Significance of reverse orientation of the ductus arteriosus in neonates with pulmonary outflow tract obstruction for early intervention.
Significance of reverse orientation of the ductus arteriosus in neonates with pulmonary outflow tract obstruction for early intervention.
复制标题
肺流出道梗阻新生儿动脉导管逆向早期干预的意义
DOI：
10.1016/j.amjcard.2005.09.121
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Michelfelder,Erik
中科院分区：
文献类型：
--
作者：
Hinton,Robert;Michelfelder,Erik
动脉导管反向（RDA），定义为主动脉交界处的下角<90°，与肺闭锁有关；然而，RDA在非闭锁性肺流出道阻塞（POTO）中的意义尚不清楚。本研究的目的是评估导管形态与早期干预需求之间的关系。回顾性分析了76例新生儿POTO的导管形态。患者被分层为圆锥截形（CT）或原发性肺动脉瓣（PV）异常。RDA患病率为40 / 68(59%)，在CT缺陷患者中（28 / 30,93%）高于PV异常患者（12 / 38,32%；卡方= 26.4,p <0.0001）。40例RDA患者中有29例（73%）需要早期干预，而28例导管形态正常的患者中只有8例（31%；卡方= 12.8,p <0.001）。RDA患者中需要早期干预的PV异常患者比例（12 / 12,100%）高于CT缺陷患者（17 / 28,61%；卡方= 6.5,p <0.02）。重要的是，在排除肺闭锁患者后，这些分析结果没有变化。对于非闭锁性POTO患者，阈下角为65°预示需要早期干预。对于PV异常或CT缺损且下角<65°的患者，RDA是早期干预的具体指标。这些发现表明，在闭锁和非闭锁POTO的情况下，RDA与早期干预的必要性之间存在关联。当确定该人群的RDA时，应考虑早期干预的必要性。
Reverse orientation of the ductus arteriosus (RDA), defined as an inferior angle at the aortic junction of <90°, is associated with pulmonary atresia; however, the significance of RDA in nonatretic pulmonary outflow tract obstruction (POTO) is unknown. The purpose of this study was to evaluate the relation between ductal morphology and the need for early intervention. Ductal morphology was retrospectively reviewed in 76 neonatal cases of POTO. Patients were stratified to those with conotruncal (CT) or primary pulmonary valve (PV) abnormalities. The prevalence of RDA was 40 of 68 (59%) and was higher in patients with CT defects (28 of 30, 93%) compared with PV abnormalities (12 of 38, 32%; chi-square = 26.4, p <0.0001). Early intervention was required in 29 of 40 patients with RDA (73%) compared with only 8 of 28 patients with normal ductal morphology (31%; chi-square = 12.8, p <0.001). The proportion of patients with RDA who required early intervention was greater in PV abnormalities (12 of 12, 100%) compared with CT defects (17 of 28, 61%; chi-square = 6.5, p <0.02). Importantly, after excluding patients with pulmonary atresia, these analyses were unchanged. In patients with nonatretic POTO, a threshold inferior angle of 65° was predictive of the need for early intervention. RDA in patients with PV abnormalities, or CT defects and an inferior angle <65°, is a specific indicator for early intervention. These findings demonstrate an association between RDA in the context of atretic and nonatretic POTO and the need for early intervention. The need for early intervention should be considered when RDA is identified in this population.