Spontaneous aneurysm of the ductus arteriosus; a review and report of the tenth adult case

Multiple vascular malformations in a newborn

We describe the case of a term newborn who presented with congenital testicular torsion at 10 hours of age. During the evaluation of this problem, additional malformations were encountered. Diagnostic and therapeutic considerations are addressed.

Isolated Dissection of the Ductus Arteriosus Associated with Sudden Unexpected Intrauterine Death

We report five cases of sudden intrauterine death due to premature closure of the ductus arteriosus. In four cases, this was caused by dissecting the hematoma of the ductus arteriosus with intimal flap and obliteration of the lumen. In one case, the ductus arteriosus was aneurysmatic, with lumen occlusion caused by thrombus stratification. No drug therapy or free medication consumption were reported during pregnancy. The time of stillbirth ranged between 26 and 33 gestational weeks. We performed TUNEL analysis for apoptosis quantification. The dissecting features were intimal tears with flap formation in four of the cases, just above the origin of the ductus arteriosus from the pulmonary artery. The dissecting hematoma of the ductus arteriosus extended downward to the descending aorta and backward to the aortic arch with involvement of the left carotid and left subclavian arteries. TUNEL analysis showed a high number of apoptotic smooth muscle cells in the media in two cases. Abnormal ductal remodeling with absence of subintimal cushions, lacunar spaces rich in glycosaminoglycans (cystic medial necrosis), and smooth muscle cell apoptosis were the pathological substrates accounting for failure of remodeling process and dissection.

Incidentally identified ductus arteriosus aneurysm in eight adults: a case series

Ductus arteriosus aneurysm (DAA) in adulthood is a rare entity. We retrospectively reviewed our medical records from the past 10 years and identified 8 cases of adult DAA (6 males and 2 females aged between 69 and 89 years; mean, 76 years), using multiplanar reconstruction and three-dimensional reconstruction CT images. The aneurysm was suspected incidentally in all cases based on the results of chest radiographic screening or post-operative follow-up CT for lung or colon cancer. All eight patients were asymptomatic but had a history of or concurrent hypertension (n = 5, 62.5%), diabetes mellitus (n = 3, 37.5%), cerebrovascular disease (n = 3, 37.5%), ischemic heart disease (n = 1, 12.5%), and cardiac failure (n = 1). All patients had no history of trauma (n = 8, 100%). Six had a history of cigarette smoking. The aneurysm size ranged from 2.0 × 4.0 to 6.3 × 5.3 cm (mean, 3 × 5 cm). The surgical procedures used were four cases of total arch replacement and two cases of thoracic endovascular aortic repair. Two patients were not surgically treated. The median follow-up was 14.5 months (range, 2 months to 9 years). In the two patients who were not surgically treated, the aneurysm enlarged in one, and remained unchanged in the other. Of the six surgically managed cases, one was lost to follow-up, and another patient died of an unrelated cause. The remaining four cases had no enlargement of the aneurysm. No ruptures were reported in any of the cases. DAA should be considered when a saccular aneurysm is located in the minor curvature of the aortic arch and extending toward the left pulmonary trunk in adult patients. Differentiating adult DAA is important, because it is associated with a high risk of rupture due to the fragile nature of true aneurysms.

Sudden Death Caused by Rupture of Spontaneous Ductus Arteriosus Aneurysm in an Adult

A 55-year-old man complained of sudden onset of severe neck pain. This was followed by prompt loss of consciousness and death. Autopsy revealed rupture of a saccular aneurysm, which was considered to have resulted from enlargement of the remaining ductal tissue, and was located on the medial aspect of the uppermost portion of the descending aorta. Dense blood extravasation was noted in the posterior mediastinum and extending to the strap muscles of the neck and larynx. Histological examination of the rupture site revealed disappearance of the medial elastic fibers and thickened intima covered with dense fibrous tissue. Spontaneous ductus arteriosus aneurysm in adults is a rare finding, but widespread use of imaging technologies has revealed that it develops more frequently than previously recognized. Fatal complications may occur even when the aneurysm is relatively small. Therefore, pathologists should be aware of this aneurysm as a potential cause of sudden death.

