Fugelseth D, Lindemann R, Liestøl K, Kiserud T, Langslet A
Department of Paediatrics, Ullevål University Hospital, Oslo, Norway.
Arch Dis Child Fetal Neonatal Ed. 1997 Sep;77(2):F131-4. doi: 10.1136/fn.77.2.f131.
To assess ultrasonographically the flow pattern and the time of postnatal closure of ductus venosus related to the other fetal shunts.
Fifty healthy, term neonates were studied from day 1 up to day 18 using a VingMed CFM 800A ultrasound scanner.
Ductus arteriosus was closed in 94% of the infants before day 3. Ductus venosus, however, was closed in only 12% at the same time, in 76% before day 7, and in all infants before day 18. A closed ductus venosus or ductus arteriosus did not show signs of reopening. Pulsed and colour Doppler flow could be detected across the foramen ovale in all infants during the sequential investigation. At day 1, when the pulmonary vascular resistance was still high, a reversed Doppler flow velocity signal was seen in ductus venosus in 10 infants (20%) and a bidirectional flow in ductus arteriosus in 26 (52%). Closure of the ductus venosus was not significantly correlated with closure of the ductus arteriosus nor related to sex nor weight loss.
The time of closure of the ductus venosus evaluated by ultrasonography is much later than that of the ductus arteriosus. The flow pattern in ductus venosus reflects the portocaval pressure gradient and the pressure on the right side of the heart and in the pulmonary arteries. Both the flow pattern in the ductus venosus as well as that in the ductus arteriosus may be an indication of compromised neonatal haemodynamics.
通过超声检查评估静脉导管的血流模式及其产后关闭时间,并与其他胎儿分流进行关联研究。
使用VingMed CFM 800A超声扫描仪,对50例足月健康新生儿从出生第1天至第18天进行研究。
94%的婴儿在出生后第3天前动脉导管关闭。然而,静脉导管在同一时间只有12%关闭,76%在第7天前关闭,所有婴儿在第18天前均已关闭。已关闭的静脉导管或动脉导管未显示重新开放的迹象。在连续检查过程中,所有婴儿的卵圆孔均可检测到脉冲和彩色多普勒血流。出生第1天,当肺血管阻力仍然较高时,10例婴儿(20%)的静脉导管出现反向多普勒血流速度信号,26例婴儿(52%)的动脉导管出现双向血流。静脉导管的关闭与动脉导管的关闭无显著相关性,与性别和体重减轻也无关。
超声检查评估的静脉导管关闭时间比动脉导管晚得多。静脉导管的血流模式反映了门静脉与腔静脉之间的压力梯度以及心脏右侧和肺动脉的压力。静脉导管和动脉导管的血流模式均可能提示新生儿血流动力学受损。