Central venous-to-arterial CO2 difference as a biomarker of outcome in children who underwent surgery for congenital heart disease / Diferencia arteriovenosa de CO2 como biomarcador de desenlace en niños operados de cardiopatías congénitas

Abstract Background: In congenital heart surgery, low cardiac output syndrome (LCOS) is a major cause of morbidity in the immediate post-operative period. A decrease in cardiac output leads to an increase in tissue oxygen consumption. Several biomarkers such as venous oxygen saturation (SvO2), arteriovenous oxygen difference (DavO2), and lactate can assess tissue perfusion in the presence of LCOS. Recently, central venous to arterial CO2 difference (ΔCO2) has been proposed as a biomarker of tissue ischemia that could be used as a predictor of death in neonatal patients. This study aimed to analyze the relationship between ΔCO2 and immediate post-operative outcomes in pediatric patients undergoing congenital heart surgery and its correlation with DavO2, SvO2, and lactate. Methods: We conducted a longitudinal study of patients aged 0-18 years who underwent congenital heart surgery with or without cardiopulmonary bypass at the Instituto Nacional de Pediatría, from March 2019 to March 2021. Results: Eighty-two patients were included; the median age was 17 months. About 59% had a ΔCO2 ≥ 6 mmHg. Patients with ΔCO2 ≥ 6 mmHg had a vasoactive-inotropic score > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048), and lactate > 2 mmol/L (p = 0.027), as well as a longer hospital stay (p = 0.043). Patients with ΔCO2 > 6 mmHg and vasoactive-inotropic score ≥ 10 were 12.6 times more likely to die. Conclusion: ΔCO2 is a good marker of tissue hypoperfusion and outcome in the post-operative period of congenital heart surgery.

Resumen Introducción: En la cirugía cardiaca de malformaciones congénitas, el síndrome de bajo gasto cardiaco (SBGC) es una de las principales causas de morbilidad en el postoperatorio inmediato. La caída del gasto cardiaco aumenta el consumo de oxígeno en los tejidos. Varios biomarcadores, como la saturación venosa de oxígeno (SvO2), la diferencia arteriovenosa de oxígeno (DavO2) y el lactato han sido utilizados como indicadores hipoperfusión tisular en presencia de SBGC. Recientemente, la diferencia arteriovenosa de CO2 (ΔCO2) se ha propuesto como otro biomarcador de isquemia tisular que podría utilizarse como predictor de muerte en pacientes en edad neonatal. El objetivo de este estudio fue analizar la relación entre la ΔCO2 y la evolución postoperatoria de pacientes pediátricos operados de cardiopatías congénitas y correlacionarlo con la DavO2, SvO2 y lactato. Métodos: Se realizó un estudio longitudinal en pacientes de 0 a 18 años operados de corazón con empleo de bomba de circulación extracorpórea en el Instituto Nacional de Pediatría. Resultados: Se incluyeron 82 pacientes; la mediana de edad fue de 17 meses. El 59% presentó un ΔCO2 > 6 mmHg. Los pacientes con un ΔCO2 > 6 mmHg mostraron un puntaje de inotrópicos > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048) y lactato > 2 mmol/L (p = 0.027), así como mayor estancia hospitalaria (p = 0.043). Los pacientes con ΔCO2 > 6 mmHg y un puntaje de inotrópicos ≥ 10 presentaron una probabilidad de muerte 12.6 veces mayor. Conclusiones: El ΔCO2 en el periodo postoperatorio de una cirugía cardiaca congénita es un buen marcador de hipoperfusión tisular y de desenlace.

Clinical value of pulse pressure/central venous pressure ratio in low cardiac output syndrome after cardiac surgery / 中华危重病急救医学

