{"paper_id":"001a9185-e7df-49d3-acec-9696f46f031e","body_text":"Ductus Arteriosus Aneurysm in Neonates | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Ductus Arteriosus Aneurysm in Neonates Qianqian Zhou, Daicheng Han, Shiwen Xia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6234989/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jul, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 11 You are reading this latest preprint version Abstract This article aims to comprehensively investigate the epidemiology, pathophysiology, diagnostic methods, therapeutic strategies, and prognosis of Ductus Arteriosus Aneurysm (DAA) in neonates, and to analyze the clinical management highlights through specific case studies. DAA is a rare congenital cardiovascular anomaly that can present with subtle symptoms or be misdiagnosed as common neonatal infections. This paper presents a case study of a 22-day-old male neonate diagnosed with a DAA complicated by left pulmonary artery and bronchial compression, which led to respiratory distress and persistent fever failure to respond to conventional anti-infective treatment. The diagnostic process, clinical management, and the outcome of surgical intervention are discussed, with a review of the relevant literature on the pathophysiology, diagnostic criteria, and management strategies for DAA in neonates. This case emphasizes the need for careful differential diagnosis in neonates presenting with persistent fever and respiratory symptoms, particularly when infection markers are elevated but infection etiology remains unclear. Ductus Arteriosus Aneurysm Neonate Respiratory Distress Differential Diagnosis Surgical Intervention Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Ductus arteriosus aneurysm (DAA) is a rare but significant congenital heart anomaly characterized by abnormal dilation of the ductus arteriosus, and is typically diagnosed in late fetal life or early neonatal period. A prospective study showed that the incidence of DAA in term neonates is 8.8% [ 1 ]. This condition, although oftentimes asymptomatic, can be life-threatening when it results in compression in adjacent vascular or bronchial structures [ 2 ]. The clinical manifestation of DAA in neonates varies, and early diagnosis is crucial to prevent catastrophic outcomes such as rupture or thrombosis [ 3 , 4 ]. This study describes a neonate with DAA complicated by significant compression of the left pulmonary artery and mainstem bronchus, which resulted in refractory respiratory symptoms and fever despite appropriate anti-infective therapy. The diagnostic workup and the management methods are discussed in detail. The neonate’s patients consented to the study protocol approved by the research ethics committee at Hubei Provincial Women and Child Health Hospital [2023]IEC027. 2. Case Presentation 2.1 Patient Overview A 22-day-old male neonate was admitted to our institution with a chief complaint of fever for the past six hours. His history indicated a spontaneous onset of fever (38.1°C) without identifiable precipitating factors. The infant exhibited poor response to external stimuli, although he continued to feed normally and had no abnormal bowel movements. Laboratory studies showed elevated white blood cell count (WBC: 26.21 × 10^9/L) and C-reactive protein (CRP: 82.82 mg/L), suggestive of an inflammatory or infectious process. 2.2 Medical and Family History The neonate was born at 41 weeks of gestation via vaginal delivery, with a birth weight of 3.5 kg. There were no complications during pregnancy, and the Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. His parents were healthy, with no known genetic or metabolic disorders in the family. The infant had received recommended vaccinations, including hepatitis B and Bacillus Calmette-Guérin (BCG). 2.3 Physical Examination On examination, the infant appeared ill and lethargic. Vital signs included: temperature = 38.1°C, blood pressure = 70/40 mmHg, respiratory rate = 46 breaths per minute, and heart rate = 151 beats per minute. Physical examination revealed soft fontanel, normal pupil reflexes, and no signs of cyanosis or respiratory distress such as subcostal retractions. Auscultation revealed coarse breath sounds with no adventitious noise in the lung, and regular heart rate with no murmurs. The abdominal examination was normal, with the liver palpated 1.5 cm below the right costal margin. 2.4 Initial Diagnosis Given the initial clinical findings, neonatal sepsis was suspected, and empirical broad-spectrum antibiotics were initiated. However, the infant's condition did not improve despite treatment, and respiratory distress appeared in progress. Further diagnostic work-up, including laboratory results and imaging studies, was pursued. 