Biventricular function in preterm infants with patent ductus arteriosus ligation: A three-dimensional echocardiographic study

Katsuaki Toyoshima; Hirosato Aoki; Takahiro Noguchi; Naka Saito; Tatsuto Shimizu; Takahiro Kemmotsu; Tomoyuki Shimokaze; Tomoko Saito; Jun Shibasaki; Motoyoshi Kawataki; Toshihide Asou; Tsuyoshi Tachibana; Satoshi Masutani

doi:10.1038/s41390-024-03180-w

Biventricular function in preterm infants with patent ductus arteriosus ligation: A three-dimensional echocardiographic study

Pediatr Res. 2024 Apr 13. doi: 10.1038/s41390-024-03180-w. Online ahead of print.

Affiliations

¹ Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan. ktoyoshima@kcmc.jp.
² Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan.
³ Department of Clinical Laboratory, Kanagawa Children's Medical Center, Yokohama, Japan.
⁴ Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
⁵ Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.

PMID: 38615076
DOI: 10.1038/s41390-024-03180-w

Abstract

Background: The detailed hemodynamics after patent ductus arteriosus (PDA) ligation in preterm infants remain unknown. We aimed to clarify the effect of surgical ligation on left ventricular (LV) and right ventricular (RV) volume and function.

Methods: Echocardiography was performed in 41 preterm infants (median gestational age: 25 weeks) before and after PDA ligation. Global longitudinal strain was determined using three-dimensional speckle-tracking echocardiography. These values were compared with those in 36 preterm infants without PDA (non-PDA).

Results: Preoperatively, the PDA group had greater end-diastolic volume (EDV) and cardiac output (CO) in both ventricles, a higher LV ejection fraction (LVEF) (53% vs 44%) and LV global longitudinal strain, and a lower RVEF (47% vs 52%) than the non-PDA group. At 4-8 h postoperatively, the two groups had a similar LVEDV and RVEDV. However, the PDA group had a lower EF and CO in both ventricles than the non-PDA group. At 24-48 h postoperatively, the RVEF was increased, but the LVEF remained decreased, and LVCO was increased.

Conclusions: PDA induces biventricular loading and functional abnormalities in preterm infants, and they dramatically change after surgery. Three-dimensional echocardiography may be beneficial to understand the status of both ventricles.

Impact: Preterm infants are at high risk of hemodynamic compromise following a sudden change in loading conditions after PDA ligation. Three-dimensional echocardiography enables quantitative and serial evaluation of ventricular function and volume in preterm infants with PDA. PDA induces biventricular loading and functional abnormalities in preterm infants, and they dramatically change after surgery.