Related Experiment Video
Updated: Oct 12, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Short-term ventriculo-arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous
Adrianne R Bischoff1, Amy H Stanford1, Patrick J McNamara1,2
1Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.
Insights
Closing a patent ductus arteriosus (PDA) in preterm infants significantly alters left ventricular (LV) loading conditions. This study reveals major short-term changes in ventriculo-arterial coupling (VAC) and myocardial energetics post-closure.
Area of Science:
- Neonatal Cardiology
- Pediatric Cardiovascular Physiology
- Medical Interventions
Background:
- Patent ductus arteriosus (PDA) closure in preterm infants causes significant left ventricular (LV) loading changes, potentially leading to cardiorespiratory instability.
- Understanding LV adaptation through ventriculo-arterial coupling (VAC) and myocardial work-energetics is crucial for managing these infants.
Purpose of the Study:
- To assess short-term changes in VAC and myocardial work-energetics after percutaneous PDA closure in preterm infants.
- To identify factors associated with post-closure cardiorespiratory instability.
Main Methods:
- Retrospective cohort study of 35 preterm infants undergoing percutaneous PDA closure.
- Echocardiographic assessment of VAC parameters (end-systolic elastance [EES], arterial elastance [EA]) and myocardial work indices before and 1-hour after closure.
- Analysis of preload, stroke volume, and global work efficiency.
Main Results:
- PDA closure led to reduced preload and stroke volume.
- Significant increases in EA (38.6 to 60 mmHg/ml/kg) and EES (72 to 91.6 mmHg/ml/kg) were observed post-closure.
- Global work efficiency decreased (93.9% to 91.1%), and 48.6% of patients experienced post-closure instability, linked to younger age and higher EA/EES.
Conclusions:
- Percutaneous PDA closure induces substantial acute alterations in ventriculo-arterial coupling and myocardial energetics.
- These findings offer insights into PDA closure physiology and infant vulnerability to altered loading conditions.
Abstract:
Definitive closure of a patent ductus arteriosus (PDA) causes significant changes in loading conditions of the left ventricle (LV) which can lead to cardiorespiratory instability including hypotension, low cardiac output, oxygenation, and ventilation impairment. Physiological insights of the adaptation of the LV can be gained by looking at ventriculo-arterial coupling (VAC) and myocardial work-energetics. We conducted a retrospective cohort study of preterm infants with echocardiographic assessment of VAC parameters, including end-systolic and arterial elastance (EES , EA ), and myocardial work indices derived from longitudinal strain analysis before and 1-h after percutaneous PDA closure. A total of 35 patients were included with mean [±SD] age at intervention of 30.8 ± 9.9 days and median [IQR] weight of 1130 [995, 1318] grams. There was a reduction in preload and stroke volume, an increase in EA (38.6 ± 11.4 vs. 60 ± 15.1 mmHg/ml/kg, p < 0.001) and in EES (72 [61.5, 109.8] vs. 91.6 [72.2, 125.2] mmHg/ml/kg, p = 0.003) post-closure. Myocardial work indices reduced after PDA closure, including global work efficiency (93.9 ± 2.3 vs. 91.1 ± 3.6%, p < 0.001). A total of 17 (48.6%) patients developed post-closure instability which was associated with younger age, lower preload, and higher EA and EES . Percutaneous PDA closure is associated with major short-term changes in VAC and myocardium energetics, which may provide novel insights on the physiology of PDA closure and on the differential vulnerability to changes in loading conditions.
