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Left ventricular performance in neonates on extracorporeal membrane oxygenation
F Berdjis1, M Takahashi, A B Lewis
1Department of Pediatrics, University of Southern California School of Medicine, Los Angeles.
Pediatric Cardiology
|July 1, 1992
Summary
Assessing left ventricular systolic performance in infants on extracorporeal membrane oxygenation (ECMO) is challenging. A load-independent index (VCFc/ESS) effectively evaluates ventricular function in neonates during ECMO.
Area of Science:
- Pediatric Cardiology
- Neonatal Physiology
- Cardiovascular Research
Background:
- Traditional ejection-phase indices for left ventricular systolic performance are unreliable in infants undergoing extracorporeal membrane oxygenation (ECMO) due to altered preload and afterload.
- Assessing myocardial function in critically ill neonates requires load-independent parameters.
Purpose of the Study:
- To evaluate left ventricular systolic performance in neonates during ECMO using a load-independent index.
- To assess the relationship between heart-rate-corrected mean velocity of circumferential fiber shortening (VCFc) and end-systolic wall stress (ESS) in this population.
Main Methods:
- A load-independent index (VCFc/ESS) was used to assess left ventricular function in 18 term neonates undergoing ECMO.
- Measurements were taken before, during, and after ECMO therapy.
Main Results:
- Left ventricular performance was highest before ECMO and decreased during and after therapy.
- Initially, 53% of patients showed enhanced performance relative to afterload, decreasing to 33% during ECMO and 0% after.
- VCFc was not elevated beyond the normal range predicted for ESS during or after ECMO.
Conclusions:
- The VCFc/ESS relation provides a meaningful assessment of ventricular performance in critically ill neonates on ECMO.
- Observed changes in performance may be linked to catecholamine variations rather than intrinsic myocardial contractility changes.