Li Cong, Zhu Zhuoting, Yuan Haiyun, Zhong Pingting, Peng Qingsheng, Dong Xinran, Huang Manqing, Liu Baoyi, Ren Yun, Kuang Yu, Zeng Xiaomin, Yu Honghua, Yang Xiaohong
Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
School of Medicine, South China University of Technology, Guangzhou, China.
Front Cardiovasc Med. 2021 Aug 31;8:712308. doi: 10.3389/fcvm.2021.712308. eCollection 2021.
Microcirculatory changes in congenital heart disease (CHD) patients undergoing cardiac surgery are not fully understood. We aimed to investigate the changes of retinal microcirculation in CHD patients after cardiac surgery by optical coherence tomography angiography (OCTA) and explore the association between retinal microcirculation and surgical outcome. This prospective observational study consisted of 71 CHD patients aged ≥6 years undergoing cardiac surgery including 19 cyanotic CHD (CCHD) and 52 acyanotic CHD (ACHD). Optical coherence tomography angiography (OCTA) was used to measure vessel density (VD) and capillary density (CD) of radial peripapillary capillary (RPC) and peripapillary, VD of superficial capillary plexus (SCP) and deep capillary plexus (DCP), thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) preoperatively and 1 month postoperatively. Transthoracic echocardiography was conducted to measure macrocirculation. In CCHD patients, VD and CD of RPC and peripapillary increased postoperatively (all < 0.05). In ACHD patients, VD of peripapillary, CD of RPC and peripapillary, and RNFL thickness increased postoperatively (all < 0.05). VD of SCP and DCP, and GCC thickness did not change significantly in CHD patients after surgery. Lower preoperative retinal microvascular density was associated with longer cardiopulmonary bypass (CPB) time and postoperative length of stay (PLOS). No correlation was found between microcirculatory and macrohemodynamic parameters (all > 0.05). Improved retinal microcirculation was observed after congenital cardiac surgery and impaired preoperative retinal microvasculature was associated with prolonged CPB time and PLOS, which might provide potential information about the outcome of congenital cardiac surgery.
先天性心脏病（CHD）患者在心脏手术过程中的微循环变化尚未完全明确。我们旨在通过光学相干断层扫描血管造影（OCTA）研究CHD患者心脏手术后视网膜微循环的变化，并探讨视网膜微循环与手术结果之间的关联。这项前瞻性观察性研究纳入了71例年龄≥6岁、接受心脏手术的CHD患者，其中包括19例青紫型CHD（CCHD）和52例非青紫型CHD（ACHD）。采用光学相干断层扫描血管造影（OCTA）测量术前及术后1个月时视网膜乳头周围放射状毛细血管（RPC）和乳头周围的血管密度（VD）、毛细血管密度（CD），浅表毛细血管丛（SCP）和深部毛细血管丛（DCP）的VD，视网膜神经纤维层（RNFL）和神经节细胞复合体（GCC）的厚度。进行经胸超声心动图检查以测量体循环情况。在CCHD患者中，术后RPC和乳头周围的VD及CD均增加（均P<0.05）。在ACHD患者中，术后乳头周围的VD、RPC和乳头周围的CD以及RNFL厚度均增加（均P<0.05）。CHD患者术后SCP和DCP的VD以及GCC厚度无明显变化。术前较低的视网膜微血管密度与较长的体外循环（CPB）时间和术后住院时间（PLOS）相关。未发现微循环参数与宏观血流动力学参数之间存在相关性（均P>0.05）。先天性心脏手术后观察到视网膜微循环有所改善，术前视网膜微血管受损与CPB时间延长和PLOS相关，这可能为先天性心脏手术的结果提供潜在信息。
