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Echocardiographic Characterization of Left Ventricular Structure, Function, and Coronary Flow in Neonate Mice
Published on: April 7, 2022
Does young age really put the heart at risk?
Michael Belanger1, Luke Tan1, Carin Wittnich2,1
1b Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada.
Insights
Younger children and those with lower body weight may experience worse outcomes after heart surgery due to unfavorable myocardial metabolic profiles, impacting recovery and intensive care unit stays.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery Outcomes
- Neonatal Physiology
Background:
- Despite advances, some pediatric heart patients face poorer outcomes.
- Younger age and lower body weight are potential risk factors for adverse responses.
- Newborn hearts show reduced tolerance to ischemia and altered metabolic profiles.
Purpose of the Study:
- To review evidence on risk factors impacting pediatric heart surgery outcomes.
- To investigate the role of young age and reduced body weight in surgical outcomes.
- To explore the correlation between myocardial energetic state and postoperative complications.
Main Methods:
- Review of evidence-based findings on pediatric cardiac surgery outcomes.
- Analysis of factors including age, body weight, and metabolic profiles.
- Correlation of myocardial energetic state with body weight and postoperative support.
Main Results:
- Newborn hearts exhibit poorer ischemia tolerance and at-risk metabolic profiles.
- Heparin administration during surgery can increase detrimental free fatty acids.
- Lower body weight in newborns with congenital heart disease correlated with poorer myocardial energetic state.
- Poorer energetic state linked to longer ventilation and intensive care unit (ICU) stay.
Conclusions:
- Unfavorable myocardial metabolic profiles may contribute to worse outcomes in pediatric heart surgery.
- Younger age and lower body weight are associated with compromised myocardial energetics.
- Findings suggest a link between metabolic state and postoperative recovery in neonates undergoing cardiac surgery.
Abstract:
Despite significant advances in the management and treatment of heart disease in children, there continue to be patients who have worse outcomes than might be expected. A number of risk factors that could be responsible have been identified. Evidence-based findings will be reviewed, including whether young age and (or) reduced body weight exacerbate these responses. For example, newborn children undergoing congenital cardiac surgery are known to have worse outcomes than older children. Evidence exists that newborn hearts do not tolerate ischemia as well as adult hearts, developing irreversible injury sooner and exhibiting at-risk metabolic profiles. As well, in response to the administration of heparin, elevations in free fatty acids occur during congenital heart surgery in children, which can have detrimental effects on the heart. Furthermore, myocardial energetic state has also been suggested to impact outcomes. Unfavourable energetic profiles were correlated to lower body weights in the same age healthy newborn piglet model. Newborn children suffering from congenital heart disease, with lower body weights, also had lower myocardial energetic state and this correlated with longer postoperative ventilatory support as well as a trend to longer intensive care unit stay. These findings imply that unfavourable myocardial metabolic profiles could contribute to postoperative complications.
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