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Surgical Repair of Mitral Valve Disease in Children: Perioperative Changes in Respiratory Function
Iliona Malaspinas1, Ferenc Petak2, Lionel Chok3
1Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland; †Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Insights
Children with mitral valve disease exhibit abnormal respiratory mechanics. Surgical repair improves airway function, but lung tissue stiffening may persist post-surgery, impacting overall lung function.
Area of Science:
- Pediatric Cardiology
- Respiratory Physiology
- Thoracic Surgery
Background:
- Mitral valve disease in children is associated with significant physiological changes.
- Understanding the impact on respiratory mechanics is crucial for comprehensive patient care.
Purpose of the Study:
- To evaluate changes in airway and respiratory tissue mechanics in children before and after mitral valve repair surgery.
- To assess the long-term effects of surgical intervention on lung function.
Main Methods:
- Prospective study involving 24 children with mitral valve insufficiency.
- Respiratory system input impedance measured via forced oscillation technique.
- Airway and respiratory tissue mechanics assessed preoperatively and postoperatively.
Main Results:
- Children with mitral valve disease demonstrated abnormal respiratory elastance and resistance.
- Airway function significantly improved immediately after surgery and remained improved at 3 weeks.
- Respiratory tissue elastance decreased 5 days postoperatively, but intraoperative effects were not clear.
Conclusions:
- Mitral valve disease adversely affects pediatric airway and respiratory tissue mechanics.
- Surgical repair effectively improves airway function, but persistent lung tissue stiffening can occur.
- Residual lung tissue impairment may contribute to sustained compromised lung function weeks after surgery.
Objective:
To assess the profile of changes in airway and respiratory tissue mechanics within a follow-up study performed in children with mitral valve disease, before and after surgical valve repair.
Design:
Perioperative measurements in a prospective, consecutive cross-sectional study.
Setting:
University hospital, tertiary care teaching hospital
Participants:
The study comprised 24 children with congenital or post-rheumatic mitral valve insufficiency.
Interventions:
Input impedance of the respiratory system during spontaneous breathing was measured before and 5 days and 3 weeks after mitral valve surgery. In addition, airway and respiratory tissue mechanics and pulmonary arterial pressure were assessed with the patient under general anesthesia preoperatively and immediately postoperatively. Respiratory tissue elastance and changes in airway measurements were estimated from forced oscillatory impedance data by fitting an appropriate model.
Measurement And Main Results:
Relating airway and respiratory tissue mechanics to previously established reference values obtained in age-matched healthy control patients revealed abnormal respiratory function (135±6.2% and 148±13% in respiratory elastance and resistance, respectively; p<0.001). Improvement in the airway properties was observed immediately after surgery (-15.2±3.4%; p<0.005) and lasted for the study period (-19±4.1%; p<0.001). Respiratory tissue elastance, which correlated preoperatively to the diastolic pulmonary arterial pressure, decreased only 5 days postoperatively (-20.6±4.1%; p<0.005). However, there was no evidence of a clear, immediate effect of surgery on the tissue mechanical parameters measured intraoperatively despite a decrease in diastolic pulmonary pressure.
Conclusions:
Mitral valve disease in children leads to abnormal airway and respiratory tissue mechanics. Even though surgical repair of mitral insufficiency alleviates abnormal airway function, residual lung tissue stiffening may persist even weeks after the surgery, contributing to a sustained impairment in lung function.
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