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Patent ductus arteriosus ligation and post-operative hemodynamic instability: case report and framework for enhanced
Arvind Sehgal1, Johny Vakayil Francis, Andrew James
1Monash Newborn, Monash Children's, VIC, Australia.
Insights
Surgical closure of a patent ductus arteriosus in preterm infants can cause cardiorespiratory issues. This case highlights hydrocortisone
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Patent ductus arteriosus (PDA) ligation in preterm infants can precipitate severe cardiorespiratory compromise.
- Surgical intervention is often necessary after medical management failure, posing significant risks.
Observation:
- A 24-week gestation preterm infant experienced refractory hypotension post-PDA ligation despite aggressive cardiotropic therapy.
- Systemic hypotension persisted for 10 hours, indicating severe cardiovascular instability.
Findings:
- The addition of hydrocortisone effectively normalized blood pressure in a preterm infant with refractory hypotension after PDA ligation.
- This suggests a potential role for corticosteroids in managing post-ligation cardiovascular instability.
Implications:
- Implementing a framework for enhanced cardiovascular care, including preprocedural risk stratification and tailored clinical guidelines, is crucial.
- Utilizing functional echocardiography and interprofessional education can optimize management of hemodynamically significant PDAs in neonates.
Abstract:
Ligation of a patent ductus arteriosus can lead to severe cardiorespiratory compromise in preterm infants. This report reviews the postoperative course of a patient with significant cardiorespiratory instability following surgical ligation of the patent ductus arteriosus and presents a framework for enhanced cardiovascular care in this population. A preterm infant, born at 24 wk gestation underwent ligation of a large haemodynamically significant ductus arteriosus after failure of 2 courses of indomethacin. He developed systemic hypotension, which was aggressively treated with high doses of multiple cardiotropic agents. After 10 hr of refractory hypotension, the addition of hydrocortisone normalized blood pressure. This article outlines preprocedural categorization of infants according to ductal illness severity which facilitates the risk assignment for postoperative deterioration, development of clinical guidelines specific to the likely haemodynamic changes, enhanced role of functional echocardiography for guiding therapy, and interprofessional education.
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