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

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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.
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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, 王丽娜, 张莉, 等.先天性心脏病合并重度肺动脉高压的诊断及外科治疗.中国胸心血管外科临床杂志, 2006, 13 (6):434-436.
12.	中华医学会小儿外科学分会胸心外科学组.小儿先天性心脏病相关性肺高压诊断和治疗(专家共识).中华小儿外科杂志, 2011, 32 (4):306-318.
13.	刘义敏, 王辉, 杨宇强, 等.内皮素受体拮抗剂在围术期治疗6个月以下婴儿肺动脉高压的临床意义.中国胸心血管外科临床杂志, 2011, 18 (5):478-480.
14.	李卫国, 谷天祥, 吴东信, 等.前列腺素E1脂肪乳剂在体外循环中对心肌缺血-再灌注损伤的保护作用.中国胸心血管外科临床杂志, 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.	王绪健, 王锦艳. 38例室间隔缺损合并肺动脉高压婴幼儿的围术期处理.中国胸心血管外科临床杂志, 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.体外循环对室间隔缺损婴儿手术后肺功能的影响.中国胸心血管外科临床杂志, 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, 王丽娜, 张莉, 等.先天性心脏病合并重度肺动脉高压的诊断及外科治疗.中国胸心血管外科临床杂志, 2006, 13 (6):434-436.
12. 中华医学会小儿外科学分会胸心外科学组.小儿先天性心脏病相关性肺高压诊断和治疗(专家共识).中华小儿外科杂志, 2011, 32 (4):306-318.
13. 刘义敏, 王辉, 杨宇强, 等.内皮素受体拮抗剂在围术期治疗6个月以下婴儿肺动脉高压的临床意义.中国胸心血管外科临床杂志, 2011, 18 (5):478-480.
14. 李卫国, 谷天祥, 吴东信, 等.前列腺素E1脂肪乳剂在体外循环中对心肌缺血-再灌注损伤的保护作用.中国胸心血管外科临床杂志, 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. 王绪健, 王锦艳. 38例室间隔缺损合并肺动脉高压婴幼儿的围术期处理.中国胸心血管外科临床杂志, 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.体外循环对室间隔缺损婴儿手术后肺功能的影响.中国胸心血管外科临床杂志, 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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