Zhou T F, Guntheroth W G
J Am Coll Cardiol. 1987 Jul;10(1):193-9. doi: 10.1016/s0735-1097(87)80179-1.
In a 1 year period, 56 neonates with a clinical diagnosis of ductus arteriosus had Doppler echocardiographic confirmation of the ductus; 33 (59%) had additional, turbulent left to right flow at the atrial level through a valve-incompetent foramen ovale. Normalized left atrial dimensions in the group with the atrial shunt were significantly larger than when there was a competent foramen ovale; when the ductus closed and left atrial enlargement receded, the atrial shunt disappeared. However, several infants with large left chambers had no interatrial shunting. When the atrial shunt was present, there were up to three flow pulses, corresponding to atrial systole, ventricular systole and ventricular diastole, but these were frequently fused into two pulses or even one pulse per cycle. The atrial septal morphology provided supporting clues: general bowing of the septum or a localized bulge in the region of the foramen ovale indicated relatively high left atrial pressure, and frequently a slitlike dropout could be seen at the superior edge of the foramen. During the study, three additional neonates with a ductus arteriosus were found to have a secundum atrial septal defect with a typical echographic image, "matchhead" appearance of the septal rim of the defect, but the Doppler flow patterns were indistinguishable from those of a valve-incompetent foramen ovale. The hemodynamic effects of the interatrial shunt, from either cause, seemed slight during the hospital course, but the presence of a valve-incompetent foramen ovale indicated a relatively large ductal shunt. Quantification of the ductal shunt, however, continues to rely primarily on measurement of the left atrial and ventricular size.
在1年的时间里，56例临床诊断为动脉导管未闭的新生儿经多普勒超声心动图证实存在动脉导管；其中33例（59%）在心房水平通过卵圆孔未闭有额外的从左向右的湍流。存在心房分流的组中，左心房大小标准化后显著大于卵圆孔功能正常时；当动脉导管闭合且左心房扩大消退时，心房分流消失。然而，一些左心房大的婴儿并无房间隔分流。当存在心房分流时，有多达三个血流搏动，分别对应于心房收缩、心室收缩和心室舒张，但这些搏动在每个心动周期中常融合为两个搏动甚至一个搏动。房间隔形态提供了辅助线索：房间隔普遍弯曲或卵圆孔区域有局部膨出提示左心房压力相对较高，并且在卵圆孔上缘常可见到裂隙样中断。在研究过程中，另外发现3例动脉导管未闭的新生儿有继发孔型房间隔缺损，具有典型的超声心动图表现，即缺损的房间隔边缘呈“火柴头”样外观，但多普勒血流模式与卵圆孔未闭时难以区分。在住院期间，无论何种原因导致的房间隔分流，其血流动力学影响似乎都较小，但卵圆孔未闭提示存在相对较大的动脉导管分流。然而，动脉导管分流的定量仍主要依赖于左心房和心室大小的测量。
