Abstract
Anatomical measurements of the circumference of the ascending aorta (AA), aortic isthmus (Al), left carotid (LC), ductus arteriosus (DA), and of the size of the foramen ovale were determined in 37 full term newborn infants without congenital heart disease who expired within 3 days of birth. Using the DA/LC ratio as a standard anatomical index of ductal size, we found that it did not vary significantly during the 3 first days of life (1.33 ± 0.32). In contrast, 8 patients with pulmonary hypertension (diaphragmatic hernia) had a significantly higher ductal index: 2.15 ± 0.66, p<0.01 . Assuming that this larger ductal size could be the result of increased pulmonary resistance, we analyzed the anatomical findings in a group of patients with a DA/LC ratio 2 SD. above the norm. Most of these patients were found to have one of the three following associated malformations: 1-lung hypoplasia, 2-narrowing of the aortic isthmus (AA/Al ratio 2 SD. above the norm), or 3-sfenosis of the foramen ovale. It is speculated that these malformations are related to the development of pulmonary hypertension in utero with larger ductal size at birth and a delayed fall in pulmonary vascular resistance in the early neonatal period. Several clinico-pathological correlations supporting this view were made in patients with documented persistence of the fetal circulation. The ductal index has frequently shed some light on the disease process by suggesting an initially undetected lesion and should be part of every neonatal autopsy.
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Blanc, W., Moessinger, A. 87 IS THERE AN ANATOMICAL BASIS FOR SOME CASES OF SO CALLED “PERSISTENT FETAL CIRCULATION”?. Pediatr Res 12 (Suppl 4), 378 (1978). https://doi.org/10.1203/00006450-197804001-00092
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DOI: https://doi.org/10.1203/00006450-197804001-00092