Are Cardiac Anomalies and Persistent Fetal Circulation a Risk Factor for Cardiovascular Events During Minimally...

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Cardiovascular Events

Background:

• Minimally invasive surgery (MIS) is increasingly used in neonates.
• The safety of endoscopic procedures in this vulnerable population requires thorough evaluation.

Purpose of the Study:

• To assess the risk of cardiovascular events during neonatal MIS.
• To investigate the impact of persistent fetal circulation and cardiac anomalies on these risks.

Main Methods:

• Retrospective review of 108 neonates undergoing MIS (laparoscopy or thoracoscopy).
• Analysis of intraoperative cardiovascular events, focusing on cardiac anomalies and persistent fetal circulation.
• Literature review of reported cardiovascular events in neonatal MIS.

Main Results:

• No cardiovascular events occurred in 108 neonates during endoscopic surgery (0.0%).
• 46.3% of neonates had evaluated cardiac anomalies or persistent fetal circulation.
• Literature search identified 4 case reports of cardiovascular events, attributed to gas embolism via patent umbilical vein.

Conclusions:

• Vascular injury to a persistent umbilical vein is the main risk factor for cardiovascular events in neonatal MIS, primarily due to gas embolism.
• Persistent fetal circulation and cardiac anomalies appear to be less significant risk factors.
• Conversion to open surgery should be considered if a persistent umbilical vein is injured.