Department of Radiology, Professor Fernando Figueira Integral Medicine Institute (IMIP), 300 Coelhos St., Boa Vista -, Recife, PE, 50070-550, Brazil.
Department of Paediatric Research, Professor Fernando Figueira Integral Medicine Institute (IMIP), Recife, PE, Brazil.
Pediatr Radiol. 2020 Jul;50(8):1107-1114. doi: 10.1007/s00247-020-04689-y. Epub 2020 Jun 16.
Very-low-birth-weight (VLBW) preterm neonates are vulnerable to patent ductus arteriosus (PDA), which might be related to high-resistance flow in the superior mesenteric artery (SMA), with decreased diastolic flow in situations of marked intestinal hypoperfusion. No previous studies have evaluated the portal vein and superior mesenteric vein (SMV) parameters to assess the PDA hemodynamic repercussions.
To assess mesenteric and portal flow in VLBW preterm neonates with or without PDA using serial Doppler ultrasonography (US).
We conducted a prospective longitudinal study on 61 VLBW preterm neonates submitted to 161 Doppler US exams, from 2 days to 20 days of age.
All infants exhibited a progressive daily increase in the mean of the SMA diameter and systolic velocity, the portal vein diameter, the peak velocity, the mean velocity and the flow volume and of SMV diameter (P<0.05). The incidence of PDA was 37.7% (n=23) and infants with the disease revealed a smaller diameter, greater systolic velocity, lower diastolic velocity, and higher resistivity and pulsatility indices on SMA compared to those without PDA (P<0.05). Additionally, 47.8% (n=11) of infants with PDA exhibited absent or reversed end-diastolic flow in the SMA, and its resolution was seen among 54.5% (n=6) of these. Infants with PDA also exhibited lower values of portal vein diameter and flow volume and of SMV diameter (P<0.01).
Doppler US enhances the understanding of mesenteric and portal flow, including the effects of PDA. The study of SMV and portal vein flow is proposed as a new parameter in PDA evaluation.
极低出生体重（VLBW）早产儿易患动脉导管未闭（PDA），这可能与肠系膜上动脉（SMA）高阻力血流有关，在明显肠道低灌注时舒张期血流减少。以前没有研究评估门静脉和肠系膜上静脉（SMV）参数来评估 PDA 的血流动力学影响。
使用连续多普勒超声（US）评估有或无 PDA 的 VLBW 早产儿的肠系膜和门静脉血流。
我们对 61 名 VLBW 早产儿进行了前瞻性纵向研究，这些早产儿在 2 至 20 天龄期间接受了 161 次多普勒 US 检查。
所有婴儿的 SMA 直径和收缩期速度、门静脉直径、峰值速度、平均速度和流量以及 SMV 直径均呈每日渐进性增加（P<0.05）。PDA 的发生率为 37.7%（n=23），与无 PDA 的婴儿相比，患有该病的婴儿的 SMA 直径较小、收缩期速度较大、舒张期速度较低、阻力和搏动指数较高（P<0.05）。此外，47.8%（n=11）患有 PDA 的婴儿的 SMA 出现终末期无或反向血流，其中 54.5%（n=6）的婴儿 SMA 恢复正常。患有 PDA 的婴儿的门静脉直径和流量以及 SMV 直径也较低（P<0.01）。
多普勒 US 增强了对肠系膜和门静脉血流的理解，包括 PDA 的影响。SMV 和门静脉血流的研究被提议作为 PDA 评估的新参数。
