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Postbypass pulmonary artery pressure influences respiratory system compliance after ventricular septal defect closure
M Takeuchi1, K Kinouchi, K Fukumitsu
1Department of Anesthesiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Insights
Surgical closure of ventricular septal defects (VSD) can impact respiratory compliance. High post-bypass pulmonary artery pressure is linked to decreased respiratory compliance in pediatric cardiac patients following VSD closure.
Area of Science:
- Pediatric Cardiology
- Respiratory Physiology
Background:
- Surgical correction of left-to-right shunts generally improves respiratory function in pediatric cardiac patients.
- However, respiratory compliance does not always improve after surgical correction.
Purpose of the Study:
- To identify factors influencing changes in respiratory system compliance (Crs) after ventricular septal defect (VSD) closure.
- To investigate the relationship between post-bypass pulmonary artery pressure and Crs changes post-VSD closure.
Main Methods:
- Prospective study of 17 pediatric patients (<10 kg) undergoing VSD closure.
- Patients divided into two groups based on post-bypass mean pulmonary artery pressure (mPAP): Group C (mPAP ≤ 18 mmHg) and Group PH (mPAP > 18 mmHg).
- Respiratory system compliance (Crs) measured using a multiple occlusion technique; Cpost/Cpre ratio compared between groups.
Main Results:
- The Cpost/Cpre ratio was significantly higher in Group C (1.11±0.17) compared to Group PH (0.81±0.12) (P<0.01).
- A significant correlation was found between post-bypass mPAP and Cpost/Cpre (rs=0.49, P<0.05).
- No significant correlation observed between preoperative mPAP, Qp/Qs, or Rp/Rs and Cpost/Cpre.
Conclusions:
- Elevated post-bypass mean pulmonary artery pressure is associated with a perioperative decrease in respiratory system compliance after VSD closure.
- This finding highlights the importance of monitoring pulmonary artery pressure post-surgery to predict respiratory outcomes.
Abstract:
It is reported that surgical correction of left-to-right shunt improves respiratory function in paediatric cardiac patients. However, such correction sometimes does not result in an improvement of respiratory compliance. The purpose of this study was to look for factors determining changes in respiratory system compliance (Crs) in patients who underwent closure of ventricular septal defect (VSD closure). In a prospective study, 17 children (< 10 kg) who underwent VSD closure were enrolled. They were divided into two groups, according to postbypass mean pulmonary artery pressure (mPAP). The patients were allocated to Group C if mPAP was < or = 18 mmHg (n=12) and to Group PH if > 18 mmHg (n=5). We compared the ratio of postoperative Crs to preoperative Crs (Cpost/Cpre) between the groups. A multiple occlusion technique was used to measure Crs. The Cpost/Cpre in group C was larger than that in group PH (1.11+/-0.17 vs. 0.81+/-0.12, P<0.01). There was a correlation between postbypass mPAP and Cpost/Cpre (r(s)=0.49, P<0.05), but no correlation was noted between preoperative mPAP, Qp/Qs or Rp/Rs and Cpost/Cpre. We concluded that high postbypass mPAP was associated with a perioperative decrease in Crs after VSD closure.