This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Parr, G. V. Articles by Kirklin, J. W. Search for Related Content PubMed PubMed Citation Articles by Parr, G. V. Articles by Kirklin, J. W.

Circulation, Vol 51, 867-874, Copyright © 1975 by American Heart Association

ARTICLES

Cardiac performance and mortality early after intracardiac surgery in infants and young children

GV Parr, EH Blackstone and JW Kirklin

One hundred thirty-nine infants and small children less than 48 months old were studied during the first 72 hours after intracardiac surgery for a variety of lesions. The hospital mortality rate was 19.4% (27 patients); 16 of those dying succumbed from acute cardiac failure. Deaths from acute cardiac failure were commonest in patients with low cardiac index (CI), and a continuous probability curve relates the two. The mean CI for all patients was 2.51 plus or minus 0.794 l-min minus 1- m minus 2, and that for individual patients varied between 0.6 and 4.9. Cardiac output normalized by surface area (cardiac index) correlated weakly with age. cardiac output normalized by weight did not correlate with age; Mean mixed venous oxygen partial pressure (P-vO2)varied between 17 and 60 mm Hg, and the weighted mean for the group of 80 patients in whom it was obtained was 33.1 plus or minus 6.57 mm Hg. CI and P-vO2 were only slightly related. Acute cardiac deaths occurred more frequently in patients with low P-vO2. Acute cardiac death was more reliably predicted using CI and P-vO2 together than either alone. The average of the mean arterial pressure was 80.5 plus or minus 2.53 mm Hg, and this did not correlate with CI. Mean average systemic vascular resistance was 30.0 plus or minus 8.395 SRU. We conclude that in such patients treatment should be directed toward keeping CI greater than 2.0 l-min minus 1-m minus 2 and P-vO2 greater than 30 mm Hg; that the possibility of maintaining adequate CI and P-vO2 is not related to the age of the patient but is related to the malformation treated; and that a therapeutic trial of reducing left ventricular afterload is indicated in some of these patients.

This article has been cited by other articles:

				J. A. Carcillo, B. A. Kuch, Y. Y. Han, S. Day, B. M. Greenwald, K. A. McCloskey, A. L. Pearson-Shaver, and R. A. Orr Mortality and Functional Morbidity After Use of PALS/APLS by Community Physicians Pediatrics, August 1, 2009; 124(2): 500 - 508. [Abstract] [Full Text] [PDF]

				M. Ma, K. Gauvreau, C. K. Allan, J. E. Mayer Jr, and K. J. Jenkins Causes of Death After Congenital Heart Surgery Ann. Thorac. Surg., April 1, 2007; 83(4): 1438 - 1445. [Abstract] [Full Text] [PDF]

				Alterations in plasma B-type natriuretic peptide levels after repair of congenital heart defects: a potential perioperative marker. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 632 - 638.

				S. J. Roth, I. Adatia, G. D. Pearson, and and Members of the Cardiology Group Summary proceedings from the cardiology group on postoperative cardiac dysfunction. Pediatrics, March 1, 2006; 117(3 Pt 2): S40 - S46. [Abstract] [Full Text] [PDF]

				J. Li, A. Hoschtitzky, M. L. Allen, M. J. Elliott, and A. N. Redington An Analysis of Oxygen Consumption and Oxygen Delivery in Euthermic Infants After Cardiopulmonary Bypass With Modified Ultrafiltration Ann. Thorac. Surg., October 1, 2004; 78(4): 1389 - 1396. [Abstract] [Full Text] [PDF]

				T. M. Hoffman, G. Wernovsky, A. M. Atz, T. J. Kulik, D. P. Nelson, A. C. Chang, J. M. Bailey, A. Akbary, J. F. Kocsis, R. Kaczmarek, et al. Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease Circulation, February 25, 2003; 107(7): 996 - 1002. [Abstract] [Full Text] [PDF]

				R. Salenger, J. S. Gammie, and T. J. Vander Salm Postoperative Care of Cardiac Surgical Patients Card. Surg. Adult, January 1, 2003; 2(2003): 439 - 469. [Full Text]

				A. F. Rossi, H. S. Seiden, R. P. Gross, and R. B. Griepp Oxygen transport in critically ill infants after congenital heart operations Ann. Thorac. Surg., March 1, 1999; 67(3): 739 - 744. [Abstract] [Full Text] [PDF]

				R. R. Chaturvedi, C. Lincoln, J. W. W. Gothard, M. H. Scallan, P. A. White, A. N. Redington, and D. F. Shore Left ventricular dysfunction after open repair of simple congenital heart defects in infants and children: Quantitation with the use of a conductance catheter immediately after bypass J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 77 - 83. [Abstract] [Full Text] [PDF]

				G. Wernovsky, D. Wypij, R. A. Jonas, J. E. Mayer Jr, F. L. Hanley, P. R. Hickey, A. Z. Walsh, A. C. Chang, A. R. Castaneda, J. W. Newburger, et al. Postoperative Course and Hemodynamic Profile After the Arterial Switch Operation in Neonates and Infants : A Comparison of Low-Flow Cardiopulmonary Bypass and Circulatory Arrest Circulation, October 15, 1995; 92(8): 2226 - 2235. [Abstract] [Full Text]