Hemodynamic alterations recorded by electrical cardiometry during ligation of ductus arteriosus in preterm infants.

Abstract

This is a prospective study using non-invasive electrical cardiometry to measure hemodynamic changes during surgical ligation of patent ductus arteriosus (PDA) in very low birth weight (VLBW, ≤1500g) infants. The aims of this study were to examine hemodynamic aberration caused by abrupt closure of a ductal shunting and to define factors that affect hemodynamic changes. Simultaneous measurements of heart rate (HR), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR) were collected at ten time points: 1h prior to anesthesia, at the beginning of anesthesia, starting of surgery, immediately after PDA being ligated, and 1h followed by 6, 12, 18, 24, and 48h after the surgery. Thirty infants with gestational age of 27.7 ± 2.0weeks and birth weight of 929 ± 280g were studied. Upon sudden termination of ductal shunting, there was a significant decline in CO to 73% of presurgery baseline. The deterioration in CO was associated with a decreased SV rather than HR. At the same time, there was an increase of SVR following ductal ligation. Magnitude of CO and SV reduction were higher in smaller infants (≤1kg), and recovery was to a lesser degree in infants with more severe PDA. Reduced stroke volume and elevated vascular resistance contribute to the major hemodynamic aberrations in VLBW infants receiving PDA ligation surgery.