Correlation between pediatric open heart surgery outcomes and arterial-mixed venous oxygen saturation differences

Low Cardiac Output Syndrome [LCOS] contributes to postoperative morbidity and mortality. This article tries to find a predictive factor to interpret outcome after cardiac operation. In a cross-sectional study, 100 children with congenital heart disease undergoing cardiovascular surgery with cardiopulmonary bypass [CPB] without significant left-to-right shunt were selected. Arterial and central venous oxygen saturation values were measured via blood samples simultaneously obtained in 6-hr intervals for a total of 24-hr during postoperative period at hours 0, 6, 12, 18, and 24. Postoperative ventilation support [intubation period] and cardiovascular support were also obtained from the hospital records. Statistical analysis was later performed comparing the arterial-mixed venous oxygen saturation differences and durations of required ventilatory and cardiovascular support, both for the complicated and non-complicated patient groups. The data was processed with correlation Pearson and Mann-Whitney U tests in SPSS 15 software, P less than 0.05 was significant. Mortality following cardiac operation is 6% and complications may happen in 45% of the cases. The highest Arterial-mixed venous oxygen saturation difference occurred immediately post operation [up to 57%]. These measures were high up to 18 hours in complicated and non-complicated groups [36% vs. 31% ; P< 0.05]. This factor cannot predict prolongation of intubation period in patients [P > 0.05]. Arterial-mixed venous oxygen saturation difference may be high as much as 57% or as low as 23%.These different measures, being higher up to 18 hours in complicated to non-complicated groups after 18 hours, can be related to tissue ischemia during surgery and cannot be discriminative.

Inferior vena cava index in edematous patients

To find a relation between extracellular over fluid and inferior vena cava index as a noninvasive, cost effective and accessible method. In a cross sectional study 54 cases [no edema 30, mild and moderate 13 and significant edema 11 cases] entered to study. Inferior vena cava index [IVCi] measured by difference of inspiration to expiration divided to maximum size multiply by 100, we also find delta ratio as difference of maximum to minimum size of inferior vena cava. All data expressed by rate and ratio, relation of edema severity to IVCi or delta ratio performed by mann whitney and regression test, P less than 0.05 was significant. IVCi in 30 cases with no edema, 13 cases with mild to moderate and 11 cases with significant edema were%46 +/- 16,%42 +/- 16,%38 +/- 17, there is a reverse relation of IVCi and edema severity but these relations were not significant [P>0.05]. Averaged Delta ratio [millimeter] decreased in severe edema but it was not significant[3.7mm +/- 2 vs. 2.8mm +/- 1.6]. In edematous conditions IVCi and delta ratio decrease but these changes are not significant for edema severity estimation.

Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar hypertrophy

Hypertrophy of adenotonsillar tissue is one of the most common problems in childhood age and causes upper airway obstruction and even obstructive sleep apnea symptoms in severe forms. The aim of this study is to evaluate the changes of pre-adentonsillectomy echocardiographic findings after operation. From August 2007 to November 2008, 55 children with adenotonsillar hypertrophy and obstructive-sleep symptoms [aged 3-11 years old of which 35 were males and 20 females] were randomly selected. Preoperatively echocardiography was performed for all patients by the pediatric cardiologist. In control group 55 children who referred to otolaryngology clinic because of non adenotonsillar related disease evaluated. One month and six months after operation, patients with positive findings were followed up and again echocardiography was performed separately. No complaints of apnea were reported. Tonsillar grades of all cases were type III or IV. The preoperative mean pulmonary arterial pressure levels of the 4 [7.3%] children were higher than normal range [25 mm Hg] and it decreased significantly after operation [P < 0.000] [Preoperative MPAP = 32 +/- 3 mm Hg, and six months postoperative follow up, MPAP = 11 +/- 5 mm Hg]. All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea of their children. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation [P < 0.000 preoperative TR = 34 +/- 8 mm Hg postoperative TR = 19 +/- 6 mm Hg]. AC/ET in these seven patients were lower than 0.4. In control group echocardiography findings are normal. Severe chronic hypertrophic adenotonsillar tissue caused higher tricuspid regurgitation pressure and mean pulmonary arterial pressure

