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Objective To study the clinical characteristics and current treatment options of neonatal congenital portosystemic shunt (CPSS).Method A newborn infant diagnosed with CPSS complicated with iliac artery-umbilical vein fistula was studied.CNKI,VIP,WanFang and Pubmed databases were searched using CPSS and Abernethy malformation as keywords.A total of 8 papers on neonatal CPSS were retrieved from 2006 to 2016.Result The case treated in our hospital was a boy with symptom of dyspnea and cyanosis.His ultrasound cardiograph showed pulmonary hypertension,and the heart and abdominal CT scan showed portosystemic shunt,dilated portal vein and umbilical vein,patent ductus venosus (PDV) and iliac artery-umbilical vein fistula.A total of 25 patients were analyzed including our patient and 24 cases reported in 8 papers.Cases of intrahepatic shunt (n =22) were nore common than extrahepatic shunt (n =3),and most cases could be diagnosed with ultrasound.Congenital heart diseases,intrauterine growth retardation,cutaneous hemangioma were common complications of CPSS.Abnormal liver function (52.0％),hyperammonemia (28.0％),pulmonary arterial hypertension (12.0％),dyspnea (12.0％) were common clinical manifestations of neonatal CPSS.Most CPSS cases were treated non-operatively during neonatal periods,and in 40.0％ of cases the shunts were closed spontaneously,but mortality was 20.0％ among previous cases.Conclusion Abnormal hepatic function is the most common clinical symptom of neonatal CPSS.Cases of extrahepatic shunts and complicated with PDV are dangerous and operation should be done as soon as possible,meanwhile complications should be treated appropriately.
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Objective To study the closure time of neonatal ductus venosus and the Z score regression equation, and to explore the variation of closure time of neonatal ductus venosus with gestationalage.Methods Color doppler ultrasound was applied to detect the closure time of neonatal ductus venosus in normal newborns, Z score regression equation ( lnY =a +bX +cX2 ) for the closure time of neonatal ductus venosus ( Y ) was developed by regression analysis which used gestational age ( X) as an independent variable. The Z scores of the closure time of neonatal ductus venosus in different gestational age were calculated by the formula [ Z = ( M - Y )/S x , M for observation value, Y for predictivevalue].Results There were 432 cases in our study.The closure time of neonatal ductus venosus was negatively related to gestational age ( r = -0. 938 , P <0. 001 ) . The nonlinear regression equation was lnY= -5. 228+0. 089X-0. 000228X2, R2 =0. 854, Sx =0. 214(P<0. 001). Based on the predicted mean of the closure time and Sx related to different gestational age, Z scores for specific closure time of neonatal ductus venosus could be calculated by the formula [ Z =( M -Y)/Sx ] . The Z scores were normally distributed,and did not change with gestational age.Conclusions Theclosure & nbsp;time of neonatal ductus venosus is negatively related to gestational age. The Z scores obtained by the predicted nonlinear regression equation are normally distributed.
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Objective To explore ductus venous abnormal -looking blood flow parameters and spectrum morphology in the application value of fetal congenital heart disease screening.Methods 210 cases of normal fetal antenatal examination were selected as a normal control group,48 cases of congenital heart disease the fetus,then the component type according to right heart function,to the abnormal ductus venous blood flow spectrum combined with pathologic contrast analysis.Results 48 cases of CHD in the fetus,18 cases of left heart system dysplasia,30 cases of right heart system dysplasia.In order to right heart function change respectively:right heart preload increased 15 cases,right heart load increased after 25 cases,8 cases of right heart function change was not obvious.Conclusion Ductus venous and parameters have abnormal blood flow spectrum,highly suggestive fetal congenital heart disease, especially dysplasia fetal heart right system can serve as an indicators of early screening for CHD.