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Cardiac output in infants and children after open-heart surgery
Insights
Cardiac index measurements in infants and children after heart surgery reveal lower values in younger infants and those with specific congenital heart defects. Low cardiac index can predict patient outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Hemodynamics
Background:
- Assessing cardiac function post-cardiopulmonary bypass is crucial for pediatric cardiac surgery patients.
- Cardiac index (CI) is a key hemodynamic parameter reflecting cardiac output relative to body size.
Purpose of the Study:
- To evaluate cardiac index (CI) in infants and children following normothermic cardiopulmonary bypass.
- To identify factors influencing CI and its predictive value for outcomes.
Main Methods:
- Green dye dilution method was used to measure cardiac index (CI) in 32 infants and 58 children at 6 and 24 hours post-bypass.
- Patient age, diagnosis, and other hemodynamic parameters were recorded.
Main Results:
- Infants under one year had significantly lower CI compared to older children.
- Lower CI was observed in patients with total anomalous pulmonary venous drainage, truncus arteriosus, and tetralogy of Fallot.
- A 6-hour CI below 2.0 L/min/m² was associated with mortality; systolic blood pressure showed limited predictive value.
Conclusions:
- Cardiac index measurement is valuable for assessing hemodynamic status in pediatric patients after intracardiac repair.
- CI aids in evaluating therapeutic interventions and predicting patient outcomes.
- Age and specific congenital heart defects are associated with lower post-bypass cardiac index.
Abstract:
Green dye measurements of cardiac index (in liters per minute per square meter) were compared in 32 infants and 58 children, 6 and 24 hours after normothermic cardiopulmonary bypass. Cardiac index was significantly lower in infants under one year of age, as compared to older infants and children. This parameter was also lower in patients with total anomalous pulmonary venous drainage, truncus arteriosus, and tetralogy of Fallot. Five infants who died had 6-hour cardiac index determinations of 2.0 L./min./sq. M. Only 2 of 27 survivors had cardiac indices below this level. Simultaneously recorded heart rate and central venous pressure did not correlate with cardiac index. Systolic blood pressure was significantly lower in infants in whom the cardiac index was less then 2.0 L./min./sq. M. (p less than 0.01). However, in individual situations, determination of systemic blood pressure lacked specificity in predicting outcome. Measurements of cardiac index are helpful in the management of infants and children following intracardiac repair by (1) assessing the hemodynamic status, (2) providing a useful indication of the cardiocirculatory effects of therapeutic interventions, and (3) predicting outcome.