Comparison of two methods for hemodynamic assessment in children with tetralogy of Fallot after radical surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Fan ,  WANG Jianming , GU Jiangrong , YAO Junping , ZHU Xiaoli , ZHANG Xuejie , HAN Zhe

Department of Cardiac Surgery, Hebei Province Children’s Hospital, Shijiazhuang, 050031, P.R.China;

Corresponding author：

WANG Jianming, Email: wang_li_w@163.com

Keywords：

Tetralogy of Fallot; Mostcare monitor; echocardiography; hemodynamics

DOI：

10.7507/1007-4848.201807064

Video：

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Objective To explore the hemodynamic assessment after radical surgery in children with tetralogy of Fallot (TOF) by both echocardiography and Mostcare monitor. Methods Clinical data of 63 children with TOF who underwent radical surgery in our hospital from February 2016 to June 2018 were retrospectively analyzed, including 34 males and 29 females, aged 6-24 (9.82±5.77) months. There were 19 patients undergoing transannular patch reconstruction of the right ventricular outflow tract (a transannular patch group) while 44 patients retained the pulmonary valve annulus (a non-transannular patch group) . The echocardiography and Mostcare monitor parameters were recorded and brain natriuretic peptide was tested at the time points of 0, 8, 12, 24 and 48 hours after operation (T 0, T 1, T 2, T 4) to analyze their correlations and the change trend at different time points after radical surgery. Results The left ventricular ejection fraction at T 1 (43.49%±3.82%) was lower than that at T 0 (48.29%±4.55%), T 2 (45.83%±3.69%), T 3 (53.76%±4.43%) and T 4 (60.54%±3.23%, P<0.05). The cardiac index at T 1 (1.85±0.35 L·min⁻¹·m⁻²) was lower than that at T 0 (2.11±0.38 L·min⁻¹·m⁻²), T 2 (2.07±0.36 L·min⁻¹·m⁻²), T 3 (2.42±0.37 L·min⁻¹·m⁻²) and T 4 (2.82±0.42 L·min⁻¹·m⁻², P<0.05). The cardiac circulation efficiency at T1 (0.19±0.05) was lower than that at T 0 (0.22±0.06), T 2 (0.22±0.05), T 3 (0.28±0.06) and T 4 (0.34±0.06, P<0.05). The right ventricular two-chambers view fraction area change at T 1 (23.17%±3.11%) was lower than that at T 0 (25.81%±3.74%), T 2 (25.38%±3.43%), T 3 (30.60%±4.50%) and T 4 (36.94%±5.85%, P<0.05). The pulse pressure variability was the highest at T 0 (18.76%±3.58%), followed by T 1 (14.81%±3.32%), T 2 (12.44%±2.94%), T 3 (10.39%±2.96%) and T 4 (9.18%±1.92%, P<0.05). The blood brain natriuretic peptide was higher at T 1 (846.67±362.95 pg/ml) than that at T 0 (42.60±18.06 pg/ml), T 2 (730.95±351.09 pg/ml), T 3 (510.98±290.39 pg/ml) and T 4 (364.41±243.56 pg/ml, P<0.05). There was no significant difference in left ventricular ejection fraction, cardiac circulation efficiency and heart index between the two groups (P>0.05). The right ventricular two-chambers view fraction area change of the transannular patch group was significantly lower than that of the non-transannular patch group at each time point (P<0.05). The blood brain natriuretic peptide and pulse pressure variability of the transannular patch group were significantly higher than those of the non-transannular patch group (P<0.05). Left ventricular ejection fraction was positively correlated with cardiac index (r=0.637, P=0.001) and cardiac circulation efficiency (r=0.462, P=0.001) while was significantly negatively correlated with blood brain natriuretic peptide (r=–0.419, P=0.001). Conclusion Both methods can accurately reflect the state of cardiac function. Mostcare monitor has a good consistency with echocardiography. Using transannular patch to recontribute right ventricular outflow tract in operation has more influence on right ventricular systolic function. The Mostcare monitor can guide the hemodynamic management after surgery in real time, continuously and accurately.

