Specificity and accuracy of echocardiographic and clinical criteria for diagnosis of patent ductus arteriosus in fluid-restricted infants.

We assessed the utility of M-mode echocardiographic and clinical criteria for diagnosis of left-to-righ shunting PDA in fluid-restricted newborn infants. The presence of a left-to-right shunting PDA was established in 56 infants by 103 aortic contrast echo injections. The studies were graded negative (pattern 0) if only the transverse aortic arch opacified; positive (pattern I) if both the transverse aortic arch and right pulmonary artery opacified; and very positive (pattern II) if only the right pulmonary artery opacified. Simultaneously with the injections, all infants underwent clinical examinations and echocardiography. By clinical criteria, only 72% of patients were correctly identified as having a left-to-right shunting PDA. No murmur was audible during 28 of 55 Grade I or II injections. M-mode echocardiographic measurements demonstrated increasing left atrial dimensions and decreasing LPEP/LVET with each advancing pattern of infection. However, combining these determinants yielded a discriminant analysis which correctly identified only 51% of cases. These data indicate that conventional M-mode echocardiographic and clinical criteria do not have acceptable specificity or accuracy for detection of left-to-right shunting PDA in fluid-restricted premature infants.