Open Access

ARTICLE

Anticipatory perioperative management for patent ductus arteriosus surgery: Understanding postligation cardiac syndrome

by

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.

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