@Article{chd.12719,
AUTHOR = {Anthony Merlocco},
TITLE = {Fetal hemodymanic effects on ductus arteriosus development and influences on postnatal management in infants with ductal‐dependent pulmonary blood flow},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {1},
PAGES = {100--104},
URL = {http://www.techscience.com/schd/v14n1/38748},
ISSN = {3071-1738},
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.},
DOI = {10.1111/chd.12719}
}