Hasan Rashed A, Kalaba Frank, Hesen Jacob Z, Hamid Kewan
Division of Pediatric Critical Care, Hurley Medical Center, Michigan State University, Flint, MI, USA.
Cardiology, Ascension Health, Michigan State University, Southfield, MI, USA.
SAGE Open Med. 2022 Jul 12;10:20503121221107338. doi: 10.1177/20503121221107338. eCollection 2022.
There are no published reports on the rib abnormalities on the plain chest radiograph in preterm infants following surgical clipping of isolated patent ductus arteriosus. The purpose of this study was to describe changes in the ribs on the plain chest radiograph following surgical clipping of patent ductus arteriosus (surgery groups) in preterm infants compared to non-surgical closure of patent ductus arteriosus (control group).
Data from preterm infants with patent ductus arteriosus clipping (surgery) via a left postero-lateral thoracotomy were compared with infants in whom the patent ductus arteriosus closed: spontaneously, with medications or use of an occlusive device (controls). Serial pre- and post-closure plain chest radiographs were randomly reviewed by a reader blinded to the route of closure and up to 1 year following the patent ductus arteriosus closure.
Of the total of 196 cases included in the study: 45 of the patent ductus arteriosus closed following treatment with medications, 8 cases closed with an occlusion device, 38 were closed surgically, and in 105 cases, the patent ductus arteriosus closed spontaneously. Compared to the pre-operative period, 36/38 (95%) infants in the surgery group had one or more of the following rib abnormalities: ipsilateral fourth and fifth rib fusion, narrowing of the ipsilateral fifth intercostal space, thinning of the ipsilateral fourth or fifth rib, or a combination of the above on the chest radiograph compared to 0% in the control group (p < 0.001).
Radiographic rib abnormalities are common and appear in infancy following surgical clipping of patent ductus arteriosus in preterm infants. Further studies are needed to clarify the natural history of these abnormalities on thoracic cage and cardiopulmonary functions.
关于早产儿孤立性动脉导管未闭手术结扎后胸部平片上肋骨异常情况，尚无公开报道。本研究的目的是描述早产儿动脉导管未闭手术结扎（手术组）后胸部平片上肋骨的变化，并与动脉导管未闭非手术闭合（对照组）进行比较。
将通过左后外侧胸廓切开术进行动脉导管未闭结扎（手术）的早产儿数据与动脉导管未闭自行闭合、药物闭合或使用闭塞装置闭合的婴儿（对照组）进行比较。由对闭合途径不知情的读者随机回顾闭合前后的系列胸部平片，直至动脉导管未闭闭合后1年。
本研究共纳入196例病例：45例动脉导管未闭经药物治疗后闭合，8例使用闭塞装置闭合，38例手术闭合，105例动脉导管未闭自行闭合。与术前相比，手术组36/38（95%）的婴儿出现以下一种或多种肋骨异常：胸部平片显示同侧第四和第五肋骨融合、同侧第五肋间间隙变窄、同侧第四或第五肋骨变薄，或上述情况的组合，而对照组为0%（p<0.001）。
影像学肋骨异常很常见，出现在早产儿动脉导管未闭手术结扎后的婴儿期。需要进一步研究以阐明这些异常对胸廓和心肺功能的自然发展过程。
