Download PREMATURE in utero CLOSURE OF THE DUCTUS ARTERIOSUS

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PREMATURE in utero CLOSURE OF THE DUCTUS ARTERIOSUS DUE TO INGESTION OF
VOLTAREN DURING PREGNANCY
Mas C, Menahem S
Paediatric Cardiology Unit, Monash Medical Centre, Clayton, Victoria 3168
Premature closure of the ductus arteriosus can lead to foetal hydrops and death if not recognised promptly. A
case of probable antenatal closure of the duct is presented.
The reason for early closure was the maternal ingestion of an non-steroidal anti-inflammatory drug (sodium
diclofenac) during weeks 34 and 35 of gestation for severe pain. A sinusoid CTG lead to antenatal
ultrasonography which revealed cardiomegaly with marked right atrial dilatation and right ventricular
enlargement and hypertrophy. An emergency caesarian section was practiced at 41 weeks of pregnancy
following failed induction. It was a stillbirth. The patient required cardiac massage and endotracheal
adrenaline and ventilation.
Hepatomegaly and gallop rhythm suggested right heart failure.
An
echocardiogram performed 30 minutes after birth showed a closed ductus arteriosus with a hyperdynamic well
contracting left ventricle compressed by a right ventricle which was dilated and hypocontractile. The right
atrium was dilated with the atrial septum bulging to the left. There was a patent foramen ovale with right to left
shunting. Moderate tricuspid regurgitation was identified. The findings suggested persistent pulmonary
hypertension, the calculated doppler systolic pulmonary artery pressure being 64 mmHg (systemic blood
pressure 75/50). The infant was ventilated for 24 hours and treated with diuretics for four weeks.
At one year follow up, the patient remains asymptomatic and the cardiac size returned to normal.
Premature closure of the ductus arteriosus should be considered in any pregancy following ingestion of
non-steroidal anti-inflammatory drugs during the third trimester. Doppler monitoring of the foetal duct should
be carried out to determine if premature closure is occurring and if this is the case, the clinician should decide
whether to stop the drug or deliver the baby.