Doocy Kelley R, Saunders Ashley B, Gordon Sonya G, Jeffery Nicholas
Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas.
J Vet Intern Med. 2018 Mar;32(2):648-657. doi: 10.1111/jvim.15068. Epub 2018 Feb 20.
Accurately assessing the morphology and shape of the patent ductus arteriosus (PDA) and obtaining measurements are important to avoid procedural complications.
To characterize and compare PDA morphology, shape, and dimensions with angiography and echocardiography.
25 client-owned dogs with echocardiographically confirmed PDA.
Prospective case series. Imaging consisted of single plane angiography, transthoracic echocardiography from the right (TTE-R) and left (TTE-L), and two-dimensional, biplane, and three-dimensional transesophageal echocardiography (TEE-2D and TEE-3D). Measurements included angiographic minimal ductal diameter (MDD), echocardiographic pulmonary ostium in a single dimension (TTE-R, TTE-L, and TEE-2D) and in perpendicular dimensions (TEE-3D) with similar measurements of the ampulla 3 mm above the MDD or pulmonary ostium. The morphology and shape of the PDA were characterized.
Catheter-based occlusion (N = 20) and surgical ligation (N = 5) were performed without complication. Angiographic morphology was classified as type II (N = 19), type III (N = 1), and other (N = 1). Angiographic MDD and TEE-2D pulmonary ostium measurements were significantly (P = .008) but weakly correlated (r = .56); similar relationships were found for ampulla diameter measurements (P < .0001; r = .75). In general, TEE-2D did not correlate with other imaging modalities measurements. Based on TEE-3D measurements, the majority of pulmonary ostium (17/24; 71%) and ampulla (19/24; 79%) were oval.
Measurements using different imaging modalities are not interchangeable. TEE-3D provided an en face view of the PDA that cannot be replicated with other echocardiographic techniques and demonstrated an oval shape in the majority of dogs. We propose an update to the current classification system to include additional PDA morphologies.
准确评估动脉导管未闭（PDA）的形态和形状并进行测量对于避免手术并发症很重要。
通过血管造影和超声心动图对PDA的形态、形状和尺寸进行表征和比较。
25只经超声心动图确诊为PDA的客户拥有的犬。
前瞻性病例系列。成像包括单平面血管造影、右胸（TTE-R）和左胸（TTE-L）经胸超声心动图以及二维、双平面和三维经食管超声心动图（TEE-2D和TEE-3D）。测量包括血管造影最小导管直径（MDD）、超声心动图单维肺口直径（TTE-R、TTE-L和TEE-2D）以及垂直维度的肺口直径（TEE-3D），对MDD或肺口上方3 mm处的壶腹进行类似测量。对PDA的形态和形状进行了表征。
进行了基于导管的封堵术（N = 20）和手术结扎术（N = 5），无并发症发生。血管造影形态分类为II型（N = 19）、III型（N = 1）和其他类型（N = 1）。血管造影MDD与TEE-2D肺口测量值显著相关（P = 0.008）但相关性较弱（r = 0.56）；壶腹直径测量值也有类似关系（P < 0.0001；r = 0.75）。一般来说，TEE-2D与其他成像方式测量值不相关。基于TEE-3D测量，大多数肺口（17/24；71%）和壶腹（19/24；79%）呈椭圆形。
使用不同成像方式进行的测量不可互换。TEE-3D提供了PDA的正面视图，这是其他超声心动图技术无法复制的，并且在大多数犬中显示为椭圆形。我们建议更新当前分类系统以纳入更多PDA形态。
