The Study Of Postoperative Right Ventricle Function And Hemodynamic In Congenital Heart Disease Children

Objective: To study the right ventricular function and hemodynamics in children with congenital heart disease,with a view to further promoting awareness and attention to right ventricular functionMethods: A total of 46 children were enrolled,the number simple VSD(Group V1,aged 7.1±5.3 months)were 17,severe VSD accompany with heart failure and pneumonia(Group V2,aged 5.7±3.3 months)were 14,complex congenital heart diease(Group C,aged 6.9±6.5 months)were 15.After arrival in intensive care unit,routine clinical monitoring consisted of electrocardiogram,peripheral pulse oxygen saturation,a arterial catheter were inserted to allow clinical routine monitoring of arterial pressure and the use of Most Care(powered by PRAM),gas analysis and echocardiography was performed on day 1 postoperatively.Parameters recorded included(1)General clinical data,surgery time,CPB time,aortic cross clamp time,intubation time and duration of ICU stay;(2)hemodynamic parameters: heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),indexed stroke volume(SVI),cardiac index(CI),indexed systemic vascular resistance(SVRI),the maximal slope of systolic upstroke(dp/dt),and cardiac cycle efficiency(CCE)were recorded by PRAM at the moment of returning ICU(T0),at 4h(T1)?8h(T2)?12h(T3)?16h(T4)?20h(T5)?24h(T6)?36h(T7)?48h(T8)in ICU;(3)Arterial blood gas parameters: lactate,PO2/Fi O2 and Alveolar-arterial oxygen difference(PA-a DO2)at T0 and T1~T8;(4)Echocardiography performed on day 1 postoperatively: left ventricle Ejection Fractions,tricuspid annular plane systolic excursion;(5)Inotropic sore(IS)at T0 and T1~T8.Results: Age,height and weight were not significantly different among three groups.Age,surgery time,CPB time,ACC time were not significantly different between Group V1 and V2,and they were significantly longer in both groups than those in Group C.three groups.The TAPSE in Group V1?Group V2 and Group C TAPSE respectively was 8.76mm?4.93 mm and 5.93 mm,and TAPSE was lower in Group V2 and Group C than that in Group V1.(1)Intra Group V1 comparison.CI was higher at T5?T8 compared with T0.Lac was lower at T4~T8 compared with T0.(2)Intra Group V2 comparison.CI was higher at T7 compared with T0.Lac was lower at T7~T8 compared with T0.(3)Intra Group C comparison.CI was higher at T8 compared with T0.Lac was lower at T7 compared with T0.(4)Among three groups comparison.dp/dt was lower in Group V2 and Group C than that in Group V1 at T0?T1?T2?T5,and dp/dt was lower in Group C than that in Group V1 at T3?T6.CCE was lower in Group V2 and Group C than that in Group V1 at T3?T5,and lower in Group C than that in Group V1 at T0?T1,and lower in Group V2 than that in Group V1 at T4.Lac was higher in Group C than that in Group V1 and Group V2 at T0~T2 and T7.PO2/Fi O2 was lower in Group C and Group V2 than that in Group V1 at T7.A-a DO2 was higher in Group C and Group V2 than that in Group V1 at T1?T3?T7,and was higher in Group C than that in Group V1 at T8.TAPSE was significantly and negatively related with surgery time among 3 groups,negatively related with CPB time in Group V1 and Group C,and negatively related with AAC time in Group C.TAPSE was significantly and negatively related with intubation time,duration of ICU stay and length of stay hospital among 3 groups,and significantly and positively related with LVEF.T0~T4 TAPSE was negatively related with Aa DO2 at T0~T4,was positively related with PO2/Fi O2 at T0,T1 and T8,and negatively related with IS at T2~T8.Conclusion: 1.The left ventricular function of VSD and other simple CHD patient has returned to normal at 24 hours postoperative,but the right ventricular systolic function is still reduced.In patients ventricular septal defect,but the left ventricular function reserve was still poor and the right ventricular systolic function was also lower level.Critically ill CHD children in the early postoperative left heart and right heart function were both significantly reduced.2.The afterload of the right heart is a key factor affecting the right ventricular function.The VSD children accompanied with pneumonia,pulmonary hypertension and other complications is more prone to lower right ventricular function after cardiopulmonary bypass.3.The prolongation of operation time and the time of cardiopulmonary bypass is a high risk factor for right heart failure after cardiac surgery.4.There was a significant negative correlation between TAPSE and PA-a DO2.Considering that PA-a DO2 reflected pulmonary ventilation function and lung compliance,it was positively correlated with pulmonary artery mean pressure which is a key factor affecting right ventricular function.PA-a DO2 can be used as a qualitative indicator of right ventricular function.