Abstract
Background and aims: The circulatory effects of surgical ligation of a haemodynamically significant ductus arteriosus (DA) in a preterm infant are poorly understood. This study aimed to measure changes in myocardial velocities, as an assessment of ventricular function, following ligation of the DA, using the new technique of Pulsed wave tissue Doppler imaging (PWTDI).
Methods: Echocardiograms were performed within 24 hours before and after DA ligation. Myocardial velocities were measured in the basal left and right ventricles and inter-ventricular septum (RV, LV & IVS). Duct size and flow, left atrium:aortic valve ratio (LA:Ao), and left ventricular output (LVO) were also measured.
Results: Data was collected in five infants, median weight 1.4 (range 0.7-2.1) kg, gestation 26.0 (24.4- 30.3) weeks, age 25 (22-50) days. Infants were ventilated, none received inotropes. PDA diameter was 0.30 (0.20-0.33) cm, ductal flow was left to right. Following DA ligation, LVO was reduced (mean [SD], 335[118] vs. 258 [63] mL/kg/min). LA:Ao was reduced but remained above normal limits (2.2[0.3] vs.1.9[0.4]). There was a trend of reduced mean LV myocardial velocities after DA ligation, however there was considerable variation between infants (Figure 1).
Conclusions: DA ligation acutely reduces LVO, altering loading conditions in the left heart. Reduced mean myocardial velocities in the LV may represent a reduction in both systolic and diastolic function after DA ligation. Individual variation in myocardial response may explain why some, but not all, infants experience cardio-respiratory instability after DA ligation.
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Patel, N. 615 Changes in Myocardial Velocities and Haemodynamics After Surgical Ligation of the Patent Ductus Arteriosus in Preterm Infants. Pediatr Res 68 (Suppl 1), 315 (2010). https://doi.org/10.1203/00006450-201011001-00615
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DOI: https://doi.org/10.1203/00006450-201011001-00615