Effect of patent ductus arteriosus on left ventricular output in premature infants

Alverson, Dale C.; Eldridge, Marlowe W.; Johnson, John D.; Burstein, Rochelle; Papile, Lu-Ann; Dillon, Terrence; Yabek, Steven M.; Berman, William

doi:10.1016/s0022-3476(83)80252-2

Cited by 74 publications

(33 citation statements)

References 15 publications

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“…The group mean LVO, in both the infants with PDA (388 m L min-I .kg-') and those without PDA (2 16 m L min-I .kg-'), are in good agreement with previous reports in preterm infants (13,20,21).…”

Section: Discussionsupporting

confidence: 91%

Relationship between Heart Rate, Left Ventricular Output, and Stroke Volume in Preterm Infants during Fluctuations in Heart Rate

Winberg

Ergander

1992

Pediatr Res

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ABSTRACT. The relationship between changes in heart rate, left ventricular output, and left ventricular stroke volume was studied in 18 preterm infants, with mean gestational age 29 wk (range 26-33 wk) and mean postnatal age 10 d (range 1-21 d). To yield left ventricular output, the blood flow velocity in the ascending aorta was measured by range-gated Doppler technique and multiplied by the aortic cross-sectional area measured by cross-sectional and M-mode echocardiography. Stroke volume was calculated by dividing left ventricular output by heart rate. The individual mean left ventricular output correlated poorly with heart rate ( 3 = 0.17), and, accordingly, there was a closer relationship between stroke volume and left ventricular output. In only four of the 18 infants was a significant correlation between heart rate changes and left ventricular output found. Substantial changes in stroke volume were seen in most infants, and in 1 3 of the 18 infants the changes exceeded 25%. These variations in stroke volume were closely related to left ventricular output. In 15 of the 18 infants, the maximum heart rate change was associated with a stroke volume change in the opposite direction. The group average of the maximum heart rate increase in each individual, 24 bpm (18%), corresponded to a decrease in stroke volume of 0.15 mL.kg-' (9%) (p < 0.05) and an increase in left ventricular output of 22.7 m L min-' .kg-' (9%) (p < 0.05). A reciprocal relationship was seen between afterload and left ventricular output. The findings indicate that the preterm infant has a substantial ability to alter stroke volume and that stroke volume is an important determinant of neonatal left ventricular output. During beat-to-beat fluctuations in heart rate, the stroke volume changes appear to reduce the effect of the heart rate changes on output. (Pediatr Res 31: 117-120,1992 Supported by the Karolinska Institute, the General Maternity Hospital Foundation, the Swedish Society for Medicine, and Sallskapet Barnavird.Studies of the fetal and neonatal heart have provided basic information about the myocardial immaturity on the cellular and subcellular levels. The immature myocardium has been shown to contain more water, less contractile elements per unit weight, and less sarcoplasmic reticulum (1, 2). Furthermore, the cardiac sympathetic innervation is not fully developed at birth (3, 4). In in vitro experiments these differences correspond to reduced compliance and reduced contractile force (1) compared with the mature myocardium. However, the hemodynamic consequences of the myocardial immaturity on the intact circulatory system are, despite extensive investigations, still not clearly delineated. It has been claimed that the fetal heart performs at or near its peak capacity even during normal conditions and has a very limited ability to change (SV) (5, 6). Accordingly, fetal and neonatal cardiac output should be almost entirely dependent on HR. This, however, has been questioned in other fetal and neonatal lamb studies (7-lo), as well as in...

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Section: Discussionsupporting

confidence: 91%

Relationship between Heart Rate, Left Ventricular Output, and Stroke Volume in Preterm Infants during Fluctuations in Heart Rate

Winberg

Ergander

1992

Pediatr Res

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“…Using equipment comparable to ours, Alverson et al [18] studied LVO in infants diagnosed with SPDA prior to ductal closure and found mean LVO values well above the predicted normal values. After closure of the PDA, the fall in LVO was accompanied by a fall in left atrial/aortic ratio and a rise in left ventricular pre-ejection period/ejection time ratio.…”

