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Postoperative fetal circulation: POFC
Insights
Persistent fetal circulation (PFC) can occur late after neonatal surgery. This condition, characterized by right-to-left shunting, requires prompt diagnosis and management in postoperative infants.
Area of Science:
- Neonatal cardiorespiratory disorders
- Pediatric surgery
- Critical care medicine
Background:
- Persistent fetal circulation (PFC) involves active pulmonary vasoconstriction and shunting of venous blood.
- This phenomenon can complicate neonatal cardiorespiratory conditions.
Observation:
- Two neonates developed late-onset PFC after major intra-abdominal surgery.
- One patient had an omphalocele repair, the other a gastric perforation repair.
- Both experienced severe hypoxia and right-to-left shunting postoperatively.
Findings:
- Postoperative fetal circulation (POFC) was diagnosed via contrast echocardiography.
- Both patients responded to hyperventilation and/or tolazoline therapy.
- Contrast echocardiography proved a valuable noninvasive diagnostic tool.
Implications:
- POFC should be considered in postoperative neonates with unexplained hypoxia.
- Early diagnosis and intervention are crucial for favorable outcomes.
- This condition highlights the importance of vigilant monitoring in surgical neonates.
Abstract:
Active pulmonary vasoconstriction and subsequent right-to-left atrial and/or ductal shunting of venous blood may influence the course of many neonatal cardiorespiratory disorders. The term "persistent fetal circulation" has been applied to these infants. This report concerns the late occurrence of fetal circulation after major intraabdominal operative procedures in two neonates. The first patient was a full-term, 3.6-kg infant with a covered, large liver-containing omphalocele. Cyanosis, hypoxia, and a right-to-left shunt were present at birth, but were improved by 24 hr of life. Primary repair was delayed for 6 days, in the belief that fetal circulation was unlikely to recur. On day 7, primary fascial closure of the omphalocele was followed by severe hypoxia secondary to right-to-left shunt, documented to be due to postoperative fetal circulation (POFC). The second was a 1600-g premature infant who was well until noted to be lethargic on the fourth day of life. Radiologic findings of pneumoperitoneum led to laparotomy and closure of a spontaneous gastric perforation. Twenty-four hours later the patient developed severe hypoxia and a right-to-left shunt at the atrial level was documented with contrast echocardiogram, again supporting the diagnosis of POFC. Each patient survived and has a normal heart. Both patients responded to hyperventilation and/or tolazoline therapy. Contrast echocardiography was a helpful, noninvasive means of establishing the diagnosis. This diagnosis should be considered in postoperative neonates after more common cardiac and pulmonary causes of hypoxia are excluded.