A Study On The Spontaneous Closure Of The Patent Ductus Arteriosus By Echocardiography In Neonates

Objective 1.To evaluate the cardiac function and the changes of hemodynamics in neonates with patent ductus arteriosus by using speckle tracking imaging of two-dimensional echocardiography.2.To analyze the value of hemodynamic parameters of echocardiography in predicting the spontaneous closure of the patent ductus arteriosus in neonates,and provide guidance for the timing of clinical intervention.Methods 1.Object: 92 neonates were selected from the neonatal ward of our hospital from from October 2016 to December 2017.All were hospitalized within 24 hours after birth.62 cases were evaluated every other day until ductal close within seven days,and divided into PDA group(22 cases)and spontaneous closure group(40 cases)according to weather the ductus arteriosus close or not.30 normal neonates were used as control group.2.Equipments: Using GE vivid E9 ultrasoud system with newborns probe(M12S)and Echo PAC work station 3.Measurements: Using speckle tracking imaging of two-dimensional echocardiography to measure the global longitudinal strain of left ventricle and right ventricle.Using tissue doppler imaging(TDI)to measure the tei index of the left ventricle and right ventricle.using two dimensional echocardiography to measure cardiac index(CI),left ventricular ejection fraction(LVEF),fractional shortening of left ventricle(LVFS)and pulmonary arterial systolic pressure(PASP).the tei index of the left ventricle and right ventricle,cardiac index and pulmonary arterial systolic pressure(PASP)were also measured before and after closure of the sponateous closure group.The PDA group and spontaneous closure group was accepted measurements including the inner diameter of ductus arteriosus(DAD),left atrial end-diastolic diameter(LA),the inner diameter of the aortic root(AO),left ventricular end-diastolic diameter(LV),the flow velocity and pressure in narrowest,pulmonary arterial systolic pressure(PASP),calculating the ratio of the inner diameter of ductus arteriosus and body surface area(DAD/BSA),left atrial end-diastolic diameter and the inner diameter of the aortic root(LA/AO),left ventricular end-diastolic diameter and the inner diameter of the aortic root(LV/AO).The value of parameters to predict the spontaneous closure of PDA in neonates were analysised by ROC curve.Analyze the the correlations between DAD/BSA and PASP,DAD/BSA and LA/AO,PASP and the Tei index of the right ventricle,PASP and the global longitudinal strain of right ventricle.Results 1.The cumulative sponateous closure rate of patent ductus arteriosus at different days of age in neonates was 3d(32.3%),5d(51.6%),and 7d(62.3%).2.Compared with the spontaneous closure group and the control group,the global longitudinal strain of left ventricle and right ventricle were lower in the PDA group(P<0.05),the Tei index of left ventricle and right ventricle and CI were higher in the PDA group,and the more significantly higher in the PDA group(P<0.05).There was no significant difference among the three groups of LVEF and LVFS(P>0.05).3.The LV-Tei index,RV-Tei index,PASP and CI were decreased significantly(P<0.05)after closure of the ductus arteriosus.4.Compared with the spontaneous closure group,the DAD/BSA,LA/AO,LV/AO and PASP were increased significantly in PDA group(P<0.05),the velocity and pressure of the ductus arteriosus were lower in PDA group(P<0.05).5.The hemodynamic indexes of DAD/BSA,LA/AO,LV/AO,PASP,the flow velocity and pressure of the ductus arteriosus were found to be good independent predictors of spontaneous closure.The best cutoffs were 19.45mm/m2,1.56,2.15,42 mm Hg,2.31m/s,21.4mm Hg.6.Correlation analysis showed that there were positive correction between DAD/BSA and LA/AO,PASP(r=0.77,0.66,P<0.05).The correlation between PASP and RV-Tei index,R-GLS were good(r=0.66?-0.73,P<0.05).Conclusion 1.The cardiac function will be impaired if the patent ductus arteriosus fails to intervene at the right time,thus affecting the prognosis and survival rate of the neonates.speckle tracking imaging of two dimensional echocardiography can be more sensitive to reflect early myocardial function.2.The hemodynamic parameters of echocardiography can predict the spontaneous closure of ductus arteriosus and provide guidance for the early treatment of neonates.