Objective:To explore the relationship between the pulse pressure/central venous pressure (PP/CVP) ratio and the cardiac output (CO) of patients after cardiac surgery from the basic principles of hemodynamics, and to further evaluate the predictive value of PP/CVP ratio in patients with secondary low cardiac output syndrome (LCOS) after cardiac surgery.Methods:A retrospective study was conducted, and patients who received pulse indicator continuous cardiac output (PiCCO) monitoring were enrolled at the department of critical care medicine of Peking Union Medical College Hospital from January 1, 2016, to September 1, 2021. Patients were divided into two groups: the LCOS group [cardiac index (CI) < 33.34 mL·s -1·m -2, 25 cases] and the non-LCOS group (CI ≥ 33.34 mL·s -1·m -2, 125 cases) according to the CI at 6 hours after surgery. The general clinical data and hemodynamic parameters were collected. Correlations between PP/CVP ratio and PiCCO monitoring indicators were performed with Pearson or Spearman correlation test. Receiver operator characteristic curve (ROC curve) analysis was carried out to evaluate the predictive value of the parameters in patients with LCOS after cardiac surgery. Results:A total of 150 patients with PiCCO monitoring after cardiac surgery were included. There were no differences in baseline characteristics between the two groups, while PP in the LCOS group was lower than that in the non-LCOS group [mmHg (1 mmHg ≈ 0.133 kPa): 40 (37, 44) vs. 55 (46, 64)], CVP was higher than that in the non-LCOS group [mmHg: 12 (11, 14) vs. 10 (8, 12)], and PP/CVP ratio in the LCOS group was lower than that in the non-LCOS group [3.3 (2.9, 3.7) vs. 5.5 (4.6, 6.8)], with significant differences (all P < 0.05). Correlation analysis results showed that PP/CVP ratio was positively correlated with CI, CO, and stroke volume index (SVI), respectively ( rs = 0.660, 0.592, 0.600, all P < 0.001). CI was negatively correlated with PP ( rs = 0.509, P < 0.001) and positively correlated with CVP ( rs = -0.297, P < 0.001). ROC curve analysis revealed that compared with PP, CVP, SVI and cardiac function index (CFI), PP/CVP ratio was the best predictor of LCOS after cardiac surgery [area under the ROC curve (AUC) was 0.94±0.02, P < 0.001], when the optimum cut-off value was 4.41, the sensitivity was 80.00%, and the specificity was 96.00%. Conclusion:PP/CVP ratio was moderately positively correlated with CO after cardiac surgery, and PP/CVP ratio could be used as a prognostic predictor for LCOS after cardiac surgery.

Low cardiac output syndrome after congenital heart disease surgery / 中国小儿急救医学

Low cardiac output syndrome (LCOS) is a common complication of patients with congenital heart disease after surgery, with a high mortality rate.The etiology and pathophysiological mechanisms of LCOS can vary widely.Better understanding of LCOS pathogenesis would allow for target prevention and therapeutic approaches, and thereby reducing the incidence and mortality of LCOS, as well as improving the prognosis of patients.

Body mass index is associated with low postoperative cardiac output in patients undergoing aortic valve replacement / El índice de masa corporal se asocia a bajo gasto cardiaco postoperatorio de pacientes sometidos a reemplazo valvular aórtico

Abstract Background: Overweight and obesity (O/O) generate lipotoxicity of the cardiac fiber and increase the incidence and progression of aortic valve stenosis. The low cardiac output syndrome (LCOS) is a timing complication after to aortic valve replacement (AVR) surgery. Objective: The objective of the study was to investigate if body mass index (BMI) kg/m2 is a risk factor associated with LCOS and mortality in the post-operative period of AVR. Methods: A historic cohort study was designed, including patients with severe aortic stenosis (SAS), who were subjected to AVR. Results: 152 patients were included, 45 (29.6%), with normal weight (NW), 60 were overweight (39.5%), and 47 obese (30.9%). The prevalence of systemic hypertension (HT) was higher in O/O (p < 0.0001). Incidence of LCOS was 44.7%, being more frequent in the O/O groups compared to the NW group, 43.3%, 68.1%, and 22.2%, respectively, (p < 0.05 in overweight and p < 0.0001 in the obese). Assessing the presence or absence of LCOS associated with BMI as a numerical variable, we found that women, HT, BMI, left ventricular mass, and valve size, were associated with LCOS (p < 0.02, p < 0.02, p < 0.001, p < 0.032, and p < 0.045, respectively). Mortality was higher in patients who had LCOS (p < 0.02). Multivariate model showed that BMI was an independent risk factor for LCOS (odds ratio [OR] 1.21 [95% CI 1.08-1.35], p < 0.001). Conclusion: BMI is a risk factor associated to LCOS in the post-operative period of AVR in patients with SAS.

