Radiographic and echocardiographic evaluation of newborns treated with indomethacin for patent ductus arteriosus.

A series of 33 consecutive preterm newborns who were treated with indomethacin, a drug which acts to close the patent ductus arteriosus, were studied retrospectively to examine the efficacy of chest radiography and echocardiography in diagnosing the presence of a significant patent ductus arteriosus. Radiographic changes in pulmonary vascular engorgement, pulmonary edema, and cardiac size on the anteroposterior film tended to precede the clinical changes of shunt appearance and resolution. The echocardiographic left atrial to aortic ratio (LA/Ao) supplemented the radiographic findings. The time of disappearance of the ductus arteriosus shunt, as judged by clinical findings, was identified accurately by radiographic and echocardiographic findings in the majority of cases; errors of under- and overestimation occurred in a minority of patients. In assessing both the presence and the resolution of the shunt, greater reliability was possible by using both radiographic and echocardiographic findings than by using either method alone.     

Patent ductus arteriosus with Eisenmenger's syndrome detected by first-pass study

The case of a 20-year-old man with patent ductus arteriosus complicated with Eisenmenger's syndrome is described. Radionuclide angiocardiography characterized the abnormal pattern of blood flow through the central circulation to establish a diagnosis of patent ductus arteriosus with a significant right-to-left shunt, which had not been indicated by other clinical findings.     

Pulmonary pseudocysts in newborn infants with respiratory distress syndrome.

Twelve neonates who developed intrathoracic cystlike structures ("pseudocysts") are described. All infants had clinical and radiographic respiratory distress syndrome and all were treated with assisted ventilation. Pulmonary interstitial emphysema preceded the development of the pseudocysts in all cases. The pseudocysts appeared between 0 and 6 days of life (average, 2.4 days), and radiographically documented disappearance occurred in 10 patients at 3--18 days old (average, 7.0 days). Two patients had persisting pseudocysts at 8 and 25 days of age, and no subsequent radiographs. In no case did these structures persist symptomatically or require surgical intervention such as has been described with patients in other series. In two cases, abrupt disappearance of the pseudocysts was accompanied by increased extraalveolar gas in other locations. Eight patients developed radiographic bronchopulmonary dysplasia, which was severe in two of the cases.     

The hemodynamic significance of massive pneumopericardium in preterm infants with respiratory distress syndrome. Clinical and experimental observations.

Radiographic and clinical data were evaluated in 12 preterm infants with pneumopericardium complicating ventilator therapy of respiratory distress syndrome. Eight infants had massive or tension pneumopericardium, reflected by bradycardia, hypotension, and cyanosis of abrupt onset; cardiac size decreased dramatically but returned to approximately the former size after aspiration of the pneumopericardium. In puppies, pneumopericardium large enought to reduce heart size by 32 +/- 3% caused decreased mean arterial pressure (-22 +/- 7%) and right ventricular peak systolic pressure (-11 +/- 2%) and increased right ventricular diastolic and intrapericardial pressures. These findings suggest that pneumopericardium per se causes severe hemodynamic compromise. When it is large enought to reduce heart size, drastic circulatory impairment is produced and pericardiocentesis should be performed immediately.     

Patent ductus arteriosus: transcatheter closure with a transvenous technique.

Transvenous closure is described of the patent ductus arteriosus with a conical device that consists of polyurethane foam mounted on a stainless steel frame. Since 1981, the procedure has been performed in 273 patients in Russia. Permanent complete ductus closure was achieved in 258 (95%) patients. In eight cases (3%), the occlusion was incomplete. Complications occurred in 10 patients (4%), seven of whom required emergency surgery. The new technique combines certain advantages of both alternative methods. The conical shape of the occlusion device is well suited for the anatomic structure of the ductus. The possibility of selecting the size of the device permits reduction in the rate of incomplete closure while still taking advantage of transvenous delivery to avoid entry-site problems. In the initial 10 years of experience, the described technique proved effective, safe, and applicable in the vast majority of patients older than 2 years.     

