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Pulmonary functions before and after pediatric cardiac surgery
Hala Agha1, Fatma El Heinady, Mona El Falaky
1Pediatric Cardiology Unit, Pediatric Department, Children Hospital, Cairo University, El Kasr El Aini St., Garden City, Cairo, Egypt, halaazza@gmail.com.
Insights
Cardiac surgery significantly improves infant lung function after congenital heart defect repair. Echocardiography parameters correlate with lung mechanics, aiding in assessing outcomes.
Area of Science:
- Pediatric Cardiology
- Pulmonary Medicine
- Medical Imaging
Background:
- Infants with congenital heart diseases and pulmonary overflow often experience impaired lung function.
- Assessing pulmonary function and its correlation with cardiac parameters is crucial for managing these patients.
Purpose of the Study:
- To evaluate pulmonary function changes in infants before and after cardiac surgery for congenital heart diseases.
- To identify echocardiographic parameters that best correlate with lung mechanics in this population.
Main Methods:
- 30 infants with left-to-right shunt congenital acyanotic heart diseases underwent echocardiography and infant pulmonary function tests (IPFTs) preoperatively and 6 months postoperatively.
- IPFTs included tidal volume, respiratory rate, respiratory system compliance (Crs), respiratory system resistance, functional residual capacity (FRC), and airway resistance, measured via baby body plethysmography.
- Correlation analysis was performed between echocardiographic parameters and IPFT results.
Main Results:
- All measured IPFT parameters showed significant improvement 6 months after surgery (p < 0.0001).
- Systolic pulmonary artery pressure negatively correlated with Crs (r = -0.493, p = 0.006) and positively with FRC (r = 0.450, p = 0.013).
- Pulmonary artery size correlated positively with effective resistance (r = 0.416, p = 0.022) and specific effective resistance (r = 0.604, p = 0.0001), and negatively with Crs (r = -0.398, p = 0.029).
Conclusions:
- Surgical correction of congenital heart diseases with left-to-right shunts positively impacts infant lung compliance, airway resistance, and FRC.
- Noninvasive echocardiographic parameters, including pulmonary artery pressure and size, are closely related to pulmonary function test indexes in these infants.
Abstract:
This study aimed to assess pulmonary functions before and after cardiac surgery in infants with congenital heart diseases and pulmonary overflow and to clarify which echocardiographic parameter correlates best with lung mechanics. Between 2008 and 2009, 30 infants with left-to-right shunt congenital acyanotic heart diseases who had indications for reparative surgery of these lesions were assessed by echocardiography and infant pulmonary function tests before the operation and 6 months afterward. Tests using baby body plethysmography were performed to assess the following infant pulmonary functions: tidal volume, respiratory rate, respiratory system compliance (C(rs)) and respiratory system resistance, functional residual capacity (FRC), and airway resistance. The mean age of the patients was 10.47 ± 3.38 months, and their mean weight was 6.81 ± 1.67 kg. Ventricular septal defect and combined lesions were the predominant cardiac diseases (26.7%). Comparison of the infant pulmonary function tests showed a highly significant improvement in all the parameters between the preoperative and 6-month postoperative visits (p < 0.0001). Systolic pulmonary artery pressure had a statistically significant negative correlation with C(rs) (r = -0.493, p = 0.006) and a positive correlation with FRC (r = 0.450, p = 0.013). The findings showed that C(rs) had a statistically significant negative correlation with the pulmonary artery size (r = -0.398, p = 0.029) and the left atrium size (r = -0.395, p = 0.031), whereas the pulmonary artery size had a statistically positive correlation with effective resistance (r = 0.416, p = 0.022) and specific effective resistance (r = 0.604, p = 0.0001). Surgical correction of left-to-right shunt congenital heart diseases had a positive impact on lung compliance, airway resistance, and FRC. Noninvasive echocardiographic parameters assessing pulmonary vascular engorgement and pulmonary artery pressure were closely related to these infant pulmonary function test indexes.
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