Noninvasive Cardiac Output Monitoring in Newborn with Hypoplastic Left Heart Syndrome

2020 ◽  
Vol 37 (S 02) ◽  
pp. S54-S56
Author(s):  
Italo Francesco Gatelli ◽  
Ottavio Vitelli ◽  
Gaia Chiesa ◽  
Francesca De Rienzo ◽  
Stefano Martinelli

Objective This study aimed to describe the first two cases of electrical cardiometry applied to newborn with hypoplastic left heart syndrome for hemodynamical assessment in the first days of life before surgical correction and see if this can help decision making process in these patients. Study Design We describe two case series of two full-term newborn with hypoplastic left heart syndrome in the Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, between December 2019 and January 2020. Results Case 1 was persistently hemodynamically stable with prostaglandin E1 infusion at 0.01 mcg/kg/min, showing good capillary refill time, good diuresis, no difference between pre- and postductal values of oxygen saturation or blood pressure. Electrical cardiometry monitoring constantly showed cardiac output values higher than 300 mL/kg/min. Case 2 showed poor clinical condition needing prostaglandin E1 infusion up to 0.05 mcg/kg/min, intubation and septostomy associated with low cardiac output around 190 mL/kg/min. Once cardiac output has begun to rise and reached values constantly over 300 mL/kg/min, clinical condition improved with amelioration in oxygen saturation, diuresis, blood pressure, and blood gas analysis values. She was then extubated and finally clinically stable until surgery with minimal infusion of prostaglandin E1 at 0.01 mcg/kg/min. Conclusion This case highlights how hemodynamic information provided by electrical cardiometry can be used to supplement the combined data from all monitors and the clinical situation to guide therapy in these newborns waiting surgery. Key Points

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Sarah Tabbutt ◽  
Chandra Ramamoorthy ◽  
Lisa M. Montenegro ◽  
Suzanne M. Durning ◽  
C. Dean Kurth ◽  
...  

Background Management strategies for preoperative infants with hypoplastic left heart syndrome (HLHS) include increased inspired nitrogen (hypoxia) and increased inspired carbon dioxide (hypercarbia). There are no studies directly comparing these 2 therapies in humans. This study compares the impact of hypoxia versus hypercarbia on oxygen delivery, under conditions of fixed minute ventilation. Methods and Results Ten anesthetized and paralyzed preoperative infants with HLHS were evaluated in a prospective, randomized, crossover trial comparing hypoxia (17% F io 2 ) with hypercarbia (2.7% F ico 2 ). Each patient was treated in a random order (10 minutes per condition) with a recovery period (15 to 20 minutes) in room air. Arterial (Sa o 2 ) and superior vena caval (Sv o 2 ) co-oximetry and cerebral oxygen saturation (Sc o 2 ) measurements were made at the end of each condition and recovery period. Sc o 2 was measured by near infrared spectroscopy. Hypoxia significantly decreased both Sa o 2 (−5.2±1.1%, P =0.0014) and Sv o 2 (−5.6±1.7%, P =0.009) compared with baseline, but arteriovenous oxygen saturation (AV o 2 ) difference (Sa o 2 −Sv o 2 ) and Sc o 2 remained unchanged. Hypercarbia decreased Sa o 2 (−2.6±0.6%, P =0.002) compared with baseline but increased both Sc o 2 (9.6±1.8%, P =0.0001) and Sv o 2 (6±2.2%, P =0.022) and narrowed the AV o 2 difference (−8.5±2.3%, P =0.005). Both hypoxia and hypercarbia decreased the balance between pulmonary and systemic blood flow (Qp:Qs) compared with baseline. Conclusions In preoperative infants with HLHS, under conditions of anesthesia and paralysis, although Qp:Qs falls in both conditions, oxygen delivery is unchanged during hypoxia and increased during hypercarbia. These data cannot differentiate cerebral from systemic oxygen delivery.


2007 ◽  
Vol 84 (4) ◽  
pp. 1301-1311 ◽  
Author(s):  
James S. Tweddell ◽  
Nancy S. Ghanayem ◽  
Kathleen A. Mussatto ◽  
Michael E. Mitchell ◽  
Luke J. Lamers ◽  
...  

Author(s):  
Ali Jalali ◽  
C. Nataraj ◽  
Gerard F. Jones ◽  
Daniel J. Licht

Hypoplastic left heart syndrome (HLHS) is a congenital heart defect (CHD) in which left side of the heart is severely underdeveloped. To better understand this unique physiology, a computational model of the hypoplastic heart was constructed on the basis of compartmental analysis. Lumped parameter model of HLHS is developed based on the electrical circuit analogy. Model is made up of three parts: hypoplastic heart, pulmonary circulation and systemic circulation. Plots of blood pressure and flow for various parts of body show great match between predicted values and what we expected for the case of HLHS babies. Influence of patent ductus arteriosus (PDA) and ASD resistances on cardiac output and pulmonary to systemic flow was also studied. Results show that by increasing the PDA resistance causes more flow to pulmonary compartments and so the ratio increases. Blood flow increases by decreasing of pulmonary artery resistant. Increasing the PDA resistance causes decrease the cardiac output because of more resistance against blood occurs. Saturation increases by decreasing of pulmonary artery resistant.


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