Right heart assist by intermittent abdominal compression after surgery for congenital heart disease

Right heart assist after open heart surgery in children can be accomplished by inflation of a balloon beneath a tight cloth wrap on the abdomen. This device can be inexpensively constructed of ordinary equipment found in the intensive care unit. This is a review of the use of intermittent abdominal compression in 14 children (mean age 19 +/- 15 months, mean weight 8 +/- 4 kg) after operation at Henrietta Egleston Hospital. Primary diagnoses were tricuspid atresia physiology in five, atrioventricular canal in four, truncus arteriosus in one, tetralogy of Fallot in one, ventricular septal defect (VSD) in one, D-transposition of the great arteries in one, and aortic-left ventricular tunnel with VSD in one. Compression was used for an average of 16.3 +/- 11.4 hr. Displacement of blood from the abdominal viscera to the central circulation by balloon inflation led to elevation of right atrial pressure by 3.6 +/- 1.8 mm Hg (p less than .001) and consequent elevation of mean arterial pressure by 9.8 +/- 5 mm Hg (p less than .001). Urine output was improved in almost every instance. In 11 surviving children, the net fluid intake and output balance in the first 12 hr after application of intermittent abdominal compression was -154 +/- 219 ml (p less than .05). This simple method of intermittent abdominal compression was effective after a variety of operations for treatment of congenital heart disease and was especially useful after the Fontan procedure.