Abstract
Intraoperative Doppler sonographic examinations were carried out on seven preterm neonates to measure cerebral blood flow velocity changes in the anterior cerebral arteries during ductus arteriosus ligation. Age at surgery was 12±6 days. Continuous recordings during the operative procedure showed a rapid increase in diastolic blood pressure (P<0.01), whereas systolic blood pressure was not significantly higher compared with pre-occlusion values. In the anterior cerebral arteries, ductal closure led to a decrease in resistance index of Pourcelot (mean=1.02±0.08 vs 0.65±0.07 (P<0.001)) and to an increase in area under the velocity curve (mean=3.64±0.38 vs 8.16±1.07 (P<0.001)). These changes were associated with a corresponding increase of the end diastolic flow velocity (P<0.001) but no change in the peak systolic velocity. The heart rate did not change significantly during ductal closure. TcPO2, TcPCO2 remained normal during the study period. These data indicate that changes in cerebral blood flow velocity during surgical ligation are principally determined by changes in systemic diastolic pressure. Systolic blood pressure and peak systolic flow velocity remain unchanged or slightly higher than preligation values, thereby restoring normal cerebral blood flow velocity pattern without increasing the stress on the wall of cerebral vessels and thus the risk of peri-intraventricular haemorrhage.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ACA:
-
anterior cerebral artery
- AUVC:
-
area under the velocity curve
- CBFV:
-
cerebral blood flow velocity
- DA:
-
ductus arterious
- EDFV:
-
end diastolic flow velocity
- PDA:
-
patent ductus arteriosus
- RI:
-
resistance index of Pourcelot
- PIVH:
-
peri-intraventricular haemorrhage
- PSFV:
-
peak systolic flow velocity
References
Alverson DC, Marlowe WE, Johnson JD, Burstein R, Papile LA, Dillon T, Yabek S, Berman W (1983) Effect of parent ductus arteriosus on left ventricular output in premature infants. J Pediatr 102:754–757
Appleton RS, Graham RP, Cotton RB, Moreau GA, Boucek RJ (1986) Abnormal diastolic cardiac function, following indomethacin therapy of patent ductus arteriosus. Pediatr Res 20:167A
Baylen BG, Ogata H, Ikegami M, Jacobs HC, Jobe AH, Emmanoulides GG (1986) Left ventricular performance and regional blood flow before and after ductus arteriosus occlusion in premature lambs treated with surfactant. Circulation 67:847–843
Bejar R, Schneider H, Osorno L, Edwards D, Coen R, Gluck L (1981) Association of early aortograms and PDA ligation with intraventricular haemorrhage. Pediatr Res 15:650
Berne R, Levy M (1981) Cardiovascular physiology. CV Mosby Co. St. Louis
Cowan F (1986) Indomethacin, patent ductus arteriosus, and cerebral blood flow. J Pediatr 109:341–344
Hansen NB, Stonestreet BS, Rosenkrantz TS, Oh W (1983) Validity of Doppler measurements of anterior cerebral artery blood flow velocity, correlation with brain blood flow in piglets. Pediatrics 72:526–531
Kirsch JR, Traystman RJ, Roger MC (1985) Cerebral blood flow measurement techniques in infants and children. Pediatrics 75:887–895
Kitterman JA (1975) Effects of intestinal ischaemia in necrotizing enterocolitis in the newborn infant. In: Moore, TD (ed), Report of the 69th Ross Conference on Pediatric Research. Ross Laboratories, Columbus, Ohio, pp 38–40
Lipman B, Serwer CA, Brazy JE (1982) Abnormal cerebral haemodynamics in preterm infants with patent ductus arterious. Pediatrics 69:778–781
Lundell BPW, Soneson SE, Cotton RR (1986) Ductus closure in preterm infants; effects on cerebral haemodynamics. Acta Paediatr Scand 329 [Suppl]:140–147
Marshall TA, Marshall II F, Reddy PP (1982) Physiologic changes associated with ligation of the ductus arteriosus in preterm infants. J Pediatr 101:749–753
Martin CG, Snider R, Katz SH, Leabody JL, Brady JP (1982) Abnormal cerebral blood flow patterns in preterm infants with a large patent ductus arteriosus. J Pediatr 101:587–593
Mellander M, Larson LE (1988) Effects of left-to-right ductus shunting on left ventricular output and cerebral blood flow velocity in 3-day-old preterm infants with or without severe lung disease. J Pediatr 113:101–109
Perlman JM, Hill A, Volpe JJ (1981) The effect of patent ductus arteriosus on flow velocity in the anterior cerebral arteries: Ductal steal in the premature newborn infant. J Pediatr 99:767–771
Pourcelot L (1973) Doppler effect study of the carotid circulation. In: Veryer M, White D, McCready V (eds) Ultrasonic in medicine. Excerpta Medica. New York, pp 104–111
Ryder RW, Shelton JD, Suinan ME (1980) Necrotizing enterocolitis: a prospective multicenter investigation. Am J Epidemiol 112:113–123
Saliba E, Chantepie A, Vaillant MC, Bloc D, Pourcelot L, Laugier J (1986) Patent ductus arteriosus and cerebral blood flow. Pediatr Res 20:124A
Saliba E, Autret E, Gold F, Bloc D, Pourcelot L, Laugier J (1989) Effect of caffeine on cerebral blood flow velocity in preterm infant. Biol Neonate 56:198–203
Sonesson SE, Lundell BPW, Herin P (1987) Changes in intracranial arterial blood flow velocities during surgical ligation of the patent ductus arteriosus. Acta Paediatr Scand 75:367–342
Strange MY, Myers G, Kirklin JK, Pacifico A, Braune K, Philips J, Cassady G (1985) Surgical closure of patent ductus arteriosus does not increase the risk of intraventricular haemorrhage in the preterm infant. J Pediatr 107:602–604
Volpe JJ, Perlman JM, Hill A, McMenamin JB (1982) Cerebral blood flow velocity in the human newborn: the value of its determination. Pediatrics 70:147–152
Way AL, Pierce YR, Wolfe RR, McGrath R, Wiggins J, Rerenstein GB (1979) ST depression suggesting subendocardial ischemia in neonates with respiratory distress syndrome and patent ductus arteriosus. J Pediatr 95:609–611
Winberg P, Dahlstrom A, Lundell B (1986) Reproducibility of intracranial Doppler flow velocimetry. Acta Paediatr Scand 329 [Suppl]:127–133
Wright LL, Baker KR, Hollander DI, Wright JN, Nagey DA (1988) Cerebral blood flow velocity in term newborn infants: changes associated with ductal flow. J Pediatr 112:768–773
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Saliba, E.M., Chantepie, A., Gold, F. et al. Intraoperative measurements of cerebral haemodynamics during ductus arteriosus ligation in preterm infants. Eur J Pediatr 150, 362–365 (1991). https://doi.org/10.1007/BF01955941
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01955941