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Pre-and Postoperative Evaluation of Patent Ductus Arteriosus in Children.

Journal of the Korean Pediatric Society 1985;28(7):683-694.
Published online July 31, 1985.
Pre-and Postoperative Evaluation of Patent Ductus Arteriosus in Children.
In Hee Park, Jung Hee Lee, In Joon Seol, Heung Jae Lee
Department of Pediatrics,Hanyang University,College of Medicine, Seoul, Korea
소아기 동맥관개존증의 임상적 고찰 및 수술후 변동에 관한 연구
박인희, 이정희, 설인준, 이흥재
한양대학교 의과대학 소아과학교실
Abstract
During a period of IOV12 years, from April, 1974 to July, 1984, 92 cases under 15 years of age with isolated patent ductus arteriosus were observed and evaluated pre- and postoperatively at pediatric department, Hanyang University Hospital, and those were confirmed by cardiac catheterization and/or surgery. The summary of observation made is as follows: 1)The sex ratio of male to female was 1 : 2.5. The highest age incidence was observed in the children from 2 to 5 years(40.2%) and 54.3% of children observed was under the age of 5 years. 2)The main symptoms of admission were frequent respiratory infection (71.7%), exertional dyspnea(30.4%), growth retardation(15.2%) and palpitation(15.2%) in the order of frequency. 3)Important preoperative physical findings observed were continuous murmur in 83.7%, atypical murmur in 16.3%, unusual murmur location in 13.2%, thrill in 95.7%, bounding pulse in 91.4%, heaving in 85.7%, precordial bulging in 45.7%, P2 accentuation in 32.9%, wide pulse pressure in 82.6% and low diastolic pressure in 65.1% of the PDA children. 4)Preoperative EKG revealed normal axis in 83.3%, left axis deviation in 1.1% and right axis deviation in 15.6% as frontal QRS axis; no hypertrophy in 11.1%, left ventricular hypertrophy in 48.9%, biventricular hypertrophy in 36.7% and right ventricular hypertrophy in 3.3% as ventricular hypertrophy pattern; P-mitrale in 47.8%, P-pulmonale in 13.3% and PR prolongation in 2.2% as other abnormal findings. 5)Chest X-ray showed cardiac enlargement in 88.6%, pulmonary plethora in 87.5%, pulmonary conus bulging in 43.2%, prominant aort in 35.2%, and ‘fill-in* sign in 13.6% of the cases. 6)From the preoperative characteristics of 4 hemodynamic groups (Group I : Qp/Qs<2.0, Pp/Ps<0.5; Group H : Qp/Qs>2.0, Pp/Ps<0.5; Group I : Qp/Qs>2.0, Pp/Ps>0.5; Group IV : Qp/Qs<2.0, Pp/Ps>0.5), the values of pulse pressure, cardiothoracic ratio and LA/Ao ratio in echocardiogram showed gradual increment from Group I to Group U, while diastolic pressure in aorta showed gradual lowering. The basic ventricular hypertrophy pattern on EKG was left ventricular in Group I, Group II and Group III. But the incidence of combined ventricular hypertrophy were gradually increased from Group I to Group IV, and right ventricular hypertrophy pattern was shown mainly in Group IV. 7)The ventricular hypertrophy patterns of EKG and hemodynamic datas revealed the close correlation of LVH with Qp/Qs, and RVH with Pp/Ps, Rp/Rs and pulmonary arterysystolic pressure. 8)Eighty-seven patient were operated during the observation period with no sugical mortality, and were followed. Postoperative values of RV6 and SVJ+RV6 on EKG were used as very simple and sensitive index to follow the postoperative regression of left ventricular hypertrophy in patent ductus arteriosus, the average values of which turned back to normal range in 2 months after operation in our cases
Key Words: Patent ductus arteriosus, Pre- and post-operative, EKG, Hemodynamic data, Korean Children


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