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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1997 Jul;77(1):F36–F40. doi: 10.1136/fn.77.1.f36

Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants

B Su, T Watanabe, M Shimizu, M Yanagisawa
PMCID: PMC1720677  PMID: 9279181

Abstract

AIMS—To identify the patent ductus arteriosus (PDA) shunt flow pattern using Doppler echocardiography; and to assess whether it could be used to predict the development of clinically significant PDA.
METHODS—Premature infants weighing under 1500 g, who required mechanical ventilation, and in whom daily echocardiography could be performed from day 1 until the ductus closed, and on day 7 to confirm closure, were studied. The PDA shunt flow was identified from four Doppler patterns, and the closed pattern of a closed duct was also presented. Clinically significant PDA was diagnosed when there was colour Doppler echocardiographic evidence of left to right ductal shunt associated with at least two of the following clinical signs: heart murmur (systolic or continuous); persistent tachycardia (heart rate>160/min); hyperactive precordial pulsation; bounding pulses; and radiographic evidence of cardiomegaly or pulmonary congestion.
RESULTS—Of 68 infants enrolled into this study, clincally significant PDA developed in 31. The most recordable sequence of transition change of shunt flow pattern for clinically significant PDA was: pulmonary hypertension pattern, to growing pattern, to pulsatile pattern, to closing pattern, to closed pattern. And that for non-clinically significant PDA was: pulmonary hypertension pattern, to closing pattern, to closed pattern. The growing and the pulsatile patterns were mostly documented in infants with clinically significant PDA. The first documented growing pattern to predict clinically significant PDA gave a sensitivity of 64.5% and a specificity of 81.1%; the first documented pulsatile pattern gave a sensitivity of 93.5% and a specificity of 100%.
CONCLUSION—Doppler echocardiographic assessment of PDA shunt flow pattern during the first 4 days of life is useful for predicting the development of clinically significant PDA in premature infants. At that stage, the closing or closed Doppler pattern indicates that infants are not at risk of developing clinically significant PDA; the growing or pulsatile Doppler pattern indicates a continuing risk of developing clinically significant PDA.

 Keywords: Echocardiography; patent ductus arteriosus; Doppler flow pattern

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Figure 1  .

Figure 1  

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Left: high left parasternal view echocardiogram. The main pulmonary artery (MPA), patent ductus arteriosus (PDA), and descending aorta (DAO) can be seen in a contiuous arc. The origin of the left pulmonary artery (LPA) is also evident. Posterior to the DAO are the vertebral bodies. The pulsed Doppler gate is positioned at the pulmonary end of the PDA. Right: resultant Doppler profile of the the PDA shunt flow.

Figure 2  .

Figure 2  

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Four Doppler flow patterns and the contrasting closed pattern. A: pulmonary hypertension pattern; B: growing pattern; C: pulsatile pattern; D: closing pattern; E: closed pattern.

Selected References

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

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