Resumen Antecedentes: El sobrepeso y la obesidad (O/O) generan lipotoxicidad de la fibra cardíaca y aumentan la incidencia y progresión de la estenosis de la válvula aórtica. El síndrome de bajo gasto cardíaco (SBGC) es una complicación postquirúrgica de la cirugía de reemplazo de válvula aórtica (RVA). Objetivo: Investigar si el índice de masa corporal kg/m2 (IMC) es un factor de riesgo asociado con SBGC y mortalidad en el postoperatorio de RVA. Métodos: Se diseñó un estudio de cohorte histórico, que incluyó pacientes con estenosis aórtica importante (EAI), que fueron sometidos a RVA. Resultados: Se incluyeron 152 pacientes, 45 (29.6%), con peso normal (N), 60 tenían sobrepeso (39.5%) y 47 obesos (30.9%). La prevalencia de hipertensión sistémica (HT) fue mayor en O/O (p < 0.0001). La incidencia de SBGC fue del 44.7%, siendo más frecuente en los grupos O/O en comparación con el grupo N, 43.3%, 68.1%, 22.2% respectivamente, (p < 0.05 en sobrepeso y p < 0.0001 en obesos). Al evaluar la presencia o ausencia de SBGC asociado con el IMC como una variable numérica, encontramos que las mujeres, HT, IMC, masa ventricular izquierda y tamaño de la válvula, se asociaron con SBGC (p < 0.02, p < 0.02, p < 0.001, p < 0.032, p < 0.045, respectivamente). La mortalidad fue mayor en pacientes con SBGC (p < 0.02). El modelo multivariado mostró que el IMC fue un factor de riesgo independiente asociado a SBGC [OR 1.21 (IC 95% 1.08-1.35), p < 0.001]. Conclusión: El IMC es un factor de riesgo asociado a SBGC en el postoperatorio de RVA en pacientes con EAI.

Efficacy of Levosimendan on postoperative low cardiac output syndrome of infants with congenital heart disease / 中华实用儿科临床杂志

Objective To investigate the efficacy of Levosimendan in the treatment of postoperative low cadiac output syndrome (LCOS) in infants with congenital heart disease (CHD).Methods Clinical data of patients with CHD developed postoperative LCOS in the Children Heart Center of Fuwai Central China Cardiovascular Hospital from January to December 2018 was collected.In patients that traditional vasoactive drugs failed to alleviate LCOS,the efficacy of continuous infusion of O.1 μg/(kg · min) Levosimendan was observed.Besides,the mechanical ventilation time,ICU stay time,mortality,the changes of ejection fraction (EF) and central venous oxygen saturation (ScvO2) at the infusion of Levosimendan and 48 h after infusion,as well as the changes of heart rate (HR),systolic blood pressure (SBP),vasoactive drugs score (VIS) and lactic acid at the infusion of Levosimendan and 3 h,6 h,12 h,24 h and 48 h after infusion were recorded.Results There were 29 cases,including 17 males (58.6％) and 12 females (41.4％),with median age of 2 (0.5,40.0) months,median body mass of 4.7 (2.6,13.5) kg,median mechanical ventilation time of 109.5 (42.5,367.0) h,ICU stay time of 187.5 (83,446) h,and 1 case died (3.4％).EF (48％ vs.52％)and ScvO2 (53％ vs.58％) increased 48 h after infusion,and the differences were statistically significant (all P ＜0.01).HR level (173 times/min,176 times/min,175 times/min,173 times/min,170 times/min,170 times/min) and lactic acid level (4.72 mmol/L,4.65 mmol/L,4.34 mmol/L,3.79 mmol/L,3.28 mmol/L,2.74 mmol/L) gradually decreased after infusion,and the differences of both between the beginning of infusion and 48 h after infusion were statistically significant (P =0.029);SBP decreased and then increased (74 mmHg,70 mmHg,71 mmHg,73 mmHg,74 mmHg,75 mmHg,1 mmHg =0.133 kPa),and VIS increased and then decreased (26 scores,27 scores,27 scores,26 scores,25 scores,25 scores) at different time points after infusion,however,the data of both between the beginning of infusion and 48 h after infusion had no significant differences (P =0.294,0.151).Conclusions Levosimendan can increase EF,enhance myocardial contractility and systemic tissue perfusion,thus improving the prognosis,when Levosimendan was applied for the treatment of postoperative LCOS of infants with CHD.

