Abstract
AIMS—To define how often transient pulmonary branch stenosis (PBS) develops after closure of a patent ductus arteriosus (PDA) in babies born at less than 32 weeks gestation; to describe the natural history of PBS and the relation between PBS and a cardiac murmur. METHODS—Fifty three preterm infants born at a gestational age less than 32 weeks and who had PDA diagnosed on echocardiography were recruited. An echocardiogram was performed on alternate days until the ductus arteriosus closed. If PBS was diagnosed, the baby was followed up until PBS resolved. RESULTS—In 59%, PBS developed in one or both branches after closure of the PDA. In 21%, both pulmonary branches were affected. In 79%, the left pulmonary artery alone was involved but the right side was never affected alone. PBS had resolved in 74% by the time the infants reached 40 weeks, in 95% at a corrected age of 6 weeks, and in 100% at a corrected age of 3 months. There is a better correlation between a cardiac murmur and PBS than between a murmur and PDA. CONCLUSIONS—PBS in preterm infants is usually not present at birth but develops after closure of a PDA. PBS resolves by a corrected age of 3 months. The presence of a murmur after closure of a PDA is usually related to PBS and not to reopening of the ductus arteriosus.
Full Text
The Full Text of this article is available as a PDF (113.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arlettaz R., Archer N., Wilkinson A. R. Natural history of innocent heart murmurs in newborn babies: controlled echocardiographic study. Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F166–F170. doi: 10.1136/fn.78.3.f166. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chatelain P., Oberhänsli I., Friedli B. Physiological pulmonary branch stenosis in newborns: 2D-echocardiographic and Doppler characteristics and follow up. Eur J Pediatr. 1993 Jul;152(7):559–563. doi: 10.1007/BF01954080. [DOI] [PubMed] [Google Scholar]
- Clyman R. I. Recommendations for the postnatal use of indomethacin: an analysis of four separate treatment strategies. J Pediatr. 1996 May;128(5 Pt 1):601–607. doi: 10.1016/s0022-3476(96)80123-5. [DOI] [PubMed] [Google Scholar]
- Danilowicz D. A., Rudolph A. M., Hoffman J. I., Heymann M. Physiologic pressure differences between main and branch pulmonary arteries in infants. Circulation. 1972 Feb;45(2):410–419. doi: 10.1161/01.cir.45.2.410. [DOI] [PubMed] [Google Scholar]
- Du Z. D., Roguin N., Barak M., Hershkowitz S., Milgram E., Brezins M. Doppler echocardiographic study of the pulmonary artery and its branches in 114 normal neonates. Pediatr Cardiol. 1997 Jan-Feb;18(1):38–42. doi: 10.1007/s002469900106. [DOI] [PubMed] [Google Scholar]
- Dunkle L. M., Rowe R. D. Transient murmur simulating pulmonary artery stenosis in premature infants. Am J Dis Child. 1972 Nov;124(5):666–670. doi: 10.1001/archpedi.1972.02110170044006. [DOI] [PubMed] [Google Scholar]
- Elzenga N. J., von Suylen R. J., Frohn-Mulder I., Essed C. E., Bos E., Quaegebeur J. M. Juxtaductal pulmonary artery coarctation. An underestimated cause of branch pulmonary artery stenosis in patients with pulmonary atresia or stenosis and a ventricular septal defect. J Thorac Cardiovasc Surg. 1990 Sep;100(3):416–424. [PubMed] [Google Scholar]
- Evans N. J., Archer L. N. Postnatal circulatory adaptation in healthy term and preterm neonates. Arch Dis Child. 1990 Jan;65(1 Spec No):24–26. doi: 10.1136/adc.65.1_spec_no.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Freund M., Wranne B. Ultrasound assessment of ductal closure, pulmonary blood flow velocity, and systolic pulmonary arterial pressure in healthy neonates. Pediatr Cardiol. 1986;6(5):233–237. [PubMed] [Google Scholar]
- Gentile R., Stevenson G., Dooley T., Franklin D., Kawabori I., Pearlman A. Pulsed Doppler echocardiographic determination of time of ductal closure in normal newborn infants. J Pediatr. 1981 Mar;98(3):443–448. doi: 10.1016/s0022-3476(81)80719-6. [DOI] [PubMed] [Google Scholar]
- Gittenberger-de Groot A. C., Strengers J. L., Mentink M., Poelmann R. E., Patterson D. F. Histologic studies on normal and persistent ductus arteriosus in the dog. J Am Coll Cardiol. 1985 Aug;6(2):394–404. doi: 10.1016/s0735-1097(85)80178-9. [DOI] [PubMed] [Google Scholar]
- Gittenberger-de Groot A. C., van Ertbruggen I., Moulaert A. J., Harinck E. The ductus arteriosus in the preterm infant: histologic and clinical observations. J Pediatr. 1980 Jan;96(1):88–93. doi: 10.1016/s0022-3476(80)80337-4. [DOI] [PubMed] [Google Scholar]
- Guntheroth W. G. The role of ductal constriction in transient stenosis of the left pulmonary artery. Pediatr Cardiol. 1998 May-Jun;19(3):240–242. doi: 10.1007/s002469900293. [DOI] [PubMed] [Google Scholar]
- Maroto E., Fouron J. C., Aké E., van Doesburg N. H., Cartwright D., Teyssier G., Bard H. Closure of the ductus arteriosus: determinant factor in the appearance of transient peripheral pulmonary stenosis of the neonate. J Pediatr. 1991 Dec;119(6):955–959. doi: 10.1016/s0022-3476(05)83055-0. [DOI] [PubMed] [Google Scholar]
- Reller M. D., Colasurdo M. A., Rice M. J., McDonald R. W. The timing of spontaneous closure of the ductus arteriosus in infants with respiratory distress syndrome. Am J Cardiol. 1990 Jul 1;66(1):75–78. doi: 10.1016/0002-9149(90)90739-n. [DOI] [PubMed] [Google Scholar]
- Rodriguez R. J., Riggs T. W. Physiologic peripheral pulmonic stenosis in infancy. Am J Cardiol. 1990 Dec 15;66(20):1478–1481. doi: 10.1016/0002-9149(90)90538-c. [DOI] [PubMed] [Google Scholar]
- So B. H., Watanabe T., Shimizu M., Yanagisawa M. Doppler assessment of physiological stenosis at the bifurcation of the main pulmonary artery: a cause of functional murmur in neonates. Biol Neonate. 1996;69(4):243–248. doi: 10.1159/000244317. [DOI] [PubMed] [Google Scholar]
- Thibeault D. W., Emmanouilides G. C., Nelson R. J., Lachman R. S., Rosengart R. M., Oh W. Patent ductus arteriosus complicating the respiratory distress syndrome in preterm infants. J Pediatr. 1975 Jan;86(1):120–126. doi: 10.1016/s0022-3476(75)80722-0. [DOI] [PubMed] [Google Scholar]
- Zevallos-Giampietri E. A., Thelmo W. L., Anderson V. M. Coarctation of the left pulmonary artery: effects on the pulmonary vasculature of infants. Pediatr Cardiol. 1997 Sep-Oct;18(5):376–380. doi: 10.1007/s002469900204. [DOI] [PubMed] [Google Scholar]