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\begin{document}

\title{Thrombosis of Isolated Ductus Arteriosus Aneurysm In A Newborn}



\author[1]{Vehbi Dogan}%
\author[1]{Ömer  Aksoy}%
\author[1]{İlker Sayıcı}%
\author[1]{Rümeysa Citli}%
\affil[1]{SBU Ankara  Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital}%


\vspace{-1em}



  
  \date{May 19, 2024}


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\selectlanguage{english}
\begin{abstract}
Congenital aneurysm of the ductus arteriosus is reported in 0.8\% in
neonatal autopsies, however true incidence is unknown because of high
rate of asymptomatic cases and spontaneous regression. Possible
complications in symptomatic cases are; thromboembolism, spontaneous
rupture, erosion, infection, compression of airways and death. In this
report we present a newborn with giant DAA diagnosed in first day of
life, surgically treated after thrombosis of aneurysm.%
\end{abstract}%



\sloppy


\textbf{Thrombosis of Isolated Ductus Arteriosus Aneurysm In A Newborn}

Do\selectlanguage{polish}ğ\selectlanguage{english}an Vehbi\textsuperscript{1}, Aksoy \selectlanguage{ngerman}ÖN\textsuperscript{2}, Say\selectlanguage{polish}ı\selectlanguage{english}c\selectlanguage{polish}ı
İ\selectlanguage{english}U\textsuperscript{1}, \selectlanguage{ngerman}Çitli R\textsuperscript{3}.

\textsuperscript{1} Dr. Sami Ulus Maternity and Children's Health and
Diseases Training and Research Hospital, Department of Pediatric
Cardiology, Ankara, Turkey.

\textsuperscript{2} Dr. Sami Ulus Maternity and Children's Health and
Diseases Training and Research Hospital, Department of Pediatric
Cardiovascular Surgery, Ankara, Turkey.

\textsuperscript{3} Dr. Sami Ulus Maternity and Children's Health and
Diseases Training and Research Hospital, Department of Neonatology,
Ankara, Turkey.

\textbf{Corresponding author}

Name : Vehbi Do\selectlanguage{polish}ğ\selectlanguage{english}an

\emph{Orcid ID : 0000-0003-3444-3419}

e-mail : \emph{vdogan86@yahoo.com}

\subsubsection*{Adress : Dr.Sami Ulus Maternity and Children Research and
Training}

{\label{adress-dr.sami-ulus-maternity-and-children-research-and-training}}

\selectlanguage{polish}\subsubsection*{Hospital, Babur Street, No:44 (06080) Altındağ/ Ankara,
Turkey}\selectlanguage{english}

{\label{hospital-babur-street-no44-06080-altux131ndaux11f-ankara-turkey}}

Fax : +90 312 3170353

Phone : +90 5053190186a

\textbf{Abstract}

Congenital aneurysm of the ductus arteriosus is reported in 0.8\% in
neonatal autopsies, however true incidence is unknown because of high
rate of asymptomatic cases and spontaneous regression. Possible
complications in symptomatic cases are; thromboembolism, spontaneous
rupture, erosion, infection, compression of airways and death. In this
report we present a newborn with giant DAA diagnosed in first day of
life, surgically treated after thrombosis of aneurysm.

\textbf{Keywords: ductus arteriosus, aneurysm, thrombosis, newborn}

\textbf{Case Report}

A male newborn with a gestational age of 38w and birth weight of 2900g
was consulted to our clinic because of murmur and 5\% difference in
pulse oximetry screening test in first day of life. Physical examination
was normal except 2/6 cardiac murmur. Echocardiography revealed a small
sized apical muscular ventricular septal defect and ductal patency with
a large ductal aneurysm, narrowed pulmonary end with left to right shunt
and swirling motion in the aneurysm (Fig.1a and 1b, Video 1 and 2). The
patient was asymptomatic, therefore we decided for clinical follow up
without medication. On the third day of life, echocardiography revealed
closed pulmonary end of the ductus and presence of trombus in the
aneurysm extending towards decscending aorta (Fig. 1c and Video 3).
Surgical resection of ductal aneurysm was enrolled because of risk of
embolism (Fig. 1d). Post-operative echocardiography showed residual
thrombosis in the aortic side, which fully disappeared on the second
week of life with low molecular weight heparin treatment.

\textbf{Discussion}

Although being mostly asymptomatic, aneurysm of the ductus arteriosus
(DAA) can lead to severe complications in some cases. It is reported in
less than 1\% of neonatal autopsies, whereas Jan et al. reported
relatively high incidence rate of 8.8\% without any symptomatic case,
probably because of the diagnostic criteria they used {[}1,2{]}. DAA
related symptoms as thromboembolism, spontaneous rupture, compression of
airways and nerves and even death are reported in up to 16-30\% of
patients {[}3-6{]}.

Etiology of DAA is unknown, however hypothesis as abnormal elastin
expression or structure, ductal wall weakening and reduced intimal
cushions are reported in some studies. Associated connective tissue
diseases (Marfan syndrome, Ehler Danlos syndrome etc.) with DAA supports
the hypothesis of ductal wall abnormality {[}2,3{]}.

Most cases are asymptomatic and regress spontaneously and should be
managed with clinical follow up. Jan et al. reported that all of the
cases regressed spontaneously in the neonatal period and suggested no
intervention {[}2{]}. However, in case of complications such as
extending thrombosis, laryngeal nerve or airway obstruction and rupture
of aneurysm, surgical intervention should be considered. Spontaneous
regression occurs in steps as constriction, thickening, trombus
formation and closure. Although thrombosis is a step in natural history
during spontaneous closure, large aneurysm and extension of the thrombus
into the descending aorta indicated surgical excision of the aneurysm in
our case. In some cases, especially in patients with nerve palsy,
ligation and decompression of the aneurysm instead of excision is also
suggested.

In our patient thrombosis developed in third day of life during
expectation of spontaneous closure. Clinical follow up for the possible
symptoms and serial echocardiography should be enrolled to identify the
need for intervention in patients with DAA.

\textbf{Conflict of Interest}

None declared.

\textbf{Funding}

None.

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Falcone MW, Perloff JK, Roberts WC. Aneurysm of the nonpatent ductus
  arteriosus. Am J Cardiol 1972;29:422-426.
\item
  Jan SL, Hwang B, Fu YC, Chai JW, Chi CS. Isolated neonatal ductus
  arteriosus aneurysm.~J Am Coll Cardiol.~2002;39:342-347.
\item
  Lund JT, Hansen D, Brocks V, Jensen MB, Jacobsen JR. Aneurysm of the
  ductus arteriosus in the Neonate: Three case reports with a review of
  the literature.~Pediatr Cardiol.~1992;13:222-226.
\item
  Dyamenahalli U, Smallhorn JF, Geva T, Fouron JC, Cairns P, Jutras L,
  Hughes V, Rabinovitch M, Mason C AE, Hornberger LK. Isolated ductus
  arteriosus aneurysm in the fetus and infant: a multi - institutional
  experience. J Am Coll Cardiol 2000;36:262-269.
\item
  Hornung TS, Nicholson IA, Nunn GR, Hawker RE. Neonatal ductus
  arteriosus aneurysm causing nerve palsies and airway compression:
  Surgical treatment by decompression without excision.~Pediatr
  Cardiol.~1999;20:158-160
\item
  Koneti NR,~Kanchi V, ~Kandraju H,~Jaishankar S. Symptomatic aneurysm
  of ductus arteriosus in neonates Ann Pediatr Cardiol. 2011;4:159--163.
\end{enumerate}\selectlanguage{english}
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