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Left ventricular performance in the critically ill premature infant with patent ductus arteriosus and pulmonary
Insights
Premature infants with patent ductus arteriosus (PDA) often show enlarged left heart dimensions. Echocardiography reveals increased left ventricular performance (%SID) in PDA cases, which normalizes after PDA closure, aiding clinical management.
Area of Science:
- Pediatric Cardiology
- Neonatal Echocardiography
- Congenital Heart Defects
Background:
- Patent Ductus Arteriosus (PDA) is common in premature infants.
- Assessing cardiac function in neonates with PDA is crucial for management.
- Left cardiac dimensions and left ventricular performance require precise evaluation.
Purpose of the Study:
- To evaluate left cardiac dimensions and left ventricular performance (%SID) in premature infants.
- To differentiate cardiac status in asymptomatic infants, those with pulmonary disease, and those with PDA.
- To assess the impact of PDA closure on cardiac parameters.
Main Methods:
- Echocardiography was used to measure left cardiac dimensions.
- Percent shortening of the internal diameter (%SID) of the left ventricle was calculated.
- Infants were categorized into asymptomatic, pulmonary disease, and PDA groups.
Main Results:
- Infants with significant PDA exhibited increased left atrial and/or left ventricular end-diastolic dimensions compared to controls.
- Percent SID did not differ significantly between normal premature infants and those with pulmonary disease alone.
- Infants with PDA and left cardiac enlargement showed increased %SID, which normalized post-closure.
Conclusions:
- Echocardiography is valuable for assessing cardiac status in premature infants with PDA.
- Increased %SID in PDA with cardiac enlargement suggests altered ventricular function.
- Monitoring cardiac dimensions and %SID aids in managing PDA and potential myocardial compromise.
Abstract:
Left cardiac dimensions and an index of left ventricular performance, the percent shortening of the internal diameter (%SID) of the left ventricle, were evaluated in premature infants who were asymptomatic, others with pulmonary disease and others with patent ductus arteriosus (PDA). In contrast to controls, left atrial and/or left ventricular end-diastolic dimensions were increased in all infants with clinical criteria of significant PDA. Postoperative dimensions decreased significantly. Percent SID values for normal premature infants (m=33.5%; SD=3.5%) and those with pulmonary disease alone did not differ significantly. In those with clinical criteria of PDA, who were subsequently found to have echocardiographic evidence of left cardiac enlargement, values for %SID were increased. As expected %SID values for individual patients represented a wider range of left ventricular function and/or afterload than for controls. Upon spontaneous or surgical closure of the PDA, %SID returned to normal. A PDA which is associated with left cardiac enlargement exhibits increased %SID, whereas decreasing %SID in the presence of increased dimensions suggests deteriorating myocardial performance. Echocardiography provides valuable insight into the cardiac status of these infants and may contribute to their medical and/or surgical management.