Santos M A, Moll J N, Drumond C, Araujo W B, Romao N, Reis N B
Circulation. 1980 Oct;62(4):818-22. doi: 10.1161/01.cir.62.4.818.
We studied the morphology of the ductus arteriosus in 14 infants, ages 2--90 days. Eight (group 1) had pulmonary atresia (structural and functional) with an intact interventricular septum; six (group 2) had pulmonary atresia with a ventricular septal defect. The inferior angle of the ductus arteriosus at the aortic junction was measured in each patient. In group 1, this angle was obtuse in all but one patient. In group 2, the angle was acute in all. Further study of intracardiac anatomy suggested that in group 1, the obtuse inferior angle of the ductus arteriosus was the result of a late and progressive obstructive phenomenon that allowed normal right-to-left flow through the ductus arteriosus during much of fetal life. In group 2, the direction of ductus arteriosus flow (normally from the pulmonary trunk to the aorta) was reversed, and flowed from the aorta to the pulmonary trunk. This reversal of flow was probably of early onset in the fetus, the aorta receiving the total combined ventricular output, and produced a small ductus arteriosus with an acute inferior angle. It is extremely important not to rule out pulmonary atresia with an intact interventricular septum when aortography in the newborn shows a normal-sized ductus arteriosus with an obtuse inferior angle. Despite existing pulmonary atresia, these patients have neither a hypoplastic right ventricle nor discontinuity of the right ventricle with the pulmonary artery.
我们研究了14例年龄在2至90天的婴儿的动脉导管形态。其中8例（第1组）患有室间隔完整的肺动脉闭锁（结构和功能方面）；6例（第2组）患有室间隔缺损的肺动脉闭锁。测量了每位患者动脉导管在主动脉连接处的下角。在第1组中，除1例患者外，其余患者的该角度均为钝角。在第2组中，该角度均为锐角。对心脏内部解剖结构的进一步研究表明，在第1组中，动脉导管下角为钝角是一种晚期进行性梗阻现象的结果，这使得在胎儿期的大部分时间里，动脉导管能够正常地从右向左分流。在第2组中，动脉导管的血流方向（正常情况下是从肺动脉干流向主动脉）发生了逆转，从主动脉流向肺动脉干。这种血流逆转可能在胎儿期就早早开始了，主动脉接受全部心室总输出量，从而形成了一个下角为锐角的小动脉导管。当新生儿主动脉造影显示动脉导管大小正常且下角为钝角时，千万不要排除室间隔完整的肺动脉闭锁。尽管存在肺动脉闭锁，但这些患者既没有右心室发育不全，也没有右心室与肺动脉的连续性中断。
