Dissecting Aneurysm of the Ductus Arteriosus in the Newborn Infant

Abstract

Dissecting aneurysm of the ductus arteriosus with thromboembolism in the descending aorta and distal arteries, while rare, is a potentially fatal combination occurring mainly in the newborn period. The aneurysm and distal thromboses of a 6-day-old infant were demonstrated angiographically for the first time antemortem and correlated with the postmortem findings. The pathogenesis of the lesion and the possibility of antemortem recognition are disAneurysm of the ductus arteriosus ¿\. is a relatively rare lesion which is encountered most frequently in in¬ fants as an incidental finding at postmortem examination.1 Sponta¬ neous dissection and rupture of the aneurysm, as well as embolism and thrombosis of distal arteries, may oc¬ cur and are potentially lethal.-4 This report presents hemodynamic, angiographie, and pathologie findings from a case of a newborn infant in whom these complications were dem¬ onstrated angiographically and in whom, retrospectively, an angiogram performed prior to dissection showed the ductal aneurysm. Report of a CaseA girl was born at term at another hos¬ pital to a 23-year-old gravida 3, para 2, Rh positive mother following an uneventful pregnancy. The membranes were rup¬ tured artifically and labor induced with oxytocin (Pitocin). Delivery was spon¬ taneous from a vertex presentation and the birth weight was 2,690 gm (5 lb 15 oz).The infant was meconium stained with the umbilical cord wrapped around the neck. The Apgar score was 3 and resusci¬ tation was required. The infant was transferred to the Yale-New Haven Hos¬ pital at 4 hours of age because of per¬ sistent cyanosis. On admission, there was moderate generalized cyanosis, a respira¬ tory rate of 65 per minute, and heart rate 100 beats per minute. An enlarged tongue protruded slightly outside the mouth. The lungs were clear. A soft, grade 2, ejection, systolic murmur was heard at the left sternal border. The liver and spleen were not enlarged. A mag¬ nification chest roentgenogram revealed increased pulmonary vascularity bilateral¬ ly. There was a fine infiltrate in the right

Aneurysm of the Nonpatent Ductus Arteriosus in the Newborn

“…From the 60 cases reported in the literature (2,3,4,5,6,7) it seems that in no instance a correct preoperative diagnosis was followed by a successful surgical cure, as was the case in our 2 weeks old infant.…”

Aneurysmal changes in silent patent ductus arteriosus in a child (year time follow-up)

“…and method of closure were hand sewing aneurysmorrhaphy [37] that has been performed in our patient or stapling in case of uncomplicated ductus aneurysm having a narrow neck [9] or with the help of a Gott shunt bypassing the aneurysm and patching the neck of aneurysm from inside the aorta [8]. In our case, both aortic and pulmonary end aneurysmorrhaphy with pledged from pericardium done without resection of the PDA after putting the patient on cardiopulmonary bypass as a stand by for any undesired complication intraoperatively.…”

“…There are report suggesting that congenital DAA that developed postnatally may be associated with a higher rate of complications especially those who are symptomatic [5,8,14,31,32]. They may present with wide spectrum of symptoms with or without complications like spontaneous rupture, thromboembolism, erosions and compression of the adjacent structures including airway and the recurrent laryngeal nerve and even death [5][6][7][8][33][34][35].…”

“…Their time of presentation can be divided in two three groups according to the age at diagnosis: infantile < 2 months, childhood (2 months to 15 years) and adult [5]. DAA has been considered as a rare congenital anomaly with potential fatal complications [5][6][7][8], although the exact incidence of DAA is unclear, but it can be ranged between 0.8-8% among fetuses and neonates [6,9], and approximately 5.2% of all adult thoracic aneurysm [10], with some reported childhood cases [3,11,12]. Some authors believe that neonatal DAA is resulted from transient widening of the ductus arteriosus prior to spontaneous obliteration and are not true aneurysm [5,13,14].…”

Ductus Arteriosus Aneurysm Imaging Using Modern Diagnostic Methods

“…Dissection or rupture can cause hemoptysis and hemorrhage usually into the left lung, as seen in our case 3 (3, 10, 11, 21, 28, 33, 50, 60) but exceptionally also into the right pleural cavity (57). Aortic and pulmonary thrombosis and embolism have also been reported (35,40,43,52,65). Only 3 cases of ductus aneurysm combined with coarctation of Fig.…”