Skip to main content
PMC home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1994 Mar;70(2):F112–F117. doi: 10.1136/fn.70.2.f112

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

P Iyer 1, N Evans 1
PMCID: PMC1061011  PMID: 8154903

Abstract

The aim of this study was to re-examine the accuracy of the left atrial aortic root ratio (LA:Ao) as a marker of significant patent ductus arteriosus (PDA) in the preterm infant by comparison with direct Doppler echocardiographic assessment. Fifty six infants (< 1500 g) had 463 serial echocardiograms. Firstly the LA:Ao was measured, then the duct was imaged and classified as wide open, restricting, or closed according to two dimensional and Doppler criteria. Probability analysis was performed to test the ability of the LA:Ao to discriminate between a wide open PDA and a restricting or closed duct. Mean LA:Ao was 1.17 and 1.21 when the duct was respectively closed or restricting compared with 1.61 when wide open. Using a LA:Ao of 1.5 as a cut off gives a sensitivity of 79% and specificity of 95% and increases the accuracy over the recommended levels of 1.3 and 1.4. With this cut off there were 20/94 false negatives, these were associated with scans on day 1 and large interatrial shunts. The sensitivity of the LA:Ao increased to 88% if only scans performed after day 1 were analysed. For diagnosing a PDA after day 1, the positive likelihood ratio of an LA:Ao of 1.5 or more was 17.5, and the negative likelihood ratio of an LA:Ao < 1.5 was 0.13. The LA:Ao is still a useful tool in the diagnosis of PDA. It is a simple method which needs less skill and resources than direct PDA imaging and is feasible on neonatal units without direct access to echocardiographic expertise. Its use on the first postnatal day is not recommended.

Full text

PDF
F114

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Dudell G. G., Gersony W. M. Patent ductus arteriosus in neonates with severe respiratory disease. J Pediatr. 1984 Jun;104(6):915–920. doi: 10.1016/s0022-3476(84)80499-0. [DOI] [PubMed] [Google Scholar]
  2. Ellison R. C., Peckham G. J., Lang P., Talner N. S., Lerer T. J., Lin L., Dooley K. J., Nadas A. S. Evaluation of the preterm infant for patent ductus arteriosus. Pediatrics. 1983 Mar;71(3):364–372. [PubMed] [Google Scholar]
  3. Evans N. Diagnosis of patent ductus arteriosus in the preterm newborn. Arch Dis Child. 1993 Jan;68(1 Spec No):58–61. doi: 10.1136/adc.68.1_spec_no.58. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Evans N., Iyer P. Change in blood pressure after treatment of patent ductus arteriosus with indomethacin. Arch Dis Child. 1993 May;68(5 Spec No):584–587. doi: 10.1136/adc.68.5_spec_no.584. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hirschklau M. J., DiSessa T. G., Higgins C. B., Friedman W. F. Echocardiographic diagnosis: pitfalls in the premature infant with a large patent ductus arteriosus. J Pediatr. 1978 Mar;92(3):474–477. doi: 10.1016/s0022-3476(78)80452-1. [DOI] [PubMed] [Google Scholar]
  6. Huhta J. C., Cohen M., Gutgesell H. P. Patency of the ductus arteriosus in normal neonates: two-dimensional echocardiography versus Doppler assessment. J Am Coll Cardiol. 1984 Sep;4(3):561–564. doi: 10.1016/s0735-1097(84)80102-3. [DOI] [PubMed] [Google Scholar]
  7. Johnson G. L., Breart G. L., Gewitz M. H., Brenner J. I., Lang P., Dooley K. J., Ellison R. C. Echocardiographic characteristics of premature infants with patient ductus arteriosus. Pediatrics. 1983 Dec;72(6):864–871. [PubMed] [Google Scholar]
  8. Kupferschmid C., Lang D., Pohlandt F. Sensitivity, specificity and predictive value of clinical findings, m-mode echocardiography and continuous-wave Doppler sonography in the diagnosis of symptomatic patent ductus arteriosus in preterm infants. Eur J Pediatr. 1988 Apr;147(3):279–282. doi: 10.1007/BF00442695. [DOI] [PubMed] [Google Scholar]
  9. Mellander M., Larsson L. E., Ekström-Jodal B., Sabel K. G. Prediction of symptomatic patent ductus arteriosus in preterm infants using Doppler and M-mode echocardiography. Acta Paediatr Scand. 1987 Jul;76(4):553–559. doi: 10.1111/j.1651-2227.1987.tb10520.x. [DOI] [PubMed] [Google Scholar]
  10. Ramsay J. M., Murphy D. J., Jr, Vick G. W., 3rd, Courtney J. T., Garcia-Prats J. A., Huhta J. C. Response of the patent ductus arteriosus to indomethacin treatment. Am J Dis Child. 1987 Mar;141(3):294–297. doi: 10.1001/archpedi.1987.04460030072028. [DOI] [PubMed] [Google Scholar]
  11. Reller M. D., Ziegler M. L., Rice M. J., Solin R. C., McDonald R. W. Duration of ductal shunting in healthy preterm infants: an echocardiographic color flow Doppler study. J Pediatr. 1988 Mar;112(3):441–446. doi: 10.1016/s0022-3476(88)80333-0. [DOI] [PubMed] [Google Scholar]
  12. Sahn D. J., DeMaria A., Kisslo J., Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978 Dec;58(6):1072–1083. doi: 10.1161/01.cir.58.6.1072. [DOI] [PubMed] [Google Scholar]
  13. Sahn D. J., Vaucher Y., Williams D. E., Allen H. D., Goldberg S. J., Friedman W. F. Echocardiographic detection of large left to right shunts and cardiomyopathies in infants and children. Am J Cardiol. 1976 Jul;38(1):73–79. doi: 10.1016/0002-9149(76)90065-5. [DOI] [PubMed] [Google Scholar]
  14. Serwer G. A., Armstrong B. E., Anderson P. A. Continuous wave Doppler ultrasonographic quantitation of patent ductus arteriosus flow. J Pediatr. 1982 Feb;100(2):297–299. doi: 10.1016/s0022-3476(82)80658-6. [DOI] [PubMed] [Google Scholar]
  15. Silverman N. H., Lewis A. B., Heymann M. A., Rudolph A. M. Echocardiographic assessment of ductus arteriosus shunt in premature infants. Circulation. 1974 Oct;50(4):821–825. doi: 10.1161/01.cir.50.4.821. [DOI] [PubMed] [Google Scholar]
  16. Simel D. L., Samsa G. P., Matchar D. B. Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol. 1991;44(8):763–770. doi: 10.1016/0895-4356(91)90128-v. [DOI] [PubMed] [Google Scholar]
  17. Valdes-Cruz L. M., Dudell G. G. Specificity and accuracy of echocardiographic and clinical criteria for diagnosis of patent ductus arteriosus in fluid-restricted infants. J Pediatr. 1981 Feb;98(2):298–305. doi: 10.1016/s0022-3476(81)80665-8. [DOI] [PubMed] [Google Scholar]
  18. Vick G. W., 3rd, Huhta J. C., Gutgesell H. P. Assessment of the ductus arteriosus in preterm infants utilizing suprasternal two-dimensional/Doppler echocardiography. J Am Coll Cardiol. 1985 Apr;5(4):973–977. doi: 10.1016/s0735-1097(85)80442-3. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal edition are provided here courtesy of BMJ Publishing Group

RESOURCES