Analysis of Perioperative Prognostic Factors of Pediatric Patients Undergoing Surgical Correction of Ventricular Septal Defect and Severe Pulmonary Arterial Hypertension_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JINMu , LIShu-wen , LUJia-kai ,  CHENGWei-ping

Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, P. R. China;

Corresponding?author：

CHENGWei-ping, Email: ch_eng9735@sina.com

Keywords：

Ventricular septal defect; Pulmonary arterial hypertension; Cardiopulmonary bypass; Multivariate regression analysis; Prognostic factor

DOI：

10.7507/1007-4848.20140089

Video：

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Objective To analyze perioperative prognostic factors of pediatric patients undergoing surgical correction of ventricular septal defect (VSD)and severe pulmonary arterial hypertension (PAH). Methods Forty pediatric patients with VSD and severe PAH (mean pulmonary artery pressure (PAPm) < 50 mm Hg)who underwent surgical repair in Beijing Anzhen Hospital from 2004 to 2012 were included in the study. There were 21 male and 19 female patients with their age of 7.2±3.3 years and body weight of 19.6±7.1 kg. All the patients were randomly divided into 2 groups:Group Ⅰ (Group=0, n=20, M/F:12/8, continuous nitroglycerin administration via central venous catheter (CVC)and GroupⅡ (Group=1, n=20, M/F:9/11, continuous prostaglandin E1 (PGE1)administration via CVC). The duration of intubation (T_intubation)was used as the dependent variable (Y). Patient age, cardiopulmonary bypass time (T_CPB), postoperative PAPm, pulmonary vascular resistance index (PVRI), systemic to pulmonary pressure ratio (P_s/p), Group, left ventricular stroke work index (LVSWI)and right ventricular stroke work index (RVSWI)were used as independent variables (X). Multivariate liner regression analysis model was used to evaluate the influence of X on Y. Results There was no perioperative death or severe complication in this group. Perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH included group[x₁, P=0.004, 95% CI (-71, -16)], T_CPB[x₂, P=0.011, 95% CI (0.9, 5.8)], posto-perative PAPm (x₃, P=0.004 with 95% CI 3.2 to 13.3), RVSWI (x₄, P=0.003 with 95% CI-16.9 to-4.3)and PVRI (x₅, P=0.03 with 95% CI-0.29 to-0.02). The standardized regression equation was:Y=-0.60x₁+0.54x₂+2.22x₃-1.70x₄-0.15x₅. Conclusion PGE1 administration, TCPB, postoperative PAPm, RVSWI and PVRI are predominant perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH.

Citation： JINMu, LIShu-wen, LUJia-kai, CHENGWei-ping. Analysis of Perioperative Prognostic Factors of Pediatric Patients Undergoing Surgical Correction of Ventricular Septal Defect and Severe Pulmonary Arterial Hypertension. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 318-321. doi: 10.7507/1007-4848.20140089 Copy

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2.	Duffels MG, Engelfriet PM, Berger RM, et al. Pulmonary arterial hypertension in congenital heart disease:An epidemiologic perspective from a Dutch registry. Int J Cardiol, 2007, 120 (2):198-204.
3.	Gazit AZ, Huddleston CB, Checchia PA, et al. Care of the pediatric cardiac surgery patient-part 2. Curr Probl Surg, 2010, 47 (4):261-376.
4.	Haworth SG, Hislop AA. Treatment and survival in children with pulmonary arterial hypertension:the UK Pulmonary Hypertension Service for Children 2001-2006. Heart, 2009, 95 (4):312-317.
5.	Rosenzweig EB, Barst RJ. Congenital heart disease and pulmonary hypertension:pharmacology and feasibility of late surgery. Prog Cardiovasc Dis, 2012, 55 (2):128-133.
6.	Beghetti M, Tissot C. Pulmonary hypertension in congenital shunts. Rev Esp Cardiol, 2010, 63 (10):1179-1193.
7.	Lowe BS, Therrien J, Ionescu-Ittu R, et al. Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes. J Am Coll Cardiol, 2011, 58 (5):538-546.
8.	Talwar S, Choudhary SK, Airan B, et al. Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension. Ann Pediatr Cardiol, 2008, 1 (2):114-119.
9.	Talwar S, Choudhary SK, Garg S, et al. Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension. Interact Cardiovasc Thorac Surg, 2012, 14 (6):699-702.
10.	Rich S. The current treatment of pulmonary arterial hypertension:time to redefine success. Chest, 2006, 130 (4):1198-1202.
11.	李少民, 王麗娜, 張莉, 等.先天性心臟病合并重度肺動脈高壓的診斷及外科治療.中國胸心血管外科臨床雜志, 2006, 13 (6):434-436.
12.	中華醫學會小兒外科學分會胸心外科學組.小兒先天性心臟病相關性肺高壓診斷和治療(專家共識).中華小兒外科雜志, 2011, 32 (4):306-318.
13.	劉義敏, 王輝, 楊宇強, 等.內皮素受體拮抗劑在圍術期治療6個月以下嬰兒肺動脈高壓的臨床意義.中國胸心血管外科臨床雜志, 2011, 18 (5):478-480.
14.	李衛國, 谷天祥, 吳東信, 等.前列腺素E1脂肪乳劑在體外循環中對心肌缺血-再灌注損傷的保護作用.中國胸心血管外科臨床雜志, 2006, 13 (4):238-241.
15.	Genseh C, CleveT Y, Wemer C, et al. Regulation of endothelial progenitor cells by prostaglandin E1 via inhibition of apoptosis. J Mol Cell Cardiol, 2007, 42 (3):670-677.
16.	Gupta V, Ahsan F. Influence of PEI as a core modifying agent on PLGA microspheres of PGE1, a pulmonary selective vasodilator. Int J Pharm, 2011, 413 (1-2):51-62.
17.	王緒健, 王錦艷. 38例室間隔缺損合并肺動脈高壓嬰幼兒的圍術期處理.中國胸心血管外科臨床雜志, 2005, 12 (6):389.
18.	McMullan DM, Bekker JM, Parry AJ, et al. Alterations in endogenous nitric oxide production after cardiopulmonary bypass in lambs with normal and increased pulmonary blood flow.Circulation, 2000, 102 (19 Suppl 3):Ⅲ172-Ⅲ178.
19.	Denault A, Deschamps A, Tardif JC, et al. Pulmonary hypertension in cardiac surgery. Curr Cardiol Rev, 2010, 6 (1):1-14.
20.	McGlothlin D, Ivascu N, Heerdt PM. Anesthesia and Pulmonary Hypertension. Prog Cardiovasc Dis, 2012, 55 (2):199-217.
21.	周燕萍, 史珍英, 蔡及明, 等.體外循環對室間隔缺損嬰兒手術后肺功能的影響.中國胸心血管外科臨床雜志, 2006, 13 (1):14-17.