An Unusual Cardiac Cause of Unilateral Neonatal Wheezing

A neonate presented three days after birth with left-sided unilateral inspiratory wheezing, intermittent respiratory distress, and desaturations. She was found to have a large ductus arteriosus aneurysm that caused compression of her left mainstem bronchus and left pulmonary artery. This lesion was not identified prior to birth on routine prenatal screening, which included fetal ultrasonography. Diagnosis was made on day of life (DOL) 5 by a computed tomography with angiography scan. On DOL 7, she underwent cardiac surgery which included resection of the ductal aneurysm, patch reconstruction of the transverse aortic arch and descending aorta, patent ductus arteriosus excision, and atrial secundum septal defect repair. There were no postoperative complications, and she has been asymptomatic since.

Ductus Arteriosus Aneurysm Imaging Using Modern Diagnostic Methods

An aneurysm of the ductus arteriosus carries a high risk of rupture. The radiologic findings are described, based on a review of the literature, and on our experience of 5 patients, successfully diagnosed and treated. A left-sided mediastinal mass is always present, obscured only if the aneurysm has already ruptured. Although the lesion seems to be congenital, conventional radiology sometimes demonstrates wall calcifications. Ultrasonography is well suited to demonstrate the vascular nature of the mass, but interpretation may be difficult because of intervening air-containing lung parenchyma. CT, especially using dynamic scanning with contrast enhancement, is an excellent non-invasive diagnostic method. Angiography is frequently necessary to demonstrate patency or occlusion of the aortic and pulmonary ends of the ductus. The differential diagnosis must include a large number of mediastinal tumors. A temporary widening of the ductus in the newborn is common and must be differentiated from a true aneurysm. Surgical treatment today is usually successful.

Treatment paradigms for ductus arteriosus aneurysms in adults

We report two symptomatic cases of ductus arteriosus aneurysm (DDA) in adults treated in our department over a 5-years period. One patient underwent an open off-pump surgical procedure, while the second one was treated with partial aortic arch debranching and endovascular stent-grafting. DDA in adults is an uncommon condition and can present with rupture, hoarseness or symptoms of airway obstruction. Although indications for intervention are not clearly established, most authors advocate that DDAs should be treated regardless of their size, to avoid the risk of rupture, while others reserve intervention for symptomatic patients. We report on the management of these patients and provide an updated review of the current literature.

A New Off-Pump Hybrid Open and Endovascular Repair to Treat Ductus Botalli and Ascendens Aneurysms

To report a combined ascending aorta and aortic arch hybrid repair, we performed off-pump with no aortic graft replacement. A 65-year-old man, developing progressive recurrent laryngeal nerve paralysis, underwent a computed tomography (CT) angiography detecting nonpatent residual ductus Botalli aneurysm and ascending aorta aneurysm. Due to severe multimorbidities, a less-invasive alternative was elaborated. In a first step, appropriate proximal landing zone for aortic stent grafting was achieved by ascending aorta diameter reduction, with epiaortic wrapping, and debranching the supra-aortic trunks. In the second step, endovascular stent grafts were deployed from proximal ascending aorta to descending aorta, excluding the ductus Botalli aneurysm. Six-month follow-up CT shows ductus Botalli aneurysm exclusion, stable stent graft position, and ascending diameter and patent and stenosis-free supra-aortic grafts. This case supports this alternative treatment to open aortic repair under circulatory arrest and deep hypothermia, especially in those patients considered unfit for such invasive treatment.

Case Report: Spontaneous aneurysm of ductus arteriosus: A rare cause of hoarseness of voice in adults

Ortner's syndrome (left recurrent laryngeal nerve palsy caused by cardiovascular pathology) is described in literature as occurring secondary to a variety of conditions. Spontaneous aneurysm of ductus arteriosus is a rare cause of this condition. We present a case where an adult patient with an aneurysm of the ductus arteriosus presented for the first time at the age of 62 years with hoarseness of voice secondary to left recurrent laryngeal nerve palsy.

