Circulation, Vol 51, 867-874, Copyright © 1975 by American Heart Association
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.
ARTICLES
Cardiac performance and mortality early after intracardiac surgery in infants and young children
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