{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:14:07Z","timestamp":1760235247038,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T00:00:00Z","timestamp":1627689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcdd8080091","type":"journal-article","created":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T21:51:07Z","timestamp":1627854667000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Isolated Dissection of the Ductus Arteriosus Associated with Sudden Unexpected Intrauterine Death"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-2937","authenticated-orcid":false,"given":"Marny","family":"Fedrigo","sequence":"first","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Visentin","sequence":"additional","affiliation":[{"name":"Department of Woman and Children Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Veronese","sequence":"additional","affiliation":[{"name":"Department of Woman and Children Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6745-1605","authenticated-orcid":false,"given":"Ilaria","family":"Barison","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Giarraputo","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich","family":"Cosmi","sequence":"additional","affiliation":[{"name":"Department of Woman and Children Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8814-2577","authenticated-orcid":false,"given":"Gaetano","family":"Thiene","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Teresa","family":"Gervasi","sequence":"additional","affiliation":[{"name":"Department of Woman and Children Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0195-9753","authenticated-orcid":false,"given":"Cristina","family":"Basso","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3578-4488","authenticated-orcid":false,"given":"Annalisa","family":"Angelini","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1038\/s41372-019-0412-z","article-title":"Results of full postmortem examination in a cohort of clinically unexplained stillbirths: Undetected fetal growth restriction and placental insufficiency are prevalent findings","volume":"39","author":"Blythe","year":"2019","journal-title":"J. Perinatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1016\/S0140-6736(10)62232-5","article-title":"Stillbirths: Why they matter","volume":"377","author":"Cacciatore","year":"2011","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/1471-0528.14971","article-title":"Making stillbirths visible: A systematic review of globally reported causes of stillbirth","volume":"125","author":"Reinebrant","year":"2018","journal-title":"BJOG An. Int. J. Obstet. Gynaecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1093\/eurheartj\/ehp128","article-title":"Premature foetal closure of the arterial duct: Clinical presentations and outcome","volume":"30","author":"Gewillig","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1056\/NEJM199311183292111","article-title":"The ductus arteriosus and its closure","volume":"329","author":"Tynan","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1055\/s-2007-994128","article-title":"Isolated ductal closure in utero diagnosed by fetal echocardiography","volume":"14","author":"Leal","year":"1997","journal-title":"Am. J. Perinatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1017\/S1047951116000871","article-title":"Prognostic factors of premature closure of the ductus arteriosus in utero: A systematic literature review","volume":"27","author":"Ishida","year":"2017","journal-title":"Cardiol. Young"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/8756479318824315","article-title":"Premature Closure of the Ductus Arteriosus in an Otherwise Healthy Fetus","volume":"35","author":"Operle","year":"2019","journal-title":"J. Diagnostic Med. Sonogr."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gittenberger-De Groot, A.C., Peterson, J.C., Wisse, L.J., Roest, A.A.W., Poelmann, R.E., B\u00f6kenkamp, R., Elzenga, N.J., Hazekamp, M., Bartelings, M.M., and Jongbloed, M.R.M. (2020). Pulmonary ductal coarctation and left pulmonary artery interruption; pathology and role of neural crest and second heart field during development. PLoS ONE, 15.","DOI":"10.1101\/2020.01.17.910224"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1002\/dvdy.23833","article-title":"Morphogenesis of Outflow Tract Rotation During Cardiac Development: The Pulmonary Push Concept","volume":"241","author":"Scherptong","year":"2012","journal-title":"Dev. Dyn."