Efficacy of Levosimendan on postoperative low cardiac output syndrome of infants with congenital heart disease / 中华实用儿科临床杂志

Objective@#To investigate the efficacy of Levosimendan in the treatment of postoperative low cadiac output syndrome (LCOS) in infants with congenital heart disease (CHD).@*Methods@#Clinical data of patients with CHD developed postoperative LCOS in the Children Heart Center of Fuwai Central China Cardiovascular Hospital from January to December 2018 was collected.In patients that traditional vasoactive drugs failed to alleviate LCOS, the efficacy of continuous infusion of 0.1 μg/(kg·min) Levosimendan was observed.Besides, the mechanical ventilation time, ICU stay time, mortality, the changes of ejection fraction (EF) and central venous oxygen saturation (ScvO2) at the infusion of Levosimendan and 48 h after infusion, as well as the changes of heart rate (HR), systolic blood pressure (SBP), vasoactive drugs score (VIS) and lactic acid at the infusion of Levosimendan and 3 h, 6 h, 12 h, 24 h and 48 h after infusion were recorded.@*Results@#There were 29 cases, including 17 males (58.6%) and 12 females (41.4%), with median age of 2 (0.5, 40.0) months, median body mass of 4.7 (2.6, 13.5) kg, median mechanical ventilation time of 109.5 (42.5, 367.0) h, ICU stay time of 187.5 (83, 446) h, and 1 case died (3.4%). EF (48% vs.52%) and ScvO2 (53% vs.58%) increased 48 h after infusion, and the differences were statistically significant (all P<0.01). HR level (173 times/min, 176 times/min, 175 times/min, 173 times/min, 170 times/min, 170 times/min) and lactic acid level (4.72 mmol/L, 4.65 mmol/L, 4.34 mmol/L, 3.79 mmol/L, 3.28 mmol/L, 2.74 mmol/L) gradually decreased after infusion, and the differences of both between the beginning of infusion and 48 h after infusion were statistically significant (P=0.029); SBP decreased and then increased (74 mmHg, 70 mmHg, 71 mmHg, 73 mmHg, 74 mmHg, 75 mmHg, 1 mmHg=0.133 kPa), and VIS increased and then decreased (26 scores, 27 scores, 27 scores, 26 scores, 25 scores, 25 scores) at different time points after infusion, however, the data of both between the beginning of infusion and 48 h after infusion had no significant differences (P=0.294, 0.151).@*Conclusions@#Levosimendan can increase EF, enhance myocardial contractility and systemic tissue perfusion, thus improving the prognosis, when Levosimendan was applied for the treatment of postoperative LCOS of infants with CHD.

Clinical analysis of extracorporeal membrane oxygenation for 26 adult patients after cardiac surgical procedures / 中国胸心血管外科临床杂志

@#Objective    To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac surgery, analyze the risk factors associated with the mortality and other severe complications and to discuss prevention methods of complications during ECMO treatment. Methods    The clinical data of 26 patients with cardiac surgery, who underwent ECMO because of cardiopulmonary insufficiency ect in Zhongshan Hospital, Fudan University from January 2012 to September 2017, were retrospectively analyzed. There were 19 males and 7 females aged 24–80 (58.0±13.9) years. Results    Twelve (42.3%) patients successfully weaned from ECMO and six (23.1%) were discharged from hospital. Among 26 patients, 24 received VA ECMO (veno-arterial ECMO), including 5 after heart transplantation, 9 after heart valve surgery, and 3 were successfully weaned from ECMO. Seven patients with valvular surgery underwent ECMO within 48 hours due to refractory low cardiac output syndrome (LCOS). Eight patients  underwent major angioplasty, 3 of whom were successfully weaned from ECMO. Four patients underwent coronary artery bypass grafting and other cardiac surgeries. Patients with VA ECMO were treated with femoral vein-femoral artery cannulation except for 2 patients undergoing femoral vein-radial artery cannulation after major angioplasty. Patients with VV ECMO (veno-venous ECMO) underwent femoral vein-jugular vein cannulation. After ECMO support, 10 patients with bleeding occurred, and 5 patients were successfully weaned from ECMO. All patients had transfusion therapy during the assist period, 7 patients had infection after ECMO support, 4 patients suffered severe distal limb ischemia. There was no significant difference in the lactic acid between the survival and the dead patients before and after ECMO support. However, the decline of serum lactic acid in the survivors was faster than that of the dead patients. The trend was the most significant within 6 h after the operation. Conclusion    ECMO is one of the significant treatments for LCOS and refractory hypoxemia after cardiac surgery. The type of cardiac surgery and the timing of catheter placement are key factors for the success of ECMO. The different ways of ECMO intubation, prevention and control of bleeding during ECMO, monitoring and management of internal environment and the strategies of anti-infection are all important for success of ECMO.