Section: Discussionmentioning

confidence: 67%

Pulsed Doppler Measurement of Left Ventricular Output as Early Predictor of Symptomatic Patent Ductus arteriosus in Very Preterm Infants

et al. 1989

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High left ventricular output (LVO) values are associated with symptomatic left-to-right ductal shunting in preterm infants. However, LVO data prior to the occurrence of symptomatic patent ductus arteriosus (SPDA) are lacking. To determine whether serial measurements could predict a SPDA, we measured LVO from day 1 until day 10 with pulsed Doppler echocardiography in 25 preterm infants with birth weights of less than 1,250 g and hematocrits of more than 0.40. Eleven infants never developed patent ductus arteriosus symptoms and had LVO values within the normal range (190–310 ml/min/kg) with only minimal daily variations. The remaining 14 infants developed SPDA which required treatment with indomethacin, ductal Hgation, or fluid restriction on days 2–5. From day 1 until day 5 their mean LVO values were significantly higher compared to the group without left-to-right ductal shunt and this increase was secondary to higher stroke volume values. An increase in LVO of more than 60 ml/min/kg consistently preceded SPDA by at least 24 h. Serial measurements of LVO using a single-pulsed Doppler approach can be used for early prediction of SPDA.

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“…Possibly, the double peaked pressure contour can be explained on the basis of fluid dynamics. An increase in stroke volume during PDA (28)(29)(30)(31)(32)(33)(34)(35) may result in an increase in blood velocity. High blood velocity may create a Venturi effect (suction effect) such that pressure energy is reduced relative to the pressure that would be registered if the blood had no kinetic energy, resulting in a temporary pressure decrease coincident with maximum flow.…”

Section: Gevers Et Almentioning

confidence: 99%

Bisferiens Peaks in the Radial Artery Pressure Wave in Newborn Infants: A Sign of Patent Ductus Arteriosus

et al. 1995

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Previously, we found evidence that radial artery pressure wave forms in newborns represent central aortic wave forms, provided that pressure is measured with adequate accuracy. Therefore, we postulated that the neonatal radial artery wave form, like the adult aortic wave form, may contribute to cardiovascular diagnosis. We investigated whether radial artery wave forms in infants suffering from patent ductus arteriosus (PDA) are different from the wave forms as seen without the presence of PDA. We studied 34 newborn infants with a radial artery line and with the possible clinical diagnosis of PDA with left-to-right shunt. On the basis of echocardiographic examination to assess PDA, these infants were divided in two groups: infants with PDA ( n = 24) and without PDA ( n = 10). In 15 out of 24 infants with PDA, recordings were repeated after ductal closure. Blood pressure measurement was performed with a high fidelity cathetermanometer system using a tip-transducer (natural frequency 95 Hz, damping coefficient 0.15). Contour analysis was performed by describing morphology of the waves during PDA and without PDA. In 23 out of 24 infants with PDA, a pulsus bisferiens was present: two peaks separated by a deep cleft. The average pressure difference between the first pressure peak and the cleft [AP,,,,,] was 0.35 -C 0.19 kPa, and the average difference between the cleft and the second pressure peak [AP,,,,,] was 0.44 i . 0.23 kPa. The ratio of mean magnitude of AP,,,,, and AP,,,,, was 0.81 ? 0.26. None of the 10 infants without PDA showed pulsus bisferiens. In 13 out of 14 infants with pulsus bisferiens during PDA and studied again after ductal closure, this twin peaks contour had disappeared. Results strongly indicate that the presence of a bisferiens pressure pulse is a sign of PDA with hemodynamically significant left-to-right shunt. (Pediatr Res 37: 800-805, 1995)

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Effect of patent ductus arteriosus on left ventricular output in premature infants

Cited by 74 publications

References 15 publications

Relationship between Heart Rate, Left Ventricular Output, and Stroke Volume in Preterm Infants during Fluctuations in Heart Rate

Relationship between Heart Rate, Left Ventricular Output, and Stroke Volume in Preterm Infants during Fluctuations in Heart Rate

Pulsed Doppler Measurement of Left Ventricular Output as Early Predictor of Symptomatic Patent Ductus arteriosus in Very Preterm Infants

Bisferiens Peaks in the Radial Artery Pressure Wave in Newborn Infants: A Sign of Patent Ductus Arteriosus

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