Isolated ductus arteriosus aneurysm in the fetus and infant: a multi-institutional experience
Umesh Dyamenahalli, MBBS, FRCPC*,
Jeffrey F. Smallhorn, MBBS, FRCPC*,
Tal Geva, MD ,
Jean-Claude Fouron, MD, FRCPC||,
Patricia Cairns, MD, FRCPC ,
Luc Jutras, MD, FRCPC¶,
Victoria Hughes,
Marlene Rabinovitch, MD, FRCPC*  ,
Catherine A. E. Mason and
Lisa K. Hornberger, MD, FACC*
* Department of Pediatrics, Division of Cardiology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Cardiovascular Research, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
MCTU Diagnostics Ltd., Toronto, Ontario, Canada
Department of Cardiology, Children’s Hospital and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
|| Division of Cardiology, Sainte-Justine Hospital, Montreal University,Montreal, Canada
¶ Division of Cardiology, Montreal Children’s Hospital, McGill University, Montreal, Canada
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Figure 1 Left, Chest X-ray performed in a one-day-old newborn (Case 15), which reveals a rounded soft tissue shadow, the so-called "ductal bump" (arrow), in the upper left mediastinum. Right, A calcified mass can be seen in the ductal area (arrow) of another newborn with DAA (Case 11). DAA = ductus arteriosus aneurysm.
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Figure 2 Left, Postnatal two-dimensional echocardiogram in a newborn (case 13), which shows saccular dilation of the ductus arteriosus to the left of the main pulmonary artery. Right, Color Doppler shows left to right shunting through a constricted pulmonary end of the PDA. DAA = ductus arteriosus aneurysm; PA = main pulmonary artery; PDA = patent ductus arteriosus.
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Figure 3 A, Echocardiogram obtained in a sagittal plane in a 38 week fetus, which demonstrates a large DAA with a tortuous course. B Aortic arch view in the same fetus, which shows normal morphology of the distal aortic arch. DAA = ductus arteriosus aneurysm; dAo = descending aorta.
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Figure 4 Left Two-dimensional echocardiogram, which demonstrates a large thrombus within the DAA with extension into main pulmonary artery (Case 12). Right The parasternal short-axis view shows extension of the thrombus into the branch pulmonary arteries with near total occlusion of the LPA. Ao = aorta; DAA = ductus arteriosus aneurysm; LPA = left pulmonary artery; PA = main pulmonary artery; RPA = right pulmonary artery.
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Figure 5 A Spin echo MRI in the oblique sagittal plane, which shows the aortic arch and the neck of the aneurysm (An) at the aortic end of the duct (Case 19). B An image in the same orientation, 1 cm leftward, shows the aneurysm superior and posterior to the left pulmonary artery (LPA). Ao = aorta; MRI = magnetic resonance imaging.
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Figure 6 Histology: Movat pentachrome staining (A,C,E) and immunohistochemical staining for semiquantitative assessment of fibronectin expression (B,D,F) in one normal term ductus arteriosus (A,B), DAA ressected (one at 10 weeks [C,D] and the other at 3 days of age [E,F]). DAA = ductus arteriosus aneurysm; IC = intimal cushions, IEL = internal elastic laminae.
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