Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants
a Department of Neonatology,
Tokyo Metropolitan Tsukiji Maternity Hospital,
Tokyo, Japan, b Department of Pediatrics, Faculty
of Medicine, University of Tokyo, Tokyo, Japan
Correspondence to: Dr Bai-Horng Su, Division of Neonatology, Department of Pediatrics, China Medical College Hospital, 75 Yuh Der Road, Taichung, Taiwan.
Accepted 30 January 1997
AIMS
To identify the patent ductus arteriosus
(PDA) shunt flow pattern using Doppler echocardiography; and to assess
whether it could be used to predict the development of clinically
significant PDA.
METHODSPremature infants weighing under 1500 g,
who required mechanical ventilation, and in whom daily echocardiography
could be performed from day 1 until the ductus closed, and on day 7 to confirm closure, were studied. The PDA shunt flow was identified from
four Doppler patterns, and the closed pattern of a closed duct was also
presented. Clinically significant PDA was diagnosed when there was
colour Doppler echocardiographic evidence of left to right ductal shunt
associated with at least two of the following clinical signs: heart
murmur (systolic or continuous); persistent tachycardia (heart
rate>160/min); hyperactive precordial pulsation; bounding pulses;
and radiographic evidence of cardiomegaly or pulmonary congestion.
RESULTSOf 68 infants enrolled into this study,
clincally significant PDA developed in 31. The most recordable sequence
of transition change of shunt flow pattern for clinically significant
PDA was: pulmonary hypertension pattern, to growing pattern, to
pulsatile pattern, to closing pattern, to closed pattern. And that for
non-clinically significant PDA was: pulmonary hypertension pattern, to
closing pattern, to closed pattern. The growing and the pulsatile
patterns were mostly documented in infants with clinically significant PDA. The first documented growing pattern to predict clinically significant PDA gave a sensitivity of 64.5% and a specificity of
81.1%; the first documented pulsatile pattern gave a sensitivity of
93.5% and a specificity of 100%.
CONCLUSIONDoppler echocardiographic assessment of
PDA shunt flow pattern during the first 4 days of life is useful for
predicting the development of clinically significant PDA in premature
infants. At that stage, the closing or closed Doppler pattern indicates that infants are not at risk of developing clinically significant PDA;
the growing or pulsatile Doppler pattern indicates a continuing risk of
developing clinically significant PDA.
© 1997 by Archives of Disease in Childhood
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