Citation： YANG Fan, WANG Jianming, GU Jiangrong, YAO Junping, ZHU Xiaoli, ZHANG Xuejie, HAN Zhe. Comparison of two methods for hemodynamic assessment in children with tetralogy of Fallot after radical surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 326-331. doi: 10.7507/1007-4848.201807064 Copy

1.	Angtuaco MJ, Sachdeva R, Jaquiss RD, et al. Long-term outcomes of intraoperative pulmonary artery stent placement for congenital heart disease. Catheter Cardiovasc Interv, 2011, 77(3): 395-399.
2.	张宝宁, 张磊, 雷军荣, 等. 法洛四联症根治术 117 例. 第四军医大学学报, 2006, 27(5): 480-480.
3.	Moustafa S, Merchant N, Prieur T. Unusual operation for tetralogy of fallot. Arch Cardiovasc Dis, 2013, 106(3): 180-181.
4.	Hata T, Mashima M, Ito M, et al. Three-dimensional HD live rendering images of the fetal heart. Ultrasound Med Biol, 2013, 301(13): 662-665.
5.	张长江, 王德才, 杜德禄, 等. 小儿法洛四联症的外科治疗. 实用儿科临杂志, 2012, 27(17): 1370-1371.
6.	Polito A, Piga S, Cogo PE, et al. Increased morbidity and mortality in very preterm/VLBW infants with congenital heart disease. Intensive Care Med, 2013, 39(6): 1104-1112.
7.	Quandt D, Ramchandani B, Penford G, et al. Right ventricular outflow tract stent versus BT shunt palliation in tetralogy of Fallot. Heart, 2017, 103(24): 1985-1991.
8.	Li J, Luo S, Liu F, et al. Systolic function of right ventricular outflow tract is a better predictor to exercise performance after pilmonary valve replacement in tetralogy of Fallot. Pediatr Cardiol, 2017, 38(8): 1556-1561.
9.	Wilder TJ, Van Arsdell GS, Benson L, et al. Young infants with severe tetralogy of Fallot: early primary surgery versus transcatheter palliation. Thorac Cardiovasc Surg, 2017, 154(5): 1692-1700.
10.	Kobayashi M, Takahashi K, Yamada M, et al. Assessment of early diastolic interaventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot. Heart Vessels, 2017, 32(11): 1364-1374.
11.	韩丁, 罗毅, 贾清彦, 等. 压力记录分析法用于小儿法洛四联症根治术中循环能量效率研究. 心肺血管病杂志, 2016, 35(8): 623-627.
12.	李桐, 张燕搏, 杨克明, 等. 成人法洛四联症一期根治术后 ICU 延迟恢复的危险因素. 中华实用诊断与治疗杂志, 2017, 31(9): 878-880.
13.	凌文通, 李建伟, 袁勇. 脉搏轮廓温度稀释连续心输出量测定与热稀释法心输出量测定的相关性分析. 河北医学, 2009, 15(11): 132.
14.	Bognar Z, Foldi V, Rezman B, et al. Extravascular lung water index as a sign of developing sepsis in burns. Burns, 2010, 36: 1263-1270.
15.	Modesti PA, Gamberi T, Bazzini C, et al. Response of serum proteome in patients undergoing infraenal aortic aneurysm repair. Anesthesiology, 2009, 11: 844-854.
16.	Alonsoiñigo JM, Fas MJ, Osca V, et al. Goal-directed fluid and hemodynamic therapy in major colon surgery with the pressure recording analytical method cardiac output monitor (MostCare/PRAM) : prospe ctive analysis of 58 patients. Crit Care, 2012, 16(1): 242-246.
17.	Sanada S, Komuro I, Kitakaze M. Pathophysiology of myocardial reperfusion injury: preconditioning, postconditioning and translational aspects of protective measures. Am J Physiol Heart Circ Physiol, 2011, 301: H1723-H1741.
18.	Romagnoli S, Romano M, Lazzeri C, et al. Cardiac cycle efficiency: a new index for cardiac work estimation tested during aortic valve plasty. Crit Care, 2010, 14: P127.
19.	Schuuring MJ, Bolmers PP, Mulder BJ, et al. Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease. Int J Cardiovasc Imaging, 2012, 28: 755-762.
20.	汪华玲, 何胜虎, 徐日新, 等. 全心舒张末期容量指数及脉压变异预测感染性休克继发 ALI 容量反应性. 中华急诊医学杂志, 2014, 23(3): 267-272.
21.	支琳琳, 冯伟, 郭轶男, 等. 感染性休克患者不同时期液体负荷对机体影响的前瞻性临床研究. 中华危重病急救医学, 2015, 27(1): 13-16.
22.	Agudelo Torres DE, Naverro Martinez J, Galiana Lvars M, et al. Consensus on circulatory shock and hemodynamic monitoring task force of the European Society of Intensive Care Medicine. Intensive Care Med, 2014, 40: 1795-1815.

