title: Assessment and treatment of post patent ductus arteriosus ligation syndrome.
abstract: OBJECTIVE
  To compare differences in tissue Doppler imaging, global longitudinal strain (GLS), and cardiac troponin T (cTnT) between infants with low (<200 mL/kg/min) and high (>200 mL/kg/min) left ventricular (LV) output 1 hour after duct ligation and assess the impact of milrinone treatment on cardiac output and myocardial performance.
  
  
  METHODS
  LV function was assessed preoperatively and 1 and 18 hours postoperatively. Infants were categorized into a low-output or a normal-output group based on the echocardiographic assessment of LV output at 1 hour.
  
  
  RESULTS
  Thirty infants with a mean gestation of 25.3 weeks were enrolled. LV basal lateral S', basal septal S', and basal right ventricular S' were lower in the low-output group (n = 19) at 1 hour postoperatively, with no significant difference in GLS (low-output -10.3% vs high-output -14.4%, P >.05) or cTnT between the groups. Patients in the low-output group were treated with milrinone, and by 18 hours LV performance recovered to levels comparable with the high output group. cTnT values increased at 18 hours in the whole cohort with no significant difference between the groups.
  
  
  CONCLUSIONS
  Tissue Doppler imaging and GLS provide novel insights and further characterization of myocardial performance immediately after patent ductus arteriosus ligation. A reduction in tissue Doppler-derived LV systolic velocity may further help in monitoring cardiac performance after patent ductus arteriosus ligation and for monitoring the effects of treatment.
authors.affiliation: Department of Pediatrics, The Rotunda Hospital, Dublin, Ireland.
authors.forename: Afif F
authors.initials: AF
authors.lastname: El-Khuffash
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada; Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada.
authors.forename: Amish
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Dany
authors.initials: D
authors.lastname: Weisz
authors.affiliation: The Labatt Family Heart Center, The Hospital for Children, Toronto, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Mertens
authors.affiliation: Department of Physiology, University of Toronto, Toronto, Canada; Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada; Department of Neonatology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada. Electronic address: patrick.mcnamara@sickkids.ca.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
mesh_terms: D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D015150:Echocardiography, Doppler; D054459:Elasticity Imaging Techniques; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D008026:Ligation / Q000379:methods; D008297:Male; D020105:Milrinone / Q000627:therapeutic use; D009200:Myocardial Contraction / Q000502:physiology; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D002316:Cardiotonic Agents; D020107:Troponin T; D020105:Milrinone