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Significance of reverse orientation of the ductus arteriosus in neonates with pulmonary outflow tract obstruction for early intervention.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2006 Mar 01; Vol. 97 (5), pp. 716-9. Date of Electronic Publication: 2006 Jan 11. - Publication Year :
- 2006
-
Abstract
- Reverse orientation of the ductus arteriosus (RDA), defined as an inferior angle at the aortic junction of <90 degrees , is associated with pulmonary atresia; however, the significance of RDA in nonatretic pulmonary outflow tract obstruction (POTO) is unknown. The purpose of this study was to evaluate the relation between ductal morphology and the need for early intervention. Ductal morphology was retrospectively reviewed in 76 neonatal cases of POTO. Patients were stratified to those with conotruncal (CT) or primary pulmonary valve (PV) abnormalities. The prevalence of RDA was 40 of 68 (59%) and was higher in patients with CT defects (28 of 30, 93%) compared with PV abnormalities (12 of 38, 32%; chi-square = 26.4, p <0.0001). Early intervention was required in 29 of 40 patients with RDA (73%) compared with only 8 of 28 patients with normal ductal morphology (31%; chi-square = 12.8, p <0.001). The proportion of patients with RDA who required early intervention was greater in PV abnormalities (12 of 12, 100%) compared with CT defects (17 of 28, 61%; chi-square = 6.5, p <0.02). Importantly, after excluding patients with pulmonary atresia, these analyses were unchanged. In patients with nonatretic POTO, a threshold inferior angle of 65 degrees was predictive of the need for early intervention. RDA in patients with PV abnormalities, or CT defects and an inferior angle <65 degrees , is a specific indicator for early intervention. These findings demonstrate an association between RDA in the context of atretic and nonatretic POTO and the need for early intervention. The need for early intervention should be considered when RDA is identified in this population.
- Subjects :
- Aortic Valve pathology
Aortic Valve surgery
Ductus Arteriosus, Patent diagnostic imaging
Ductus Arteriosus, Patent epidemiology
Echocardiography
Humans
Infant, Newborn
Prevalence
Pulmonary Valve Stenosis diagnostic imaging
Pulmonary Valve Stenosis epidemiology
ROC Curve
Retrospective Studies
Time Factors
Treatment Outcome
Catheterization
Ductus Arteriosus, Patent pathology
Ductus Arteriosus, Patent therapy
Heart Bypass, Right
Pulmonary Valve Stenosis pathology
Pulmonary Valve Stenosis therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0002-9149
- Volume :
- 97
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 16490444
- Full Text :
- https://doi.org/10.1016/j.amjcard.2005.09.121