Serial Assessment of Ductus Arteriosus Hemodynamics in Hyaline Membrane Disease

Objectives. To assess the efficacy of Doppler echocardiography (DE) in the quantification of patent ductus arteriosus (PDA) shunt volume and to correlate PDA shunt volume with clinical outcome in infants with hyaline membrane disease. Methods. Ninety-eight DE studies were performed in 30 preterm ventilated infants with hyaline membrane disease within the first 24 hours of age and then at 48-hour intervals to a maximum of three studies while ventilated with a final study after extubation. Right and left ventricular outputs (QRV and QLV, respectively) and PDA flow were calculated using cross-sectional area and flow velocity integrals. Left atrial-to-aortic root diameter measurements were also taken. Clinical outcomes were correlated with the shunt fraction (QLV/QRV). Results. QLV/QRV demonstrated a linear relationship with the left atrial-to-aortic root diameter ratio (n = 92; r = .79). In the absence of a PDA (n = 33 studies), QRV versus QLV demonstrated a linear relationship (r = .88). In the presence of a PDA (n = 64 studies) the mean QLV (334 ± 133 ml/kg per minute) was significantly greater than the mean QRV (237 ± 84 ml/kg per minute). There was a linear relationship between QLV - QRV (PDA shunt volume) and PDA flow (n = 60; r = .84). In studies with exclusive left-to-right shunting at the PDA (n = 48), the mean QLV - QRV (112 ± 83 ml/kg per minute) was significantly higher than in those with bidirectional shunting (n = 16; mean QLV - QRV = 50 ± 27 ml/kg per minute). Two infants with severe intraventricular hemorrhage (IVH grade 3) and two infants with periventricular leukomalacia (PVL) had significantly higher QLV/QRV (2.09 ± 0.36 and 1.67 ± 0.02 respectively) than those with no IVH (n = 6; QLV/QRV = 1.31 ± 0.18) or those with IVH grades 1 and 2 (n = 8; QLV/QRV = 1.48 ± 0.27). There was no difference in QLV/QRV in infants with or without bronchopulmonary dysplasia retinopathy of prematurity. Necrotizing enterocolitis did not develop in any of the 30 infants. Conclusion. PDA shunt volume can be quantified by DE. Larger studies are needed to correlate clinical outcome with QLV/QRV.

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Impaired left atrial mechanical functions as indicators for increased aortic root diameter in hypertensive and diabetic patients

Herz ◽

10.1007/s00059-020-04997-x ◽

2020 ◽

Author(s):

Ezgi Kalaycıoğlu ◽

Mustafa Çetin ◽

Ali Gökhan Özyıldız ◽

Tuncay Kırış

Keyword(s):

Aortic Root ◽

Left Atrial ◽

Root Diameter ◽

Diabetic Patients

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Re-evaluation of the left atrial to aortic root ratio as a marker of patent ductus arteriosus.

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/fn.70.2.f112 ◽

1994 ◽

Vol 70 (2) ◽

pp. F112-F117 ◽

Cited By ~ 66

Author(s):

P Iyer ◽

N Evans

Keyword(s):

Patent Ductus Arteriosus ◽

Aortic Root ◽

Left Atrial ◽

Ductus Arteriosus ◽

Patent Ductus

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Aortic root blood flow increases after pancuronium in neonates with hyaline membrane disease

Critical Care Medicine ◽

10.1097/00003246-199102000-00013 ◽

1991 ◽

Vol 19 (2) ◽

pp. 187-190 ◽

Cited By ~ 2

Author(s):

DENNIS T. COSTAKOS ◽

CHRISTINE E. BLACKWELL ◽

ALFRED N. KRAUSS ◽

CAROLYN EISEN ◽

KIMON VIOLARIS ◽

...

Keyword(s):

Blood Flow ◽

Aortic Root ◽

Hyaline Membrane Disease ◽

Hyaline Membrane

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Circulatory changes following premature delivery in a baboon model of hyaline membrane disease

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1991.261.4.h1148 ◽

1991 ◽

Vol 261 (4) ◽

pp. H1148-H1154 ◽

Cited By ~ 3

Author(s):

J. P. Kinsella ◽

D. R. Gerstmann ◽

R. A. Delemos

Keyword(s):

Blood Flow ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Oxygen Transport ◽

