title: Preoperative left ventricular internal dimension in end-diastole as earlier identification of early patent ductus arteriosus operation and postoperative intensive care in very low birth weight infants.
abstract: Patent ductus arteriosus (PDA) is common in premature infants. In very low birth weight infants (VLBWI), PDA requires surgical therapy in many cases. It is unclear to know at-risk infants showing cardio-dysfunction after PDA surgery. The purpose of this study was to identify at-risk infants showing cardio-dysfunction after surgery for patent ductus arteriosus (PDA). We examined the relationship between left ventricular (LV) performance before and after PDA ligation in a retrospective observational cohort study. We studied 64 preterm neonates with symptomatic PDA before and after surgical ligation. Echocardiographic examinations were performed pre- and postoperatively. M-mode measurements included left ventricular internal dimension in end-diastole (LVIDd) and LV fractional shortening (FS). All cases showed decreased LVFS after PDA closure. Most cases (49/64, 77%) showed postoperative FS decreased to below normal (<28%). Preoperative relative LVIDd was significantly larger in abnormal FS infants (137 ± 18%) than in normal FS infants (118 ± 11%; p<0.01). A cut-off value of preoperative relative LVIDd (absolute LVIDd/normal value) for predicting postoperative cardio-dysfunction was 127.4% (sensitivity, 0.735; specificity, 0.933; area under curve, 0.817). Determination of preoperative LVIDd might facilitate earlier identification of infants needing early PDA surgery and postoperative intensive care.
authors.affiliation: Division of Neonatology, Nagano Children's Hospital, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Saida
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Nakamura
authors.forename: Takehiko
authors.initials: T
authors.lastname: Hiroma
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Takigiku
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasukochi
mesh_terms: D015331:Cohort Studies; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis* / Q000601:surgery*; D005865:Gestational Age; D006352:Heart Ventricles; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000601:surgery; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D015931:Intensive Care, Neonatal; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D007213:Indomethacin
keywords: LVIDd; PDA; VLBWI