[False aneurysm complicating ligation of patent ductus arteriosus operated on successfully]

Postoperative aneurysm of ductus arteriosus is a rare complication but may be lethal without treatment. It is less frequent than spontaneous aneurysm of ductus arteriosus. We report the case of 5 years-old girl who underwent a ligation of patent ductus arteriosus complicated, 6 months later, with a false aneurysm of ductus arteriosus and endocarditis of the ductus and the aortic valve. The diagnosis of the aneurysm was suspected on the anteroposterior chest X-ray which showed a left superior mediastinal opacity and confirmed by echocardiography. Through bilateral thoracotomy, an anevrismorraphy and aortic repair was carried out without problem. The postoperative course was unremarkable.

Spontaneous closure and thrombosis of a ductal aneurysm in a neonate

The natural history of a ductal aneurysm detected prenatally is presented. Neurologic concerns in the neonate and absence of cardio-respiratory compromise permitted serial echo demonstration of constriction, thickening and subsequent closure with formation of thrombus in the aneurysm.

[Aneurysm of the nonpatent ductus arteriosus in the adult--a report of the case and review of the literature]

Aneurysm of the ductus arterious in adult in rare. 28 cases have been previously reported in the Japanese literature. A new 73-year-old male case, preoperatively diagnosed and successfully repaired, are presented. The patient with hoarseness was admitted to our hospital. Contrast-enhanced CT scans and aortograms made a diagnosis for the aneurysm of the ductus arteriosus. Operation was done through left thoracotomy with the aid of partial cardiopulmonary bypass. The pulmonary arterial end of the ductus arteriosus was closed and a Ligamentum arteriosus was identified. A 3 by 2.7 cm saccular aneurysm was resected and segmental replacement of the aorta with woven dacron graft was performed. Because of it's critical location and the high incidence of complications, aneurysm of the ductus arteriosus in the adult should be surgically corrected when diagnosed.

Aneurysm of the ductus arteriosus in the neonate: three case reports with a review of the literature

Ductus arteriosus aneurysm was demonstrated in three neonates by echocardiography. One case was already diagnosed in utero. One patient needed surgical resection, whereas in one case the aneurysm of the ductus arteriosus regressed spontaneously. In the third case the patient died of associated lesions. In a review of the literature, 61 previous cases of ductus aneurysm in infants less than 2 months were found. Ductus arteriosus aneurysm may be diagnosed by echocardiography both pre- and postnatally. A ductus aneurysm should be monitored closely by echocardiography. Since a high incidence of complications is reported, surgical resection is indicated if the aneurysm does not regress within a few days.

Three arterial ostia in the base of the pig's heart. Abnormal ductus arteriosus or an additional stem vessel?

A macroscopic description of four hearts showing three arterial ostia in the base of the pig's heart was carried out. Portions of the vascular walls were histologically examined in three hearts. All hearts belong to the Tetralogy of Fallot group. Spitzer's hypothesis concerning the phylogenetic development of the mammalian heart was tested against the observations. The hypothesis could not be verified. The study leads to the conclusion that the ductus arteriosus has its origin in the base of the heart in the four hearts studied.

Aneurysm of the ductus arteriosus

Two neonates with aneurysms of the ductus arteriosus were seen. One suffered a fatal spontaneous rupture of the aneurysm, and the second (in which it was an incidental finding) the aneurysm was monitored by echocardiography, and seemed to resolve spontaneously.

Ductus diverticulum aneurysm and coronary stenosis: repair using circulatory arrest

The case of a 68-year-old man with advanced symptomatic coronary artery disease and large aneurysm of the diverticulum of the ductus arteriosus is presented. Both the coronary artery disease and the aneurysm were successfully repaired at the same time via median sternotomy using cardiopulmonary bypass and a brief period of profound hypothermic circulatory arrest. To our knowledge, this is the 27th reported case of such an aneurysm in an adult.

