Guntheroth W G
Department of Pediatrics (Cardiology), University of Washington School of Medicine, Seattle 98195-6320, USA.
Pediatr Cardiol. 1998 May-Jun;19(3):240-2. doi: 10.1007/s002469900293.
To confirm the hypothesis that narrowing of the left pulmonary artery is produced by ductal closure, Doppler velocities in the pulmonary arteries from 20 premature infants with a patent duct were compared to velocities from 20 with a closed duct. In infants with a patent duct, the mean Doppler velocity in the main, right, and left pulmonary arteries were, respectively, 86 cm/sec +/- 5 standard error (SE), 120 +/- 7, and 125 +/- 8. With closed duct, the comparable velocities were 102 cm/sec +/- 7, 129 +/- 8, and 190 +/- 11. The only significant difference was the higher velocity in the left pulmonary artery associated with a closed duct (p = 0.00003). This physiologic origin of left-branch stenosis associated with ductal constriction should be considered when a murmur is detected after administration of indomethacin (in addition to possible persistent ductal flow), and as an explanation for some murmurs in the normal newborn. No anatomic or physiologic support was found for the theories that murmurs in the neonate were due to ductal flow, or to acute angulation of the branch pulmonary arteries.
为了证实动脉导管关闭会导致左肺动脉狭窄这一假说，研究人员比较了20例动脉导管未闭早产儿肺动脉的多普勒流速与20例动脉导管已闭早产儿的流速。在动脉导管未闭的婴儿中，主肺动脉、右肺动脉和左肺动脉的平均多普勒流速分别为86厘米/秒±5标准误（SE）、120±7和125±8。动脉导管已闭时，相应的流速分别为102厘米/秒±7、129±8和190±11。唯一显著的差异是动脉导管已闭时左肺动脉流速较高（p = 0.00003）。在使用吲哚美辛后检测到杂音时（除了可能存在的持续性动脉导管血流外），应考虑与动脉导管收缩相关的左分支狭窄的这种生理起源，并以此解释正常新生儿中的一些杂音。关于新生儿杂音是由于动脉导管血流或肺分支动脉急性成角的理论，未找到解剖学或生理学支持。
