Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.
Physiol Rep. 2021 Nov;9(22):e15108. doi: 10.14814/phy2.15108.
Definitive closure of a patent ductus arteriosus (PDA) causes significant changes in loading conditions of the left ventricle (LV) which can lead to cardiorespiratory instability including hypotension, low cardiac output, oxygenation, and ventilation impairment. Physiological insights of the adaptation of the LV can be gained by looking at ventriculo-arterial coupling (VAC) and myocardial work-energetics. We conducted a retrospective cohort study of preterm infants with echocardiographic assessment of VAC parameters, including end-systolic and arterial elastance (E , E ), and myocardial work indices derived from longitudinal strain analysis before and 1-h after percutaneous PDA closure. A total of 35 patients were included with mean [±SD] age at intervention of 30.8 ± 9.9 days and median [IQR] weight of 1130 [995, 1318] grams. There was a reduction in preload and stroke volume, an increase in E (38.6 ± 11.4 vs. 60 ± 15.1 mmHg/ml/kg, p < 0.001) and in E (72 [61.5, 109.8] vs. 91.6 [72.2, 125.2] mmHg/ml/kg, p = 0.003) post-closure. Myocardial work indices reduced after PDA closure, including global work efficiency (93.9 ± 2.3 vs. 91.1 ± 3.6%, p < 0.001). A total of 17 (48.6%) patients developed post-closure instability which was associated with younger age, lower preload, and higher E and E . Percutaneous PDA closure is associated with major short-term changes in VAC and myocardium energetics, which may provide novel insights on the physiology of PDA closure and on the differential vulnerability to changes in loading conditions.
动脉导管未闭（PDA）的明确关闭会导致左心室（LV）的负荷条件发生重大变化，从而导致包括低血压、心输出量低、氧合和通气障碍在内的心肺不稳定。通过观察心室-动脉偶联（VAC）和心肌功-能，我们可以获得 LV 适应的生理见解。我们对接受经皮 PDA 关闭治疗的早产儿进行了回顾性队列研究，通过超声心动图评估 VAC 参数，包括收缩末期和动脉僵硬度（E, E ），以及从纵向应变分析中得出的心肌工作指数，分别在 PDA 关闭前和 1 小时后进行。共纳入 35 例患者，介入时平均[±标准差]年龄为 30.8 ± 9.9 天，中位数[IQR]体重为 1130 [995, 1318] 克。前负荷和每搏量减少，E 增加（38.6 ± 11.4 对 60 ± 15.1 mmHg/ml/kg，p < 0.001），E 增加（72 [61.5, 109.8] 对 91.6 [72.2, 125.2] mmHg/ml/kg，p = 0.003）。PDA 关闭后心肌工作指数降低，包括整体工作效率（93.9 ± 2.3 对 91.1 ± 3.6%，p < 0.001）。共有 17 例（48.6%）患者在 PDA 关闭后出现不稳定，与年龄较小、前负荷较低、E 和 E 较高有关。经皮 PDA 关闭与 VAC 和心肌能量的重大短期变化相关，这可能为 PDA 关闭的生理学和对负荷条件变化的不同易感性提供新的见解。
