在复杂的胎儿心脏畸形中可以发现胎儿动脉导管(DA)收缩,但很少作为一个孤立的缺陷。尽管许多DA收缩病例通常与非甾体抗炎药(NSAIDs)母体摄入有关,其他原因仍然没有确定的病因,被称为特发性。最近,广泛的风险因素或物质(富含多酚的食物摄入量,萘甲唑啉,氟西汀,咖啡因和杀虫剂)对炎症途径有明确的影响,导致DA收缩。我们报告了一例女性过早发生DA收缩的情况,该女性的母亲职业暴露于溶剂中,可能的危险因素被确定,并对176例与NSAID无关的DA收缩进行了全面的文献综述。一名30岁的亚洲妇女因怀疑过早的DA收缩而在33孕周零0天时被转诊到我们的机构。这名妇女没有服药史,包括NSAIDs,酒精,怀孕期间食用烟草或富含多酚的食物。详细的胎儿超声心动图显示正常的心脏解剖与肥大,运动减退和右心室扩张由于右压力超负荷,全收缩期三尖瓣反流,and,在DA的层面上,高收缩和舒张速度,指示过早的导管限制。右流出显示肺动脉扩张,DA狭窄。由于DAPI恶化和右侧压力超负荷的迹象,在妊娠33周和4天时进行了紧急剖腹产,尽管中断接触溶剂。我们假设过早的DA收缩与母体职业暴露于溶剂之间存在关系。在患者的两个孩子中,相关胎儿畸形的存在加强了这一假设。需要进一步的研究来证实暴露于溶剂和有毒化学物质在DA收缩的发病机理中的作用。还有实验动物模型。关键信息许多DA收缩病例通常与非甾体抗炎药(NSAIDs)的母体摄入有关。广泛的风险因素或物质(富含多酚的食物摄入量,萘甲唑啉,氟西汀,咖啡因和杀虫剂)会导致胎儿DA收缩。需要进一步研究以确认母体暴露于溶剂在DA收缩的发病机理中的作用。
Foetal ductus arteriosus (DA) constriction can be found in complex
foetal heart malformations, but rarely as an isolated defect. Although many cases of DA constriction are usually related to Non-steroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake, other causes remain without an established aetiology and are referred to as idiopathic. Recently, a wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) showed a definitive effect upon the pathway of inflammation, causing DA constriction. We report a
case of a premature DA constriction in a woman whose possible risk factor was identified in her maternal occupational exposure to solvents and a comprehensive literature review of 176 cases of NSAID-unrelated DA constriction. A 30-year-old Asian woman was referred to our institution at 33 gestational weeks and 0 days because of suspicion of premature DA constriction. The woman had no history of medication intake, including NSAIDs, alcohol, tobacco or polyphenol-rich-food consumption during pregnancy. A detailed
foetal echocardiography revealed a normal cardiac anatomy with hypertrophic, hypokinetic and a dilated right ventricle due to right pressure overload, holosystolic tricuspid regurgitation, and, at the level of the DA, high systolic and diastolic velocities, indicating premature ductal restriction. The right outflow showed dilatation of the pulmonary artery with narrow DA. An urgent caesarean section was performed at 33 gestational weeks and 4 days due to worsening of DA PI and signs of right pressure overload, despite the interruption of exposure to solvents. We assume a relationship exists between premature DA constriction and a maternal occupational exposure to solvents. This hypothesis is reinforced by the presence of associated
foetal malformations in in two of the patient\'s children. Further research is needed to confirm the role of exposure to solvents and toxic chemicals in the pathogenesis of DA constriction, also with experimental animal models.KEY MESSAGESMany cases of DA constriction are usually related to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) maternal intake.A wide range of risks factors or substances (polyphenol-rich foods intake, naphazoline, fluoxetine, caffeine and pesticides) can cause
foetal DA constriction.Further investigation are needed to confirm the role of maternal exposure to solvents in the pathogenesis of DA constriction.