3. Diagnostic Workup 3.1 Laboratory Results A second set of blood tests revealed a WBC count of 20.59 × 10^9/L, CRP > 200 mg/L, and a predominance of neutrophils. Blood and urine cultures as well as tests for common respiratory viruses were all negative, ruling out bacterial and viral infections. A comprehensive immunological panel, including TORCH screening and fungal cultures, was also negative, further suggesting that infection was not the primary etiology. 3.2 Imaging Studies The initial chest X-ray showed vague and coarse lung markings with scattered patchy opacities (Figure 1). A repeat X-ray five days later showed worsening lung findings, including enlarged thymic shadow (Figure 2). Chest Computed tomography(CT) demonstrated significant compression of left pulmonary artery and bronchial narrowing due to a mass-like structure in the mediastinum (Figure 3). A subsequent Computed tomography angiography (CTA) identified a large pseudoaneurysm originating from the aortic end of the ductus arteriosus, which compressed both the left mainstem bronchus and left pulmonary artery, resulting in collapse of the left lung (Figure 4). 3.3 Diagnosis The combination of imaging findings, clinical presentation, and absence of infection collectively led to a diagnosis of DAA complicated by left pulmonary artery and bronchial compression. 4. Management and Treatment 4.1 Surgical Intervention The neonate was transferred to a cardiovascular surgical unit for further management. Given the risk of rupture and the significant compression of vital structures, surgery was recommended. The ductus arteriosus aneurysm was successfully resected, and the patent foramen ovale was closed to prevent further complications related to the aneurysm. 4.2 Postoperative Recovery Post-surgery, the neonate exhibited gradual improvement in respiratory status, and his fever subsided following the surgical correction. He was closely monitored for potential complications, including respiratory infections or thrombosis. Eventually, he fully recovered with no long-term sequelae. 5. Discussion DAA is a rare congenital vascular anomaly characterized by localized dilation or aneurysm because of the failure of the ductus arteriosus to close properly after birth [ 5 ]. The exact etiology of DAA remains unclear and it may stem from several factors, including high pressure gradients in the ductus arteriosus, connective tissue abnormalities (e.g., Marfan, Ehlers-Danlos and Larsen syndromes), infective causes, and protein S-deficient [ 6 , 7 , 8 ]. Further research is needed to elucidate the precise mechanisms underlying this condition. 5.1 Clinical Manifestations and Diagnosis In neonates, DAA may manifest nonspecific symptoms such as fever, respiratory distress, or failure to thrive [ 9 ], which could result in delay in imaging studies that are essential for diagnosing DAA [ 10 ]. CT or Magnetic resonance imaging(MRI) is indicated when the diagnosis is in doubt or there is suspicion of associated complications, such as thromboembolism, infection, compression or erosion of adjacent structures, or aneurysm rupture [ 11 ]. In this case under investigation, the absence of infection despite elevated inflammatory markers and chest CT findings of pseudoaneurysm at the aortic end of the ductus arteriosus that compressed the left pulmonary artery and mainstem bronchus affirmed the eventual diagnosis. Antenatal diagnosis has improved, leading to better parental awareness and more timely and appropriate intervention [ 12 , 13 ]. 5.2 Treatment Strategies While many DAAs resolve spontaneously, those that cause significant compression of adjacent structures, such as the trachea, bronchus, or pulmonary artery, leading to symptoms including respiratory distress, stridor, or feeding difficulties, may require surgical intervention [ 14 , 15 ]., Previous studies suggested the use of surgical resection to prevent complications such as thrombus formation, thromboembolism, or rupture [ 3 , 4 ] for DAAs that persist beyond the neonatal period (two months). In cases where DAA is associated with other intracardiac defects, surgical correction may be performed simultaneously. In this studied case, the patient underwent successful surgical resection of the aneurysm, which resulted in relief in compression and a complete recovery. The surgical approach involved median sternotomy or lateral thoracotomy, and in some adult cases, can be completed with assistance of femorofemoral bypass [ 16 ]. 