{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:28:02Z","timestamp":1785421682898,"version":"3.56.0"},"reference-count":19,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002560","name":"Soonchunhyang University","doi-asserted-by":"publisher","award":["no"],"award-info":[{"award-number":["no"]}],"id":[{"id":"10.13039\/501100002560","id-type":"DOI","asserted-by":"publisher"}]},{"award":["no"],"award-info":[{"award-number":["no"]}],"id":[{"id":"https:\/\/ror.org\/03qjsrb10","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background and Clinical Significant: Patent ductus arteriosus (PDA) is a common cardiovascular disorder in extremely low-birth-weight (ELBW) infants, for which surgical ligation is indicated when pharmacologic closure fails. Sudden increases in afterload combined with immature myocardial contractility can lead to post-ligation cardiac syndrome (PLCS), which usually occurs within hours after surgery. However, acute intraoperative hemodynamic collapse during PDA ligation has rarely been described. Case Presentation: A preterm infant born at 24 weeks and 3 days of gestation with a birth weight of 890 g underwent emergency PDA ligation for a hemodynamically significant PDA (hs-PDA) refractory to pharmacological treatment. Fifteen minutes after skin incision, the infant developed desaturation, bradycardia, and non-measurable noninvasive blood pressure, which required immediate hemodynamic resuscitation with manual ventilation, fluid administration, and dopamine and dobutamine infusions. Hemodynamics gradually recovered after completion of ductal ligation, whereas oxygen saturation did not fully recover. Postoperative chest radiography revealed a left-sided pneumothorax, and oxygen saturation stabilized after pleural air aspiration. The subsequent clinical course was uneventful, and typical PLCS did not develop. Conclusions: This case suggests that intraoperative hemodynamic collapse during PDA ligation may share pathophysiologic features with PLCS, and that concomitant pneumothorax can further aggravate hemodynamic instability by worsening hypoxemia and reducing venous return.<\/jats:p>","DOI":"10.3390\/children13040518","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:41:18Z","timestamp":1775648478000},"page":"518","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Hemodynamic Collapse During Patent Ductus Arteriosus Ligation in an Extremely Low-Birth-Weight Infant: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5554-3657","authenticated-orcid":false,"given":"Jeongsoo","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho Soon","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da Hyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0577-1253","authenticated-orcid":false,"given":"Yong Han","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3655-9052","authenticated-orcid":false,"given":"Hea Rim","family":"Chun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9950-5479","authenticated-orcid":false,"given":"Hyung Yoon","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Young","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7446-3479","authenticated-orcid":false,"given":"Jin Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangwoo","family":"Im","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"781","DOI":"10.18203\/2349-3291.ijcp20190729","article-title":"Association of Patent Ductus Arteriosus (Pda) with Prematurity and Low Birth Weight Neonates","volume":"6","author":"Wani","year":"2019","journal-title":"Int. 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Pediatr., 8.","DOI":"10.3389\/fped.2020.573627"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e14759","DOI":"10.1111\/ped.14759","article-title":"Evaluation of Postoperative Complications for Patent Ductus Arteriosus in Extremely-Low-Birthweight Infants","volume":"64","author":"Ishida","year":"2022","journal-title":"Pediatr. Int."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Caruggi, S., Calandrino, A., Cipresso, G., Battaglini, M., Massirio, P., Vinci, F., Bonato, I., Andreato, C., Mela, F., and Curcio, L. (2025). Second Attempt for Patent Ductus Arteriosus (Pda) Closure: Room for Acetaminophen? A Retrospective Single-Center Experience at Gaslini Children\u2019s Hospital. 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Dis."},{"key":"ref_15","first-page":"130","article-title":"Profound Bradycardia Following Patent Ductus Arteriosus Closure; a Rare but Correctable Event","volume":"1","author":"Zarrabi","year":"2013","journal-title":"Bull. Emerg. Trauma"},{"key":"ref_16","first-page":"46","article-title":"Ligation of Patent Ductus Arteriosus in Preterm Infant with Comorbidities: An Unforgotten Nightmare","volume":"1","author":"Choudhury","year":"2024","journal-title":"J. Neonatal Crit. Care Anesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1001\/jama.2017.10476","article-title":"Pneumothorax","volume":"318","author":"Imran","year":"2017","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/08941930802046469","article-title":"Acute Hemodynamic Decompensation Following Patent Ductus Arteriosus Ligation in Premature Infants","volume":"21","author":"Harting","year":"2008","journal-title":"J. Investig. 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