Resolution of neonatal posthemorrhagic ventricular dilation coincident with patent ductus arteriosus ligation: case report

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  • 1 Keck School of Medicine of University of Southern California, Los Angeles; and Divisions of
  • 2 Neurosurgery,
  • 3 Neonatology, and
  • 4 Cardiology, Children’s Hospital Los Angeles, California
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Preterm infants commonly present with a hemodynamically significant patent ductus arteriosus (hsPDA). The authors describe the case of a preterm infant with posthemorrhagic ventricular dilation, which resolved in a temporally coincident fashion to repair of hsPDA. The presence of a PDA with left-to-right shunting was confirmed at birth on echocardiogram and was unresponsive to repeated medical intervention. Initial cranial ultrasound revealed periventricular-intraventricular hemorrhage. Follow-up serial ultrasound showed resolving intraventricular hemorrhage and progressive bilateral hydrocephalus. At 5 weeks, the ductus was ligated with the goal of improving hemodynamic stability prior to CSF diversion. However, neurosurgical intervention was not required due to improvement of ventriculomegaly occurring immediately after PDA ligation. No further ventricular dilation was observed at the 6-month follow-up.

Systemic venous flow disruption and abnormal patterns of cerebral blood circulation have been previously associated with hsPDA. Systemic hemodynamic change has been reported to follow hsPDA ligation, although association with ventricular normalization has not. This case suggests that the unstable hemodynamic environment due to left-to-right shunting may also impede CSF outflow and contribute to ventriculomegaly. The authors review the literature surrounding pressure transmission between a PDA and the cerebral vessels and present a mechanism by which PDA may contribute to posthemorrhagic ventricular dilation.

ABBREVIATIONS CVP = central venous pressure; FOHR = frontal-occipital horn ratio; FTHR = frontal-temporal horn ratio; hsPDA = hemodynamically significant PDA; OFC = occipital frontal circumference; PA = pulmonary artery; PDA = patent ductus arteriosus; PHVD = posthemorrhagic ventricular dilation; PIVH = periventricular-intraventricular hemorrhage; SVC = superior vena cava; VLBW = very low birth weight; VSGS = ventriculosubgaleal shunt.

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Contributor Notes

Correspondence Peter A. Chiarelli: Children’s Hospital Los Angeles, CA. pchiarelli@chla.usc.edu.

INCLUDE WHEN CITING Published online May 22, 2020; DOI: 10.3171/2020.3.PEDS19694.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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