Characteristics of Patent Ductus Arteriosus in Congenital Rubella Syndrome

Michiko Toizumi,Hung Thanh Nguyen,Lay-Myint Yoshida,Nhan Nt Le,Hideki Motomura,Cam Giang T Do,Tin N Do,Makiko Iijima,Hiroyuki Moriuchi,Hirofumi Fukunaga

doi:10.1038/s41598-019-52936-6

Michiko Toizumi, Hung Thanh Nguyen + Show 8 more

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https://doi.org/10.1038/s41598-019-52936-6

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This study investigated the characteristics of congenital rubella syndrome (CRS)-associated cardiac complications, particularly patent ductus arteriosus (PDA). We reviewed the medical records of patients with CRS who were admitted to the Children’s Hospital 1 in Vietnam between December 2010 and December 2012, and patients with CRS who underwent PDA transcatheter occlusion therapy at the cardiology department between December 2009 and December 2015. We compared the characteristics of PDA treated with transcatheter closure between children with CRS (CRS-PDA) and those without CRS (non-CRS-PDA) who underwent PDA transcatheter closure between July 2014 and December 2015. One-hundred-and-eight children with CRS were enrolled. Cardiac defects (99%), cataracts (72%), and hearing impairment (7%) were detected. Fifty CRS-PDA and 290 non-CRS-PDA patients were examined. CRS-PDA patients had smaller median birthweight (p < 0.001), more frequent pulmonary (p < 0.001) and aortic stenosis (p < 0.001), higher main pulmonary artery pressure, and higher aortic pressure in systole/diastole (p < 0.001 for each) than did non-CRS-PDA patients. The proportion of tubular-type PDA was higher in CRS-PDA patients (16%) than in non-CRS-PDA patients (3%) (p = 0.020). Tubular-type PDA was frequently seen in patients with CRS and accompanied by pulmonary/systemic hypertension and pulmonary/aortic stenosis; in these patients, more cautious device selection is needed for transcatheter PDA closure.

Highlights

Outbreaks of rubella and congenital rubella syndrome (CRS) continue to occur in various countries where a rubella-containing vaccine is not included in the national immunization program, in Africa and Asia[1]
We found that mitral regurgitation occurred among children with CRS-patent ductus arteriosus (PDA) (18%) less frequently than in those with non-CRS-PDA (41%), but children with CRS-PDA had pulmonary (34%) and aortic stenosis (22%) more frequently than did children with non-CRS-PDA (0.7% and 1.7%, respectively) (Table 2)
We found that the number of transcatheter PDA occlusions in a hospital by birth date peaked in October and November 2011, similar to the number of infants with CRS born in Vietnam[3,4]

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Introduction

Outbreaks of rubella and congenital rubella syndrome (CRS) continue to occur in various countries where a rubella-containing vaccine is not included in the national immunization program, in Africa and Asia[1]. Mortality among children with CRS was highly associated with pulmonary hypertension (PH) due to PDA; PH in those with CRS could be overcome with transcatheter PDA closure[4]. While PDA has frequently been associated with CRS, its morphologic and hemodynamic characteristics have not been investigated precisely. Characteristics Pulmonary hypertension by echo Coarctation of aorta Aortic stenosis Aortic regurgitation Pulmonary stenosis Pulmonary regurgitation Mitral regurgitation Tricuspid regurgitation Status at discharge Alive Died/went home to die CRS and PDA from the Department list. We 1) described the clinical and cardiac manifestations of children with CRS and 2) investigated the PDA types and sizes, the device types for transcatheter PDA occlusion, and cardiac complications other than PDA among PDA patients with CRS (CRS-PDA) comparing with those without CRS (non-CRS-PDA)

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