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Early signs that predict later haemodynamically significant patent ductus arteriosus

  • Defne Engür (a1), Murat Deveci (a2) and Münevver K. Türkmen (a1)

Abstract

Objective

Our aim was to determine the optimal cut-off values, sensitivity, specificity, and diagnostic power of 12 echocardiographic parameters on the second day of life to predict subsequent ductal patency.

Methods

We evaluated preterm infants, born at ⩽32 weeks of gestation, starting on their second day of life, and they were evaluated every other day until ductal closure or until there were clinical signs of re-opening. We measured transductal diameter; pulmonary arterial diastolic flow; retrograde aortic diastolic flow; pulsatility index of the left pulmonary artery and descending aorta; left atrium and ventricle/aortic root ratio; left ventricular output; left ventricular flow velocity time integral; mitral early/late diastolic flow; and superior caval vein diameter and flow as well as performed receiver operating curve analysis.

Results

Transductal diameter (>1.5 mm); pulmonary arterial diastolic flow (>25.6 cm/second); presence of retrograde aortic diastolic flow; ductal diameter by body weight (>1.07 mm/kg); left pulmonary arterial pulsatility index (⩽0.71); and left ventricle to aortic root ratio (>2.2) displayed high sensitivity and specificity (p<0.0001; area under the curve>0.9). Parameters with moderate sensitivity and specificity were as follows: left atrial to aortic root ratio; left ventricular output; left ventricular flow velocity time integral; and mitral early/late diastolic flow ratio (p<0.05; area under the curve 0.7–0.88). Descending aortic pulsatility index and superior caval vein diameter and flow (p>0.05) had low diagnostic value.

Conclusion

Left pulmonary arterial pulsatility index, left ventricle/aortic root ratio, and ductal diameter by body weight are useful adjuncts offering a broader outlook for predicting ductal patency.

Copyright

Corresponding author

Correspondence to: Dr D. Engür, Adnan Menderes University Department of Neonatology, Aytepe Mevki, 32100, Aydın, Turkey. Tel: +90 256 444 12 56; Fax: +90 256 214 40 86; E-mail: defneka@hotmail.com

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