Left ventricular performance and regional blood flows before and after ductus arteriosus occlusion in premature lambs treated with surfactant

Abstract

The hemodynamic consequences of patent ductus arteriosus (PDA) were studied during the first few hours of life (1.9 ± 0.7 hours) in 13 mechanically ventilated, surfactant-treated, preterm lambs (gestational age of 120-124 days). Cardiovascular pressures, left ventricular (LV) performance and regional blood flows were measured using cine left ventriculography and radionuclide-labeled microspheres before and after occlusion of the PDA with a catheter balloon. Before occlusion, the left-to-right shunt was 44 ± 13%; after occlusion the shunt was negligible (2%). Heart rate (164 ± 17 beats/min), LV end-diastolic pressure (5 ± 3 mm Hg), ejection fraction (74 ± 8%) and cardiac output (241 ± 13 ml·min-1·kg-1) were normal and did not change after ductus occlusion. However, 'effective' systemic blood flow increased significantly after occlusion (130 ± 53 vs 228 ± 93 ml·min-1·kg-1, p<0.001), as did blood flow to organs such as the brain, myocardium and gastrointestinal tract. The reduction of systemic blood flow in the presence of a left-to-right PDA shunt may be responsible for many early pathologic manifestations of the PDA 'syndrome' of prematurity even in the absence of overt LV dysfunction.