Diagnostic values of related ventricular indicators for neonatal critical pulmonary stenosis

Abstract

Objective To investigate diagnostic values of critical pulmonary stenosis (CPS) in neonates by ratio of right ventricular diameter to left ventricular end-diastolic diameter (RVD/LVEDD) and ratio of right ventricular systolic pressure to left ventricular systolic pressure (RVSP/LVSP). Methods From January 2016 to November 2018, a total of 28 neonates with simple CPS who were underwent percutaneous balloon pulmonary valvuloplasty (PBPV) in Qingdao Women and Children′s Hospital, were chosen as research subjects and enrolled in CPS group. Meanwhile, a total of 27 neonates with moderate pulmonary stenosis (MPS) who received PBPV because of aggravation of hyoxemia in the same hospital during neonatal period, were enrolled in MPS group as control. RVD and LVEDD were measured by color Doppler echocardiography, and values of RVSP were measured by right cardiac catheterization. General clinical data and related ventricular indicators between two groups of neonates with pulmonary stenosis (PS) were compared statistically by t test. The correlation between RVD/LVEDD and right ventricular systolic pressure (RVSP) was analyzed by linear correlation analysis. The procedure followed in this study was in accordance with World Medical Association Declaration of Helsinki revised in 2013. Informed consents of clinical research were signed by guardians of all subjects. Results ①The age and oxygen saturation of neonates in CPS group were (4.6±4.1) d and (82.3±3.7)%, respectively, which were younger or lower than those of (14.6±3.0) d and (84.7±3.5)% in MPS group, and the differences were statistically significant (t=—9.932, P<0.001; t=—2.503, P=0.015). ② RVSP, RVSP/LVSP and RVD/LVEDD of neonates in CPS group were (97.5+ 7.1) mmHg (1 mmHg=0.133 kPa), (1.15±0.16) and (0.70±0.05), respectively, which were higher or larger than those of (69.9±5.7) mmHg, (0.85±0.11) and (0.56±0.07) in MPS group, and the differences were statistically significant (t=15.912, 10.582, 8.823, all P<0.001). ③There was linear and positive correlation between RVD/LVEDD with RVSP of all PS neonates in this study (r=0.706, P<0.001). Conclusions The values of RVD/LVEDD obtained by color Doppler echocardiography have certain guiding value for preliminary evaluation and identification of neonatal with CPS in clinical work. The RVSP/LVSP value close to 1.0 is an important reference to diagnose neonates with CPS. Key words: Pulmonary valve stenosis; Ventricular pressure; Echocardiography, Doppler, color; Heart catheterization; Ratio of right ventricular diameter to left ventricular end-diastolic diameter; Ratio of right ventricular systolic pressure to left ventricular systolic pressure; Infant, newborn