5.3 Prognosis The prognosis for neonates with DAA varies; however most cases have a favorable outcome with a high likelihood of spontaneous resolution, particularly when the aneurysm is small. Nevertheless, complications such as thromboembolism, compression of surrounding structures, or spontaneous rupture can arise, necessitating close monitoring and potential surgical intervention [ 4 , 15 ]. Regular echocardiographic follow-up is recommended to monitor the size and behavior of the aneurysm. Surgical intervention may be considered if the aneurysm persists beyond 2 months, shows signs of growth, or is associated with complications [ 3 ]. 6. Conclusion Ductus arteriosus aneurysm is a rare but severe condition that can present with nonspecific symptoms in neonates, often mimicking infections or other common neonatal diseases. Imaging provides a way for early recognition of DAA and therefore enables timely intervention to prevent the associated life-threatening complications. The reported case highlights the importance of considering DAA in the differential diagnosis of neonates with unexplained fever and respiratory distress. Further investigation of the pathophysiology and management of DAA in neonates is needed to refine treatment protocols and improve patient outcomes. Abbreviations DAA: Ductus arteriosus aneurysm WBC: White blood cell count CRP: C-reactive protein BCG: Bacillus Calmette-Guérin CT: Computed tomography CTA: Computed tomography angiography MRI: Magnetic resonance imaging Declarations Ethics approval and consent to participate This study was approved by the hospital ethics committee [2023]IEC027. Informed consent was obtained from the parents prior to the inclusion in the study. Consent for publication Written, informed consent was obtained from the parents. Availability of data and materials No datasets were generated or analyzed during the current study. Competing Interests The authors declare no competing interests. Funding This work was supported by the Public Health Leading Talents Training Program of Hubei Province(No. 1020013003). Authors’ Contributions Qianqian Zhou drafted and revised the manuscript, Daicheng Han and Shiwen Xia participated in the clinical evaluation and revised the manuscript. All authors reviewed the manuscript. Acknowledgements Not applicable. References Jan SL, Hwang B, Fu YC, et al. Isolated neonatal ductus arteriosus aneurysm[J]. J Am Coll Cardiol. 2002;39(2):342–347. Koneti NR, Kanchi V, Kandraju H, et al. Symptomatic aneurysm of ductus arteriosus in neonates[J]. Ann Pediatr Cardiol. 2011;4(2):159-163. Inagi Y, Kitagawa A, Miyaji K, et al. Rapidly growing thrombus from a ductus arteriosus aneurysm in a neonate[J]. J Cardiol Cases.2022;26(4):283-285. Xie, W., Chen, Z., Zhuang, J. et al. Acute thrombosis of ductus arteriosus aneurysm causing bilateral pulmonary artery occlusion in a neonate[J]. J Cardiothorac Surg.2024;19: 680. Thuy Huynh, Thuy Pham, Phuong Ho, et al. Asymptomatic congenital ductus arteriosus aneurysm in a newborn: Case by approach[J]. Radiology Case Reports.2023;18(11): 3917-3921. MüllerNL, MayoJ, CulhamJA, et al. Ductus arteriosus aneurysm in Marfan syndrome [J]. Can Assoc Radiol J, 1986;37(3): 195-197. Wu P, Zheng C, Zhang F, et al. Pulmonary artery aneurysm caused by infective endarteritis attributed to patent ductus arteriosus in children: a case report and literature review[J]. Front Pediatr. 2023;17(11):1181462. Shirozu H, Ichiyama M, Ishimura M, et al. Ductus Arteriosus Aneurysm and Pulmonary Artery Thromboses in a Protein S-Deficient Newborn. AJP Rep[J]. 2023 ;13(3):e44-e48. Chihiro Ajimi, Tomohisa Akamatsu, Masao Kaneshige, et al. Clinical characteristics of ductus arteriosus aneurysm: a report of 14 cases[J]. Journal of Japan Society of Perinatal and Neonatal Medicine. 2022; 58(3): 555-560. Badr Bannan, Safwat Aly, Shi-Joon Yoo, et al. The Many Faces of Neonatal Ductus Arteriosus Aneurysms: Multimodality Imaging with an Emphasis on CT and MRI Appearance[J].Radiology: Cardiothoracic Imaging.2021;3(3):e210017. Giulia Peacock, Darshan Kothari, Luigi D’Orsogna, et al. The Impact of Prenatal Diagnosis on Clinical Outcomes of Isolated Vascular Rings From a Statewide Paediatric Cardiology Tertiary Service[J]. Heart, Lung and Circulation.2023;32(6):735-744. Lianza AC*, Morhy SS, Tavares GMP, et al. Prenatal Diagnosis of Ductus Arteriosus Aneurysms and Neonatal Outcome: Two Case Reports and Literature Review[J].Austin J Radiol. 2021; 8(4): 1135. Molina-Giraldo, S., Galindez-Guerrero, C.C., Estupiñan-Rincon, W., et al. Fetal Diagnosis of a Ductus Arteriosus Aneurysm: A Case Report[J]. J Clin Ultrasound. 2025;53: 364-368. LundJT, HansenD, BrocksV, et al. Aneurysm of the ductus arteriosus in the neonate: three case reports with a review of the literature [J]. Pediatr Cardiol. 1992;13(4): 222-226. Henmi S, Nakai C, Izumi S, et al. Giant Patent Ductus Arteriosus Aneurysm Compressing the Esophagus[J]. Ann Vasc Dis. 2023;16(4):265-267. Kise Y, Kuniyoshi Y, Higa S, et al. Open Repair for Patent Ductus Arteriosus Aneurysm in an Adult[J]. Ann Vasc Dis. 2021;14(4):415-418. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Jul, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 25 Apr, 2025 Reviews received at journal 24 Apr, 2025 Reviewers agreed at journal 17 Apr, 2025 Reviews received at journal 16 Apr, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviewers agreed at journal 14 Apr, 2025 Reviewers invited by journal 13 Apr, 2025 Editor assigned by journal 07 Apr, 2025 Editor invited by journal 07 Apr, 2025 Submission checks completed at journal 04 Apr, 2025 First submitted to journal 04 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6234989\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":447389422,\"identity\":\"8802269d-1a52-468e-b00c-7ac693f75cdc\",\"order_by\":0,\"name\":\"Qianqian Zhou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Qianqian\",\"middleName\":\"\",\"lastName\":\"Zhou\",\"suffix\":\"\"},{\"id\":447389424,\"identity\":\"50f436d8-29fa-4993-b510-0a53a0c7c6c2\",\"order_by\":1,\"name\":\"Daicheng Han\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACeWbm45///JCQY2NvIFKLYXtbGgNvj40xH88BYq05c8aMgYctLVFOIoFIHYwz0tIeSPAcTmCTfLzxBkONTTRBLewSyccNDCwO57FJpxVbMBxLy20gwpYEiQSew8Vs0jlmEowNhwlrYbiRYyBxgO1wYpvkGWK1AL0v2QD0fpsED5FagIGcbMwIDGQ2HqBfEojxCzAqDz5mAEalfPvhjTc+1NgQ4TAkYEB01CBpIVXHKBgFo2AUjAwAAMnJPJ2lEb80AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Daicheng\",\"middleName\":\"\",\"lastName\":\"Han\",\"suffix\":\"\"},{\"id\":447389426,\"identity\":\"1c38ffc1-c0bb-483c-a523-704482689298\",\"order_by\":2,\"name\":\"Shiwen Xia\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shiwen\",\"middleName\":\"\",\"lastName\":\"Xia\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-03-15 23:08:07\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6234989/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6234989/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12872-025-04925-z\",\"type\":\"published\",\"date\":\"2025-07-04T15:57:06+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":82389675,\"identity\":\"d1270148-3db5-4a35-a662-a804ee513b2f\",\"added_by\":\"auto\",\"created_at\":\"2025-05-09 17:51:39\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":85348,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eChest X-ray on admissionc\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6234989/v1/ff2bf88a74f07b9e4db723aa.png\"},{\"id\":82389677,\"identity\":\"3a8af908-0d93-4935-8112-5336117279cd\",\"added_by\":\"auto\",\"created_at\":\"2025-05-09 17:51:39\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":81874,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eChest X-ray re-examination on day 5 of admission\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6234989/v1/ea8e83e4f07861347020ab2e.png\"},{\"id\":82389676,\"identity\":\"5ce99196-b9dd-448d-ada0-39b690488d13\",\"added_by\":\"auto\",\"created_at\":\"2025-05-09 17:51:39\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":99469,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eChest CT on day 7 of admission\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6234989/v1/304dd5b0005e338e3469cf1c.png\"},{\"id\":82389680,\"identity\":\"31f4ca5d-d59f-456d-9dc6-aacc574302a9\",\"added_by\":\"auto\",\"created_at\":\"2025-05-09 17:51:39\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":791186,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCTA on day 10 of admission\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6234989/v1/8b1ee9e28aac2656359a0dac.png\"},{\"id\":86179017,\"identity\":\"1d340454-3cab-43f8-abd9-bf2ded0a02c4\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 16:14:36\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1789226,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6234989/v1/fb251a7b-26a4-4736-839b-2c05e0d70f17.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Ductus Arteriosus Aneurysm in Neonates\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eDuctus arteriosus aneurysm (DAA) is a rare but significant congenital heart anomaly characterized by abnormal dilation of the ductus arteriosus, and is typically diagnosed in late fetal life or early neonatal period. A prospective study showed that the incidence of DAA in term neonates is 8.8% [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. This condition, although oftentimes asymptomatic, can be life-threatening when it results in compression in adjacent vascular or bronchial structures [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The clinical manifestation of DAA in neonates varies, and early diagnosis is crucial to prevent catastrophic outcomes such as rupture or thrombosis [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. This study describes a neonate with DAA complicated by significant compression of the left pulmonary artery and mainstem bronchus, which resulted in refractory respiratory symptoms and fever despite appropriate anti-infective therapy. The diagnostic workup and the management methods are discussed in detail. The neonate\\u0026rsquo;s patients consented to the study protocol approved by the research ethics committee at Hubei Provincial Women and Child Health Hospital [2023]IEC027.