J Cardiovasc Ultrasound.  2017 Dec;25(4):131-137. 10.4250/jcu.2017.25.4.131.

Outcomes of Left Ventricular Function According to Treatment Response for a Patent Ductus Arteriosus in Preterm Infants

• Kang SJ
• Cho YS
• Hwang SJ
• Kim HJ

• KMID: 2399414
• DOI: http://doi.org/10.4250/jcu.2017.25.4.131

Abstract

BACKGROUND
To evaluate the outcomes of left ventricular (LV) function according to treatment response for a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants.
METHODS
Echocardiograms of 21 preterm infants born at gestational age < 31 weeks obtained at term-equivalent age were retrospectively studied. Among preterm infants with a hsPDA, 9 underwent ligation after failure of pharmacological closure (ligation group) and 6 experienced successful pharmacological closure (medication group). Six preterm infants without hsPDA (no-hsPDA group) were studied as controls. LV peak longitudinal systolic strain (ε) of each infant was retrospectively obtained from echocardiograms using velocity vector imaging, along with neonatal outcomes.
RESULTS
Pharmacological closures were attempted at postnatal day 2-3. In the ligation group, the median postnatal age at ligation was 20 days. In the ligation group, LV peak longitudinal systolic ε was significantly decreased at term-equivalent age compared to the other groups. Between the medication and no-hsPDA groups, LV peak longitudinal systolic ε did not differ significantly. Among the neonatal outcomes, infants who experienced necrotizing enterocolitis (NEC) showed significantly decreased LV peak longitudinal systolic ε compared to the infants who did not experience NEC .
CONCLUSION
We speculate that in preterm infants with an hsPDA, in cases of medical treatment failure, early PDA ligation at less than 20 days of postnatal age would be beneficial for preserving LV systolic function.

Keyword

Ductus arteriosus; Premature; Myocardium; Systole; Ventricle

MeSH Terms

Ductus Arteriosus
Ductus Arteriosus, Patent*
Enterocolitis, Necrotizing
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature*
Ligation
Myocardium
Retrospective Studies
Systole
Treatment Failure
Ventricular Function, Left*

Figure

• 

  Fig. 1 Left ventricular (LV) longitudinal peak systolic. A: LV longitudinal peak systolic ε obtained by velocity vector imaging from the apical four-chamber view. B: LV longitudinal peak systolic ε was identified as the highest point of the average of the derived six curves by the software. ε: strain.

• 

  Fig. 2 Representative examples of left ventricular longitudinal peak systolic ε in the no-hsPDA group (A), medication group (B), and ligation group (C). ε: strain.

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