Nursing care for one case of newborn with delayed closure of chest and acute renal injury after Switch operation and underwent Peritoneal dialysis / 中国实用护理杂志

Objective To summarize the nursing experience of delayed closure of chest with acute renal injury after switch operation and underwent peritoneal dialysis in neonates and to improve the therapeutic effect. Methods To summarize the curative effects and perioperative nursing experience of one case of the complete transposition of great arteries with intact interventricular septum neonate who underwent delayed closure of chest with acute renal injury and peritoneal dialysis after Switch operation under general anesthesia and extracorporeal circulation in November 2017 in our department. Results The child was postponed to close the chest after surgery. Low cardiac output syndrome and acute renal function injury occurred 1 hour after operation. Through monitoring hemodynamic indexes during ICU, the child recovered after timely treatment of low cardiac output syndrome, maintaining stabilization of circulation, diuresis, peritoneal dialysis, keeping water, electrolyte and acid-base balance, nursing care for delayed closure of chest and other related treatment. Postoperative assisted mechanical ventilation time was 168 hours, postoperative ICU hospitalization time was 12 days, and postoperative total hospitalization time was 19 days. Conclusion The infants who have complete transposition of the great arteries and the intact interventricular septum after Switch operation have many complications and rapid changes in the state of illness. Rigorous and meticulous nursing plays a key role in reducing the postoperative complications and improving the achievement ratio of the operation.

The clinical application of extracorporeal membrane oxygenation in the preoperative period of cardiovascular surgery / 中华胸心血管外科杂志

Objective To summarize and evaluate the clinical effect of extraco-rporeal membrane oxygenation(ECMO) support for critically ill patients after heart surgery,and to explore the factors that influenced the prognosis of ECMO.Methods The clinical data of 67 patients undergoing ECMO admitted to the Second Hospital of Jilin University from August 2013 to July 2017 were retrospectively analyzed.The patient's age ranged from 22 months to 78 years,including 3 infants aged 22,24,30 months and 64 adults ranged from 32 to 78 years,the mean age was(56.52 ± 10.99) years.Results The average ECMO support time was (235.79 ± 123.87) h,the mean mechanical ventilation time was (166.11 ± 148.31) h.49 patients weaned off successfully from ECMO,38 of them were discharged and 11 died within 28 days.18 patients gaved up treatment.42 patients suffered the complications.Conclusion VA-ECMO is a significant supportive method for preoperative intensive care in patients undergoing cardiovascular surgery.The keys to optimal results are grasping the indications of ECMO,earlier stopping mechanical ventilation,cluster curing(which involves reasonable anticoagulation,protection of organ function,prevention of hemorrhage,infection and limb distal ischemia).

Advances in the application of intraaortic balloon pumping in children / 中国小儿急救医学

Intraaortic balloon pump (IABP) is one of the short-term circulatory mechanical support technique. This technique can increase the blood flow of the coronary arteries to improve the blood and oxy-gen supply to myocardium,reduce the cardiac afterload,increase cardiac output. This technique was first used on adult in 1967 and till 1980 doctor Pollock used it on children successfully. After that there were several reports of pediatric patients using IABP,most of them are patients with congenital heart disease who had low cardiac output syndrome postoperatively,others were cardiomyopathy,myocarditis and children waiting for a heart transplant, total survival rate was 25%-100%. For children who can′t wean from cardiopulmonary bypass,bridge to the use of ventricular assist or extracorporeal membrane oxygenation and heart transplant, left ventricle failure leads to low cardiac output,IABP can be used to improve cardiac output and reduce mor-tality. However,with maturing of extracorporeal membrane oxygenation and ventricular assist device,whether IABP is the best choice for early cardiac assistance needs to be further studied.

