Department of Cardiology, Xiamen ChangGung Hospital, Xiamen, Fujian, China.
Division of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2021 Apr;44(2):209-216. doi: 10.1016/j.bj.2019.12.007. Epub 2021 Apr 15.
Persistent patent foramen ovale (PFO) and patent ductus arteriosus (PDA) increase the adult risk of cryptogenic embolic stroke and chronic pulmonary hypertension. To understand the characteristics of PFO and PDA in newborns, we investigated the spontaneous closure rate and derived the determinants for residual defects.
We utilized the database of congenital heart disease (CHD) in Xiamen ChangGung Memorial Hospital from 2015 to 2017 and allocated 2523 eligible newborns into four groups according to PDA, PFO, both or neither at birth. A total of 574, 1229, 202 and 518 newborns were assigned into the group of PFO and PDA, PFO alone, PDA alone and non-PFO/non-PDA, respectively. Regular echocardiographic follow-ups at baseline, 6, 12 and 24 months after birth were performed for evaluating the spontaneous closure rate in the subjects. Regression analysis was carried out to study the risk factors of residual congenital defects.
Newborns with PFO alone had the youngest birth age and lowest birth weight among the four groups. About one in four PDA-alone newborns had concomitant small ASD, i.e., <5 mm in diameter. Echocardiographic study showed that 71.3% and 30.8% of CHD newborns had PFO and PDA, respectively, compared to less than 10% of them having ASD or VSD. However, more than 95% of newborns with PFO or PDA closed spontaneously at 6 months, in contrast to about 30% of newborns with ASD or VSD had persistent existence of the intracardiac defects. Complex CHD significantly linked to persistent PFO or PDA at 6 and 12 months, with an adjusted hazard ratio of 9.03 (95% CI 1.97-41.46) and 12.11 (95% CI 2.11-69.72), respectively.
Chinese newborns with PFO or PDA expressed differences in characteristics and concomitant congenital defects. Additionally, persistent PFO or PDA is strongly associated with complex CHD and requires long-term regular monitoring for future associated complications.
持续性卵圆孔未闭（PFO）和动脉导管未闭（PDA）会增加成人隐源性栓塞性中风和慢性肺动脉高压的风险。为了了解新生儿 PFO 和 PDA 的特征，我们研究了其自然闭合率，并得出了残余缺陷的决定因素。
我们利用 2015 年至 2017 年厦门长庚纪念医院先天性心脏病（CHD）数据库，根据出生时是否存在 PDA、PFO、两者或两者均无，将 2523 名符合条件的新生儿分为四组。共有 574、1229、202 和 518 名新生儿分别被分配到 PFO 和 PDA 组、PFO 组、PDA 组和非 PFO/非 PDA 组。在出生后基线、6、12 和 24 个月时进行常规超声心动图随访，以评估受试者的自然闭合率。回归分析用于研究残余先天性缺陷的危险因素。
单独存在 PFO 的新生儿在四组中出生年龄最小，出生体重最低。大约四分之一的单独存在 PDA 的新生儿同时存在小的 ASD，即直径<5mm。超声心动图研究显示，71.3%和 30.8%的 CHD 新生儿存在 PFO 和 PDA，而 ASD 或 VSD 的比例不到 10%。然而，超过 95%的 PFO 或 PDA 新生儿在 6 个月时自然闭合，而大约 30%的 ASD 或 VSD 新生儿存在持续性心脏内缺陷。复杂的 CHD 与 6 个月和 12 个月时持续存在的 PFO 或 PDA 显著相关，调整后的危险比分别为 9.03（95%CI 1.97-41.46）和 12.11（95%CI 2.11-69.72）。
中国新生儿的 PFO 或 PDA 在特征和伴发先天性缺陷方面存在差异。此外，持续性 PFO 或 PDA 与复杂的 CHD 密切相关，需要长期定期监测以预防未来的相关并发症。
