Division of Neonatology, Department of Pediatrics, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32608, USA.
Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
Semin Fetal Neonatal Med. 2020 Oct;25(5):101120. doi: 10.1016/j.siny.2020.101120. Epub 2020 Jun 2.
Patent ductus arteriosus is associated with multiple comorbidities in premature infants, however a causal link or strategy to decrease these morbidities has not been found. The association between the patent ductus arteriosus and morbidities has biologic plausibility as, like any cardiac mixing lesion, a significant systemic to pulmonic shunt may lead to pulmonary over-circulation and systemic hypoperfusion. Understanding the underlying pathophysiology of associated morbidities in the setting of a patent ductus arteriosus may aid in risk stratifying infants and offer a patient targeted approach to infants with a pathological ductal shunt. While the deleterious impact of increased pulmonary blood flow maybe easier to identify, the impact on end-organ perfusion is more challenging. In this review, we will discuss the pathophysiology of a hemodynamically significant patent ductus arteriosus in premature infants, impact on end-organ perfusion and associated morbidities, and novel modalities to assess shunt volume and effect on end-organ perfusion.
动脉导管未闭与早产儿的多种合并症相关，但尚未发现与之相关的因果关系或降低这些合并症的策略。动脉导管未闭与合并症之间存在生物学上的合理性，因为与任何心脏混合性病变一样，大量的体循环至肺循环分流可能导致肺过度循环和全身低灌注。了解动脉导管未闭情况下相关合并症的潜在病理生理学可能有助于对婴儿进行风险分层，并为存在病理性导管分流的婴儿提供针对患者的治疗方法。虽然增加肺血流量的有害影响可能更容易识别，但对终末器官灌注的影响更具挑战性。在这篇综述中，我们将讨论早产儿中具有血流动力学意义的动脉导管未闭的病理生理学、对终末器官灌注的影响以及相关合并症，以及评估分流体积和对终末器官灌注影响的新方法。
