Neonatal decompensation before surgery in hypoplastic left heart syndrome: a case control study

Sheward, V; Murdoch, Ian A.; Durward, Andrew; Tibby, Shane M.

doi:10.1136/archdischild-2013-305182

Cited by 2 publications

(1 citation statement)

References 35 publications

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“…In the preoperative state, SV neonates maintained on prostaglandin E1 to maintain a patent ductus arteriosus are at risk of pulmonary overcirculation (i.e., systemic hypoperfusion with increased pulmonary blood flow). While an essential right to left shunt occurs during systole, diastolic steal increases as pulmonary vascular resistance falls [27, [63][64][65]. It is not until after the Stage I palliation that the SV circulation is better balanced between pulmonary and systemic blood flow, which leads to a decrease in SaO 2 .…”

Section: Discussionmentioning

confidence: 99%

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Dehaes

Cheng

Buckley

et al. 2015

Biomed. Opt. Express

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Abstract:Congenital heart disease (CHD) patients are at risk for neurodevelopmental delay. The etiology of these delays is unclear, but abnormal prenatal cerebral maturation and postoperative hemodynamic instability likely play a role. A better understanding of these factors is needed to improve neurodevelopmental outcome. In this study, we used bedside frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) to assess cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle (SV) CHD undergoing surgery and compared them to controls. Our goals were 1) to compare cerebral hemodynamics between unanesthetized SV and healthy neonates, and 2) to determine if FDNIRS-DCS could detect alterations in cerebral hemodynamics beyond cerebral hemoglobin oxygen saturation (SO 2 ). Eleven SV neonates were recruited and compared to 13 controls. Preoperatively, SV patients showed decreased cerebral blood flow (CBF i ), cerebral oxygen metabolism (CMRO 2i ) and SO 2 ; and increased oxygen extraction fraction (OEF) compared to controls. Compared to preoperative values, unstable postoperative SV patients had decreased CMRO 2i and CBF i , which returned to baseline when stable. However, SO 2 showed no difference between unstable and stable states. Preoperative SV neonates are flow-limited and show signs of impaired cerebral development compared to controls. FDNIRS-DCS shows potential to improve assessment of cerebral development and postoperative hemodynamics compared to SO 2 alone. References and links 1. J. I. E. Hoffman and S. Kaplan, "The incidence of congenital heart disease," J. Am. Coll. Cardiol. 39, 1890-1900 A. Rappaport, and D. Wypij, "Randomized trial of hematocrit 25% versus 35% during hypothermic cardiopulmonary bypass in infant heart surgery," J. Thorac. Cardiovasc. Surg. 135, 347-54, 354.e1-4 (2008).

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Section: Discussionmentioning

confidence: 99%

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Dehaes

Cheng

Buckley

et al. 2015

Biomed. Opt. Express

View full text Add to dashboard Cite

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Improved Outcomes in Management of Hypoplastic Left Heart Syndrome Associated With Congenital Diaphragmatic Hernia: an Algorithmic Approach

Balduf

Kumar

Boston

et al. 2018

Seminars in Thoracic and Cardiovascular Surgery

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Neonatal decompensation before surgery in hypoplastic left heart syndrome: a case control study

Abstract: Heart and respiratory rates, and metabolic acid base trajectories show subtle differences prior to decompensation in neonates with HLHS. These findings highlight the importance of evaluating rates of change rather than absolute values of physiological and laboratory variables.

Cited by 2 publications

References 35 publications

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Improved Outcomes in Management of Hypoplastic Left Heart Syndrome Associated With Congenital Diaphragmatic Hernia: an Algorithmic Approach

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