| Autor: |
Ronald W. Day |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Předmět: |
|
| Zdroj: |
International Journal of Cardiology Congenital Heart Disease, Vol 4, Iss , Pp 100184- (2021) |
| Druh dokumentu: |
article |
| ISSN: |
2666-6685 |
| DOI: |
10.1016/j.ijcchd.2021.100184 |
| Popis: |
Background: Based upon expert opinion, guidelines have been proposed for the correctability of congenital cardiovascular shunts with increased pulmonary vascular resistance. This study reports the accuracy of published guidelines using a dataset from the Inhaled Nitric Oxide as a Preoperative Test study. Methods: The hemodynamic measurements and outcome of 52 patients with relatively high pulmonary vascular resistance who underwent corrective surgery of congenital shunts were used to determine how well recent guidelines would accurately identify correctable and uncorrectable patients. Results: The accuracy of preoperative testing was 19%, 29% and 17% using a baseline indexed pulmonary vascular resistance less than 4 WU-m2, indexed pulmonary vascular resistance less than 6 WU-m2 and ratio of pulmonary to systemic vascular indices less than 0.30 as criteria for correctable shunts, respectively. Accuracy improved to 71%, 87% and 88% by using the results of acute vasodilator testing with oxygen and nitric oxide instead of baseline measurements. The accuracy of preoperative testing was 46% and 48% using a baseline indexed pulmonary vascular resistance greater than 8 WU-m2 and a ratio of pulmonary to systemic vascular indices greater than 0.50 as criteria for uncorrectable shunts, respectively. Accuracy improved to 88% and 88% by using the results of acute vasodilator testing with oxygen and nitric oxide instead of baseline measurements. Conclusions: Guidelines using baseline hemodynamic measurements do not provide accurate guidance for identifying patients with correctable or uncorrectable congenital cardiovascular shunts and increased pulmonary vascular resistance. The accuracy of a preoperative evaluation can be increased with acute vasodilator testing. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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