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Preoperative management in patients with single-ventricle physiology
Evonne Krushansky1, Nelson Burbano, Victor Morell
1Department of Pediatrics, Division of Cardiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15201, USA. evonne.krushansky@chp.edu
Congenital Heart Disease
|November 5, 2011
Summary
This study found that combining afterload reduction with inhaled hypoxemic therapy improved patient outcomes. This approach effectively managed cardiac output in single-ventricle patients before surgery.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Congenital Heart Disease
Background:
- Preoperative management of single-ventricle physiology is evolving.
- Previous studies questioned the efficacy of inhaled nitrogen for systemic cardiac output in these patients.
Purpose of the Study:
- To review institutional experience with afterload reduction and inhaled hypoxemic therapy in preoperative single-ventricle patients.
- To assess the impact of this combined therapy on cardiac output indicators.
Main Methods:
- Retrospective review of 49 single-ventricle patients (July 2004-January 2009).
- Patients received milrinone (afterload reduction) and inhaled nitrogen (hypoxemic therapy) preoperatively.
- Collected clinical, hemodynamic, and laboratory data at admission and before surgery.
Main Results:
- Statistically significant decrease in lactate and increase in pH, bicarbonate, and PaO2.
- No preoperative deaths observed.
- Only two patients showed evidence of multiorgan dysfunction before surgery.
Conclusions:
- The combination therapy effectively maintained appropriate cardiac output distribution.
- An adequate balance of systemic and pulmonary blood flow was achieved.
- Increased arterial PaO2 values indicated successful therapy.
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