\\u003c/p\\u003e\"},{\"header\":\"2. Case Presentation\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.1 Patient Overview\\u003c/h2\\u003e \\u003cp\\u003eA 22-day-old male neonate was admitted to our institution with a chief complaint of fever for the past six hours. His history indicated a spontaneous onset of fever (38.1\\u0026deg;C) without identifiable precipitating factors. The infant exhibited poor response to external stimuli, although he continued to feed normally and had no abnormal bowel movements. Laboratory studies showed elevated white blood cell count (WBC: 26.21 \\u0026times; 10^9/L) and C-reactive protein (CRP: 82.82 mg/L), suggestive of an inflammatory or infectious process.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.2 Medical and Family History\\u003c/h2\\u003e \\u003cp\\u003eThe neonate was born at 41 weeks of gestation via vaginal delivery, with a birth weight of 3.5 kg. There were no complications during pregnancy, and the Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. His parents were healthy, with no known genetic or metabolic disorders in the family. The infant had received recommended vaccinations, including hepatitis B and Bacillus Calmette-Gu\\u0026eacute;rin (BCG).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.3 Physical Examination\\u003c/h2\\u003e \\u003cp\\u003eOn examination, the infant appeared ill and lethargic. Vital signs included: temperature\\u0026thinsp;=\\u0026thinsp;38.1\\u0026deg;C, blood pressure\\u0026thinsp;=\\u0026thinsp;70/40 mmHg, respiratory rate\\u0026thinsp;=\\u0026thinsp;46 breaths per minute, and heart rate\\u0026thinsp;=\\u0026thinsp;151 beats per minute. Physical examination revealed soft fontanel, normal pupil reflexes, and no signs of cyanosis or respiratory distress such as subcostal retractions. Auscultation revealed coarse breath sounds with no adventitious noise in the lung, and regular heart rate with no murmurs. The abdominal examination was normal, with the liver palpated 1.5 cm below the right costal margin.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.4 Initial Diagnosis\\u003c/h2\\u003e \\u003cp\\u003eGiven the initial clinical findings, neonatal sepsis was suspected, and empirical broad-spectrum antibiotics were initiated. However, the infant's condition did not improve despite treatment, and respiratory distress appeared in progress. Further diagnostic work-up, including laboratory results and imaging studies, was pursued.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"3. Diagnostic Workup\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e3.1 Laboratory Results\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA second set of blood tests revealed a WBC count of 20.59 \\u0026times; 10^9/L, CRP \\u0026gt; 200 mg/L, and a predominance of neutrophils. Blood and urine cultures as well as tests for common respiratory viruses were all negative, ruling out bacterial and viral infections. A comprehensive immunological panel, including TORCH screening and fungal cultures, was also negative, further suggesting that infection was not the primary etiology.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.2 Imaging Studies\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe initial chest X-ray showed vague and coarse lung markings with scattered patchy opacities (Figure 1). A repeat X-ray five days later showed worsening lung findings, including enlarged thymic shadow (Figure 2). Chest Computed tomography(CT) demonstrated significant compression of left pulmonary artery and bronchial narrowing due to a mass-like structure in the mediastinum (Figure 3).\\u003c/p\\u003e\\n\\u003cp\\u003eA subsequent Computed tomography angiography (CTA) identified a large pseudoaneurysm originating from the aortic end of the ductus arteriosus, which compressed both the left mainstem bronchus and left pulmonary artery, resulting in collapse of the left lung (Figure 4).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.3 Diagnosis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe combination of imaging findings, clinical presentation, and absence of infection collectively led to a diagnosis of DAA complicated by left pulmonary artery and bronchial compression.