Department of Cardiac Anaesthesiology, Cardiothoracic Centre, AIIMS, New Delhi, India.
Department of Cardiac Anaesthesiology, Cardiothoracic Centre, AIIMS, New Delhi, India.
J Cardiothorac Vasc Anesth. 2019 Sep;33(9):2404-2413. doi: 10.1053/j.jvca.2019.01.036. Epub 2019 Jan 12.
To evaluate the role of echocardiographic right ventricular function parameters in predicting postoperative vasoactive inotrope requirement after tetralogy of Fallot repair.
Prospective observational study.
A tertiary care hospital.
Fifty-two children undergoing elective intracardiac repair.
Comprehensive transesophageal echocardiography was performed before and after surgery. Fractional shortening, fractional area change, tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index, tricuspid annular velocities (S', E', A'), and right ventricular global longitudinal strain and strain rate (RV Gls and RV Glsr) were measured. The ratio of peak systolic pressure of the right and left ventricles (P) was measured directly from the surgical field pre- and post-repair. The inotrope requirement during first 24 postoperative hours was calculated using the mean Vasoactive-Inotropic Score (VIS). Pearson correlation analysis was used to study the relation between echocardiographic parameters and VIS as well as P and VIS. Receiver operating characteristic analysis was used to study the predictive strength of parameters.
Among the measured parameters, both pre- and post-repair TAPSE had significant negative correlation with the mean VIS (p < 0.05). Both pre- and post-repair right ventricular myocardial performance index and S', E', A', RV Gls, RV Glsr, P also had significant correlation with the mean VIS (p < 0.05). Of these, TAPSE, RV Gls, RV Glsr, and P had significant predictive strength (p < 0.05) and reasonable sensitivity and specificity (area under the curve > 0.6) for predicting high mean VIS (VIS > 20).
Tricuspid annular plane systolic excursion, RV Gls, RV Glsr, and P could predict a postoperative high mean VIS with significant strength and reasonable sensitivity and specificity.
评估超声心动图右心室功能参数在预测法洛四联症修复术后血管活性药物需求中的作用。
前瞻性观察性研究。
一家三级保健医院。
52 名接受择期心内修复的儿童。
在术前和术后进行全面经食管超声心动图检查。测量射血分数、面积变化分数、三尖瓣环平面收缩期位移（TAPSE）、右心室心肌运动指数、三尖瓣环速度（S'、E'、A'）、右心室整体纵向应变和应变率（RV Gls 和 RV Glsr）。在术前和术后修复过程中直接从手术现场测量右心室和左心室收缩峰值压力比（P）。使用平均血管活性-正性肌力药物评分（VIS）计算术后 24 小时内的正性肌力药物需求。使用 Pearson 相关分析研究超声心动图参数与 VIS 以及 P 与 VIS 的关系。使用接收者操作特征分析研究参数的预测强度。
在测量的参数中，TAPSE 在术前和术后均与平均 VIS 呈显著负相关（p < 0.05）。在术前和术后，右心室心肌运动指数和 S'、E'、A'、RV Gls、RV Glsr、P 也与平均 VIS 呈显著相关（p < 0.05）。其中，TAPSE、RV Gls、RV Glsr 和 P 具有显著的预测强度（p < 0.05），以及合理的敏感性和特异性（曲线下面积 > 0.6），可预测高平均 VIS（VIS > 20）。
TAPSE、RV Gls、RV Glsr 和 P 可预测术后高平均 VIS，具有显著的强度和合理的敏感性和特异性。