1. N Galie, A Manes, M Palazzini, et al. Management of pulmonary arterial hypertension associated with congenital systemic-to-pulmonary shunts and Eisenmenger's syndrome. Drugs, 2008, 68 (8):1049-1066.
2. Duffels MG, Engelfriet PM, Berger RM, et al. Pulmonary arterial hypertension in congenital heart disease:An epidemiologic perspective from a Dutch registry. Int J Cardiol, 2007, 120 (2):198-204.
3. Gazit AZ, Huddleston CB, Checchia PA, et al. Care of the pediatric cardiac surgery patient-part 2. Curr Probl Surg, 2010, 47 (4):261-376.
4. Haworth SG, Hislop AA. Treatment and survival in children with pulmonary arterial hypertension:the UK Pulmonary Hypertension Service for Children 2001-2006. Heart, 2009, 95 (4):312-317.
5. Rosenzweig EB, Barst RJ. Congenital heart disease and pulmonary hypertension:pharmacology and feasibility of late surgery. Prog Cardiovasc Dis, 2012, 55 (2):128-133.
6. Beghetti M, Tissot C. Pulmonary hypertension in congenital shunts. Rev Esp Cardiol, 2010, 63 (10):1179-1193.
7. Lowe BS, Therrien J, Ionescu-Ittu R, et al. Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes. J Am Coll Cardiol, 2011, 58 (5):538-546.
8. Talwar S, Choudhary SK, Airan B, et al. Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension. Ann Pediatr Cardiol, 2008, 1 (2):114-119.
9. Talwar S, Choudhary SK, Garg S, et al. Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension. Interact Cardiovasc Thorac Surg, 2012, 14 (6):699-702.
10. Rich S. The current treatment of pulmonary arterial hypertension:time to redefine success. Chest, 2006, 130 (4):1198-1202.
11. 李少民, 王麗娜, 張莉, 等.先天性心臟病合并重度肺動脈高壓的診斷及外科治療.中國胸心血管外科臨床雜志, 2006, 13 (6):434-436.
12. 中華醫學會小兒外科學分會胸心外科學組.小兒先天性心臟病相關性肺高壓診斷和治療(專家共識).中華小兒外科雜志, 2011, 32 (4):306-318.
13. 劉義敏, 王輝, 楊宇強, 等.內皮素受體拮抗劑在圍術期治療6個月以下嬰兒肺動脈高壓的臨床意義.中國胸心血管外科臨床雜志, 2011, 18 (5):478-480.
14. 李衛國, 谷天祥, 吳東信, 等.前列腺素E1脂肪乳劑在體外循環中對心肌缺血-再灌注損傷的保護作用.中國胸心血管外科臨床雜志, 2006, 13 (4):238-241.
15. Genseh C, CleveT Y, Wemer C, et al. Regulation of endothelial progenitor cells by prostaglandin E1 via inhibition of apoptosis. J Mol Cell Cardiol, 2007, 42 (3):670-677.
16. Gupta V, Ahsan F. Influence of PEI as a core modifying agent on PLGA microspheres of PGE1, a pulmonary selective vasodilator. Int J Pharm, 2011, 413 (1-2):51-62.
17. 王緒健, 王錦艷. 38例室間隔缺損合并肺動脈高壓嬰幼兒的圍術期處理.中國胸心血管外科臨床雜志, 2005, 12 (6):389.
18. McMullan DM, Bekker JM, Parry AJ, et al. Alterations in endogenous nitric oxide production after cardiopulmonary bypass in lambs with normal and increased pulmonary blood flow.Circulation, 2000, 102 (19 Suppl 3):Ⅲ172-Ⅲ178.
19. Denault A, Deschamps A, Tardif JC, et al. Pulmonary hypertension in cardiac surgery. Curr Cardiol Rev, 2010, 6 (1):1-14.
20. McGlothlin D, Ivascu N, Heerdt PM. Anesthesia and Pulmonary Hypertension. Prog Cardiovasc Dis, 2012, 55 (2):199-217.
21. 周燕萍, 史珍英, 蔡及明, 等.體外循環對室間隔缺損嬰兒手術后肺功能的影響.中國胸心血管外科臨床雜志, 2006, 13 (1):14-17.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of Perioperative Prognostic Factors of Pediatric Patients Undergoing Surgical Correction of Ventricular Septal Defect and Severe Pulmonary Arterial Hypertension

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