Abhay Divekar, Mary M Seshia and Murray Kesselman
The pulmonary vascular resistance (PVR) is elevated to some extent in all patients with congenital diaphragmatic hernia (CDH). In those with severely elevated PVR closure or restriction of a previously patent ductus arteriosus (PDA) can precipitate hemodynamic compromise secondary to acute heart failure. Maintaining ductal patency in this subset of patients is not a well-established therapeutic strategy. This report reviews the potential utility of maintaining ductal patency by discussing the pathophysiology and reviewing the published literature.