Saccular aneurysm of the transverse thoracic aorta detected by transesophageal echocardiography

A patient with a saccular aneurysm of the thoracic aortic arch presented with severe right ventricular failure due to pulmonary artery compression. Contradictory data were derived from computed tomography, pulmonary isotope perfusion scan and cardiac catheterization. Transesophageal echocardiography revealed a saccular aneurysm which compressed the main pulmonary artery and gave access to a fistulous connection to the left pulmonary artery. Surgery confirmed these findings.

Aneurysm of patent ductus arteriosus in an adult case: findings of cardiac catheterization, angiography, and pathology

A 42-year-old male was admitted to our hospital for evaluation of a left precordial continuous murmur. Results of catheterization revealed a step-up of oxygen content in the pulmonary arteries and the calculated left-to-right shunt flow was 40% of the pulmonary arterial flow. Furthermore, aortography unexpectedly revealed an aneurysm of the patent ductus arteriosus. During surgery, the aneurysm was discovered to arise from the frontal wall of the ductus arteriosus, and histological observation showed focal necrosis and mucoid degeneration of the media of the aneurysmal wall in contrast to a thickened intimal fibroelastosis of the adjacent ductal wall. This is presumed to be the first adult case of patent ductal aneurysm ever reported in which antemortem diagnosis and surgical treatment were successfully conducted. Our case may suggest that the fragility of the ductal wall following the structural change in an incomplete closing process is considered as a potential pathogenesis of ductal aneurysm formation.

Spontaneous aneurysm of a patent ductus arteriosus in an elderly patient

Spontaneous aneurysm of a patent ductus arteriosus has rarely been reported in an adult. Successful operation on such an aneurysm is reported.

Ductus arteriosus aneurysm in infancy

An infant with symptoms of congestive heart failure at 6 months of age was found by cardiac catheterization at the age of 1 year to have a fusiform aneurysm of the ductus arteriosus as well as discrete stenosis of the left pulmonary artery and a secundum atrial septal defect. The aneurysm was resected, and a pericardial patch angioplasty corrected the peripheral pulmonary stenosis. The atrial septal defect was closed in a separate procedure. To our knowledge, this case is one of four ductal aneurysms reported in infants that have been diagnosed before operation and successfully treated. The pathophysiology and literature are reviewed.

Dissecting aortic aneurysm in childhood and adolescence. Case report and literature review

A 15-year-old adolescent male with dissecting aortic aneurysm is presented. His young age, lack of predisposing factors, and fulminant course with rapid progression to death precluded a correct antemortem diagnosis. Review of the literature reveals that most instances of dissecting aortic aneurysm in childhood and adolescence are associated with predisposing conditions, especially congenital cardiovascular anomalies. The clinical picture is generally characteristic. Prompt evaluation and therapy may be lifesaving.

The pulmonary artery segment in normal and in valvular pulmonary stenosis

1. The length and arrow or the PAS of 130 normal cases were measured, respectively. The BSA (m2) ranged between 0.30--2.05, and the ages between 6 months and 40 years. 2. Seventy-three cases VPS were divided into four groups according to the peak SPRV: Group 1, less than 50 mm Hg; Group 2, from 50--75 mm Hg; Group 3, from 75--150 mm Hg; and Group 4, with more than 150 mm Hg. The length and arrow of the PAS was measured. The age of the patient ranged from 4--38 years. 3. In normal cases, the PAS was a straight line or presented a slight concavity in 30% of the cases. 4. In cases of VPS all of them had a slight or marked bulging of the PAS, except one in Group 1 (6.6%); two in Group 2 (11%); three in Group 3 (10%); and one in Group 4 (8.3%). Marked convexity (more than 10 mm of arrow of this segment) was found one time in Group 1 (6.6%); three times in Group 2 (16%); three times in Group 3 (10%); and twice in Group 4 (16%). 5. In normal cases the length and the arrow of the PAS tend to have greater values when the BSA is higher. When the arrow of the segment is above 5 mm and the length higher than 50 mm, irrespective to the patient's age, we must be facing an abnormal finding and all those diseases capable of giving an abnormal PAS should be considered. 6. We want to stress the importance of obtaining a proper roentgenogram to assess, with accuracy, the quantitative and qualitative data needed to do a correct interpretation of the cardiac silhouette.

