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Left ventricular dysfunction postsurgical patent ductus arteriosus ligation in children: predictor factors analysis.

ABSTRACT: OBJECTIVE:To identify the predictor factors of left ventricular (LV) dysfunction following patent ductus arteriosus (PDA) surgical ligation. BACKGROUND:PDA is viewed as a noticeable amongst the most widely recognized congenital heart defects in children and its closure is responsible for many hemodynamic changes that require intervention and care. METHODS:A retrospective study included fifty children with isolated PDA treated by surgical ligation from June 2015 to June 2018. The LV dimensions and systolic function were assessed by two-dimensional echocardiography pre and post PDA ligation. All cases were followed-up on the first-day, 1 month and 6 months post ligation. RESULTS:The mean age of cases was 15.78?±?7.58?months and 72% were females. The mean duct size was 4.08?±?1.25?mm. There was a marked decrease in LVEDd, LA/Ao, EF and FS in the first-day post ligation contrasted with pre ligation values. Moreover, an amazing decline in LVEDd and LA/Ao ratio was observed 1 month post ligation contrasted with the early post ligation status with asynchronous improvement of FS and EF at one and 6 months postoperatively. CONCLUSION:PDA ligation is associated with a noteworthy LV systolic dysfunction within the first day post ligation; that in a significant number of patients may require anti-failure measures, prolong the hospital stay and necessitate a regular follow up and monitoring of LV function. PDA size, age, preoperative LVEDd and FS can be considered as predictor factors for suspicion of acute decrease in the LV systolic function early post PDA ligation. TRIAL REGISTRATION:ClinTrial.Gov NCT04018079 .

SUBMITTER: Abdel-Bary M

PROVIDER: S-EPMC6751680 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Left ventricular dysfunction postsurgical patent ductus arteriosus ligation in children: predictor factors analysis.

Abdel-Bary Mohamed M Abdel-Baseer Khaled Abdalla KA Abdel-Latif Ahmed Fathy AF Abdel-Naser Mohamed Abdella MA Nafie Mahmoud M Eisa Karam Mosallam KM

Journal of cardiothoracic surgery 20190918 1

<h4>Objective</h4>To identify the predictor factors of left ventricular (LV) dysfunction following patent ductus arteriosus (PDA) surgical ligation.<h4>Background</h4>PDA is viewed as a noticeable amongst the most widely recognized congenital heart defects in children and its closure is responsible for many hemodynamic changes that require intervention and care.<h4>Methods</h4>A retrospective study included fifty children with isolated PDA treated by surgical ligation from June 2015 to June 2018 ...[more]

PMID: 31533759

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Project description:OBJECTIVE:Preoperative risk factors associated with poor outcomes after patent ductus arteriosus ligation in preterm infants have not been well defined. The aim of this study was to determine the association between preoperative echocardiographic measures of left ventricular mechanics and postoperative clinical outcomes after patent ductus arteriosus ligation. METHODS:Preterm infants less than 90 days of age with no other significant congenital anomalies who underwent patent ductus arteriosus ligation between 2007 and 2015 were considered for retrospective analysis. The primary outcome was peak postoperative vasoactive inotropic score. Conventional echocardiographic measures of ventricular size, function, and patent ductus arteriosus size were performed. Echocardiographic single-beat, pressure-volume loop analysis estimates of contractility (end-systolic elastance) and afterload (arterial elastance) were calculated. Ventriculoarterial coupling was assessed using the arterial elastance/end-systolic elastance ratio. Multivariable linear regression was performed using clinical and echocardiographic data. RESULTS:Echocardiograms from 101 patients (42.5% male) were analyzed. We found a statistically significant association between vasoactive inotropic score and both end-systolic elastance and arterial elastance. No patient with arterial elastance/end-systolic elastance greater than 0.78 (n = 32) had a vasoactive inotropic score 20 or greater. Analysis of our secondary outcomes found associations between preoperative end-systolic elastance and postoperative urine output less than 1 mL/kg/h at 24 hours, creatinine change greater than 0.5 mg/dL, and time to first extubation. CONCLUSIONS:End-systolic elastance and arterial elastance were the only predictors of postoperative vasoactive inotropic score after patent ductus arteriosus ligation in preterm infants. Those neonates with increased contractility and low afterload were at highest risk for elevated inotropic support. These findings suggest a role for echocardiographic end-systolic elastance and arterial elastance in the preoperative assessment of preterm infants undergoing patent ductus arteriosus ligation.

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Left ventricular dysfunction postsurgical patent ductus arteriosus ligation in children: predictor factors analysis.

Publications

Left ventricular dysfunction postsurgical patent ductus arteriosus ligation in children: predictor factors analysis.

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