Figure 3.

Hemodynamic alterations and clinical algorithm following patent DA (PDA) ligation. L to R, left to right; GA, gestational age; SAP, systolic arterial pressure; DAP, diastolic arterial pressure; PLCS, post-ligation cardiac syndrome. *Transient hypertension, with a predominant increase in diastolic blood pressure, has also been observed in the immediate postoperative period following PDA ligation (75), lasting for a variable amount of time, but rarely beyond the first 24–48 h post-ligation. Persistent hypertension lasting days or weeks and hypertension needing treatment are relatively rare complications, with only a few cases reported in infants and older children (76, 77). Post-PDA treatment hypertension is ascribed to the increased systemic vascular resistance (SVR), resulting from sudden obliteration of the low-resistance ductal pathway, along with some degree of vasomotor dysregulation in the presence of maintained myocardial performance. **Consider hydrocortisone (refractory hypotension with adrenal insufficiency) with systolic and/or diastolic hypotension.