| Purpose:The purpose of this study was to explore the Echocardiography performance and matters needing attention of the persistent pulmonary hypertension of newborns (PPHN), based on this, to improve the clinical value of echocardiography in diagnosis of PPHN and reduce the occurrence of missed diagnosis and misdiagnosis of this disease.Methods:We collected42newborns suffer from PPHN which diagnosed by pediatrician and confirmed by Echocardiography as case group,40newborns as control group which had no cyanosis and dyspnea and confirmed normal by Echocardiography. All the infant patients were diagnosed and treated in our hospital during January2008to January2012and undertaken Echocardiography examination within24hours after hospitalized. The regular exploration contained tangent plane of parasternal, the tip of the heart, subcostal and suprasternal fossae. The anatomic structure and bloodstream of every tangent plane were observed and efferent tract block of ventriculus dexter, pulmonary artery narrow, cardiogenic pulmonary artery hypertension were excluded. We regrouped the case group into three subgroups of mild, medium and severe based on pulmonary artery systolic press (PASP). Other measure items contained internal diameters of every atrium, ventricle and main artery, fraction of blood ejection and other abnormal hemodynamic data. Every infant patient was reexamined Echocardiography one to three days and the same baby used the same echocardiograph in the same condition. SPSS17.0package was used in statistical analysis. Measurement data was expressed in the form of (x±s) and T test was employed in analyses with the standard of P<0.05. Correlation analysis of ranked data was conducted to deduce whether there was correlativity.Results:(1) Tricuspid regurgitation (TR) in PPHN is all functional reflux, their levels of reflux are not associated with the degree of pulmonary hypertension. The TR disappears naturally or eases along with the decline of pulmonary hypertension in overwhelming majority of infant patients.(2) The hypoxemia of newborn aggravate accompanying with the increased pulmonary artery systolic pressure (PASP) measured by echocardiography, and with increased pulmonary artery pressure, the right atrioventricular cavity and pulmonary artery diameter have an increasing trend.(3) Two-dimensional and color Doppler image can display the right to left or bi-directional shunt of patent ductus arteriosus (PDA) or patent foramen oval (PFO) in PPHN more intuitively.(4)The ductal arch of newborn should be revealed in order to increase detection rate of PDA in pulmonary artery hypertension.(5) The right to left shunt of PDA can cause characteristic morphological changes of spectrum of anterior descending aorta catheter in severe pulmonary hypertension. The sign should be one of the indirect signs of pulmonary arterial hypertension and be raised concern.(6) Transient pulmonary artery hypertension should be considered in mild group children and its characteristic is that the hypoxemia can be corrected quickly.(7) PPHN can combine with slight and simple congenital heart disease but the heart malformation can not explain the severity and clinical symptoms of the pulmonary hypertension.(8) Part of the infant patients in severe group appears left atrioventricular cavity enlargement and left ventricle hypofunction based on the right atrioventricular cavity enlargement. This is the result of hypoxic ischemic cardiac myocardial injury and adumbrative disease deterioration.Conclusion:Echocardiography has been one of the most important and non-invasive examinations in the diagnosis of PPHN which can make qualitative and quantitative diagnosis to pulmonary arterial pressure. Through comprehensive analyzing Echocardiography, we can not only early diagnose PPHN, treat in time, reduce or avoid serious complication caused by PPHN, but also can reexamine conveniently, observe the recovery procedure dynamically, estimate the prognosis and guide the clinical diagnosis and treatment. |
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