\\u003c/p\\u003e\"},{\"header\":\"4. Management and Treatment\",\"content\":\"\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.1 Surgical Intervention\\u003c/h2\\u003e \\u003cp\\u003eThe neonate was transferred to a cardiovascular surgical unit for further management. Given the risk of rupture and the significant compression of vital structures, surgery was recommended. The ductus arteriosus aneurysm was successfully resected, and the patent foramen ovale was closed to prevent further complications related to the aneurysm.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.2 Postoperative Recovery\\u003c/h2\\u003e \\u003cp\\u003ePost-surgery, the neonate exhibited gradual improvement in respiratory status, and his fever subsided following the surgical correction. He was closely monitored for potential complications, including respiratory infections or thrombosis. Eventually, he fully recovered with no long-term sequelae.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"5. Discussion\",\"content\":\"\\u003cp\\u003eDAA is a rare congenital vascular anomaly characterized by localized dilation or aneurysm because of the failure of the ductus arteriosus to close properly after birth [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The exact etiology of DAA remains unclear and it may stem from several factors, including high pressure gradients in the ductus arteriosus, connective tissue abnormalities (e.g., Marfan, Ehlers-Danlos and Larsen syndromes), infective causes, and protein S-deficient [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Further research is needed to elucidate the precise mechanisms underlying this condition.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e5.1 Clinical Manifestations and Diagnosis\\u003c/h2\\u003e \\u003cp\\u003eIn neonates, DAA may manifest nonspecific symptoms such as fever, respiratory distress, or failure to thrive [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], which could result in delay in imaging studies that are essential for diagnosing DAA [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. CT or Magnetic resonance imaging(MRI) is indicated when the diagnosis is in doubt or there is suspicion of associated complications, such as thromboembolism, infection, compression or erosion of adjacent structures, or aneurysm rupture [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. In this case under investigation, the absence of infection despite elevated inflammatory markers and chest CT findings of pseudoaneurysm at the aortic end of the ductus arteriosus that compressed the left pulmonary artery and mainstem bronchus affirmed the eventual diagnosis. Antenatal diagnosis has improved, leading to better parental awareness and more timely and appropriate intervention [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e5.2 Treatment Strategies\\u003c/h2\\u003e \\u003cp\\u003eWhile many DAAs resolve spontaneously, those that cause significant compression of adjacent structures, such as the trachea, bronchus, or pulmonary artery, leading to symptoms including respiratory distress, stridor, or feeding difficulties, may require surgical intervention [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]., Previous studies suggested the use of surgical resection to prevent complications such as thrombus formation, thromboembolism, or rupture [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e] for DAAs that persist beyond the neonatal period (two months). In cases where DAA is associated with other intracardiac defects, surgical correction may be performed simultaneously. In this studied case, the patient underwent successful surgical resection of the aneurysm, which resulted in relief in compression and a complete recovery. The surgical approach involved median sternotomy or lateral thoracotomy, and in some adult cases, can be completed with assistance of femorofemoral bypass [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e5.3 Prognosis\\u003c/h2\\u003e \\u003cp\\u003eThe prognosis for neonates with DAA varies; however most cases have a favorable outcome with a high likelihood of spontaneous resolution, particularly when the aneurysm is small. Nevertheless, complications such as thromboembolism, compression of surrounding structures, or spontaneous rupture can arise, necessitating close monitoring and potential surgical intervention [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Regular echocardiographic follow-up is recommended to monitor the size and behavior of the aneurysm. Surgical intervention may be considered if the aneurysm persists beyond 2 months, shows signs of growth, or is associated with complications [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"6. Conclusion\",\"content\":\"\\u003cp\\u003eDuctus arteriosus aneurysm is a rare but severe condition that can present with nonspecific symptoms in neonates, often mimicking infections or other common neonatal diseases. Imaging provides a way for early recognition of DAA and therefore enables timely intervention to prevent the associated life-threatening complications. The reported case highlights the importance of considering DAA in the differential diagnosis of neonates with unexplained fever and respiratory distress. Further investigation of the pathophysiology and management of DAA in neonates is needed to refine treatment protocols and improve patient outcomes.