Predicting Postoperative Hypertension Among Patients With Ventricular Septal Defect in Infants

Abstract Purpose: Patients with strong pulmonary vascular occlusive lesions are at risk of developing postoperative pulmonary hypertension (PH). We aimed to evaluate preoperative right ventricular (RV) function in patients with ventricular septal defect (VSD) who required cardiac surgery during infancy and consequently developed postoperative PH and to determine whether we could preliminarily evaluate postoperative PH in these patients.Methods: We retrospectively analyzed 55 infants with VSD who underwent cardiac surgery between March 2014 and April 2020. We evaluated the measurements of preoperative atrial/ventricular general function and 2D atrial/ventricular strain between these two groups: a group with postoperative PH (post-PH) and a group without postoperative PH (post-NPH). Results: Post-PH patients had a significantly lower tricuspid annular plane systolic excursion (TAPSE) (11.2 mm) and TAPSERA (the proportion of TAPSE due to RA contraction alone) (6.6 mm) than the post-NPH patients (14.1 mm, 8.5 mm). Furthermore, the post-PH group had a significantly lower peak right atrial (RA) longitudinal strain (PRALS) (31.0%) than the post-NPH group (43.0%). Multivariate logistic regression analysis identified that PRALS and TAPSERA were independent echocardiographic parameters for the presence of post-PH. The sensitivity and specificity of predicting post-PH for ≤38% of the PRALS were 83.0% and 100.0%, respectively, with an area under the curve of 0.94 (p < 0.01).Conclusion: Preoperative RA function and RV diastolic function decreased in the post-PH group. The RA strain and TAPSERA could be useful factors for predicting postoperative PH.

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Predicting postoperative hypertension among patients with ventricular septal defect in infants.

10.22541/au.163252985.57677966/v1 ◽

2021 ◽

Author(s):

Junpei Kawamura ◽

Kentaro Ueno ◽

Tsubasa Shimozono ◽

Yoshihiro Takahashi ◽

Koji Nakae ◽

...

Keyword(s):

Cardiac Surgery ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Area Under The Curve ◽

Right Atrial ◽

Multivariate Logistic Regression Model ◽

General Function ◽

2D Strain ◽

Echocardiographic Parameters ◽

Postoperative Hypertension

Background: Patients with strong pulmonary vascular occlusive lesions are at risk of developing postoperative pulmonary hypertension (PH). We aimed to evaluate preoperative right ventricular (RV) function in patients with ventricular septal defect (VSD) who required cardiac surgery during infancy and consequently developed postoperative PH and to determine whether we could preliminarily evaluate postoperative PH in these patients. Methods: We retrospectively analyzed 55 infants with VSD who underwent cardiac surgery between March 2014 and April 2020. We evaluated the measurements of preoperative general function and 2D strain between these two groups: a group with postoperative PH (post-PH, n=10) and a group without postoperative PH (post-NPH, n=45). Results: Post-PH patients had a significantly lower tricuspid annular plane systolic excursion (TAPSE) (11.1 mm), TAPSERA (the proportion of TAPSE due to right atrial (RA) contraction alone) (7.0 mm), RA ejection fraction (36.1 %) and RA expansion index (56.4 %) than the post-NPH patients. Furthermore, the post-PH group had a significantly lower peak RA longitudinal strain (PRALS) (32.0 %) than the post-NPH group (43.0%). Multivariate logistic regression model demonstrated that PRALS was independent echocardiographic parameters for the presence of post-PH (OR 1.18, 95% CI: 1.02 - 1.36, p = 0.03) . The sensitivity and specificity of predicting post-PH for ≤ 35 % of the PRALS were 88.9 % and 70.0 %, respectively, with an area under the curve of 0.85 (p < 0.01). Conclusion: RA parameters demonstrated preoperative RV diastolic dysfunction in the post-PH group. PRALS could be useful factors for predicting postoperative PH.

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A Left Ventricular–to–Right Atrial Shunt in a Patient With a Perimembranous Ventricular Septal Defect: Role of Intraoperative Transesophageal Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2008.12.005 ◽

2009 ◽

Vol 23 (5) ◽

pp. 675-678

Author(s):

Shrinivas Gadhinglajkar ◽

Rupa Sreedhar ◽

Shyamkrishnan Kumaralingam Gopalakrishnan ◽

Adil Sadiq ◽

Mallikarjun Rao ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Transesophageal Echocardiography ◽

Septal Defect ◽

Left Ventricular ◽

Right Atrial ◽

Perimembranous Ventricular Septal Defect ◽

Intraoperative Transesophageal Echocardiography ◽

Atrial Shunt

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An Intriguing Right Atrial Object in a Child With Ventricular Septal Defect

