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Entropy score, patent ductus arteriosus (PDA), and cardiopulmonary bypass (CPB): Ligation of PDA on CPB can compromise cerebral blood flow

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Author(s): Neema Praveen | Dharan Baiju | Singha Subrata | Sethuraman Manikandan | Rathod Ramesh

Journal: Annals of Cardiac Anaesthesia
ISSN 0971-9784

Volume: 14;
Issue: 3;
Start page: 203;
Date: 2011;
Original page

Keywords: Cardiopulmonary bypass | cerebral hypoperfusion | patent ductus arteriosus

ABSTRACT
A patent ductus arteriosus (PDA) is often present in patients undergoing correction of congenital heart disease. It is well appreciated that during cardiopulmonary bypass (CPB), a PDA steals arterial inflow into pulmonary circulation, and may lead to systemic hypoperfusion, excessive pulmonary blood flow (PBF) and distention of the left heart. Therefore, PDA is preferably ligated before initiation of CPB. We describe acute decreases of arterial blood pressure and entropy score with the initiation of CPB and immediate increase in entropy score following the PDA ligation in a child undergoing intracardiac repair of ventricular septal defect and right ventricular infundibular stenosis. The observation strongly indicates that a PDA steals arterial inflow into pulmonary circulation and if the PDA is dissected and ligated on CPB or its ligation on CPB is delayed the cerebral perfusion is potentially compromised.
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Tango Jona
Tangokurs Rapperswil-Jona