Hu Xin-Lu, Wang Hui, Hou Cui, Hou Miao, Zhan Shi-Hong, Pan Tao, Ding Yue-Yue, Gu Pei-Pei, Xu Qiu-Qin
Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, Suzhou, 215003, Jiangsu, China.
Department of Neonatology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Int J Cardiovasc Imaging. 2022 Jul;38(7):1443-1452. doi: 10.1007/s10554-022-02531-0. Epub 2022 Feb 2.
The spontaneous closure rate of patent ductus arteriosus (PDA) is high, and the necessity of early intervention is debated. Quantitative echocardiographic assessment of the intima in PDA has not been reported. This study evaluated intimal thickness growth in neonatal cases of PDA via echocardiography and investigated its correlation with clinical factors. Seventy-three neonates were enrolled, and echocardiography was performed three times: within 24 h post-birth (first echo), 48 h after the first echo (second echo), and before discharge (third echo). According to PDA outcome, the neonates were divided into the PDA-open group (n = 18 cases), PDA-closure at second echo group (n = 32 cases), and non-PDA at first echo group (n = 23 cases). We measured the intimal thickness (IT1 and IT2 at first and second echo, respectively), lumen diameter of ductus arteriosus (D1 and D2 at first and second echo, respectively), IT1/D1 ratio, and intimal thickness growth rate (V). Correlations between echocardiographic indicators, perinatal factors, and clinical treatment were analyzed. On first echo, the PDA-open group showed a significantly lower IT1/D1 than the combined PDA-closure group (P < 0.05). On second echo, the PDA-open group showed a significantly lower IT2 and V than the PDA-closure group as well as a significantly higher D2 (P < 0.05). Smaller gestational age correlated with a larger D2 but smaller IT2 and V (P < 0.05) and a higher level of respiratory support within 72 h post-birth correlated with a larger D2 and smaller IT 2 (P < 0.05). Increasing oxygen demand within 72 h of birth correlated with a larger D1 and D2 (P < 0.05). Echocardiographic assessment of intimal thickness growth in PDA may provide an approach for predicting spontaneous PDA closure, thereby guiding decision-making regarding early intervention.
动脉导管未闭（PDA）的自然闭合率很高，早期干预的必要性存在争议。尚未有关于PDA内膜的定量超声心动图评估的报道。本研究通过超声心动图评估了新生儿PDA病例的内膜厚度增长情况，并研究了其与临床因素的相关性。纳入73例新生儿，进行了三次超声心动图检查：出生后24小时内（首次回声）、首次回声后48小时（第二次回声）和出院前（第三次回声）。根据PDA结局，将新生儿分为PDA开放组（n = 18例）、第二次回声时PDA闭合组（n = 32例）和首次回声时无PDA组（n = 23例）。我们测量了内膜厚度（首次和第二次回声时分别为IT1和IT2）、动脉导管内径（首次和第二次回声时分别为D1和D2）、IT1/D1比值以及内膜厚度增长率（V）。分析了超声心动图指标、围产期因素和临床治疗之间的相关性。在首次回声时，PDA开放组的IT1/D1显著低于PDA闭合组（P < 0.05）。在第二次回声时，PDA开放组的IT2和V显著低于PDA闭合组，D2显著高于PDA闭合组（P < 0.05）。较小的胎龄与较大的D2相关，但与较小的IT2和V相关（P < 0.05），出生后72小时内较高水平的呼吸支持与较大的D2和较小的IT2相关（P < 0.05）。出生后72小时内氧气需求增加与较大的D1和D2相关（P < 0.05）。对PDA内膜厚度增长进行超声心动图评估可能为预测PDA自然闭合提供一种方法，从而指导早期干预的决策。