Progressive volume deflation followed by rate reduction in weaning intra-aortic balloon pump / 中国胸心血管外科临床杂志

@#Objective    To investigate the changes of hemodynamics in patients weaning intra-aortic balloon pump (IABP) by using progressive volume deflation followed by rate reduction. Methods    We retrospectively analyzed the clinical data of 36 patients aged 68.9±4.7 years, 22 males and 14 females, who underwent progressive volume deflation followed by rate reduction for IABP weaning in Xinhua Hospital between September 2006 and January 2016. Progressive volume deflation followed by rate reduction was used to wean IABP and collect hemodynamics parameters of each time point. Results    All the patients successfully weaned IABP. One patient got re-IABP assistant 36 hours after the first successful weaning. One early death and three patients (8%) with postoperative IABP-related complications were embolization of the toe artery. One was in ipsilateral limb, and two of contralateral limb. One patient with acute hepatic insufficiency and one patient with acute renal insufficiency cured after treatment. Conclusion    Intra-aortic balloon pump weaning is successful by using volume deflation followed by rate reduction which allowed better hemodynamic parameters.

Critical Illness-Related Corticosteroid Insufficiency in Patients with Low Cardiac Output Syndrome after Cardiac Surgery

BACKGROUND: Low cardiac output syndrome (LCOS) after cardiac surgery usually requires inotropes. In this setting, critical illness-related corticosteroid insufficiency (CIRCI) may develop. We aimed to investigate the clinical features of CIRCI in the presence of LCOS and to assess the efficacy of steroid treatment. METHODS: We reviewed 28 patients who underwent a rapid adrenocorticotropic hormone (ACTH) test due to the suspicion of CIRCI between February 2010 and September 2014. CIRCI was diagnosed by a change in serum cortisol of <9 μg/dL after the ACTH test or a random cortisol level of <10 μg/dL. RESULTS: Twenty of the 28 patients met the diagnostic criteria. The patients with CIRCI showed higher Sequential Organ Failure Assessment (SOFA) scores than those without CIRCI (16.1±2.3 vs. 11.4±3.5, p=0.001). Six of the patients with CIRCI (30%) received glucocorticoids. With an average elevation of the mean blood pressure by 22.2±8.7 mm Hg after steroid therapy, the duration of inotropic support was shorter in the steroid group than in the non-steroid group (14.1±2.3 days versus 30±22.8 days, p=0.001). Three infections (15%) developed in the non-steroid group, but this was not a significant between-group difference. CONCLUSION: CIRCI should be suspected in patients with LCOS after cardiac surgery, especially in patients with a high SOFA score. Glucocorticoid replacement therapy may be considered to reduce the use of inotropes without posing an additional risk of infection.

Simple peritoneal dialysis in the treatment of severe congenital heart disease after operation complicated with low cardiac output syndrome in children / 中华实用儿科临床杂志

Objective To study the effect of simple peritoneal dialysis on the treatment of severe congenital heart disease(CHD) after operation complicated with low cardiac output syndrome(LCOS) in children with perioperative therapy.Methods After operation,fifty-three cases of severe CHD complicated with LCOS and the application of easy peritoneal dialysis were collected from Jan.to Jun.2013 in Department of Children's Surgical Intensive Care Specialist,Bayi Children's Hospital were collected.Functional parameters of vital organs,e.g.lung,kidney and heart were observed.Ages varied from 2 days to 2 years old,body weight from 2 to 8 kg.It contained 8 cases of complete transposition of great arteries with intact ventricular septum(TGA/IVS),10 cases of Tetralogy of Fallot(TOF),10 cases of pulmonary atresia (PA),6 cases of interruption of aortic arch (IAA),totally anomalous pulmonary venous drainage (TAPVC) in 6 cases,5 cases of coarctation of the aorta (COA),4 cases with right ventricular double outlet (DORV),3 cases with endocardial cushion defect(CAVC),1 case with ventricular septal defect(VSD).Results Fifty cases were completely cured,postoperative simple peritoneal dialysis treatment for 2 to 10 days,living ICU treatment time 2-15 days,urine output returns to normal 1-3 days,serum creatinine,blood urea nitrogen recovery time after 3-10.days,lactic acid to normal time 1-3 days,and 3 cases complicated with severe LCOS received extracorporeal membrane oxygenation therapy for difficult recovery,and postoperative recovery was good.Three cases died.Conclusions Easy peritoneal dialysis is convenient,safe,minimally invasive,inexpensive and effective.It can improve survival rate and reduce complications,shorten the time of mechanical ventilation and ICU residence time,hospitalization time and cost savings.

