Determining hemodynamic significance of patent ductus arteriosus using echocardiographic data prognostic tables
DOI:
https://doi.org/10.26641/2307-0404.2021.2.234503Keywords:
patent ductus arteriosus (PDA), hemodynamic significance, transthoracic echocardiographic (TTE) examinationAbstract
The paper presents an analysis of echocardiographic data of patients with PDA having different hemodynamic significance. Presently, the concept of “degree of hemodynamic significance” remains controversial. Criteria for determining the hemodynamic significance of PDA in term infants are not described. In our work, we used a classification of three degrees of hemodynamic significance: non-hemodynamically significant PDA – insignificant, moderately hemodynamically significant – moderately significant and large PDA – hemodynamically significant PDA. Aim – to work out an algorithm for determining the degree of PDA hemodynamic significance for prediction of its further development. The study involved children under 18 years old (80% of them ‒ children under 3 years old) who were examined in the cardiac surgery department of the SI “IGUS n.a.V.T. Zaytsev NAMS of Ukraine” during 2013-2017 yy. Gestational age (from 37 weeks), the presence of left to right PDA shunt, absence of a ASD shunt and other congenital heart defects served as enrollment criteria for the trial. Two prognostic tables were formed with the main criteria for determining hemodynamic significance of PDA by the sum of the signs according to gradations (insignificant, moderately significant and hemodynamically significant) as an outcome of the trial. Based on the determination of the main and additional criteria of hemodynamic significance and the strength of their influence, a diagnostic algorithm is formed for a patient with PDA with the possibility of predicting a further clinical scenario. For determination of hemodynamic significance, an increase in pulmonary gradient with an information index of 1.135 and a prognostic factor of +5.90/-1.75 were dominant, while the left ventricular dilatation located from the A4C with an informational index of 1.020 and a prognostic coefficient of +3.69/-2.50 dominated in determining the degree of hemodynamic significance in the presence of secondary changes. The proposed mechanism for determining the level of hemodynamic significance of PDA for children with borderline changes will predict more precisely the development of the disease, determine the patient’s observation tactics and regulate the decision-making process of surgical intervention.
References
Bojchenko AD, Gonchar MO, Kondratova Iyu, et al. Criteria for diagnostics of hemodynamically significant patent ductus arteriosus in preterm infants. Neonatologiya, hirurgiya ta perynatalna medycyna. 2015;V(1(15)):24-27. Ukrainian. doi : https://doi.org/10.24061/2413-4260.V.1.15.2015.4
Gubler EV, Genkin AA. [Application of nonparametric statistical criteria in biomedical research]. Leningrad: Medicina; 1973. p. 141. Russian.
Saperova EV, Vahlova IV. Congenital heart defects in children: prevalence, risk factors, mortality. Voprosy sovremennoj pediatrii. 2017;16(2):126-33. Rus¬sian. doi: https://doi.org/10.15690/vsp.v16i2.1713
Arlettaz R. Echocardiographic evaluation of patent ductus arteriosus in preterm infants. Frontiers in Pediatrics. 2017;5(147):1-9. doi: https://doi.org/10.3389/fped.2017.00147
Bancalari E, Jain D. Management of Patent Ductus Arteriosus: Are We Looking at the Right Outcomes? The Journal of pediatrics. 2016 Dec 29;PII:S0022-3476(16)31432-9. doi: https://doi.org/10.1016/j.jpeds.2016.12.033
Cimadevilla C, Nadiaa B, Dreyfusa J, et al. Echocardiographic measurement of left atrial volume: does the method matter? Archives of Cardiovascular Disease. 2015;108(12):643-49. doi: https://doi.org/10.1016/j.acvd.2015.07.001
Baumgartner H, De Backer J, Babu-Narayan SV, et al. ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2020;ehaa554. doi: https://doi.org/10.1093/eurheartj/ ehaa554
Evans Nick. Compliance with this Guideline is recommended: women and babies: management of patent ductus arteriosus in preterm infants. Sydney Local Health District; 2016. р. 19
Kulikova DA, Safonova IN, Chumak LI. Determination of criteria for the hemodynamic significance of patent ductus arteriosus using echocardiography. Promeneva diagnostyka, promeneva terapiya. 2019;1-2:14-21.
Nagasawa H, Hamada C, Wakabayashi M, et al. Time to spontaneous ductus arteriosus closure in full-term neonates. Open Heart. 2016;3(1):e000413. doi: https://doi.org/10.1136/openhrt-2016-000413
Nady ME, Amrousy DE, Salah N, Zoair A. Transcatheter versus surgical closure of patent ductus arteriosus in pediatric patients: a systematic review with meta-analysis. Journal of Pediatric Surgery. 2017;3(4):1-6.
Stout KK, et al. 2018 AHA/ACC Guideline for the management of adults with congenital heart disease: a report of the American college of cardiology / American heart association task force on clinical practice guidelines. AHA J. Circulation. 2019 ;139(14):698-800. doi: https://doi.org/10.1161/CIR.0000000000000603
Şahin İO, Yolcu C, Şahin AE, et al. Which criteria are more valuable in defining hemodynamic significance of patent ductus arteriosus in premature infants? Respiratory or echocardiographic? Med Bull Haseki. 2017;55(1):32-36. doi: https://doi.org/10.4274/haseki.3278
Yong-quan Huang, Yin Huang, Dan Huang. Reliability of Echocardiography Measurement of Patent Ductus Arteriosus Minimum Diameter: A Meta-analysis. International Journal of Cardiovascular and Cerebrovascular Disease. 2016;4(2):15-19. doi: https://doi.org/10.13189/ijccd.2016.040201
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