Ductus Arteriosus ◽

Hyaline Membrane Disease ◽

Premature Delivery ◽

Organ Blood Flow ◽

Hemodynamic Changes ◽

Hyaline Membrane

The premature baboon delivered by hysterotomy at 140 +/- 2 days (75%) gestation develops hyaline membrane disease (HMD) and left-to-right (L-R) shunting through the patent ductus arteriosus (PDA). To characterize hemodynamic changes that follow premature delivery, we measured systemic and organ blood flow, oxygen transport, and systemic vascular resistance over the first 96 h of life. We compared these measurements with those from more mature animals of the same species. Radiolabeled microspheres were used to measure organ blood flow (in ml.min-1.g-1) at 3 (n = 18), 23 (n = 17), and 96 h (n = 4) in the premature animals, and at 13 +/- 4 mo in the older animals (n = 5). Premature animals demonstrated over the first 96 h of life significant hemodynamic changes that included decreased systemic vascular resistance (P less than 0.001), increased systemic (P less than 0.05), intestinal (P less than 0.05), and hepatic blood flow (P less than 0.05), as well as resolution of L-R PDA shunting. These 96-h values were similar to those of the more mature infant baboons. Blood flow and oxygen transport to the kidneys and cerebrum did not significantly increase over the first 96 h in premature baboons and were significantly less than those of 13-mo-old animals (P less than 0.01, both). We speculate that low renal and cerebral blood flow in the 140-day premature baboon are manifestations of multisystem immaturity and, as such, may represent persistent physiological disturbances that are distinct from the severity of underlying lung disease in HMD.

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1236 CONTRIBUTION OF LEFT-TO-RIGHT (L→R) DUCTUS ARTERIOSUS SHUNTING (DUCT SHUNT) TO PULMONARY BLOOD FLOW (PBF) IN PREMATURE LAMBS WITH AND WITHOUT HYALINE MEMBRANE DISEASE (HMD) DURING THE FIRST HOURS OF LIFE

Pediatric Research ◽

10.1203/00006450-197804001-01242 ◽

1978 ◽

Vol 12 ◽

pp. 570-570

Author(s):

Dora A Stinson ◽

Alexander C Allen ◽

Hugh M Macdonald ◽

Paul M Taylor

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Ductus Arteriosus ◽

Hyaline Membrane Disease ◽

Hyaline Membrane

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Severe Retinopathy of Prematurity and Steroid Exposure

PEDIATRICS ◽

10.1542/peds.90.4.534 ◽

1992 ◽

Vol 90 (4) ◽

pp. 534-536

Author(s):

Daniel G. Batton ◽

Connie Roberts ◽

Michael Trese ◽

M. Jeffrey Maisels

Keyword(s):

Lung Disease ◽

Retinopathy Of Prematurity ◽

Neonatal Intensive Care ◽

Case Control Study ◽

Ductus Arteriosus ◽

Hyaline Membrane Disease ◽

Case Control ◽

Retrospective Case ◽

Hyaline Membrane ◽

Control Study

During a 3-year period (1988 through 1990) an increase was observed in the number of infants born at 23- to 26-weeks' gestation who required cryotherapy for severe retinopathy of prematurity (0/20, 1988; 3/14, 1989; 6/18, 1990; P = .015). Inasmuch as this was not related to improved survival, a retrospective case-control study was conducted to try to explain this observation. Of 52 surviving infants who had been born at 23 to 26 weeks' gestation, 9 required cryotherapy and the other 43 served as control subjects. There were no differences between groups in birthweight, gestational age, or the number of infants with hyaline membrane disease, intraventricular hemorrhage, or hydrocephalus. Factors related to the need for cryotherapy included patent ductus arteriosus (P = .046), mechanical ventilation for more than 21 days (P = .045), and the use of steroids for lung disease (P < .001). In this neonatal intensive care unit, steroids are administered according to the attending neonatologist's preference. Inasmuch as steroids are considered only for infants still ventilator dependent at 21 days, this group was analyzed separately (n = 36). Of the 21 factors examined, only the use of steroids for lung disease was associated with the need for cryotherapy (P < .001).

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Retrospective evaluation of occlusion of patent ductus arteriosus with hemoclips in 20 dogs

Journal of the American Animal Hospital Association ◽

10.5326/15473317-36-6-548 ◽

2000 ◽

Vol 36 (6) ◽

pp. 548-555 ◽

Cited By ~ 22

Author(s):

LB Corti ◽

D Merkley ◽

OL Nelson ◽

WA Ware

Keyword(s):

Clinical Outcome ◽

Patent Ductus Arteriosus ◽

Left Atrial ◽

Ductus Arteriosus ◽

Retrospective Evaluation ◽

Good Clinical Outcome ◽

Heart Size ◽

Fractional Shortening ◽

Patent Ductus

Twenty dogs with patent ductus arteriosus occluded with Hemoclips were evaluated with a mean follow-up time of 799.4 days (range, 83 to 3,580 days). Significant decreases were found between pre- and postsurgical means for vertebral heart size and for echocardiographic left atrial/aortic-root ratios and percent fractional shortening (%FS). Despite a good clinical outcome, six of 20 dogs had persistent cardiomyopathy of overload with diminished %FS (28% or less) at follow-up. One dog had residual ductal flow identified five days postoperatively. Subsequent evaluations in this case at 60, 144, 226, 344, and 560 days postoperatively demonstrated gradually diminishing ductal flow. The remaining 19 dogs did not recanalize.

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