Open Access
ARTICLE
Fetal hemodymanic effects on ductus arteriosus development and influences on postnatal management in infants with ductal‐dependent pulmonary blood flow
Anthony Merlocco
Division of Cardiology, Department
of Pediatrics, Le Bonheur Children’s
Hospital, University of Tennessee Health
Science Center, Memphis, Tennessee
* Corresponding Author: Anthony Merlocco, MD, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, 49 N. Dunlap Room 363, Memphis, TN 38103, USA. Email:
Congenital Heart Disease 2019, 14(1), 100-104. https://doi.org/10.1111/chd.12719
Abstract
The ductus arteriosus (DA) has been studied since Galen. Initially after birth in neo‐
nates with obstruction to pulmonary blood flow, DA patency is integral to ensure out‐
put and oxygenation. While DA stenting dates back 25 years, there is emerging interest
in better understanding how and when to utilize this strategy as an alternative to surgi‐
cal shunt placement or ongoing prostaglandin administration. Understanding the nor‐
mal fetal circulation and the perturbations that affect flow and oxygenation is integral
to comprehending how normal DA anatomy and morphology may change and how this
may influence technical and clinical considerations. In the normal human fetus the
great majority of descending aorta circulation comes from the DA, whereas this is a
small minority in pulmonary outflow lesions, resulting in size and angle abnormalities.
Study of the DA morphology has previously sought to identify patients requiring early
intervention and more novel classifications are contributing to knowledge of complica‐
tions and increasing the likelihood of success. As well, optimal patient selection for
aorto‐pulmonary shunt vs DA stent remains unclear. This review seeks to convey how
fetal circulation can affect the DA, how other clinical considerations such as neurocog‐
nitive development support these finding and influence management, and emphasize
that the variability in the DA will affect suitability for stenting, which requires further
study as guidelines and standards are developed.
Keywords
Cite This Article
Merlocco, A. (2019). Fetal hemodymanic effects on ductus arteriosus development and influences on postnatal management in infants with ductal‐dependent pulmonary blood flow.
Congenital Heart Disease, 14(1), 100–104. https://doi.org/10.1111/chd.12719