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Left ventricular dysfunction postsurgical patent ductus arteriosus ligation in children: predictor factors analysis
Mohamed Abdel-Bary1, Khaled Abdalla Abdel-Baseer2, Ahmed Fathy Abdel-Latif3
1Department of cardiothoracic surgery, Qena Faculty of Medicine, South Valley University, Safaga Road, Qena, 83523, Egypt. Dr_abdelbary@med.svu.edu.eg.
Insights
Surgical closure of patent ductus arteriosus (PDA) can cause temporary left ventricular (LV) systolic dysfunction. PDA size and preoperative LV function are key predictors of this dysfunction.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect in children.
- Surgical closure of PDA leads to significant hemodynamic changes.
- Understanding these changes is crucial for patient management.
Purpose of the Study:
- To identify predictors of left ventricular (LV) dysfunction after PDA surgical ligation.
- To assess the impact of PDA ligation on LV systolic function.
- To establish monitoring guidelines for post-ligation LV function.
Main Methods:
- Retrospective study of 50 children with isolated PDA undergoing surgical ligation.
- Two-dimensional echocardiography used to assess LV dimensions and systolic function pre- and post-ligation.
- Follow-up at 1 day, 1 month, and 6 months post-surgery.
Main Results:
- LV dimensions and systolic function (EF, FS) decreased significantly by day 1 post-ligation.
- Further decreases in LVEDd and LA/Ao observed at 1 month, with gradual improvement in EF and FS.
- PDA size, patient age, preoperative LVEDd, and FS were identified as predictors.
Conclusions:
- PDA ligation is associated with early and significant LV systolic dysfunction.
- This dysfunction may necessitate anti-failure measures and prolonged monitoring.
- Preoperative factors like PDA size and LV function can predict the severity of post-ligation dysfunction.
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 .
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