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.12.003 ◽

2020 ◽

Author(s):

Madan Mohan Maddali ◽

Pranav Subbaraya Kandachar ◽

Eapen Thomas ◽

Salim Nasser Al-Maskari

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Right Atrial

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Prevalence of Culture-Negative Fever in Infants With Down Syndrome Undergoing Cardiac Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119864575 ◽

2019 ◽

Vol 10 (5) ◽

pp. 599-603

Author(s):

Jeffrey Vergales ◽

Michael D. Seckeler ◽

Joshua Chew ◽

James Gangemi

Keyword(s):

Down Syndrome ◽

Cardiac Surgery ◽

Septal Defect ◽

Surgical Repair ◽

Area Under The Curve ◽

Control Group ◽

Chromosomal Anomalies ◽

Retrospective Case ◽

Postoperative Fever ◽

Culture Negative

Background: Children with Down syndrome (DS) often have congenital heart disease that requires surgical repair in the first year. Anecdotally, we have noted that patients with DS seem to have a higher rate of culture-negative postoperative fever. The objective was to evaluate the prevalence of postoperative fever and recovery among patients with DS undergoing cardiac surgery. Methods: We conducted a retrospective, case–control study of all patients at our institution less than one year of age with DS undergoing surgical repair of an atrioventricular septal defect or ventricular septal defect between 2010 and 2016. The control group was patients with no chromosomal anomalies who were age and surgery matched to the DS group. Temperatures were recorded for the first 72 hours postoperatively, with duration and degree of fever being assessed using the area under the curve. Results: Patients with DS (n = 34) had a significantly higher prevalence of fever than the control group (59% vs 24%, P = .003), longer ventilator time, and longer length of stay. Among the DS group, those who developed fever tended to be older at the time of surgery (146 ± 63 vs 103 ± 45 days, P = .04). The DS group with fever had similar cardiopulmonary bypass times, intensive care unit and total lengths of stay, ventilator days, and hospital costs compared to patients with DS without fever. Conclusions: Patients with DS have a higher incidence of culture-negative fever within the first 72 hours. The presence of fever in these patients, however, does not affect their overall postoperative course.

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Adult Ventricular Septal Defect Repair Using a Robotic Totally Endoscopic Approach: A Case Report

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520922978 ◽

2020 ◽

Vol 15 (4) ◽

pp. 372-375

Author(s):

Saeid Mirzai ◽

Narutoshi Hibino ◽

Gianluca Torregrossa ◽

Husam H. Balkhy

Keyword(s):

Cardiac Surgery ◽

Ventricular Septal Defect ◽

Minimally Invasive ◽

Septal Defect ◽

Outcome Data ◽

Safe Procedure ◽

Persistent Symptoms ◽

Congenital Cardiac Anomalies ◽

Robotic Cardiac Surgery ◽

Defect Repair

The growth and advancement of minimally invasive cardiac surgery in recent years has allowed robotic and totally endoscopic procedures to become safe and effective options for the treatment of patients with various diseases of the heart. However, despite these advances, outcome data for robotic correction of congenital cardiac anomalies are scarce. This is particularly true for robotic ventricular septal defect (VSD) repair with initial experiences only recently having been published by a single group. Here, we present the case of a 29-year-old female who underwent robotic totally endoscopic VSD repair due to persistent symptoms with resolution of preoperative shunting and severe tricuspid regurgitation following surgery. This unique case adds to the limited data currently available in the literature on robotic VSD repair to show that it is a safe procedure when performed by a dedicated surgical team experienced in minimally invasive robotic cardiac surgery. We feel that, in this setting, the benefits of a robotic surgical approach can be afforded to more patients with excellent results.

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Development of chylous ascites in an infant with ventricular septal defect: a case report

Cardiology in the Young ◽

10.1017/s1047951116000597 ◽

2016 ◽

Vol 26 (6) ◽

pp. 1225-1227 ◽

Cited By ~ 1

Author(s):

Yoshio Ootaki ◽

George R. Verghese ◽

Ross M. Ungerleider

Keyword(s):

Cardiac Surgery ◽

Case Report ◽

Ventricular Septal Defect ◽

Clinical Finding ◽

Septal Defect ◽

Chylous Ascites

AbstractThis case report describes chylous ascites associated with a CHD in a 4-month-old infant. Although atraumatic chylous ascites are a rare clinical finding, the recognition and treatment of chylous ascites influence the timing of cardiac surgery.

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