Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
J Cardiothorac Vasc Anesth. 2023 Aug;37(8):1456-1468. doi: 10.1053/j.jvca.2023.04.010. Epub 2023 Apr 13.
Little is known about changes in portal, splenic, and hepatic vein flow patterns in children undergoing congenital heart surgery. This study aimed to determine the characteristics of portal, splenic, and hepatic vein flow patterns using ultrasonography in children undergoing cardiac surgery.
Single-center, prospective observational study.
Tertiary children's hospital, operating room.
Children undergoing cardiac surgery.
The authors obtained ultrasound data from the heart, inferior vena cava, portal, splenic, and hepatic veins before and after surgeries. In the biventricular group, which included children with atrial and ventricular septal defects and pulmonary stenosis (n = 246), the portal pulsatility index decreased from 38.7% to 25.6% (p < 0.001) after surgery. The preoperative portal pulsatility index was significantly higher in patients with pulmonary hypertension (43.3% v 27.4%; p < 0.001). In the single-ventricle group (n = 77), maximum portal vein flow velocities of Fontan patients were significantly lower (13.5 cm/s) compared with that of patients with modified Blalock-Taussig shunt (19.7 cm/s; p = 0.035) or bidirectional cavopulmonary shunt (23.1 cm/s; p < 0.001). The cardiac index was inversely correlated with the portal pulsatility index in the bidirectional cavopulmonary shunt and Fontan circulation. (β = -5.693, r = 0.473; p = 0.001) The portal pulsatility index was correlated with splenic venous pulsatility and hepatic venous atrial reverse flow velocity in biventricular and single-ventricle groups.
The characteristics of venous Doppler patterns in the portal, splenic, and hepatic veins differed according to congenital heart disease. Further studies are required to determine the association between splanchnic venous Doppler findings and clinical outcomes in this population.
关于接受先天性心脏病手术的儿童门静脉、脾静脉和肝静脉血流模式的变化知之甚少。本研究旨在使用超声心动图确定接受心脏手术的儿童门静脉、脾静脉和肝静脉血流模式的特征。
单中心前瞻性观察性研究。
三级儿童医院手术室。
接受心脏手术的儿童。
作者在手术前后从心脏、下腔静脉、门静脉、脾静脉和肝静脉获得了超声数据。在包括房间隔缺损和室间隔缺损以及肺动脉瓣狭窄的双心室组（n=246）中，门静脉搏动指数从手术前的 38.7%降至手术后的 25.6%（p<0.001）。肺动脉高压患者的术前门静脉搏动指数明显更高（43.3%比 27.4%；p<0.001）。在单心室组（n=77）中，Fontan 患者的门静脉最大流速明显较低（13.5cm/s），而改良 Blalock-Taussig 分流术患者（19.7cm/s；p=0.035）或双向腔静脉肺动脉分流术患者（23.1cm/s；p<0.001）。心脏指数与双向腔静脉肺动脉分流术和 Fontan 循环中的门静脉搏动指数呈负相关。（β=-5.693，r=0.473；p=0.001）门静脉搏动指数与双心室和单心室组的脾静脉搏动和肝静脉心房逆行流速相关。
根据先天性心脏病，门静脉、脾静脉和肝静脉的静脉多普勒模式特征不同。需要进一步研究以确定该人群内脏静脉多普勒发现与临床结果之间的关联。
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