Echocardiographic diastolic flutter of the pulmonary valve in isolated patent ductus arteriosus.

M-mode echocardiograms performed in 192 infants and children with a clinical diagnosis of isolated patent ductus arteriosus were reviewed. Thirty-six (19 percent) had unequivocal diastolic pulmonary valve flutter. The diagnosis was confirmed in 39/192 patients. Of these, 15 (38 percent) had diastolic flutter of the pulmonary valve. Eight of these 15 patients were full-term infants and children 20 days to 43i years of age at initialecho study. All eight, plus three premature infants six to 11 days of age at the time of the initial echo study, underwent diagnostic cardiac catheterization, cineangiography, and surgery, Three additional premature infants had surgical closure of the ductus, and another premature infant had autopsy confirmation of the diagnosis. In the patients with a confirmed diagnosis of patent ductus but without diastolic pulmonary valve flutter, the diagnosis was confirmed by cardiac catheterization (20 patients), surgery (14 patients, three of whom had no catheterization), and autopsy (two patients, one of whom had no catheterization). Pulmonary valve echograms in 64 patients with documented subvalvular pulmonary stenosis (one isolated, five double chambered right ventricle, and 58 tetralogy of Fallot-43 preoperative only, 14 preoperative and postoperative, and 15 postoperative only) and in 50 infants with clinically normal hearts were reviewed for the presence of diastolic pulmonary valve flut-