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Haemodynamic changes in children with portal hypertension during the postoperative period
I A Ismail-Zade1, N A Trifonova, A Y Razumovski
1Department of Anaesthesia and Intensive Care, Filatov Children's Hospital, Moscow, Russia.
Insights
Portosystemic shunt surgery in children with extrahepatic portal hypertension induces a hyperdynamic state. Postoperative cardiovascular changes vary, with some developing pulmonary hypertension and right ventricular dysfunction, while others benefit from dobutamine treatment.
Area of Science:
- Pediatric Cardiology
- Vascular Surgery
- Hepatology
Background:
- Extrahepatic portal hypertension (EPH) presents unique cardiovascular challenges in children.
- Portosystemic shunt surgery (PSSS) is a treatment option for EPH, but its cardiovascular effects require detailed investigation.
Purpose of the Study:
- To evaluate the cardiovascular changes in children with EPH following PSSS.
- To determine the influence of PSSS on hemodynamic parameters and cardiac function.
Main Methods:
- Hemodynamic data were collected from 33 children with EPH undergoing PSSS.
- Utilized two-dimensional and M-mode echocardiography, pulsed-wave Doppler, and direct invasive techniques.
- Patients were categorized into groups based on preoperative hemodynamic status and postoperative responses.
Main Results:
- All patients exhibited a postoperative hyperdynamic state, characterized by increased cardiac index (CI) and heart rate (HR), and decreased systemic vascular resistance index (SVRI).
- Group I (preoperative hyperdynamic state with pulmonary hypertension) showed improved pulmonary artery acceleration time to ejection time ratio (AT/ET).
- Group II (preoperative normodynamic) developed pulmonary hypertension and right ventricular (RV) dysfunction postoperatively, indicated by decreased AT/ET and increased Vmax/AT.
- Group III (preoperative normodynamic) treated with dobutamine demonstrated significant increases in CI, left ventricular ejection fraction (LVEF), and AT/ET.
Conclusions:
- PSSS significantly alters cardiovascular hemodynamics in children with EPH, typically inducing a hyperdynamic state.
- Postoperative cardiovascular complications, including pulmonary hypertension and RV dysfunction, can occur in normodynamic patients.
- Dobutamine infusion may be beneficial in improving cardiac function and hemodynamics in select pediatric patients following PSSS.
Abstract:
The cardiovascular changes following portosystemic shunt surgery (PSSS) in 33 children with extrahepatic portal hypertension (EPH) were studied to determine if portosystemic shunt surgery had any influence on the cardiovascular state. Haemodynamic data were obtained using two-dimensional and M-mode echocardiography, pulsed-wave Doppler and direct invasive techniques. Postoperatively all patients developed a hyperdynamic state, associated with an increase in cardiac index (CI), heart rate (HR) and a decrease in systemic vascular resistance index (SVRI). In 16 patients (group I), who preoperatively exhibited a hyperdynamic state accompanied by pulmonary hypertension, postoperative studies found an increase in acceleration time to ejection time ratio (AT/ET) in the pulmonary artery from 0.32 +/- 0.05 (mean +/- SEM) to 0.43 +/- 0.01; P < 0.01. Nine patients (group II) who were normodynamic preoperatively developed pulmonary hypertension and right ventricular (RV) dysfunction postoperatively: decrease in AT/ET from 0.42 +/- 0.02 (mean +/- SEM) to 0.32 +/- 0.01; P < 0.01 and an increase in maximal peak pulmonary artery velocity to acceleration time ratio (Vmax/AT) from 702.56 +/- 69.10 (mean +/- SEM) to 1127 +/- 105.30 cm.sec-2; P < 0.01. In eight patients (group III) who were normodynamic preoperatively and were treated with dobutamine infusions at a rate of 5 micrograms.kg-1.min-1 postoperatively, the CI was found to increase from 5.28 +/- 1.1 (mean +/- SEM) to 7.97 +/- 1.64 L.min-1.m-2; P < 0.01, left ventricular ejection fraction (LVEF) from 69.0 +/- 4.1 (mean +/- SEM) to 81.0 +/- 2.9%; P < 0.01 and AT/ET from 0.37 +/- 0.04 (mean +/- SEM) to 0.44 +/- 0.03; P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)