ABSTRACT
OBJECTIVES: To determine the incidence and degree of acute lung reperfusion injury (ARI) in patients undergoing balloon angioplasty of branch pulmonary artery stenosis and to evaluate the correlation and efficacy of an oxygenation index in confirming the clinical diagnosis. DESIGN: Retrospective, single-center observational study. SETTING: Cardiac catheterization laboratory at a tertiary care children's hospital. PATIENTS: Patients with congenital heart disease undergoing pulmonary artery balloon angioplasty. INTERVENTION: Review of patient medical and catheterization records. MEASUREMENTS AND MAIN RESULTS: The records of all patients with biventricular physiology undergoing balloon angioplasty of branch pulmonary artery stenosis over a period of 2 years (12/2006-12/2008) were reviewed. Data collection included demographics, details of pulmonary artery intervention, right ventricle/femoral artery systolic pressure (RV/FA) ratio, and post-procedure recovery condition. Markers of ARI, including clinical, radiographic, and blood gas analysis, were examined. Criteria for ARI were based on the International Society of Heart and Lung Transplantation (ISHLT) grading system, in which a PaO2/FIO2 of 200 to 300 indicates ARI. The distribution of PaO2/FIO2 after pulmonary artery intervention, the relation of clinical to laboratory manifestation of ARI, and the correlation among different oxygenation indices were examined. During the study period, 46 patients with congenital heart disease and branch pulmonary artery stenosis were identified. Patient age ranged from 2 months to 25 years (mean 6.2±6 years) and weight ranged from 5 to 86 kg (mean 23±18 kg). ARI was identified in 10 of 46 patients (22%) using clinical criteria and correlated with ISHLT gas exchange criteria. Analysis of RV/FA ratio before (0.82±0.34) and after (0.71±0.22) balloon angioplasty revealed statistically significant decrease (p<0.004). The degree of ARI was graded using ISHLT criteria and correlated with the presence of clinical symptoms (p<0.002). As anticipated, the PaO2/FIO2 ratio had a strong correlation with A-aDO2 (r = 0.75) and SpO2/FIO2 (r = 0.7) and a strong specificity (0.78) to identify patients with clinical ARI. CONCLUSION: ARI often can occur after pulmonary artery interventions. The PaO2/FIO2 is a valuable test for identifying patients at risk of developing ARI and can help guide the care of these patients in the postintervention period.
Subject(s)
Acute Lung Injury/epidemiology , Angioplasty, Balloon/adverse effects , Postoperative Complications/epidemiology , Pulmonary Artery/pathology , Reperfusion Injury/epidemiology , Acute Lung Injury/diagnosis , Adolescent , Adult , Cardiac Surgical Procedures/adverse effects , Child , Child, Preschool , Constriction, Pathologic/surgery , Female , Humans , Male , Oxygen/blood , Postoperative Complications/diagnosis , Pulmonary Gas Exchange , Reperfusion Injury/diagnosis , Retrospective Studies , Young AdultABSTRACT
Infants with a large patent arterial duct (PDA) may develop signs of congestive heart failure secondary to pulmonary overcirculation. As the PVR decreases, the relative pulmonary blood flow (Qp :Qs ) increases and this may cause tachypnea, respiratory distress, failure to thrive, ventricular dysfunction and even ventilator dependency. The diastolic runoff from the systemic circulation may result in intestinal hypoperfusion resulting in necrotizing enterocolitis, and in severe cases, myocardial ischemia. Cardiac ischemia due to coronary steal is a recognized clinical entity. We present two cases of infants who developed coronary artery steal with the use of supplemental oxygen therapy during anesthesia induction for PDA occlusion. These cases highlight the importance of prudent use of supplemental oxygen therapy in infants with large PDAs.
Subject(s)
Ductus Arteriosus, Patent/complications , Myocardial Ischemia/etiology , Oxygen Inhalation Therapy/adverse effects , Anesthesia , Coronary Circulation , Ductus Arteriosus, Patent/diagnosis , Ductus Arteriosus, Patent/physiopathology , Ductus Arteriosus, Patent/therapy , Electrocardiography , Gestational Age , Hemodynamics , Humans , Infant , Infant, Extremely Premature , Infant, Newborn , Myocardial Ischemia/diagnosis , Myocardial Ischemia/physiopathology , Myocardial Ischemia/therapy , Pulmonary Circulation , Treatment OutcomeABSTRACT
Acute myocardial infarction results in 7.2 million deaths per year world-wide. The treatment of AMI in the post-myocardial infarction period differs among the races and genders. This study investigated differences in mortality between Mexican American (MA) males and females, post-AMI who received BB therapy and those who did not receive BB therapy. Findings from this secondary analysis indicate that MA females experienced a higher mortality post-AMI compared to MA males. However, MA females taking BB therapy post-AMI had a reduced odds of mortality compared to MA males taking BB post-AMI. Interestingly, MA females were less likely to have received BB therapy post-AMI compared to MA males, despite its apparent benefit.
