Department of Neonatology, Hospital Infantil de México Federico Gómez, Ciudad de Mexico, Mexico.
Department of Pediatrics, Center for Global Child Health, Hospital for Sick Children, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
J Ultrasound Med. 2021 Aug;40(8):1505-1514. doi: 10.1002/jum.15528. Epub 2020 Oct 12.
To characterize the relationship of echocardiographic markers of left heart overload and flow in peripheral major end-organ vessels (eg, celiac artery) with the presence of reversed holodiastolic flow in the descending aorta, considered a surrogate marker of an increased transductal shunt volume, in preterm patients with a patent ductus arteriosus (PDA).
This work was a retrospective study of data from echocardiography performed to investigate the hemodynamic significance of a PDA in preterm patients. We studied differences in echocardiographic markers of the PDA shunt volume according to patterns of flow in the postductal descending aorta (no PDA, PDA with antegrade diastolic flow, and PDA with reversed diastolic flow). The strength of the association between each echocardiographic marker and the presence of aortic holodiastolic flow reversal was investigated.
We studied 137 patients with a median (interquartile range) birth weight of 850 (694-1030) g and a median gestational age of 25 (24-27) weeks. Among patients with a PDA (113), those with diastolic flow reversal in the descending aorta (44) presented had increased echocardiographic markers representative of the shunt volume (increased left ventricular output, left atrial-to-aortic ratio, pulmonary vein D wave, and shorter isovolumic relaxation time) compared to those with aortic antegrade diastolic flow. A positive, albeit weak, correlation between diastolic flow reversal and shunt volume echocardiographic markers was found. Abnormal diastolic flow in the celiac artery had the strongest correlation (R = 0.24).
In preterm patients with a PDA, echocardiographic markers of the shunt volume were more abnormal in patients with reversed diastolic flow in the descending aorta. These data support the assumption that variance in these markers are related to the shunt volume, which needs consideration when adjudicating hemodynamic significance.
描述左心负荷和外周主要终末器官血管（如腹腔动脉）内血流的超声心动图标志物与降主动脉内反向舒张期血流之间的关系，降主动脉内反向舒张期血流被认为是体循环-肺循环分流增加的替代标志物，存在于动脉导管未闭（PDA）的早产儿中。
这是一项回顾性研究，对接受超声心动图检查的早产儿的资料进行研究，以评估 PDA 的血流动力学意义。我们根据降主动脉后段（无 PDA、PDA 伴正向舒张期血流和 PDA 伴反向舒张期血流）的血流模式，研究了 PDA 分流量的超声心动图标志物的差异。研究了每个超声心动图标志物与主动脉反向舒张期血流逆转之间的相关性。
我们研究了 137 名出生体重中位数（四分位距）为 850（694-1030）g 和中位胎龄为 25（24-27）周的患者。在有 PDA 的患者中（113 名），44 名降主动脉内有舒张期血流逆转的患者具有增加的分流量超声心动图标志物（左心室输出增加、左心房与主动脉比值增加、肺静脉 D 波增加和等容舒张时间缩短），与主动脉正向舒张期血流相比。发现舒张期血流逆转与分流量超声心动图标志物之间存在正相关，尽管相关性较弱。腹腔动脉异常舒张期血流相关性最强（R=0.24）。
在患有 PDA 的早产儿中，降主动脉内反向舒张期血流的患者其分流量的超声心动图标志物更为异常。这些数据支持这样一种假设，即这些标志物的变化与分流量有关，在判断血流动力学意义时需要考虑这一点。