明胶海绵栓塞动脉导管未闭1例

患儿女,7岁。体重23kg,因“发现心脏杂音1周”入院。入院查体:神清,无缺氧征,胸骨左缘第2~3肋间可闻及Ⅰ~Ⅱ级收缩期杂音,无震颤。超声心动图发现直径3mm图1线样对比剂经动脉导管喷入肺动脉端图2未见对比剂通过PDA到肺动脉的管型动脉导管未闭(PDA)。心电图及X线胸片正常。治疗方法:全麻下穿刺右股静、动脉,分别送入6F端侧孔导管及5F猪尾导管,先后行右心导管检查及主动脉弓降部造影。测得肺动脉平均压为16mmHg(1mmHg=0·133KPa),肺循环血量/体循环血量(QP/Qs)为1·05,为少量左向右分流。造影显示主动脉弓降部与主肺动脉间一长约10cm的…     

Chest film diagnosis of patent ductus arteriosus in infants with hyaline membrane disease.

Patent ductus arteriosus in an infant with hyaline membrane disease is usually a serious complication. To evaluate the diagnostic role of chest radiography in these infants, a double-blind study comparing patients with both hyaline membrane disease and patent ductus arteriosus and matched controls was undertaken. Three pediatric radiologists acted as observers. In no instance were they more reliable than chance in predicting the presence of a patent ductus arteriosus. Analysis according to various clinical criteria (e.g., severity of illness, PAO2) also failed to show any subgroup in which the observers were accurate. From these data it is concluded that chest radiography does not play a significant role in the diagnosis of patent ductus arteriosus in infants with hyaline membrane disease.     

新生儿呼吸窘迫综合征的临床X线诊断

目的 探讨新生儿呼吸窘迫综合征(IRDS)的X线表现及其动态变化。方法 回顾近三年来62例经临味诊断、对症治疗并且有完整X线资料的新生儿呼吸窘迫综合征病例结果 62例中X线表现与临床相符合55例(88.71％),不典型表现7例(11．29％)；其中合并肺炎12例，先天性心脏病2例(PDA)，肺出血3例，气胸5例。根据X线征象分期，轻度37例，中度11例，重度7例。结论 X线平片是协助临床诊断新生儿呼吸窘迫综合征的重要方法之，应结合临床提高X线诊断能力。     

Early diagnosis and medical treatment of the persistent ductus arteriosus in infants

Diagnosis of an isolated patent ductus arteriosus (PDA) is usually straightforward. If at later age it is associated with pulmonary hypertension, however, the symptoms may be variable and more difficult to assess. In the age group primarily discussed here, pulmonary hypertension is frequently present, so diagnosis cannot be based on physical findings alone. Echocardiography and Doppler echocardiography are essential diagnostic procedures; however, cardiac catheterization and angiography may still be needed especially in cases with associated heart defects. At present, surgical closure of the PDA is the therapy of choice in infants. In preterm newborns, an attempt by medical treatment is indicated and often promising. Unfortunately, there are no interventional techniques available at present for duct closure in this age group, whereas in some centers catheter closure of a PDA is successfully employed in older children.     

Asymmetrical pulmonary changes in premature infants with surgical closure of a persistent ductus arteriosus

The chest radiographs of 57 premature infants admitted consecutively with hyaline membrane disease and receiving respirator therapy were reviewed, comparing right and left pulmonary abnormalities. Fifteen infants (Group I) did not develop a persistent ductus arteriosus (PDA). Forty-two infants developed a PDA, which was successfully treated with indomethacin in 17 infants (Group II), while in 25 infants (Group III) the ductus was closed surgically. Analysis of the three groups showed that infants who had undergone surgical closure of their PDA developed significantly more asymmetrical broncho-pulmonary damage. Statistically significant fewer radiological findings of broncho-pulmonary damage were found on the left side in comparison with the right side in the group treated surgically.     

The value of radiology in the idiopathic respiratory distress syndrome: a radiological and pathological correlation study.

The authors have reviewed the chest radiographs of 337 newborn babies who were referred for examination with respiratory distress. They have devised a system of grading of severity of hyaline membrane disease according to the degree of radiological changes and have been able to give a prognosis for each grade. The various complications of hyaline membrane disease have been reviewed. One hundred and sixteen autopsies were carried out and the radiological and pathological findings were correlated. A positive relationship in 82% of cases was found.