Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery

Cortés, Rafael González; Villaescusa, Javier Urbano; Garcia, M.J.; González, J. L.; Lafever, S.N. Fernández; Moya-Gómez, Borja; Moran, J. Roberto; García, Irene Hidalgo; Pensado, A; Pérez-Caballero, Ramón; Prado, Carlos A. Pardo; Ogando, A. Rodríguez; Blázquez, María López; Cid, J. López-Herce

doi:10.1007/s12265-021-10132-w

Cited by 4 publications

(6 citation statements)

References 35 publications

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“…Secondary analyses also showed that children with cyanotic CHD had a similar microcirculation as those with a non-cyanotic CHD, while they did exhibit higher hemoglobin and hematocrit levels. This is contrary to findings by González et al, who showed cyanotic patients to have higher vessel densities, a possible compensatory mechanism for chronic hypoxemia [4,7]. The difference between our findings could have resulted from the classification of cyanotic CHD.…”

Section: The Effect Of Chd On the Microcirculationcontrasting

confidence: 99%

“…Due to our small number of patients with cyanotic CHD and missing data, we could not replicate these findings. González Cortés et al showed similar postoperative results with SDF in the sublingual microcirculation [7]. Microcirculatory parameters worsened intraoperatively and microcirculatory parameters returned to baseline values postoperatively.…”

Section: Microcirculatory Changes After Cardiac Surgerymentioning

confidence: 79%

“…However, patients with cyanotic CHD showed different time trends for microcirculatory parameters after surgery than those with non-cyanotic CHD. A recent study showed that the sublingual microcirculation was impaired intraoperatively but recovered to baseline values after surgery [7].…”

Section: Introductionmentioning

confidence: 99%

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Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery

Erdem

Hilty

Kraemer

et al. 2023

J. of Cardiovasc. Trans. Res.

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In this prospective observational study, we investigated whether congenital heart disease (CHD) affects the microcirculation and whether the microcirculation is altered following cardiac surgery with cardiopulmonary bypass (CPB). Thirty-eight children with CHD undergoing cardiac surgery with CPB and 35 children undergoing elective, non-cardiac surgery were included. Repeated non-invasive sublingual microcirculatory measurements were performed with handheld vital microscopy. Before surgery, children with CHD showed similar perfused vessel densities and red blood cell velocities (RBCv) but less perfused vessels (p < 0.001), lower perfusion quality (p < 0.001), and higher small vessel densities (p = 0.039) than children without CHD. After cardiac surgery, perfused vessel densities and perfusion quality of small vessels declined (p = 0.025 and p = 0.032), while RBCv increased (p = 0.032). We demonstrated that CHD was associated with decreased microcirculatory perfusion and increased capillary recruitment. The microcirculation was further impaired after cardiac surgery. Decreased microcirculatory perfusion could be a warning sign for altered tissue oxygenation and requires further exploration. Graphical abstract

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Section: The Effect Of Chd On the Microcirculationcontrasting

confidence: 99%

Section: Microcirculatory Changes After Cardiac Surgerymentioning

confidence: 79%

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Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery

Erdem

Hilty

Kraemer

et al. 2023

J. of Cardiovasc. Trans. Res.

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“…This impairment of microvascular function appeared to be related to a reduced systemic bioavailability of nitric oxide, resulting from the inflammatory and pro-oxidative response typical of this surgical procedure [33] . Similar results were reported by Cortés et al [34] , who showed that children with congenital heart disease displayed decreased vascular density and microvascular blood flow and increased microvascular heterogeneity during CPB. All these parameters returned to baseline values after surgery [34] .…”

Section: Anesthesia and Surgery Monitoringsupporting

confidence: 90%

From bench to bedside: A review of the application and potential of microcirculatory assessment by hand-held videomicroscopy

De Lorenzo,

Fernandes,

Tibirica

2024

IJC Heart & Vasculature

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“…Their data demonstrated a higher TVD with an increase in small blood vessels in the sublingual microcirculation, possibly related to the chronic hypoxia in patients with cyanosis, potentially a mechanism of adaptation. Gonzalez Cortes et al, using SDF-HVM, found that children with CHD have higher small vessel density and higher density of perfused small vessels at baseline; and lower MFI and higher heterogeneity during surgery in 24 patients undergoing surgery under cardiopulmonary bypass surgery ( 42 ).…”

Section: Congenital Heart Diseasementioning

confidence: 99%

End organ perfusion and pediatric microcirculation assessment

Arteaga,

Crow

2023

Front. Pediatr.

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Cardiovascular instability and reduced oxygenation are regular perioperative critical events associated with anesthesia requiring intervention in neonates and young infants. This review article addresses the current modalities of assessing this population's adequate end-organ perfusion in the perioperative period. Assuring adequate tissue oxygenation in critically ill infants is based on parameters that measure acceptable macrocirculatory hemodynamic parameters such as vital signs (mean arterial blood pressure, heart rate, urinary output) and chemical parameters (lactic acidosis, mixed venous oxygen saturation, base deficit). Microcirculation assessment represents a promising candidate for assessing and improving hemodynamic management strategies in perioperative and critically ill populations. Evaluation of the functional state of the microcirculation can parallel improvement in tissue perfusion, a term coined as “hemodynamic coherence”. Less information is available to assess microcirculatory disturbances related to higher mortality risk in critically ill adults and pediatric patients with septic shock. Techniques for measuring microcirculation have substantially improved in the past decade and have evolved from methods that are limited in scope, such as velocity-based laser Doppler and near-infrared spectroscopy, to handheld vital microscopy (HVM), also referred to as videomicroscopy. Available technologies to assess microcirculation include sublingual incident dark field (IDF) and sublingual sidestream dark field (SDF) devices. This chapter addresses (1) the physiological basis of microcirculation and its relevance to the neonatal and pediatric populations, (2) the pathophysiology associated with altered microcirculation and endothelium, and (3) the current literature reviewing modalities to detect and quantify the presence of microcirculatory alterations.

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Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery

Cited by 4 publications

References 35 publications

Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery

Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery

From bench to bedside: A review of the application and potential of microcirculatory assessment by hand-held videomicroscopy

End organ perfusion and pediatric microcirculation assessment

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