Cardiac findings in congenital nephrotic syndrome

Congenital nephrotic syndrome is a severe debilitating problem associated with extra renal manifestation such as diverse cardiac findings. During four years 6 cases diagnosed as congenital nephritic syndrome in base of definitive criteria their documents reviewed and echocardiographic evaluation has been done for all with or without cardiac sign or symptoms, results gathered and expressed as incidence. All cases have some grades of structural or functional defects from simple form like as tricus-pid regurgitation to complex defects. It may be run in consecutively in siblings of a family from non consanguine parents. Pulmonary stenosis may occur in all parts subvalvualr, valvular and peripheral parts of pulmonary artery, left ventricular hypertrophy and mitral regurgitation observed in some, moderate tricuspid regurgitation observed in half of cases due to pulmonary hypertension or right ventricular hypertrophy due to pulmonary stenosis

Subclinical pulmonary hypertension in children with obstructive adenotonsillar hypertrophy

Adenotonsillar hypertrophy [ATH] is the most common cause of upper airway obstruction and obstructive sleep symptoms in children. The aim of this study is to compare pre-adentonsillectomy echocardiographic findings with postoperative findings. Fifty five children with adnotonsillar hypertrophy and obstructive-sleep apnea symptoms [aged 4 to14 years, 35 males, 20 females] were randomly selected from Aug 2007 to November 2008. Preoperatively echocardiography was performed for all patients by the same pediatric cardiologist. Patients with positive findings were followed and again echocardiography was performed separately one month and six months after operation. All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea. No complaints of apnea were reported. Tonsillar grades of all cases were of Ill or N. The preoperative mean pulmonary arterial pressure levels of the 4[7.3%] children were higher than normal range [25mmhg] and it significantly decreased after operation [P<0.0001 Npar test] [Preoperative MPAP = 32 +/- 3 mmHg, and six months postoperative follow up, MPAP=11 +/- 5 mmHg]. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation [p 0.0001 preoperative TR=34 +/- 8 mmHg postoperative TR=19 +/- 6mmhg] Acceleration time /Ejection time [AC/ET] in these 7patient were lower than 0.4. This study showed that chronic symptomatic obstructive hypertrophy of adenotonsillar tissue results in higher tricuspid regurgitation pressure and mean pulmonary arterial pressure, which could be relieved by adenotonsillectomy

Right atrial pressure significance in renal function indices

With attention to association of right atrial pressure to renal venous hypertension, we try to review renal function indices changing due to congenital heart disease as base of right atrial pressure and cyanosis condition. Forty five children without preexisting renal disease, diagnosed as pulmonary hypertension due to congenital heart disease with or without cyanosis entered to this study their renal function indices besides to their right atrial pressure measured by angiographic documents .The effects of right atrial pressure and cyanosis on renal function indices evaluated by appropriate statistical methods. Right atrial pressure is not a common problem but it is more frequent in cyanotic than acyanotic patients. In addition significant proteinuria occurs in cyanotic patients with high right atrial pressure [above 5 mmHg]. There is not any difference between renal function as glomerular filtration rate or creatinine in either groups of cyantic or acyanotic with a high or normal right atrial pressure. In cyanotic congenital heart disease patients who have pulmonary hypertension measuring of right atrial pressure seems essential; in high risk group including those with high right atrial pressure and cyanosis, significant proteinuria may happen in up to 30% of cases independent of age or gender

Association of proteinurai in children with acyanotic congenital heart disease and pulmonary hypertension in a Tertiary University Hospital in Northwest Iran

This study was performed to detect the severity of proteinuria in children with cyanotic pulmonaryhypertension. Twenty children suffering from pulmonary hypertension due to acyanotic heart disease evaluated for proteinuria. They were divided into two groups of equal less than two amd more than two years old, because of the difference in proteinuria ratio in these two groups. Association of proteinuria with age, hematocrit, mean pulmonary arterial pressure and tricuspid regurgitation were evaluated. Although there was not any case of proteinuria in nephrotic range but significant roteinuria was observed in 2 out of 11 children aged below 2 years of age, and 3 out of 9 in children above 2 years old. However there was no relationship between ages, mean pulmonary. Arterial pressure, hemoglobin, hematocrit, tricuspid regurgitation and proteinuria. There was not any relationship between proteinuria and the severity of pulmonary artery pressure, tricuspid 1-egurgitation, age and hematocrit in this group of children Significant proteinuria in children with acyanotic congential heart disease was present in 25% of cases [5 out of 20]. Nephrotic syndrome is uncommon in children with acyanotic pulmonary hypertension congenital heart disease