ABSTRACT. A model of patent ductus arteriosus in premature lambs was created to examine the lamb's ability to handle the volume load imposed by a patent ductus arteriosus and to determine the lamb's ability to handle any additional volume load. Fifteen preterm lambs I133 -C 2 ( 2 SD) days gestation, term 145 days], whose ductal diameter could be regulated with a mechanical occluder, were studied to determine the independent effects of ductus patency and a saline volume load (50 ml/kg over 3 min) on left ventricular output and its distribution. During a saline infusion, preterm lambs with a closed ductus could only increase their stroke volume by 40% above baseline stroke volume. When challenged with a saline infusion, lambs with an open ductus still were able to increase their stroke volume significantly; the maximal increase in stroke volume during the saline load with the ductus open was 70% above baseline stroke volume. W e hypothesize that the associated reduced left ventricular afterload plays a significant role in the preterm lamb's ability to increase its stroke volume when challenged with a patent ductus arteriosus. Even with a patent ductus arteriosus, the lamb still has the ability to handle additional volume loads. (Pediatr Res 22: 531-535, 1987) Abbreviations PDA, patent ductus arteriosus LV, left ventricle QLV, left ventricular output Q pulmonary, pulmonary blood flow Q ductus, ductus arteriosus blood flow Q systemic, systemic blood flow R pulmonary, pulmonary vascular resistance R systemic, systemic vascular resistance R ductus, ductus arteriosus resistance R total, total resistance Hbg, hemoglobin GI, gastrointestinalThe PDA represents a significant stress on the premature cardiovascular system. The extent of this stress depends both on the magnitude of the left to right shunt through the PDA and on the ability of the cardiovascular system to adjust to that shunt. Full-term newborn lambs respond to volume loading with a limited increase in stroke volume, compared with adult sheep. The left ventricle of the full-term newborn lamb is capable of developing greater force than the left ventricle of the preterm lamb (with closed ductus) at comparable filling volume and resistance (6). Several studies have shown that the fetal lamb has a limited ability to increase its stroke volume above its baseline value during an acute volume load (8-12).The limited ability of the developing left ventricle to increase its output during a volume load is caused by some degree of myocardial immaturity (13) as well as by the high resting output needed to supply the demand for oxygen after delivery (14). The high resting level of performance demanded of the newborn heart may exhaust any reserve pumping capacity. The purpose of our study was both to examine the premature lamb's ability to handle the volume load imposed by a PDA and to see how the presence of a PDA alters the lamb's ability to tolerate any additional volume load.
METHODSPreparafion. Fifteen mixed breed western time-dated pregnant ewes at 128-133 days ge...