title: Novel treatment criteria for persistent ductus arteriosus in neonates.
abstract: BACKGROUND
  The indications for ductus arteriosus ligation in very-low-birth-weight infants (VLBWIs) with persistent ductus arteriosus (PDA) are unclear. Increased left ventricular end-diastolic dimension (LVDd) is commonly found in patients with PDA. Here, the enlargement of LVDd in term and preterm neonates without congenital heart disease was estimated by two-dimensional echocardiography.
  
  
  METHODS
  The value of the measured LVDd was divided by the normal LVDd as an index (LVDd ratio) to compare 30 patients who underwent PDA ligation with 30 patients treated with indomethacin and 30 patients who did not undergo radical therapy.
  
  
  RESULTS
  An LVDd ratio between 122% and 197% (mean, 142%) was considered to be an indication for the ligation procedure. The proportion of patients exceeding 130% in the LVDd ratio was 87% (26/30) in those patients who underwent ligation. Catecholamines and/or vasodilators were required in 83% patients for the treatment of low ejection fraction or hypertension after operations, suggesting that patients had been in preload and/or afterload remodeling failure during the operation. The percentage of patients with less than 115% in the LVDd ratio was 90% in the non-radical-therapy patients. The LVDd ratios of 130% and 115% were regarded as cut-off values for surgical ligation and indomethacin treatment.
  
  
  CONCLUSIONS
  The LVDd ratio is a useful measure to determine the treatment of VLBWIs with PDA.
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan. Electronic address: hironag@ccn2.aitai.ne.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagasawa
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Terazawa
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kohno
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Sugawara
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Toshinari
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Miura
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000188:drug therapy; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D008026:Ligation; D008297:Male
chemical_list: D002317:Cardiovascular Agents; D007213:Indomethacin
keywords: Qp/Qs; left ventricular end-diastolic dimension; treatment criteria; two-dimensional echocardiography; very-low-birth-weight infant