Open Access
ARTICLE
Anticipatory perioperative management for patent ductus arteriosus surgery: Understanding postligation cardiac syndrome
Regan E. Giesinger1, Adrianne R. Bischoff3, Patrick J. McNamara1,2
1 Department of Pediatrics, University of
Iowa, Iowa City, Iowa
2 Department of Internal
Medicine, University of Iowa, Iowa City,
Iowa
3 Department of Pediatrics, University of
Toronto, Toronto, Canada
* Corresponding Author: Patrick J. McNamara, MB, MRCPH, MSC, Pediatrics and Internal Medicine, Neonatology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. Email:
Congenital Heart Disease 2019, 14(2), 311-316. https://doi.org/10.1111/chd.12738
Abstract
Ligation of a hemodynamically significant ductus arteriosus results in significant
changes in loading conditions which have predictable consequences. Postligation
cardiac syndrome, defined as hypotension requiring inotropic support and failure of
oxygenation and ventilation, may occur 6‐12 hours following ligation due to left ven‐
tricular systolic and diastolic failure, respectively. Afterload is the primary driver of
this decompensation. In this review, we describe the pathophysiological changes in
loading conditions associated with postligation cardiac syndrome and other contrib‐
utors to cardiovascular dysfunction following ductal ligation. We present strategies
for perioperative optimization and a physiology‐based algorithm for postoperative
management guided by targeted neonatal echocardiography. The use of these strate‐
gies to reduce the frequency of postligation deterioration may be an avenue to im‐
prove outcomes for neonates in this vulnerable patient population.
Keywords
Cite This Article
Giesinger, R. E., Bischoff, A. R., McNamara, P. J. (2019). Anticipatory perioperative management for patent ductus arteriosus surgery: Understanding postligation cardiac syndrome.
Congenital Heart Disease, 14(2), 311–316.