@Article{chd.12738,
AUTHOR = {Regan E. Giesinger, Adrianne R. Bischoff, Patrick J. McNamara},
TITLE = {Anticipatory perioperative management for patent ductus arteriosus surgery: Understanding postligation cardiac syndrome},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {2},
PAGES = {311--316},
URL = {http://www.techscience.com/schd/v14n2/38776},
ISSN = {3071-1738},
ABSTRACT = {Ligation of a hemodynamically significant ductus arteriosus results in significant 
changes in loading conditions which have predictable consequences. Postligation 
cardiac syndrome, defined as hypotension requiring inotropic support and failure of 
oxygenation and ventilation, may occur 6‐12 hours following ligation due to left ven‐
tricular systolic and diastolic failure, respectively. Afterload is the primary driver of 
this decompensation. In this review, we describe the pathophysiological changes in 
loading conditions associated with postligation cardiac syndrome and other contrib‐
utors to cardiovascular dysfunction following ductal ligation. We present strategies 
for perioperative optimization and a physiology‐based algorithm for postoperative 
management guided by targeted neonatal echocardiography. The use of these strate‐
gies to reduce the frequency of postligation deterioration may be an avenue to im‐
prove outcomes for neonates in this vulnerable patient population.},
DOI = {10.1111/chd.12738}
}