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J Pediatr. 2014 Jul;165(1):46-52.e1. doi: 10.1016/j.jpeds.2014.03.048. Epub 2014 May 10.

Assessment and treatment of post patent ductus arteriosus ligation syndrome.

Author information

1
Department of Pediatrics, The Rotunda Hospital, Dublin, Ireland.
2
Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada; Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada.
3
Department of Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada.
4
The Labatt Family Heart Center, The Hospital for Children, Toronto, Canada.
5
Department of Physiology, University of Toronto, Toronto, Canada; Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada; Department of Neonatology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada. Electronic address: patrick.mcnamara@sickkids.ca.

Abstract

OBJECTIVE:

To compare differences in tissue Doppler imaging, global longitudinal strain (GLS), and cardiac troponin T (cTnT) between infants with low (<200 mL/kg/min) and high (>200 mL/kg/min) left ventricular (LV) output 1 hour after duct ligation and assess the impact of milrinone treatment on cardiac output and myocardial performance.

STUDY DESIGN:

LV function was assessed preoperatively and 1 and 18 hours postoperatively. Infants were categorized into a low-output or a normal-output group based on the echocardiographic assessment of LV output at 1 hour.

RESULTS:

Thirty infants with a mean gestation of 25.3 weeks were enrolled. LV basal lateral S', basal septal S', and basal right ventricular S' were lower in the low-output group (n = 19) at 1 hour postoperatively, with no significant difference in GLS (low-output -10.3% vs high-output -14.4%, P >.05) or cTnT between the groups. Patients in the low-output group were treated with milrinone, and by 18 hours LV performance recovered to levels comparable with the high output group. cTnT values increased at 18 hours in the whole cohort with no significant difference between the groups.

CONCLUSION:

Tissue Doppler imaging and GLS provide novel insights and further characterization of myocardial performance immediately after patent ductus arteriosus ligation. A reduction in tissue Doppler-derived LV systolic velocity may further help in monitoring cardiac performance after patent ductus arteriosus ligation and for monitoring the effects of treatment.

PMID:
24814414
DOI:
10.1016/j.jpeds.2014.03.048
[Indexed for MEDLINE]

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