Cardiac adaptations to patent ductus arteriosus ligation in preterm infants: a speckle-tracking study.

BACKGROUND

Understanding the complex cardiac adaptations following patent ductus arteriosus (PDA) ligation in preterm infants is essential for optimizing postoperative care. This study tested the hypothesis that left ventricular (LV), left atrial (LA) and right ventricular (RV) longitudinal strain are acutely impaired and then recover after PDA surgery in preterm infants.

METHODS

Thirty-two preterm infants who underwent PDA ligation (median gestational age: 25 weeks) were evaluated using speckle-tracking echocardiography to quantify LV, RV, and LA longitudinal strain before and at 4-8 and 24-48 h post-surgery. These data were compared with 36 preterm infants without PDA (non-PDA).

RESULTS

LV global longitudinal strain (LVGLS) was higher and RV free wall longitudinal strain (RVFWSL) was lower in the PDA group than in the non-PDA group preoperatively (both p < 0.01). In the non-PDA group, LVGLS and RVFWSL were -16% and -28%, respectively. In the PDA group, LVGLS at the three time points was -20%, -13%, and -15%, and RVFWSL was -21%, -21%, and -25%, respectively (all p < 0.05). LA reservoir strain (LASr) initially decreased and then increased.

CONCLUSIONS

After PDA ligation, LVGLS and LASr transiently decrease then increase within 24-48 h, while RVFWSL normalizes without a decrease.

IMPACT: Preoperatively, preterm infants with PDA had higher left ventricular global longitudinal strain (LVGLS), and lower right ventricular free wall strain (RVFWSL) than those without PDA. After PDA ligation, LVGLS and left atrial reservoir strain (LASr) initially decreased and then recovered within 24-48 h, while RVFWSL rapidly improved. Our findings indicate dynamic and different post-surgical cardiac adaptation in the right ventricle and left ventricle after PDA ligation.