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eDAA: Ductus arteriosus aneurysm\\u003c/p\\u003e\\n\\u003cp\\u003eWBC: White blood cell count\\u003c/p\\u003e\\n\\u003cp\\u003eCRP: C-reactive protein\\u003c/p\\u003e\\n\\u003cp\\u003eBCG: Bacillus Calmette-Guérin\\u003c/p\\u003e\\n\\u003cp\\u003eCT: Computed tomography\\u003c/p\\u003e\\n\\u003cp\\u003eCTA: Computed tomography angiography\\u003c/p\\u003e\\n\\u003cp\\u003eMRI: Magnetic resonance imaging\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the hospital ethics committee [2023]IEC027.\\u003c/p\\u003e\\n\\u003cp\\u003eInformed consent was obtained from the parents prior to the inclusion in the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWritten, informed consent was obtained from the parents.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo datasets were generated or analyzed during the current study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis work was supported by the Public Health Leading Talents Training Program of Hubei Province(No. 1020013003).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors’ Contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eQianqian Zhou drafted and revised the manuscript, Daicheng Han and Shiwen Xia participated in the clinical evaluation and revised the manuscript. All authors reviewed the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eJan SL, Hwang B, Fu YC, et al. Isolated neonatal ductus arteriosus aneurysm[J]. J Am Coll Cardiol. 2002;39(2):342\\u0026ndash;347.\\u003c/li\\u003e\\n \\u003cli\\u003eKoneti NR, Kanchi V, Kandraju H, et al. Symptomatic aneurysm of ductus arteriosus in neonates[J]. Ann Pediatr Cardiol. 2011;4(2):159-163.\\u003c/li\\u003e\\n \\u003cli\\u003eInagi Y, Kitagawa A, Miyaji K, et al. Rapidly growing thrombus from a ductus arteriosus aneurysm in a neonate[J]. J Cardiol Cases.2022;26(4):283-285.\\u003c/li\\u003e\\n \\u003cli\\u003eXie, W., Chen, Z., Zhuang, J.\\u0026nbsp;et al.\\u0026nbsp;Acute thrombosis of ductus arteriosus aneurysm causing bilateral pulmonary artery occlusion in a neonate[J].\\u0026nbsp;J Cardiothorac Surg.2024;19: 680.\\u003c/li\\u003e\\n \\u003cli\\u003eThuy Huynh, Thuy Pham, Phuong Ho, et al. Asymptomatic congenital ductus arteriosus aneurysm in a newborn: Case by approach[J]. Radiology Case Reports.2023;18(11): 3917-3921.\\u003c/li\\u003e\\n \\u003cli\\u003eM\\u0026uuml;llerNL, MayoJ, CulhamJA, et al. Ductus arteriosus aneurysm in Marfan syndrome [J]. Can Assoc Radiol J, 1986;37(3): 195-197.\\u003c/li\\u003e\\n \\u003cli\\u003eWu P, Zheng C, Zhang F, et al. Pulmonary artery aneurysm caused by infective endarteritis attributed to patent ductus arteriosus in children: a case report and literature review[J]. Front Pediatr. 2023;17(11):1181462.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eShirozu H, Ichiyama M, Ishimura M, et al. Ductus Arteriosus Aneurysm and Pulmonary Artery Thromboses in a Protein S-Deficient Newborn. AJP Rep[J]. 2023 ;13(3):e44-e48.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eChihiro Ajimi, Tomohisa Akamatsu, Masao Kaneshige, et al. Clinical characteristics of ductus arteriosus aneurysm: a report of 14 cases[J]. Journal of Japan Society of Perinatal and Neonatal Medicine. 2022; 58(3): 555-560.\\u003c/li\\u003e\\n \\u003cli\\u003eBadr Bannan, Safwat Aly, Shi-Joon Yoo, et al. The Many Faces of Neonatal Ductus Arteriosus Aneurysms: Multimodality Imaging with an Emphasis on CT and MRI Appearance[J].Radiology: Cardiothoracic Imaging.2021;3(3):e210017.\\u003c/li\\u003e\\n \\u003cli\\u003eGiulia Peacock, Darshan Kothari, Luigi D\\u0026rsquo;Orsogna, et al. The Impact of Prenatal Diagnosis on Clinical Outcomes of Isolated Vascular Rings From a Statewide Paediatric Cardiology Tertiary Service[J]. Heart, Lung and Circulation.2023;32(6):735-744.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eLianza AC*, Morhy SS, Tavares GMP, et al. Prenatal Diagnosis of Ductus Arteriosus Aneurysms and Neonatal Outcome: Two Case Reports and Literature Review[J].Austin J Radiol. 2021; 8(4): 1135.