Left Ventricular Contractile State of Early Human Neonates with Patent Ductus Arteriosus.

Harada, Kenji; Shiota, Terukazu; Tamura, Masazumi; Noguchi, Hiroo; Ishida, Akira; Takada, Goro

doi:10.1620/tjem.172.155

Cited by 11 publications

(2 citation statements)

References 21 publications

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“…In both cases, the DA was associated with 2D echo and clinical evidence of pulmonary overcirculation and volume loading of the heart. In human neonates and animal experimental models, reducing LV afterload enables the LV to contract more effectively and to increase its stroke volume in the presence of a PDA [14,15] . Both patients were treated with intravenous milrinone, a phosphodiesterase III inhibitor, as it's cardiotropic and afterload reducing properties have been shown to be beneficial in neonates with a low cardiac output state [16] and possibly in a setting of resistant PPHN [17,18] .…”

Section: Effects Of the Da On Myocardial Performancementioning

confidence: 99%

The Hemodynamically Significant Ductus Arteriosus in Critically Ill Full-Term Neonates

Ly¹,

Hawes²,

Whyte³

et al. 2006

Neonatology

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In premature infants, the clinical effects and management of a hemodynamically significant patent ductus arteriosus (HSDA) are well-described. In full-term neonates the ductus arteriosus (DA) is rarely monitored except in cases of concomitant pulmonary hypertension or duct dependant congenital heart disease. Although systemic–pulmonary shunting commonly occurs in mature infants, coinciding with the normal postnatal fall in pulmonary vascular resistance, cardiac failure in the neonatal period is rarely attributed directly to the DA. In this case series, we report two full-term infants who were initially treated for pulmonary hypertension and myocardial dysfunction but developed clinical, radiographic and two-dimensional echocardiographic evidence of cardiac failure secondary to a large unrestrictive patent DA (PDA). One patient was treated with indomethacin, and, although transductal diameter decreased, there was no clinical benefit. Cardiac failure resolved and myocardial function improved in both cases after PDA ligation. We suggest that PDA be monitored closely in neonates recovering from PPHN who have ongoing oxygenation difficulties or myocardial failure. PDA ligation should be considered an option for full term neonates with cardiac failure secondary to a HSDA when other therapeutic options fail.

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Section: Effects Of the Da On Myocardial Performancementioning

confidence: 99%

The Hemodynamically Significant Ductus Arteriosus in Critically Ill Full-Term Neonates

Ly¹,

Hawes²,

Whyte³

et al. 2006

Neonatology

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“…Myocardial contraction velocity will fall as afterload increases. A steeper negative slope of the regression line of the relationship indicates a more rapidly reducing mVcfs in response to increasing LV stress, or reduced myocardial contractility (4,8). Preterm infants have been documented to have reduced LV contractility in the first days after birth compared with term infants (9), although the relationship to low blood flow states has not been reported.…”

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confidence: 99%

Left Ventricular Contractility in Extremely Premature Infants in the First Day and Response to Inotropes

2007

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ABSTRACT:The aim was to assess myocardial contractility in infants born Ͻ30 wk gestation developing low systemic blood flow (SBF) in the first day, and the effect of dobutamine versus dopamine. Superior vena cava (SVC) flow was used as a measure of SBF at 3, 10, and 24 h (n ϭ 106). Infants with low SVC flow randomized to dopamine or dobutamine. Myocardial contractility was determined by the relationship between left ventricular (LV) mean velocity of circumferential fiber shortening (mVcfs) and wall stress. Infants who developed low SVC flow had significantly worse myocardial contractility at 3 h, but not 10 h. At 24 h, low-flow infants had lower than expected mVcfs for any given LV stress. In 37 infants randomized to inotrope, there was no significant difference in contractility at 10 g/kg/min. At 20 g/kg/min (n ϭ 21), dopamine increased whereas dobutamine decreased LV stress. Infants on dobutamine had significantly lower than expected mVcfs for any given LV stress compared with infants on dopamine. Contractility was not improved by either inotrope at either dose. In conclusion, infants developing low SVC flow in the first day have worse myocardial contractility at 3 h. Neither inotrope increased contractility, but dopamine increased LV stress at 20 g/kg/min. E xtremely preterm infants with low brain and upper body blood flow, as measured by SVC flow, in the first day are at increased risk of late peri/intraventricular hemorrhage (1,2), mortality, and subsequent neurodevelopmental impairment (3). Low SVC flow was associated with infants born at lower gestation, with a higher MAP in the first 12 h and a larger diameter DA at 5 h of age (1). Although infants with low SVC flow frequently had normal BP, they had significantly higher calculated UBVR compared with infants with normal flows. However, calculated vascular resistance is not a direct measure of LV afterload. LV stress is affected by LV dimensions, which are affected by preload, and LV wall thickness (4,5).Although LV shortening fraction has been reported to be reduced in shocked and acidotic preterm infants (6), this measure of LV performance does not take preload or afterload conditions into account and has been reported to be unreliable in preterm infants (7). In contrast, the relationship between LV mVcfs and LV wall stress (LV stress) has been used as a preload independent measure of LV contractility that takes into account afterload conditions. Myocardial contraction velocity will fall as afterload increases. A steeper negative slope of the regression line of the relationship indicates a more rapidly reducing mVcfs in response to increasing LV stress, or reduced myocardial contractility (4,8). Preterm infants have been documented to have reduced LV contractility in the first days after birth compared with term infants (9), although the relationship to low blood flow states has not been reported. In addition, the effects on myocardial contractility of commonly used inotropes in preterm infants have not been measured in infants with low flow in the firs...

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Changes in transmitral and pulmonary venous flow patterns in the first day of life

Harada

Shiota

Tamura

et al. 1995

J of Clinical Ultrasound

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The purpose of this study was to see the relationship between changes in pulmonary venous flow velocities and those in transmitral flow velocities during the first day of life. A serial Doppler echocardiography was performed in 24 normal neonates at 2, 12, and 24 hours of age. The size of the ductus arteriosus was 4.3 +/- 0.5 mm at 2 hours and 2.1 +/- 0.7 mm at 12 hours, and closed in 21 of 24 neonates at 24 hours. The peak systolic pulmonary venous flow (peak S), peak diastolic pulmonary venous flow (peak D), peak D/S, peak velocity at early diastolic filling (peak E), and peak E/A, which were high at 2 hours, decreased significantly at 12 hours but remained constant thereafter. The size of the ductus arteriosus was found to be correlated with peak S, peak D, and peak D/S. There was a direct correlation between peaks E and D (r: 0.64, p < 0.01) as well as a direct correlation between peaks E/A and D/S (r: 0.36, p < 0.05). These results indicate that the diastolic pulmonary venous flow is determined by the same factors that influence the transmitral flow. These waveforms may reflect the increase in pulmonary circulatory volume by left-to-right shunting through the ductus arteriosus.

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Left Ventricular Contractile State of Early Human Neonates with Patent Ductus Arteriosus.

Cited by 11 publications

References 21 publications

The Hemodynamically Significant Ductus Arteriosus in Critically Ill Full-Term Neonates

The Hemodynamically Significant Ductus Arteriosus in Critically Ill Full-Term Neonates

Left Ventricular Contractility in Extremely Premature Infants in the First Day and Response to Inotropes

Changes in transmitral and pulmonary venous flow patterns in the first day of life

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