Analysis of risk factors of low cardiac output syndrome after cardiac valvular replacement surgery / 中国综合临床

Objective To find out the risk factors of postoperative low cardiac output syndrome(LCOS) of patients undergoing cardiac valvular surgery in ICU in order to provide basic for prevention and control measures.Methods Ninety-six valve replacement patients with valvular heart disease were enrolled as our subjects and they were hospitalized in ICU of the First People's hospital of Yichang from Jan.2008 to May.2013.The patients postoperative LCOS (Dopamine ＞ 10 μg/(kg · min)) were served as observation group (n =41),and the other were control groups(n =55).All data of the patients were recorded.Non-conditions Logistic regressions analysis were adopted to analyze the independent risk factors which resulted in LCOS undergoing cardiac valvular surgery.Results Of 96 patients undergoing cardiac vavular surgery,41cases (42.7％) had postoperative LCOS.Single factor analysis showed that hepatomegaly (P =0.007),course of diseases ≥ 15 years (P =0.042),cardiopulmonary bypass ≥ 120 min (x2 =3.937,P =0.047),pre-operative cardiac function ≥ Ⅲ degree (P =0.003) were the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery.The Logistic multi factor regression analysis showed that the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery included course of diseases ≥ 15 years (OR =2.825,95％ CI =(1.015-7.861)),Pre-operative cardiac function ≥ Ⅲ degree (OR =7.306,95％ CI =(2.050-26.035),P=0.002).Conclusion Course of diseases ≥15 years and Pre-operative cardiac function≥ Ⅲ-Ⅳ degree are the independent risk factors of LCOS undergoing cardiac valvular surgery.

Levosimendan in a neonate with severe coarctation of aorta and low cardiac output syndrome.

We report successful use of levosimendan after failed balloon angioplasty in a critically ill neonate with coarctation of aorta (CoA) and severe low cardiac output syndrome (LCOS). Treatment with levosimendan improved left heart function, and decreased lactate and brain natriuretic peptide levels. To our knowledge, this is the first report on the safe and successful use of levosimendan in the management of LCOS due to severe CoA in a neonate awaiting surgical repair.

Discussion on valve re-operative cases after cardiac valve replacement / 中国医师进修杂志

Objective To summarize the results of valve re-operative cases after cardiac valve replacement, to find the better re-operative time, and to estimate the re-operative methods and influencing factors of the operation. Methods Thirteen valve re-operative cases after cardiac valve replacement from October 2008 to February 2010 were retrospectively studied. According to NYHA classification, 9 cases belonged to class Ⅳ, and only 4 cases belonged to class Ⅲ preoperatively. Mitral valve replacement (MVR)was performed in 7 cases, aortic valve replacement (AVR) in 3 cases, MVR + AVR in 3 cases. Results The early-stage postoperative mortality was 7.7%( 1/13),and the reason was low cardiac output syndrome. Two cases who underwent re-operation and re-intubation respectively after operation for hemorrhage were improved after treatment. Twelve cases were discharged in 3-6 weeks after heart valve surgery and all were followed up for 6-15 months. The cardiac function of all the discharged patients recovered well and no death occurred during follow-up. Conclusion The key factors to reduce the death of re-operation are improving preoperative heart function,setting up extracorporeal circulation as soon as possible,consummating myocardial preservation,perfecting operating skills,correcting low cardiac output syndrome in time and preventing complications.

Study on Predisposing Factors of Low Cardiac Output Syndrome after Corrective Surgery for Tetralogy of Fallot / 第三军医大学学报

One hundred and seven cases of tetralogy of Fallot (TOF) were surgically corrected in this institute in the period from Jan 1983 to Dec 1989. Adequate corrective procedures were performed in 106 cases and aorto-pulmo-nary shunt with 1.2 Dacron tube in one. The corrective procedures employed included simple intracardiac repair in 18, subpulmonary RV outflow patch in 50, transannular RV outflow patch in 37, and RV-PA coronary conduit in 1 because of anomalous right coronary artery. The operative mortality rate was 13% , and the main complication was low cardiac output syndrome (LCOS) , which occurred in 26 cases (24%) .It was found that the predisposing factors of LOS after corrective surgery for TOF were serious clinical manifestations of the patient before operation, and residual right ventricular outflow tract obstruction due to improper repair of the right ventricular outflow tract, which were fatal in some cases.