\\u003c/li\\u003e\\n \\u003cli\\u003eMolina-Giraldo, S., Galindez-Guerrero, C.C., Estupi\\u0026ntilde;an-Rincon, W., et al. Fetal Diagnosis of a Ductus Arteriosus Aneurysm: A Case Report[J]. J Clin Ultrasound. 2025;53: 364-368.\\u003c/li\\u003e\\n \\u003cli\\u003eLundJT, HansenD, BrocksV, et al. Aneurysm of the ductus arteriosus in the neonate: three case reports with a review of the literature [J]. Pediatr Cardiol. 1992;13(4): 222-226.\\u003c/li\\u003e\\n \\u003cli\\u003eHenmi S, Nakai C, Izumi S, et al. Giant Patent Ductus Arteriosus Aneurysm Compressing the Esophagus[J]. Ann Vasc Dis. 2023;16(4):265-267.\\u003c/li\\u003e\\n \\u003cli\\u003eKise Y, Kuniyoshi Y, Higa S, et al. Open Repair for Patent Ductus Arteriosus Aneurysm in an Adult[J]. Ann Vasc Dis. 2021;14(4):415-418.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cardiovascular-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcar\",\"sideBox\":\"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcar/default.aspx\",\"title\":\"BMC Cardiovascular Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Ductus Arteriosus Aneurysm, Neonate, Respiratory Distress, Differential Diagnosis, Surgical Intervention\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6234989/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6234989/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eThis article aims to comprehensively investigate the epidemiology, pathophysiology, diagnostic methods, therapeutic strategies, and prognosis of Ductus Arteriosus Aneurysm (DAA) in neonates, and to analyze the clinical management highlights through specific case studies. DAA is a rare congenital cardiovascular anomaly that can present with subtle symptoms or be misdiagnosed as common neonatal infections. This paper presents a case study of a 22-day-old male neonate diagnosed with a DAA complicated by left pulmonary artery and bronchial compression, which led to respiratory distress and persistent fever failure to respond to conventional anti-infective treatment. The diagnostic process, clinical management, and the outcome of surgical intervention are discussed, with a review of the relevant literature on the pathophysiology, diagnostic criteria, and management strategies for DAA in neonates. This case emphasizes the need for careful differential diagnosis in neonates presenting with persistent fever and respiratory symptoms, particularly when infection markers are elevated but infection etiology remains unclear.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Ductus Arteriosus Aneurysm in Neonates\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-05-09 17:51:35\",\"doi\":\"10.21203/rs.3.rs-6234989/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-04-25T05:14:14+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-04-24T09:40:20+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"158104780220588065274318643717460135825\",\"date\":\"2025-04-17T20:21:28+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-04-16T15:51:39+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"80398967737953640770018497318571523640\",\"date\":\"2025-04-15T07:27:39+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"36546440941403150710434523945879015130\",\"date\":\"2025-04-14T04:48:23+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-04-14T03:34:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-04-08T03:13:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-04-07T17:59:20+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-04-05T00:45:07+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cardiovascular Disorders\",\"date\":\"2025-04-05T00:44:02+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cardiovascular-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcar\",\"sideBox\":\"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcar/default.aspx\",\"title\":\"BMC Cardiovascular Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"6b6e82ad-de8f-4de7-9b1c-3df18584f7e9\",\"owner\":[],\"postedDate\":\"May 9th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-07-07T16:02:43+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-6234989\",\"link\":\"https://doi.org/10.1186/s12872-025-04925-z\",\"journal\":{\"identity\":\"bmc-cardiovascular-disorders\",\"isVorOnly\":false,\"title\":\"BMC Cardiovascular Disorders\"},\"publishedOn\":\"2025-07-04 15:57:06\",\"publishedOnDateReadable\":\"July 4th, 2025\"},\"versionCreatedAt\":\"2025-05-09 17:51:35\",\"video\":\"\",\"vorDoi\":\"10.1186/s12872-025-04925-z\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12872-025-04925-z\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6234989\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6234989\",\"identity\":\"rs-6234989\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}