Surgical closure of the patent ductus arteriosus and its effect on the cerebral tissue oxygenation
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Published on: December 23, 2022
J Vanderhaegen1, D De Smet, B Meyns
1Department of Paediatrics, University Hospital Leuven UZ Gasthuisberg, Leuven, Belgium. Joke.vanderhaegen@uz.kuleuven.ac.be
Insights
Surgical patent ductus arteriosus (PDA) clipping does not negatively impact cerebral oxygenation in preterm infants. Near-infrared spectroscopy (NIRS) monitoring showed no lasting adverse effects on brain oxygenation after PDA ligation.
Area of Science:
- Neonatal physiology
- Cardiovascular surgery
- Neurodevelopmental research
Background:
- Surgical patent ductus arteriosus (PDA) ligation is an option for neonates when medical management fails.
- Concerns exist regarding potential neurodevelopmental issues following PDA clipping.
Purpose of the Study:
- To investigate the immediate and short-term effects of PDA clipping on cerebral oxygenation in preterm infants.
- To assess changes in cerebral tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) during and after surgical PDA ligation.
Main Methods:
- Near-infrared spectroscopy (NIRS) was used to monitor cerebral TOI and FTOE in ten preterm infants undergoing PDA ligation.
- Hemodynamic parameters including heart rate (HR) and mean arterial blood pressure (MABP) were continuously recorded.
- Data analysis focused on changes at 5 minutes and 1 hour post-clipping.
Main Results:
- At the time of clipping, a significant increase in TOI (2.9%) and HbD, along with a decrease in FTOE (0.02%), was observed.
- Heart rate also showed a significant increase immediately after clipping.
- Cerebral and peripheral parameters returned to baseline levels within one hour post-clipping.
Conclusions:
- Surgical patent ductus arteriosus (PDA) clipping itself does not appear to have a negative impact on cerebral oxygenation.
- The observed transient changes in cerebral oxygenation are not sustained, suggesting no long-term adverse effects from the clipping procedure.
Aim:
Surgical patent ductus arteriosus (PDA) ligation is considered after failure or contraindication of medical treatment. Till now ligation of the PDA has been associated with low morbidity and mortality although recently concerns have been raised about the possible association of ductal clipping and neurodevelopmental abnormalities later in life. By means of near-infrared spectroscopy (NIRS), we analysed the changes in the cerebral tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) at the time of clipping as well as after clipping.
Method:
Ten preterm infants with a symptomatic PDA who underwent surgical ligation were continuously monitored for heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SaO(2)) and TOI from 1 h before up to 1 h after clipping. FTOE and haemoglobin difference (HbD) were calculated. Changes in parameters at 5 min after ligation represent the effect of the clipping itself whereas changes up to 1 h-post-clipping represent the post-clipping effect.
Results:
At the exact time of clipping, over the entire group, we found a significant increase in TOI of 2.9% (p = 0.037), in HbD of 12.5 micromol/l (p = 0.047) and in HR of 6.5 bpm (p = 0.012). FTOE significantly decreased by 0.02% (p = 0.013). One hour post-clipping, the cerebral and peripheral parameters were not significantly different from the control values before clipping.
Conclusion:
The ductal clipping in se has no negative effect on the cerebral oxygenation.
