Redlin Mathias, Miera Oliver, Habazettl Helmut, Photiadis Joachim, Carísimo-Cresta María Irene, Hommel Mathias, O'Brien Benjamin, Kukucka Marian
Department of Anaesthesiology, Deutsches Herzzentrum, Berlin, Germany.
Department of Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany.
Interact Cardiovasc Thorac Surg. 2017 Dec 1;25(6):887-891. doi: 10.1093/icvts/ivx240.
Left ventricular assist device implantation is an established therapy for paediatric patients with end-stage heart failure. Early right ventricular dysfunction (RVD) after implantation still remains a challenge in the postoperative period. This study sought to determine the incidence of RVD and to identify echocardiographic predictors of RVD in paediatric patients, as well describing associated clinical outcome.
Prospectively collected preoperative echocardiographic, haemodynamic, demographic and biochemical data from 48 patients scheduled for left ventricular assist device implantation were evaluated. Incidence of high central venous pressure, decreased central venous saturation, high inotropic support requirements or need for mechanical support of the right ventricle during the first 48 h after implantation were used to define RVD. Echocardiographic assessments of right ventricular geometry, function using linear dimensions, areas and tricuspid annular plane systolic excursion (TAPSE) were performed preoperatively and the relative relationships between these parameters were evaluated.
We included 48 consecutive paediatric patients (median age 5 years, range 0-17; median weight 15.9 kg, range 3.6-91). According to our criteria, 24 (50%) patients developed RVD. TAPSE as the parameter for assessment of longitudinal systolic function was significantly lower in this group (P = 0.01). The difference became even more pronounced after normalization to the RV end-diastolic diameter in long axis with P = 0.003. The odds ratio for patients with TAPSE/RV end-diastolic diameter in long axis <17.1% to develop RVD was 7.7 (P = 0.002).
RVD occurs frequently in paediatric patients after left ventricular assist device. TAPSE, normalized to the RV end-diastolic diameter, may help to identify patients at risk for RVD. The predictive value of this parameter supports decision making to plan for adequate pharmacological support or consider early upgrading to mechanical RV support.
左心室辅助装置植入术是治疗终末期心力衰竭患儿的既定疗法。植入术后早期右心室功能障碍（RVD）仍是术后的一项挑战。本研究旨在确定小儿患者中RVD的发生率，并识别RVD的超声心动图预测指标，同时描述相关的临床结局。
对48例计划植入左心室辅助装置的患者术前前瞻性收集的超声心动图、血流动力学、人口统计学和生化数据进行评估。植入后最初48小时内中心静脉压升高、中心静脉血氧饱和度降低、高剂量血管活性药物支持需求或右心室机械支持需求的发生率被用于定义RVD。术前对右心室几何形状、使用线性尺寸、面积和三尖瓣环平面收缩期位移（TAPSE）评估右心室功能，并评估这些参数之间的相对关系。
我们纳入了48例连续的儿科患者（中位年龄5岁，范围0 - 17岁；中位体重15.9 kg，范围3.6 - 91 kg）。根据我们的标准，24例（50%）患者发生了RVD。作为纵向收缩功能评估参数的TAPSE在该组中显著更低（P = 0.01）。在长轴上与右心室舒张末期直径归一化后，差异变得更加明显，P = 0.003。长轴上TAPSE/右心室舒张末期直径<17.1%的患者发生RVD的比值比为7.7（P = 0.002）。
左心室辅助装置植入术后小儿患者中RVD频繁发生。经右心室舒张末期直径归一化的TAPSE可能有助于识别有RVD风险的患者。该参数的预测价值支持做出规划适当药物支持或考虑早期升级为右心室机械支持的决策。
