Assessment of cardiac function in infants with transposition of the great arteries after surgery: comparison of two methods

作者：Yang, Fan; Iacobelli, Roberta; Wang, Jian-Ming; Iorio, Fiore Salvatore^*

来源：World Journal of Pediatrics, 2018, 14(4): 373-377.

DOI：10.1007/s12519-018-0178-y

• Cardiac index
• Doppler echocardiography
• dp
• dt(max)
• Pressure recording analytic method
• Transposition of the great arteries

Background: Assessment of cardiac function is crucial in pediatric patients undergoing cardiovascular surgery, monitoring cardiac output and changing hemodynamic conditions during surgery accordingly is important to improve post-surgical outcome. We aimed to measure cardiac index (CI) and maximal rate of the increase of left ventricular pressure dp/dt(max) with the pressure recording analytic method (PRAM, MostCare((R))) and compared it with transthoracic echocardiographic cardiac index estimation in infants with transposition of the great arteries (TGA) undergoing surgical correction.
Methods We enrolled 74 infants with TGA consecutively into this study. CI and dp/dt(max) were measured with PRAM and echocardiography at 0, 4, 8, 12, 24 and 48h postoperatively. Blood brain natriuretic peptide (BNP) and blood lactate (Lac) were measured at baseline and after operation.
Results The median age at surgery was 13 days (range 1-25 days) with an average weight of 3.24kg (range 2.31-4.17kg). CI estimated by PRAM was 1.11 +/- 0.12 L/min/m(2) (range 0.69-1.36) and by Doppler echocardiography was 1.13 +/- 0.13 L/min/m(2) (range 0.76-1.40). dp/dt(max) estimated by PRAM was 1.31 +/- 0.03mmHg/s (range 1.23-1.43) and by Doppler echocardiography was 1.31 +/- 0.04 L/min/m(2) (range 1.25-1.47). CI (r=0.817, P<0.001) and dp/dt(max) (r=0.794, P<0.001) measured by two methods were highly correlated with a linear relation. Blood BNP and lactate increased to the highest level at 8-12 h post-operatively.
Conclusions In the early post-operative period, PRAM provides reliable estimates of cardiac index and dp/dt(max) value compared with echocardiographic measurements. PRAM through mostcare((R)) is a reliable continuous monitoring method for peri-operative management in children with congenital heart disease.

• 出版日期2018-8
• 单位河北省儿童医院