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Dichotomy in biventricular function, progress and recovery among extreme preterm infants with persistent ductus

Krishna Revanna Gopagondanahalli1, Joyce Khoo May Lyn2, Abdul Alim Abdul Haium1

  • 1Department of Neonatology, KK Women's and Children's Hospital, Singapore; Yong Loo Ling School of Medicine, Singapore; Lee Kong Chian School of Medicine, Singapore; Duke- NUS Medical School, Singapore.

Pediatrics and Neonatology
|April 2, 2026
PubMed

Insights

Persistent patent ductus arteriosus (PDA) in extremely premature infants is linked to prolonged right ventricular dysfunction, which lasts longer than left ventricular changes. This highlights biventricular functional differences in neonates with PDA.

Area of Science:

  • Neonatal Cardiology
  • Pediatric Cardiac Surgery
  • Fetal Medicine

Background:

  • Patent ductus arteriosus (PDA) is a common condition in extremely premature infants, potentially leading to significant cardiovascular complications.
  • Biventricular cardiac function assessment is crucial for understanding the impact of PDA on neonatal hemodynamics.
  • Tissue Doppler echocardiography offers valuable insights into myocardial function in this vulnerable population.

Purpose of the Study:

  • To evaluate the impact of persistent PDA on biventricular cardiac function in extremely premature infants.
  • To compare the progression and recovery of cardiac function between infants with and without persistent PDA.

Main Methods:

  • Prospective observational study involving 80 infants born before 28 weeks gestation.
  • Serial cardiac function assessment using tissue Doppler echocardiography at 4-week intervals until 36 weeks gestation.
  • Comparison of biventricular function parameters between infants with persistent PDA and those with a closed PDA.

Main Results:

  • Persistent PDA was associated with higher incidences of moderate to severe bronchopulmonary dysplasia (BPD) and BPD with pulmonary hypertension (BPD-PH).
  • Infants with persistent PDA exhibited prolonged right ventricular (RV) isovolumetric relaxation time (IVRT) and RV myocardial performance index (MPI).
  • Left ventricular (LV) dysfunction, indicated by a higher LV E/E' ratio and abnormal LV eccentricity index, was observed in the persistent PDA group and normalized by 36 weeks, while RV dysfunction persisted.

Conclusions:

  • A significant dichotomy exists in biventricular function, progression, and recovery in extremely premature neonates with PDA.
  • Right ventricular dysfunction is more consistent and persistent compared to left ventricular changes in PDA-exposed infants.
  • These findings underscore the long-term impact of PDA on neonatal cardiac health and the need for targeted monitoring.
Abstract

Keywords:
Bronchopulmonary dysplasiaExtreme prematurityFunctional echocardiographyPatent ductus arteriosusPulmonary hypertensionTissue Doppler imaging

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