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Adaptive Growth of the Ductus Arteriosus and Aortic Isthmus in Various Ductus-Dependent Complex Congenital Heart Diseases

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Abstract

Background

The ductus arteriosus (DA) is critical in maintaining postnatal circulation in neonates with obstructed systemic circulation (OSC) and pulmonary circulation (OPC). We hypothesized that the size of the DA and aortic isthmus (AoI) undergoes adaptive growth in utero to counteract the hemodynamic challenges in these congenital heart diseases (CHD).

Methods

Postnatal echocardiograms of neonates diagnosed prenatally with ductal-dependent CHD who were started on prostaglandins within 24 h of birth were reviewed. We assessed the cross-sectional area of the aortic valve opening, pulmonary valve opening, AoI, and DA by calculating (diameter)2/body surface area. Neonates were classified into OSC or OPC then subgrouped depending upon the patency of semilunar valves: OSC with and without aortic atresia (OSC-AA and OSC-nAA, respectively) and OPC with and without pulmonary atresia (OPC-PA and OPC-nPA, respectively).

Results

Ninety-four cases were studied. The DA in OSC was significantly larger than OPC, and the DA in OSC-AA was significantly larger than OSC-nAA. The size of the AoI was significantly larger in OPC than OSC and larger in OSC-AA than OSC-nAA. Within the OSC-nAA group, there was no significant difference in the size of the DA, AoI, or pulmonary valve opening between those with retrograde flow (RF) at the AoI and without (nRF) except the aortic valve opening was significantly larger in nRF. All groups had comparable cross-sectional areas of systemic output.

Conclusions

Our findings suggest that DA and AoI show compensatory growth to maintain critical blood flow to vital organs against primary anatomical abnormalities in ductus-dependent CHD. (249 words)

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Abbreviations

AA:

Aortic atresia

AoI:

Aortic isthmus

AS:

Aortic stenosis

AVO:

Aortic valve opening

BSA:

Body surface area

CoA:

Coarctation of aorta

CCAVC:

Complete common atrioventricular canal

CHD:

Congenital heart disease

DA:

Ductus arteriosus

DAo:

Descending aorta

DORV:

Double outlet right ventricle

HLHS:

Hypoplastic left heart syndrome

IVS:

Intact ventricular septum

LV:

left ventricle/ventricular

MA:

Mitral Atresia

MS:

Mitral stenosis

n:

Without

OPC:

Obstructed pulmonary circulation

OSC:

Obstructed systemic circulation

PA:

Pulmonary atresia

PDA:

Patent ductus arteriosus

PGE1:

Prostaglandin E1

PS:

Pulmonary stenosis

PVO:

Pulmonary valve opening

RF:

Retrograde flow

TOF:

tetralogy of Fallot

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Acknowledgements

We thank Ms. Kimberley Eissmann for her editing of the manuscript text.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Liza Hashim

    Present address: Department of Pediatrics, Division of Pediatric Cardiology, University of Virginia Children’s Hospital, 1204 W. Main St, Charlottesville, VA, 22903, USA

  2. Daniel Vari

    Present address: Cincinnati Children’s Hospital Medical Center, The Heart Institute, 3333 Burnet Ave, Cincinnati, OH, 45229, USA

Authors and Affiliations

  1. Nemours Cardiac Center, Nemours Children’s Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Liza Hashim, Daniel Vari, Abdul M. Bhat & Takeshi Tsuda

  2. Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St. #100, Philadelphia, PA, 19107, USA

    Abdul M. Bhat & Takeshi Tsuda

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Contributions

TT conceptualized the study design. DV created an initial database of the study cohort. All authors participated in data collection. LH, AMB, and TT analyzed the collected data, and LH and TT summarized the data and created the Tables and Figures. LH wrote an original draft, which was repeatedly edited by TT and AMB. All authors reviewed and approved the final version of the manuscript.

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Correspondence to Takeshi Tsuda.

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Hashim, L., Vari, D., Bhat, A.M. et al. Adaptive Growth of the Ductus Arteriosus and Aortic Isthmus in Various Ductus-Dependent Complex Congenital Heart Diseases. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03236-4

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