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Estimation of intracardiac shunts in young children with a novel indicator dilution technology
Theodor Skuli Sigurdsson1,2, Lars Lindberg3
1Department of Pediatric Anesthesia and Intensive Care, Children´s Hospital, University Hospital of Lund, Lund, Sweden. theodors@landspitali.is.
Insights
A new COstatus monitor shows promise for detecting intracardiac shunts in children, accurately identifying their presence but slightly underestimating shunt ratios compared to invasive methods.
Area of Science:
- Pediatric Cardiology
- Medical Device Technology
- Hemodynamics
Background:
- Accurate assessment of intracardiac shunts is crucial for pediatric cardiac surgery planning.
- Current methods like echocardiography lack quantitative shunt ratio (Qp/Qs) estimation.
- Invasive techniques for Qp/Qs measurement carry inherent risks.
Purpose of the Study:
- To validate the COstatus monitor, a novel device using indicator dilution technology, for estimating intracardiac shunt ratios (Qp/Qs) in children.
- To compare the COstatus monitor's performance against established invasive reference techniques.
- To assess the device's utility before and after corrective cardiac surgery.
Main Methods:
- Prospective, observational, method-comparison study at a single center.
- COstatus monitor (indicator dilution) compared with perivascular ultrasonic flow probes and the oximetric shunt equation.
- Inclusion of pediatric patients undergoing corrective cardiac surgery.
Main Results:
- The COstatus monitor demonstrated high sensitivity and specificity in detecting intracardiac shunts.
- A trend towards underestimation of shunt ratios (Qp/Qs) was observed compared to reference methods.
- The device provided quantitative estimates of pulmonary to systemic blood flow ratios.
Conclusions:
- The COstatus monitor is a potentially valuable non-invasive tool for evaluating intracardiac shunts in pediatric patients.
- Further refinement may be needed to improve the accuracy of shunt ratio quantification.
- The device offers a promising alternative for clinical decision-making in pediatric congenital heart disease management.
Abstract:
Clinical evaluation of intracardiac shunts in children is not straightforward. Echocardiography can only diagnose the presence of a shunt but does not estimate the shunt ratio. This can be a critical factor that influences treatment options. In this single-center, prospective, observational, method-comparison study, we validate the ability of a novel monitoring device COstatus to estimate the intracardiac shunt ratio (Qp/Qs) of pulmonary (Qp) to systemic (Qs) blood flow in young children before and after corrective cardiac surgery. The indicator dilution technology COstatus monitor was compared to two other more invasive reference techniques, perivascular ultrasonic flow probes (placed around the pulmonary truncus and ascending aorta) and the oximetric shunt equation (using arterial and venous blood gases). Our study revealed that the COstatus monitor detected intracardiac shunts with high sensitivity and specificity but there was some underestimation of the shunt ratios compared to the reference techniques.
