Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm infants.

OBJECTIVE To characterize the changes in systemic hemodynamics and systolic, diastolic, and global myocardial performance after patent ductus arteriosus (PDA) ligation in very-low-birth-weight infants. STUDY DESIGN Echocardiograms were performed on 23 neonates (mean gestational age, 26.2 +/- 2.2 weeks) at 2.3 +/- 2.0 hours before PDA ligation (n = 23) and at 2.0 +/- 1.4 hours (n = 23) and 23.5 +/- 2.5 hours after (n = 11) PDA ligation. RESULTS Mean blood pressure, heart rate, load-independent contractility, shortening fraction, left ventricular (LV) afterload, and diastolic function did not change. Preload (early and atrial mitral inflow velocities) decreased immediately after ligation but remained unchanged thereafter. LV output decreased and systemic vascular resistance increased after surgery. The LV myocardial performance index (MPI), a measure of global myocardial performance, deteriorated acutely after ligation but improved by 23.5 hours after surgery. Changes in LV MPI were most closely correlated with changes in LV output. CONCLUSIONS After PDA ligation, LV output and MPI decrease, due primarily to a decrease in LV preload, although LV contractility and diastolic function do not change. However, the changes in LV MPI after ligation also reflect an acute deterioration followed by an improvement in global cardiac function, because LV loading conditions remained unchanged after surgery and thus cannot explain the improvement in MPI by 24 hours after ligation.