通过基于导管的介入封堵动脉导管已成为首选的治疗选择。然而,尚未研究与该程序相关的血液动力学扰动。这项研究旨在检查早产新生儿手术引起的现场血液动力学影响。在这项研究中,在米兰的ASSTGrandeOspedaleMetropolitanoNiguarda接受经皮动脉导管未闭关闭术的5名早产儿中,使用电心测法以非侵入性方式进行了血液动力学监测。所有五名婴儿均成功进行了经导管闭合。所有患者在导管关闭后立即发生血液动力学变化。显著改变主要发生在心脏收缩力,心输出量,和冲程量。在三种情况下,全身血管阻力也显着增加,并在关闭后持续4小时。虽然在两种情况下,它们自发地减少心输出量和收缩力的改善,在另一种情况下,它们一直很高,与高血压危象和心脏功能逐渐降低有关。由于这些原因,开始米力农,血流动力学参数在约3小时内恢复正常,所以停止了治疗.结论:我们的单中心,prospective,连续的,病例系列显示由于动脉导管未闭突然闭合而引起的血流动力学异常。此外,术后血流动力学监测对于早熟发现可能的心脏损伤并开始适当的治疗非常重要.已知内容:•其先前已提示在动脉导管未闭关闭后暂时损害心输出量。•对手术过程中的其他血液动力学参数以及根据新的血液动力学状态在接下来的几个小时内如何变化知之甚少。新增内容:•经皮动脉导管闭合后持续增加的全身血管阻力可能提示血液动力学并发症的发生。•心脏电测有助于早期发现术后血流动力学变化。
Patent ductus arteriosus closure by catheter-based interventions has become the preferred therapeutic choice. However, hemodynamic perturbances associated to this procedure have not yet been investigated. This study sought to examine the on-site hemodynamic impact caused by the procedure in preterm neonates. In this study, hemodynamic monitoring was obtained in a non-invasive way using electrical cardiometry in five preterm infants who underwent percutaneous patent ductus arteriosus closing at ASST Grande Ospedale Metropolitano Niguarda of Milan. All five infants underwent successful transcatheter closures. All patients experienced immediate hemodynamic changes upon ductal closing. Significative modifications occurred mainly in heart contractility, cardiac output, and stroke volume. In three cases, there was also a significative increase of systemic vascular resistance which persisted for 4 h after closing. While in two cases they spontaneously reduced with an amelioration of cardiac output and contractility, in the other
case they were persistently high, associated with an hypertensive crisis and a progressive reduction of cardiac functions. For these reasons, milrinone was started and hemodynamic parameters returned normal in about 3 h, so therapy was discontinued. Conclusions: Our single-center, prospective, consecutive,
case series demonstrated hemodynamic aberrations due to sudden closure of a patent ductus arteriosus. Moreover, post procedural hemodynamic monitoring is important to precociously detect possible cardiac impairment and start an adequate therapy. What is Known: • It has previously suggested a temporarily impairment in cardiac output following patent ductus arteriosus closing. • Little is known about the other hemodynamic parameters during the procedure and how they change in the next hours according to the new hemodynamic status. What is New: • The persistence of increased systemic vascular resistance after percutaneous closure of ductus arteriosus could suggest the occurrence of hemodynamic complications. • Electrical cardiometry was useful to early detect postoperative hemodynamic changes.