| Autor: |
Oh, Jimi, Song, In-Kyung, Cho, Junki, Yun, Tae-Jin, Park, Chun Soo, Choi, Jae Moon, Gwak, Mijeung, Shin, Won-Jung |
| Předmět: |
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| Zdroj: |
Pediatric Cardiology; Dec2019, Vol. 40 Issue 8, p1618-1626, 9p, 1 Diagram, 4 Charts, 1 Graph |
| Abstrakt: |
Ventricular performance and its loading condition change drastically after surgical correction of congenital heart defect. Pressure–volume loops analysis can provide quantitative information about ventriculo-arterial coupling (VAC) indicating the interaction between ventricular contractility and loading condition. Therefore, we investigated changes in VAC after corrective surgery for ventricular septal defect (VSD)/tetralogy of Fallot (TOF), and implication of ventriculo-arterial decoupling as a prognostic factor of post-operative outcomes. In children with VSD/TOF, pre- and post-operative arterial elastance (Ea), end-systolic ventricular elastance (Ees) and VAC (Ea/Ees) were non-invasively estimated using echocardiographic parameters. Post-operative outcomes included maximum vasoactive-inotropic score, the duration of mechanical ventilation and hospital stay. Preoperatively, patients with VSD had significantly lower Ea and Ees than patients with TOF; however, VAC were preserved in both. In patients with VSD, post-operative Ea increased disproportionately to change in Ees, resulting in increased VAC. Post-operative higher VAC in patients with VSD was independently associated with maximum vasoactive-inotropic score (odds ratio [OR] 63.9; 95% Confidence Interval [CI] 4.0–553.0; P = 0.003), prolonged mechanical ventilation (OR 6.3; 95% CI 1.1–37.8; P = 0.044) and longer hospitalization (OR 17.6; 95% CI 1.6–187.0; P = 0.018). In patients with TOF, Ea and Ees reduced post-operatively; however, VAC remained unchanged and was not associated with post-operative outcomes. Despite of different loading condition, preoperative VAC maintained in both of VSD and TOF. However, particularly in VSD patients, abrupt increase in post-operative loading state induces contractility-load decoupling, which leads to worse post-operative outcomes. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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