Fistulous aneurysm of ductus arteriosus

We present clinical, haemodynamic, and angiographic data on a 48-year-old woman with a fistulous aneurysm of the ductus arteriosus. This is the first reported case of a spontaneous fistulous aneurysm of the ductus arteriosus in an adult in which an antemortem diagnosis was made. This lesion typically presents with shortness of breath, hoarseness caused by recurrent laryngeal nerve paralysis, and chest pain, and poses a critical threat to life because of progressive compression, erosion, and haemorrhage into the oesophagus or tracheobronchial tree. Fistulous aneurysm of the ductus arteriosus should be considered in the differential diagnosis of an enlarging mediastinal mass, especially when a continuous heart murmur is noted. Early definitive diagnosis and surgical repair in adults are essential for survival.

Aneurysm of the ductus arteriosus

A 59-year-old man with an aneurysm of the ductus arteriosus is described. Macroscopically and histologically it was ascertained that the aneurysm had originated from the ductus arteriosus itself. We suggest the following pathogenesis: after obliteration of the pulmonary end, the aneurysm was formed, and as a result of a gradual increase in pressure in the lumen, the obliterated pulmonary end, the aneurysm was formed, and as a result of a gradual increase in pressure in the lumen, the obliterated pulmonary end recanalized.

Aneurysm of the nonpatent ductus arteriosus in the newborn

Aneurysm of the nonpatent ductus arteriosus in the newborn is a rare, but potentially fatal condition. Of reported ductal aneurysm up to 1969, diagnosis was made at autopsy only. We report here to our knowledge for the first time on a two week old infant with correct preoperative angiographic diagnosis followed by a successful surgical cure.

Preferential atherosclerosis at the aortic junction of the ligamentum arteriosum: clinical significance and pathological correlation

Clinical experience with 5 patients who had complications of atherosclerosis within the aorta at the site of the obliterated ductus arteriosus suggested the occurrence of clinically significant preferential atherosclerosis at this location. To examine this hypothesis, the clinical findings in these patients (4 with saccular aneurysm and 1 with systemic emboli from an ulcerated plaque at this location) were correlated with postmortem examination of the aortic isthmus in 40 consecutive cadavers. The point of ductal closure was the area of most severe atheromatous involvement in 32 of the 40 cadavers, and 25 of the 40 specimens demonstrated ulcerated plaques at this location. Microscopical examination consistently demonstrated intimal irregularity or disruption and thinning of the aortic media in this area. These studies indicate that preferential atherosclerosis occurs at the aortic end of the obliterated ducts arteriosus and that these atherosclerotic changes can be a clinically significant development.

Ruptured ductus arteriosus. Aneurysm in an infant. Report of a survivor

The diagnosis of a large ductus arteriosus aneurysm was made in a 3 1/2-month-old infant by cardiac catheterization following massive hemoptysis. Prompt surgical correction accounted for the patient's survival. Differential diagnosis of an intrathoracic mass should include a ductus arteriosus aneurysm even in the newborn period.

Aneurysms of the Previously Ligated Patent Ductus Arteriosus

Five cases of postoperative aneurysm of the ductus arteriosus are presented and discussed, together with 12 from the literature. The ductus had become recanalized in all 17 patients. Infection was present in 11, having existed preoperatively in only two of these cases. The evidence suggests that contamination at the time of surgery was responsible for the infection in at least seven cases.