Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T09:49:35.196Z Has data issue: false hasContentIssue false
  • English
  • Français

Quantification of left-to-right shunt through patent ductus arteriosus by colour Doppler in children admitted for a device closure

Published online by Cambridge University Press:  11 July 2011

Solweig Harling ,
Tomas Jansson ,
Milad El-Segaier  and
Erkki Pesonen
Solweig Harling*
Affiliation:
Department of Paediatrics, Halmstad Hospital, Halmstad, Sweden
Tomas Jansson
Affiliation:
Department of Electrical Measurements, Lund University, Lund, Sweden
Milad El-Segaier
Affiliation:
Department of Paediatrics, Section of Paediatric Cardiology, Lund University Hospital, Lund, Sweden
Erkki Pesonen
Affiliation:
Department of Paediatrics, Section of Paediatric Cardiology, Lund University Hospital, Lund, Sweden
*
Correspondence to: Dr S. Harling, MD, Department of Paediatrics, Halmstad Hospital, SE-301 85 Halmstad, Sweden. Tel: +46-35 131 000; Fax: +46-35 134 126; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose

Our animal model suggests that quantification of ductal flow from colour Doppler pixels is possible. We aimed to clarify whether this method can be used to determine a clinically significant ductal shunt in children.

Methods

We retrospectively quantified ductal flow from saved images from 20 children who had been admitted for device occlusion of patent ductus arteriosus. Colour Doppler images over the main stem of the pulmonary artery were obtained in longitudinal cross-sections. The colour pixel percentages during diastole, representing ductal flow, were correlated with the documented shunt, measured invasively according to Fick's principle.

Results

The ratio of pulmonary to systemic flow correlated best with the sum of the percentages of green colour pixels (r = 0.73, r2 = 0.54, p < 0.001). When the shunt was 1.5:1 or more, 12 out of 13 infants had 50% or more of the region of interest covered with green pixels – sensitivity 92%, specificity 71%. The correlation between ductal diameter and pulmonary-to-systemic flow ratio was less significant (r = 0.6, r2 = 0.37, p < 0.03).

Conclusions

We conclude that clinically significant shunts with pulmonary-to-systemic flow ratio over 1.5 can be diagnosed with this method where neither the size of the patient nor echocardiographic settings seem to be critical. The method could be used to provide an objective indication for ductal closure, but further prospective studies in children are needed to verify the power of the method.

Keywords

Image analysisductal flowindications for closure
Type
Original Articles
Information
Cardiology in the Young , Volume 22 , Issue 1 , February 2012 , pp. 57 - 62
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Steinberger, J, Moller, JH, Berry, JM, Sinaiko, AR. Echocardiographic diagnosis of heart disease in apparently healthy adolescents. Pediatrics 2000; 105: 815–818.CrossRefGoogle ScholarPubMed
2. Nora, JJ. Multifactorial inheritance hypothesis for the etiology of congenital heart diseases. The genetic–environmental interaction. Circulation 1968; 38: 604–617.CrossRefGoogle ScholarPubMed
3. Schneider, DJ, Moore, JW. Patent ductus arteriosus. Circulation 2006; 114: 1873–1882.CrossRefGoogle ScholarPubMed
4. Morgan, JM, Gray, HH, Miller, GA, Oldershaw, PJ. The clinical features, management and outcome of persistence of the arterial duct presenting in adult life. Int J Cardiol 1990; 27: 193–199.CrossRefGoogle ScholarPubMed
5. Onji, K, Matsuura, W. Pulmonary endarteritis and subsequent pulmonary embolism associated with clinically silent patent ductus arteriosus. Intern Med 2007; 46: 1663–1667.CrossRefGoogle ScholarPubMed
6. Espino-Vela, J, Cardenas, N, Cruz, R. Patent ductus arteriosus. With special reference to patients with pulmonary hypertension. Circulation 1968; 38: 45–60.CrossRefGoogle ScholarPubMed
7. Thilén, U, Alström-Olsson, K. Does the risk of infective endarteritis justify routine patent ductus arteriosus closure? Eur Heart J 1997; 18: 364–366.CrossRefGoogle ScholarPubMed
8. Bennhagen, RG, Benson, LN. Silent and audible persistent ductus arteriosus: an angiographic study. Pediatr Cardiol 2003; 24: 27–30.CrossRefGoogle ScholarPubMed
9. Reller, MD, Rice, MJ, McDonald, RW. Review of studies evaluating ductal patency in the premature infant. J Pediatr 1993; 122: 59–62.CrossRefGoogle ScholarPubMed
10. Jim, WT, Chiu, NC, Chen, MR, et al. Cerebral hemodynamic change and intraventricular hemorrhage in very low birth weight infants with patent ductus arteriosus. Ultrasound Med Biol 2005; 31: 197–202.CrossRefGoogle ScholarPubMed
11. Shimada, S, Kasai, T, Konishi, M, Fujiwara, T. Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant. J Pediatr 1994; 125: 270–277.CrossRefGoogle ScholarPubMed
12. Harling, S, Jansson, T, Gudmundsson, S, Pesonen, E. Quantification of left to right shunt in patent ductus arteriosus by color Doppler. Ultrasound Med Biol 2009; 35: 403–408.CrossRefGoogle ScholarPubMed
13. Delorme, S, Weisser, G, Zuna, I, Fein, M, Lorenz, A, van Kaick, G. Quantitative characterization of color Doppler images: reproducibility, accuracy, and limitations. J Clin Ultrasound 1995; 23: 537–550.CrossRefGoogle ScholarPubMed
14. Moore, JW, Schneider, DJ, Dimeglio, D. The duct-occlud device: design, clinical results, and future directions. J Interv Cardiol 2001; 14: 231–237.CrossRefGoogle ScholarPubMed
15. Pass, RH, Hijazi, Z, Hsu, DT, Lewis, V, Hellenbrand, WE. Multicenter USA Amplatzer patent ductus arteriosus occlusion device trial: initial and one-year results. J Am Coll Cardiol 2004; 44: 513–519.CrossRefGoogle ScholarPubMed
16. Roberts, P, Adwani, S, Archer, N, Wilson, N. Catheter closure of the arterial duct in preterm infants. Arch Dis Child Fetal Neonatal Ed 2007; 92: 248–250.CrossRefGoogle ScholarPubMed
17. Lundell, BP, Sonesson, SE, Sundell, H. Cerebral blood flow following indomethacin administration. Dev Pharmacol Ther 1989; 13: 139–144.CrossRefGoogle ScholarPubMed
18. Van Bel, F, Guit, G, Schipper, J, van de Bor, M, Baan, J. Indomethacin-induced changes in renal blood flow velocity waveform in premature infants with color Doppler imaging. J Pediatr 1991; 118: 621–626.CrossRefGoogle ScholarPubMed
19. Chiang, MC, Lin, WS, Lien, R, Chou, YH. Reexpansion pulmonary edema following patent ductus arteriosus ligation in a preterm infant. J Perinat Med 2004; 32: 365–367.CrossRefGoogle Scholar