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J Pediatr. 2018 Nov;202:50-55.e3. doi: 10.1016/j.jpeds.2018.06.045. Epub 2018 Aug 13.

Relationship of Patent Ductus Arteriosus Size to Echocardiographic Markers of Shunt Volume.

Author information

1
Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Neonatology Department, Fernandes Figueira Institute, Rio de Janeiro, Brazil. Electronic address: fermartins1964@gmail.com.
2
Neonatology Department, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico.
3
Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
4
Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
5
Department of Neonatology, Mount Sinai Hospital, New York, NY.
6
Neonatology Department, Fernandes Figueira Institute, Rio de Janeiro, Brazil.
7
Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

To define the technique of estimating ductal diameter (DD) that best correlates with echocardiographic markers of transductal shunt volume in preterm infants >7 days old with persistent patent ductus arteriosus (PDA).

STUDY DESIGN:

We conducted a retrospective study of 104 neonates born at <30 weeks gestation that had targeted neonatal echocardiography evaluation of PDA performed between 7 and 30 days. We used univariate analysis to determine the association of echocardiographic markers of shunt volume with ductal size definitions: DD, DD indexed to weight, and DD indexed to left pulmonary artery diameter.

RESULTS:

Two hundred echocardiograms were reviewed from 104 patients with a median gestational age of 25.4 weeks (range, 25-26.3 weeks) and a median birth weight of 810 g (range, 740-920 g). We found a weak correlation of each method of PDA size definition with individual echocardiographic markers of transductal shunt volume, of which nonindexed DD demonstrated the best correlation. The best correlation was found with markers of systemic hypoperfusion, such as diastolic flow reversal in the descending aorta (R2 = 0.24) and celiac artery (R2 = 0.21). Markers of pulmonary overcirculation, such as left ventricular end-diastolic diameter (R2 = 0.19) and left ventricular output (R2 = 0.17), showed fair correlation with nonindexed DD.

CONCLUSION:

In preterm infants >7 days old with PDA, nonindexed DD demonstrated weak correlations with individual echocardiographic markers of shunt volume. These data highlight the need for comprehensive echocardiographic evaluation in addition to diameter measurements to provide a better understanding of the hemodynamic consequences of PDA.

KEYWORDS:

hemodynamic significance; preterm; target neonatal echocardiography

PMID:
30115452
DOI:
10.1016/j.jpeds.2018.06.045
[Indexed for MEDLINE]

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