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Epicardial damage induced by topical cooling during paediatric cardiac surgery
1Cardiothoracic Centre, University of Milan, Hospital "S Raffaele", Milan, Italy.
Insights
Topical cooling with ice during congenital heart defect surgery in children may cause temporary electrocardiographic changes due to epicardial damage. Cold saline is a safer alternative, showing fewer ST elevations post-operation.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Hypothermia
Background:
- Congenital heart defect (CHD) repair often involves hypothermia to reduce metabolic demand.
- Topical cooling is a common method to achieve systemic hypothermia during CHD surgery.
- Electrocardiographic (ECG) changes can occur postoperatively, but their specific association with topical cooling methods requires investigation.
Purpose of the Study:
- To investigate electrocardiographic (ECG) changes in infants and children undergoing surgical repair of congenital heart defects (CHDs).
- To compare ECG findings between two topical cooling methods: ice and cold saline.
- To assess the potential link between topical cooling techniques and myocardial injury.
Main Methods:
- A retrospective study analyzed ECGs of 26 pediatric patients who underwent CHD repair with topical cooling (ice vs. cold saline).
- Patients were divided into two groups: topical cooling with ice (n=11) and cold saline (n=15).
- ECGs were evaluated for ST elevation, timing of recordings, and compared between groups using statistical tests.
Main Results:
- No significant differences were observed in demographics, diagnosis, ischemia duration, or postoperative myocardial function between the groups.
- Temporary ST elevation occurred in all children cooled with ice (Group 1) within 48 hours post-surgery, compared to only seven in the cold saline group (Group 2) (p<0.005).
- The mean ST elevation score was significantly higher in the ice group (1.34 mV) versus the cold saline group (0.52 mV) (p<0.01).
Conclusions:
- Temporary ECG changes, specifically ST elevation, were more frequent and pronounced when ice was used for topical cooling.
- These ECG changes are likely due to epicardial damage from hypothermic osmotic injury caused by ice.
- Cold saline appears to be a safer alternative for topical cooling in pediatric CHD surgery, minimizing potential epicardial injury.
Objective:
To study electrocardiographic changes in infants and children in whom topical cooling was used during surgical repair of congenital heart defects.
Design:
A retrospective study of all patients who had surgical repair of congenital heart disease during cold blood cardioplegia and topical cooling from January to August 1990. Eleven patients (group 1) had topical cooling with ice and 15 (group 2) with cold saline.
Patients:
All 36 paediatric patients operated on during this period. All the available electrocardiographic records were analysed. Ten patients in whom reliable records were not available were excluded. Twenty six patients entered in this retrospective study.
Interventions:
Topical cooling with ice or with a slush of cold saline.
Main Outcome Measure:
Recordings from all the precordial leads were examined and scored as the sum of the maximum ST elevation (mV) in each precordial lead. The score obtained for each electrocardiogram was recorded together with the timing of the electrocardiogram (preoperative, arrival in intensive care unit immediately after surgery, postoperatively in the intensive care unit, and at discharge).
Results:
There were no differences between the two groups in terms of demographic data, diagnosis, duration of ischaemia, and postoperative myocardial performance. There was temporary ST elevation during the first 48 postoperative hours in all the children in group 1 but in only seven of the 15 children in group 2 (Fisher's test, p less than 0.005). The mean (SD) score for maximum ST elevation was 1.34 (0.83) mV in group 1 and 0.52 (0.64) mV in group 2 (Student's t test, p less than 0.01).
Conclusions:
These temporary electrocardiographic changes in the presence of adequate myocardial performance were attributed to epicardial damage induced by hypothermicosmotic injury. The use of ice for topical cooling may damage the epicardium in children.