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Published on: January 27, 2023
Narrative Review on Echocardiographic Evaluation of Patent Ductus Arteriosus in Preterm Infants
Yogen Singh1, Belinda Chan2, Shahab Noori3
1Department of Pediatrics, Division of Neonatology, University of California-UC Davis Children's Hospital, Sacramento, CA 95817, USA.
Insights
Persistent Patent Ductus Arteriosus (PDA) in preterm infants is common and linked to serious complications. Treatment decisions should focus on hemodynamic impact, not just PDA presence or size.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Medical Imaging
Background:
- Persistent Patent Ductus Arteriosus (PDA) is common in extremely preterm infants, with incidence inversely related to gestational age.
- PDA is associated with increased mortality and morbidities, including intraventricular hemorrhage, pulmonary issues, and necrotizing enterocolitis.
- Clinical trials have yielded conflicting results regarding the benefits of PDA treatment.
Purpose of the Study:
- To review echocardiographic parameters for assessing the hemodynamic significance of PDA.
- To explore the utility of lung ultrasound as an adjunct in evaluating PDA's impact on pulmonary circulation.
- To emphasize individualized PDA management based on hemodynamic effects.
Main Methods:
- Comprehensive narrative review of existing literature.
- Description of echocardiographic techniques for hemodynamic assessment.
- Discussion of lung ultrasound for evaluating pulmonary overcirculation.
Main Results:
- Echocardiography provides key parameters to understand PDA's hemodynamic impact.
- Lung ultrasound offers an adjunctive method to assess PDA's effect on pulmonary circulation.
- Individualized assessment of hemodynamic significance is crucial for effective PDA management.
Conclusions:
- PDA management requires a nuanced approach focusing on hemodynamic consequences.
- Echocardiography and lung ultrasound are vital tools for assessing PDA's impact.
- Tailoring treatment to individual hemodynamic status improves patient outcomes.
Abstract:
Persistent Patent Ductus Arteriosus (PDA) is prevalent among extremely preterm infants, with its occurrence inversely related to gestational age. A persistent PDA correlates with increased mortality and morbidities such as intraventricular hemorrhage, pulmonary hemorrhage, chronic lung disease, bronchopulmonary dysplasia, and necrotizing enterocolitis as observed clinically. Conversely, numerous randomized controlled trials have failed to demonstrate significant benefits from PDA treatment. One contributing factor to these conflicting findings is that PDA affects each individual differently depending on the cardiovascular decompensation and its hemodynamic impact. PDA management should be based on the hemodynamic significance, rather than just the presence or size of PDA. This comprehensive narrative review paper describes echocardiographic parameters that allow a better understanding of the hemodynamic impact of PDA. A newer modality, like lung ultrasound, is also described here as an adjunct to assess the PDA impact on the lungs from pulmonary overcirculation.