1. Angtuaco MJ, Sachdeva R, Jaquiss RD, et al. Long-term outcomes of intraoperative pulmonary artery stent placement for congenital heart disease. Catheter Cardiovasc Interv, 2011, 77(3): 395-399.
2. 张宝宁, 张磊, 雷军荣, 等. 法洛四联症根治术 117 例. 第四军医大学学报, 2006, 27(5): 480-480.
3. Moustafa S, Merchant N, Prieur T. Unusual operation for tetralogy of fallot. Arch Cardiovasc Dis, 2013, 106(3): 180-181.
4. Hata T, Mashima M, Ito M, et al. Three-dimensional HD live rendering images of the fetal heart. Ultrasound Med Biol, 2013, 301(13): 662-665.
5. 张长江, 王德才, 杜德禄, 等. 小儿法洛四联症的外科治疗. 实用儿科临杂志, 2012, 27(17): 1370-1371.
6. Polito A, Piga S, Cogo PE, et al. Increased morbidity and mortality in very preterm/VLBW infants with congenital heart disease. Intensive Care Med, 2013, 39(6): 1104-1112.
7. Quandt D, Ramchandani B, Penford G, et al. Right ventricular outflow tract stent versus BT shunt palliation in tetralogy of Fallot. Heart, 2017, 103(24): 1985-1991.
8. Li J, Luo S, Liu F, et al. Systolic function of right ventricular outflow tract is a better predictor to exercise performance after pilmonary valve replacement in tetralogy of Fallot. Pediatr Cardiol, 2017, 38(8): 1556-1561.
9. Wilder TJ, Van Arsdell GS, Benson L, et al. Young infants with severe tetralogy of Fallot: early primary surgery versus transcatheter palliation. Thorac Cardiovasc Surg, 2017, 154(5): 1692-1700.
10. Kobayashi M, Takahashi K, Yamada M, et al. Assessment of early diastolic interaventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot. Heart Vessels, 2017, 32(11): 1364-1374.
11. 韩丁, 罗毅, 贾清彦, 等. 压力记录分析法用于小儿法洛四联症根治术中循环能量效率研究. 心肺血管病杂志, 2016, 35(8): 623-627.
12. 李桐, 张燕搏, 杨克明, 等. 成人法洛四联症一期根治术后 ICU 延迟恢复的危险因素. 中华实用诊断与治疗杂志, 2017, 31(9): 878-880.
13. 凌文通, 李建伟, 袁勇. 脉搏轮廓温度稀释连续心输出量测定与热稀释法心输出量测定的相关性分析. 河北医学, 2009, 15(11): 132.
14. Bognar Z, Foldi V, Rezman B, et al. Extravascular lung water index as a sign of developing sepsis in burns. Burns, 2010, 36: 1263-1270.
15. Modesti PA, Gamberi T, Bazzini C, et al. Response of serum proteome in patients undergoing infraenal aortic aneurysm repair. Anesthesiology, 2009, 11: 844-854.
16. Alonsoiñigo JM, Fas MJ, Osca V, et al. Goal-directed fluid and hemodynamic therapy in major colon surgery with the pressure recording analytical method cardiac output monitor (MostCare/PRAM) : prospe ctive analysis of 58 patients. Crit Care, 2012, 16(1): 242-246.
17. Sanada S, Komuro I, Kitakaze M. Pathophysiology of myocardial reperfusion injury: preconditioning, postconditioning and translational aspects of protective measures. Am J Physiol Heart Circ Physiol, 2011, 301: H1723-H1741.
18. Romagnoli S, Romano M, Lazzeri C, et al. Cardiac cycle efficiency: a new index for cardiac work estimation tested during aortic valve plasty. Crit Care, 2010, 14: P127.
19. Schuuring MJ, Bolmers PP, Mulder BJ, et al. Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease. Int J Cardiovasc Imaging, 2012, 28: 755-762.
20. 汪华玲, 何胜虎, 徐日新, 等. 全心舒张末期容量指数及脉压变异预测感染性休克继发 ALI 容量反应性. 中华急诊医学杂志, 2014, 23(3): 267-272.
21. 支琳琳, 冯伟, 郭轶男, 等. 感染性休克患者不同时期液体负荷对机体影响的前瞻性临床研究. 中华危重病急救医学, 2015, 27(1): 13-16.
22. Agudelo Torres DE, Naverro Martinez J, Galiana Lvars M, et al. Consensus on circulatory shock and hemodynamic monitoring task force of the European Society of Intensive Care Medicine. Intensive Care Med, 2014, 40: 1795-1815.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of two methods for hemodynamic assessment in children with tetralogy of Fallot after radical surgery

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