title: Ischemic changes associated with a large patent arterial duct in small infants.
abstract: Infants with a large patent arterial duct (PDA) may develop signs of congestive heart failure secondary to pulmonary overcirculation. As the PVR decreases, the relative pulmonary blood flow (Qp :Qs ) increases and this may cause tachypnea, respiratory distress, failure to thrive, ventricular dysfunction and even ventilator dependency. The diastolic runoff from the systemic circulation may result in intestinal hypoperfusion resulting in necrotizing enterocolitis, and in severe cases, myocardial ischemia. Cardiac ischemia due to coronary steal is a recognized clinical entity. We present two cases of infants who developed coronary artery steal with the use of supplemental oxygen therapy during anesthesia induction for PDA occlusion. These cases highlight the importance of prudent use of supplemental oxygen therapy in infants with large PDAs.
authors.affiliation: New York Presbyterian-Morgan Stanley Children's Hospital of New York/Columbia University Medical Center, New York, NY.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Crystal
authors.forename: Saeed
authors.initials: S
authors.lastname: Yacouby
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
mesh_terms: D000758:Anesthesia; D003326:Coronary Circulation; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects*; D011652:Pulmonary Circulation; D016896:Treatment Outcome