The effects of the patent ductus arteriosus on diaphragmatic blood flow and function

Abstract

Decreased diaphragmatic blood flow (Qdi) is associated with decreased contractility in adult animals. To see whether the decrease in Qdi associated with a patent ductus arteriosus was associated with a decrease in diaphragmatic contractility (Pdi, we prepared 11 near-term fetal lambs by infiltrating the ductus with formalin and placing a snare around it to regulate its patency. The lambs (with open chest) were delivered and mechanically ventilated, and the phrenic nerves and diaphragm were paced (using transvenous wires) at rates of 20/min, 60/min, and 100/min (Inspiratory time/total respiratory cycle time = 0.5) for 7-min contraction periods after 30-min recovery periods. Qdi was measured with radiolabeled microspheres at the end of each contraction period. Diaphragmatic performance was determined by comparing Pdi at the start (Pdi-start) and end (Pdi-end) of the contraction period. When the ductus was closed, Qdi increased 6.9:fold at 20/ min and 9.8-fold at 100/min (compared with Qdi at rest). Pdi-end was less than Pdi-start at all contraction rates, but the reduction was significantly greater at 100/min (Pdi-end/Pdi-start: 0.80 ± 0.10 at 20/min; 0.67 ± 0.17 at 100/min). Pdi-start also decreased with increasing rates of contraction. When the ductus was open, the left-to-right shunt was 64 ± 11% of left ventricular output. Qdi in the unpaced diaphragm was significantly reduced (open 4.0 ± 3.8 versus closed, 7.4 ± 2.4 mL/min/100 g). However, with pacing, Qdi increased with open ductus and so did not differ from Qdi with closed ductus. Similarly, at each contraction rate, ductus patency did not alter diaphragmatic performance (Pdi-end/Pdi-start, open versus closed: 20/min = 0.80 ± 0.15 versus 0.80 ± 0.10; 60/min = 0.76 ± 0.11 versus 0.73 ± 0.17; 100/min = 0.62 ± 0.14 versus 0.67 ± 0.17). We conclude that diaphragm performance decreases at faster contraction rates despite an increase in Qdi. Although a patent ductus arteriosus reduces Qdi in the noncontracting diaphragm, during contractions Qdi can increase to levels achieved when the ductus is closed so that there is no change in diaphragmatic performance. © 1990 International Pediatric Research Foundation, Inc.