Aortic flow velocity curves in the diagnosis and the followup of symptomatic patent ductus arteriosus in preterm infants during therapeutic interventions.

Abstract

In preterm infants, persistent ductus arteriosus (PDA) fails to close soon after birth and becomes symptomatic (sPDA) in about 40% of the infants, causing cardio-respiratory deterioration by a left-to-right shunt across the PDA. Aortic run-off of blood, predominantly occurring during ventricular diastole, causes an abnormal diastolic retrograde aortic blood flow. This aortic reverse flow can be assessed semi-quantitatively in a noninvasive way, using continuous-wave Doppler-ultrasonography. An increased ratio (R/F ratio) of the abnormal retrograde aortic blood flow (R) related to the normal forward flow (F) in the aorta indicates presence of sPDA in preterm infants. The R/F ratio was assessed in 30 premature infants, including 13 cases without sPDA, and 17 infants with sPDA--in 12 of them before and after surgical ligation of PDA, in five concomitantly to pharmacological closure of PDA by the application of indomethacin. The R/F ratio was low in all infants without sPDA and in infants following surgical ligation of PDA. On the other hand, a high R/F ratio was found in all patients with sPDA before specific treatment. During indomethacin-induced closure of PDA the R/F ratio decreased continuously, whereas it remained high in infants with sPDA not responding to indomethacin treatment.