Document Detail


Diastolic left ventricular function in preterm infants with a patent ductus arteriosus: a serial Doppler echocardiography study.
MedLine Citation:
PMID:  14757261     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In very low birth weight neonates, a left-to-right shunt via persistent ductus arteriosus (PDA) may interact with diastolic left ventricular function, but specific changes of Doppler parameters have yet to be reported. In a serial transmitral Doppler study, we investigated the impact of a PDA on diastolic function parameters. Twenty-two patients with and without PDA were examined on day 3.8+/-1 and day 14+/-2 after birth. By the first examination, 13 out of 22 patients had a PDA; by the second examination, the number was still 8 out of 22. Peak early and atrial flow velocities (44.8+/-15 and 50.1+/-13 cm/s, respectively) were higher (p<0.05) for neonates with PDA compared to those with closed duct (30.9+/-6 and 34.2 cm/s, respectively). Isovolumic relaxation time (IVRT) was shorter in neonates with PDA (45+/-7 ms, N=21) compared to those with a closed duct (55.3+/-5 ms, N=23) (p<0.01). IVRT correlated inversely with cardiac index (R=-0.79, p<0.01). All observed changes reversed to the normal range after closure of the PDA. When premature infants with a PDA experience a preload challenge, early and atrial peak velocities increase and IVRT shortens significantly. This coincidence of elevated transvalvular pressure differences and decreased IVRT in neonates with immature diastolic function can best be explained as a result of left atrial pressure elevation. Consequently, pulmonary venous pressure must be elevated, with its inherent effect on pulmonary capillary physiology. Thus, the monitoring of left ventricular diastolic function adds significant information to the care of preterm infants with a PDA.
Authors:
Lothar Schmitz; Brigitte Stiller; Heike Koch; Petra Koehne; Peter Lange
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Early human development     Volume:  76     ISSN:  0378-3782     ISO Abbreviation:  Early Hum. Dev.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-03     Completed Date:  2004-09-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7708381     Medline TA:  Early Hum Dev     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  91-100     Citation Subset:  IM    
Affiliation:
Department of Pediatric Cardiology, Charité Medical Center, Humboldt-University, Augustenburger Platz 1, D-13353 Berlin, Germany. lothar.schmitz@berlin.de
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MeSH Terms
Descriptor/Qualifier:
Blood Gas Analysis
Diastole*
Ductus Arteriosus, Patent / blood,  physiopathology,  ultrasonography*
Echocardiography, Doppler / methods*
Follow-Up Studies
Gestational Age
Humans
Infant, Newborn
Infant, Premature, Diseases / blood,  physiopathology,  ultrasonography*
Infant, Very Low Birth Weight
Ventricular Function, Left*

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