that is 50% greater than the velocity in the main pulmonary artery, 16 of our 20 patients (80%) met this criterion in the left pulmonary artery after ductal closure, and in the right, none met this criterion.…”

Section: Resultsmentioning

confidence: 74%

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The Role of Ductal Constriction in Transient Stenosis of the Left Pulmonary Artery

Guntheroth

1998

Pediatr Cardiol

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To confirm the hypothesis that narrowing of the left pulmonary artery is produced by ductal closure, Doppler velocities in the pulmonary arteries from 20 premature infants with a patent duct were compared to velocities from 20 with a closed duct. In infants with a patent duct, the mean Doppler velocity in the main, right, and left pulmonary arteries were, respectively, 86 cm/sec +/- 5 standard error (SE), 120 +/- 7, and 125 +/- 8. With closed duct, the comparable velocities were 102 cm/sec +/- 7, 129 +/- 8, and 190 +/- 11. The only significant difference was the higher velocity in the left pulmonary artery associated with a closed duct (p = 0.00003). This physiologic origin of left-branch stenosis associated with ductal constriction should be considered when a murmur is detected after administration of indomethacin (in addition to possible persistent ductal flow), and as an explanation for some murmurs in the normal newborn. No anatomic or physiologic support was found for the theories that murmurs in the neonate were due to ductal flow, or to acute angulation of the branch pulmonary arteries.

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Section: Resultsmentioning

confidence: 74%

“…The possibility of transient stenosis of the left pulmonary artery as a result of ductal closure was proposed by Maroto and colleagues in 1991 [9]. In that study, the dimensions of the main, left, and right pulmonary arteries were determined before and after ductal closure.…”

mentioning

confidence: 99%

The Role of Ductal Constriction in Transient Stenosis of the Left Pulmonary Artery

Guntheroth

1998

Pediatr Cardiol

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“…In the study by Maroto et al [2] only the LPA showed an abnormal flow pattern. In our study, flow in the RPA was also significantly accelerated although less than in the LPA.…”

Section: Discussionmentioning

confidence: 84%

“…After birth and closure of the ductus, the pulmonary trunk is much larger than the branches for several weeks with small transient pressure gradients in some newborns, particularly prematures. Recently, Maroto et al [2] demonstrated that in the premature, ductus closure precipitates a narrowing of the LPA and suggested that this was related to traction on the bifurcation. According to our findings, this cannot be the sole explanation since, in our study, flow through a small ductus arteriosus was detected not only in patients with murmur but also in controls.…”

Section: Discussionmentioning

confidence: 99%

“…For some authors [2], the appearance of the murmur is directly and invariably related to the closure of the ductus arteriosus. Pulmonary circulatory changes in neonates have been extensively studied [8] but 2D-echocardiographic and Doppler correlations in the presence of murmurs have been only recently established by Rodriguez and Riggs [4] and by Maroto et al [2]. They demonstrated an "underdevelopment" of the pulmonary branches compared to the MPA which was considered to be the source of the murmur.…”

Section: Correspondence To: P Chatelainmentioning

confidence: 99%

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Physiological pulmonary branch stenosis in newborns: 2D-echocardiographic and Doppler characteristics and follow up

1993

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Transient systolic murmurs in neonates and premature infants due to mild left (LPA) and right (RPA) pulmonary branch stenosis is recognized but follow up studies are lacking. We studied echocardiographically 21 neonates with murmur and 10 controls. Diameters of the main pulmonary artery (MPA), LPA and RPA were smaller in patients with murmur. Colour-coded Doppler showed turbulent flow in LPA and RPA in 20/21 (95%) patients and flow velocities of both pulmonary branches were significantly higher than in controls. The follow up study at 3 months in 14/21 (67%) patients showed absent or decreased murmur in 9 (64%). Echographically, absolute and relative diameters of LPA and RPA increased whereas the ratio of MPA/aorta did not change suggesting accelerated growth or dilatation of the pulmonary branches. Flow velocities decreased significantly in the branches. Thus, transient systolic murmurs in neonates are associated with temporary relative hypoplasia of the pulmonary branches which showed increased growth leading to disappearance of the murmur in most cases within 3 months of life.

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2003

The Natural and Modifed History of Congenital Heart Disease

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Closure of the ductus arteriosus: Determinant factor in the appearance of transient peripheral pulmonary stenosis of the neonate

Cited by 23 publications

References 4 publications

The Role of Ductal Constriction in Transient Stenosis of the Left Pulmonary Artery

The Role of Ductal Constriction in Transient Stenosis of the Left Pulmonary Artery

Physiological pulmonary branch stenosis in newborns: 2D-echocardiographic and Doppler characteristics and follow up

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