title: Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation.
abstract: OBJECTIVE
  We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.
  
  
  METHODS
  A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was > 15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).
  
  
  RESULTS
  Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.
  
  
  CONCLUSIONS
  We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.
authors.affiliation: 1] Department of Pediatrics, Children's Hospital of Los Angeles, University of South California, Los Angeles, CA, USA [2] Department of Pediatrics, University of Oklahoma, Oklahoma, OK, USA.
authors.forename: S
authors.initials: S
authors.lastname: Noori
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: McNamara
authors.affiliation: 1] Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada [2] Department of Pediatrics, Mount Sinai Hospital, University of Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Pediatrics Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.
authors.forename: P M
authors.initials: PM
authors.lastname: Lavoie
authors.affiliation: Department of Pediatrics, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Wickremasinghe
authors.affiliation: Department of Pediatrics, Loma Linda University, Loma Linda, CA, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Merritt
authors.affiliation: Department of Pediatrics, Loma Linda University, Loma Linda, CA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Solomon
authors.affiliation: Department of Pediatrics, University of Oklahoma, Oklahoma, OK, USA.
authors.forename: K
authors.initials: K
authors.lastname: Sekar
authors.affiliation: Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Attridge
authors.affiliation: Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Swanson
authors.affiliation: Department of Pediatrics, Vanderbilt University, Nashville, TN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Gillam-Krakauer
authors.affiliation: Department of Pediatrics, Vanderbilt University, Nashville, TN, USA.
authors.forename: J
authors.initials: J
authors.lastname: Reese
authors.affiliation: Department of Pediatrics, Indiana University, Indianapolis, IN, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Poindexter
authors.affiliation: Department of Pediatrics, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Brook
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Auchus
authors.affiliation: Department of Pediatrics, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
authors.forename: R I
authors.initials: RI
authors.lastname: Clyman
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002395:Catecholamines / Q000008:administration & dosage / Q000009:adverse effects; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects; D004298:Dopamine / Q000008:administration & dosage / Q000009:adverse effects; D004351:Drug Resistance; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007231:Infant, Newborn; D007234:Infant, Premature; D008026:Ligation; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D002395:Catecholamines; D004280:Dobutamine; D004298:Dopamine