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s004290050304","article-title":"Comparative anatomy and ontogeny of the ductus arteriosus, a vascular outsider","volume":"200","author":"Bergwerff","year":"1999","journal-title":"Anat. Embryol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1136\/hrt.39.6.610","article-title":"Persistent ductus arteriosus: Most probably a primary congenital malformation","volume":"39","year":"1977","journal-title":"Br. Heart J."},{"key":"ref_13","first-page":"829","article-title":"Anatomical closure of the ductus arteriosus: A study in 35 specimens","volume":"128","author":"Anderson","year":"1979","journal-title":"J. Anat."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/S0735-1097(85)80178-9","article-title":"Histologic studies on normal and persistent ductus arteriosus in the dog","volume":"6","author":"Strengers","year":"1985","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/S0046-8177(81)80333-4","article-title":"The morphology of the human newborn ductus arteriosus: A reappraisal of its structure and closure with special reference to prostaglandin E1 therapy","volume":"12","author":"Silver","year":"1981","journal-title":"Hum. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1111\/j.1747-0803.2010.00424.x","article-title":"The fetal ductus arteriosus and its abnormalities\u2014A review","volume":"5","author":"Weichert","year":"2010","journal-title":"Congenit. Heart Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/S0002-9378(96)70317-4","article-title":"Spontaneous closure of the human fetal ductus arteriosus\u2014A cause of fetal congestive heart failure","volume":"174","author":"Hofstadler","year":"1996","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/0002-9343(58)90287-0","article-title":"Spontaneous Aneurysm of the Ductus Arteriosus. A review and report of the tenth adult case","volume":"25","author":"Cruickshank","year":"1958","journal-title":"Am. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/S0022-5223(19)42739-6","article-title":"Spontaneous aneurysm of the ductus arteriosus in childhood","volume":"57","author":"Tutassaura","year":"1969","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/0002-9149(72)90542-5","article-title":"Aneurysm of the Nonpatent Ductus Arteriosus in the Newborn","volume":"29","author":"Falcone","year":"1971","journal-title":"Am. J. Cardiol."},{"key":"ref_21","first-page":"165","article-title":"Dissecting Aneurysm of the Ductus Arteriosus in the Newborn Infant","volume":"122","author":"Ithuralde","year":"1971","journal-title":"Am. J. Dis. Child."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/1010-7940(91)90220-E","article-title":"Aneurysm of the ductus arteriosus. A review of the literature and the surgical implications","volume":"5","author":"Lund","year":"1991","journal-title":"Eur. J. Cario-Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/BF00838780","article-title":"Aneurysm of the ductus arteriosus in the neonate: Three case reports with a review of the literature","volume":"13","author":"Lund","year":"1992","journal-title":"Pediatr. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/S0735-1097(00)00707-5","article-title":"Isolated ductus arteriosus aneurysm in the fetus and infant: A multi-institutional experience","volume":"36","author":"Dyamenahalli","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/S0735-1097(01)01736-3","article-title":"Isolated neonatal ductus arteriosus aneurysm","volume":"39","author":"Jan","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1111\/1556-4029.14264","article-title":"Sudden Death Caused by Rupture of Spontaneous Ductus Arteriosus Aneurysm in an Adult","volume":"65","author":"Fukuta","year":"2020","journal-title":"J. Forensic Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/BF03218110","article-title":"Ductal aneurysm of adult patients","volume":"48","author":"Komai","year":"2000","journal-title":"Jpn. J. Thorac. Cardiovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/j.1540-8191.2005.200490.x","article-title":"Ductus arteriosus aneurysm in an adult patient presenting with hoarseness","volume":"20","author":"Pastuszko","year":"2005","journal-title":"J. Card. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1017\/S1047951119003287","article-title":"Congenital ductus arteriosus aneurysm in association with MYH11 mutation: A case report","volume":"30","author":"Ardhanari","year":"2020","journal-title":"Cardiol. Young"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/S0022-3476(80)80337-4","article-title":"The ductus arteriosus in the preterm infant: Histologic and clinical observations","volume":"96","author":"Moulaert","year":"1980","journal-title":"J. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1159\/000262481","article-title":"Insights into the pathogenesis and genetic background of patency of the ductus arteriosus","volume":"98","author":"Deruiter","year":"2010","journal-title":"Neonatology"},{"key":"ref_32","unstructured":"Gallucci, V., Bini, R.M., and Thiene, G. (1979, January 25\u201326). Influence of Prostaglandin E1 on the Histology of the Normal and the Persistent Ductus Arteriosus. Proceedings of the Selected Topics in Cardiac Surgery, Symposium Hel, Padova, Italy."},{"key":"ref_33","first-page":"27","article-title":"Morphology of the patent arterial duct: Features relevant to treatment","volume":"10","author":"Matsui","year":"2008","journal-title":"Images Paediatr. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1542\/peds.2008-0313","article-title":"Determination of Genetic Predisposition to Patent Ductus Arteriosus in Preterm Infants","volume":"123","author":"Dagle","year":"2009","journal-title":"Pediatrics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"698","DOI":"10.5858\/arpa.2015-0225-CC","article-title":"Sampling and definitions of placental lesions Amsterdam placental workshop group consensus statement","volume":"140","author":"Khong","year":"2016","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1136\/bmj.38629.587639.7C","article-title":"Classification of stillbirth by relevant condition at death (ReCoDe): Population based cohort study","volume":"331","author":"Gardosi","year":"2005","journal-title":"Br. Med. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0002-9149(77)80005-2","article-title":"Pathogenesis of dissecting aneurysm of aorta. Comparative histopathologic study of significance of medial changes","volume":"39","author":"Schlatmann","year":"1977","journal-title":"Am. J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.carpath.2016.03.002","article-title":"Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: II. Noninflammatory degenerative diseases-Nomenclature and diagnostic criteria","volume":"25","author":"Halushka","year":"2016","journal-title":"Cardiovasc. Pathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1055\/s-0043-122230","article-title":"Fetal Abdominal Aorta: Doppler and Structural Evaluation of Endothelial Function in Intrauterine Growth Restriction and Controls","volume":"40","author":"Visentin","year":"2019","journal-title":"Ultraschall Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1038\/ng1721","article-title":"Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm\/aortic dissection and patent ductus arteriosus","volume":"38","author":"Zhu","year":"2006","journal-title":"Nat. Genet."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1097\/01.AOG.0000160486.37321.d1","article-title":"Rupture of Fetal Ductus Arteriosus Aneurysm","volume":"105","author":"Tongsong","year":"2005","journal-title":"Am. Coll. Obstet. Gynecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e1259","DOI":"10.1542\/peds.2005-0897","article-title":"Ductus arteriosus aneurysm with community-acquired methicillin-resistant Staphylococcus aureus infection and spontaneous rupture: A potentially fatal quandary","volume":"117","author":"Stewart","year":"2006","journal-title":"Pediatrics"},{"key":"ref_43","first-page":"1","article-title":"Case report on surgical repair of unusual dissection of arterial duct involving main pulmonary artery in a child with vein of Galen malformation","volume":"2","author":"Muthialu","year":"2018","journal-title":"Eur. Hear. J. Case Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/uog.1859","article-title":"Fetal echocardiographic diagnosis of isolated ductus arteriosus aneurysm: A longitudinal study from 32 weeks of gestation to term","volume":"26","author":"Tseng","year":"2005","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1590\/S0066-782X2003001200007","article-title":"Intrauterine ductus arteriosus constriction: Analysis of a historic cohort of 20 cases","volume":"81","author":"Luchese","year":"2003","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/(SICI)1097-0223(199802)18:2<139::AID-PD230>3.0.CO;2-#","article-title":"Circulatory changes following intrauterine closure of the ductus arteriosus in the human fetus and newborn","volume":"18","author":"Mielke","year":"1998","journal-title":"Prenat. Diagn."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/8\/8\/91\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:38:35Z","timestamp":1760164715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/8\/8\/91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,31]]},"references-count":46,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["jcdd8080091"],"URL":"https:\/\/doi.org\/10.3390\/jcdd8080091","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2021,7,31]]}}}