Abstract 12971: Oxidative Stress in Children With Left to Right Shunt Congenital Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takamichi Ishikawa ◽  
Hiroki Uchiyama
Keyword(s):  
Oxidative Stress ◽  
Congenital Heart ◽  
Septal Defect ◽  
Control Group ◽  
Healthy Children ◽  
Flow Ratio ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
End Diastolic Volume ◽  
Blood Flow Ratio

Background: Oxidative stress has recently been noted as a factor involved in myocardial remodeling and has been reported to be a predictor of heart failure severity and cardiac death in adults. However, its relevance in the pediatric field is unclear. Objective: This study aimed to investigate the reference range of oxidative stress dynamics and evaluate the role of oxidative stress in children with left to right shunt congenital heart disease (CHD). Methods: The subjects consisted of 40 patients (CHD group) with left to right shunt CHD who underwent cardiac catheterization at Hamamatsu University Hospital and 105 healthy children. The oxidative stress markers were measured in blood derivatives of reactive oxygen metabolites (ROM; adult reference value 250-300 U. CARR). We examined the dynamics of ROM in healthy children and then compared the various parameters, including ROM, in 40 age- and sex-matched healthy controls (control group). Results: The median age of the CHD group (21 boys and 19 girls) was 9.5 months (interquartile range: 2.8-32.0 months). CHD consisted of 27 cases of ventricular septal defect, 8 cases of atrial septal defect, 4 cases of patent ductus arteriosus, and 1 case of atrioventricular septal defect. In the healthy children, ROM showed a significant positive correlation with age (r = 0.482, p <0.001). The blood ROM of the CHD group (292 ± 84 U.CARR) was significantly higher (p <0.001) than that in the control group (199 ± 82 U.CARR), and the ROM showed a significant positive correlation with the pulmonary-to-systemic blood flow ratio (r = 0.333, p = 0.022), the percentage of left ventricular end diastolic volume (r = 0.503, p <0.001), and the percentage of right ventricular end diastolic volume (r = 0.771, p <0.001). The area under ROC curve of ROM for pulmonary-to-systemic-blood-flow ratio > 1.5 was 0.741 (95% CI: 0.576-0.906, p=0.026), with a cut-off value of 293 U.CARR. Conclusions: ROM, an indicator of oxidative stress, showed a gradual upward trend with age in childhood, and this transition was confirmed to differ from that of NT-proBNP, which decreases to a steady state after marked elevation in the early neonatal period. These findings suggest that ROM is a biological marker reflecting at least the volume load in left to right shunt CHD.

scholarly journals Plasma NT-proBNP and pulmonary to systemic blood flow ratio in congenital heart defects with left-to-right shunts

2020 ◽  
Vol 60 (6) ◽  
pp. 310-5
Author(s):  
Eko Kristanto Kunta Adjie ◽  
Ni Putu Veny Kartika Yantie ◽  
Made Gede Dwi Lingga Utama ◽  
Eka Gunawijaya ◽  
Ketut Ariawati ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Congenital Heart ◽  
Heart Defects ◽  
Defect Size ◽  
Confounding Factors ◽  
Flow Ratio ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Blood Flow Ratio

Background Cardiac left-to-right shunts changes to the pulmonary-to-systemic blood flow ratio (Qp/Qs ratio). This ratio can be used to monitor the hemodynamics of the heart. Left-to right-shunts cause the release of amino terminal proB-ty natriuretic peptide (NT-proBNP) that can be utilized as a specific marker for the presence of heart failure in children with congenital heart defects (CHDs). Early intervention such as defect closure in CHD is important to prevent heart failure.  Objective To assess for a correlation between the level of NT pro-BNP and Qp/Qs ratio in CHD patients with left-to-right shunts. Methods This cross-sectional, analytical study was conducted in 32 children who underwent cardiac catheterization at Sanglah General Hospital, Denpasar, Bali, and were recruited by consecutive sampling. NT-proBNP levels were measured by ELISA with a two-step sandwich assay system; Qp/Qs ratio using Fick rules. Statistical analyses included Shapiro-Wilk test, descriptive analysis for subject characteristics, and Pearson’s correlation analysis. A P value of <0.05 was considered to be statistically significant. Age and defect size were analyzed as confounding factors by partial correlation test. Results The correlation value between NT-proBNP and Qp/Qs ratio was r=0.384 (P<0.05), after controlling for age and defect size as cofounding factors. Conclusion There is a weak positive correlation between NT-proBNP levels and pulmonary-to-systemic blood flow ratio in patients with left-to-right shunt, after controlling for age and defect size as confounding factors.

scholarly journals Optimal pulmonary to systemic blood flow ratio for best hemodynamic status and outcome early after Norwood operation

2006 ◽  
Vol 29 (4) ◽  
pp. 551-556 ◽  
Author(s):  
Joachim Photiadis ◽  
Nicodème Sinzobahamvya ◽  
Christoph Fink ◽  
Martin Schneider ◽  
Ehrenfried Schindler ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Ratio ◽  
Norwood Operation ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Hemodynamic Status ◽  
Blood Flow Ratio

scholarly journals Evaluation of Optimization of Pulmonary and Systemic Blood Flow in Children after Bidirectional Cavapulmonary Anastomosis

2021 ◽  
pp. 57-62
Author(s):  
Ivan V. Dziuryi ◽  
Iaroslav P. Truba ◽  
Liliya M. Prokopovych ◽  
Vasyl V. Fylypchuk ◽  
Vasyl V. Lazoryshynets
Keyword(s):  
Blood Flow ◽  
Oxygen Saturation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Flow Ratio ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Blood Flow Ratio ◽  
Systemic Oxygen

In patients after bidirectional cavapulmonary anastomosis, blood flow through the superior vena cava (SVC), providing effective pulmonary blood flow, is the most important factor influencing blood oxygen saturation. Blood flow through the inferior vena cava recirculates into the systemic bloodstream. The study of the ratio of these flows will provide better understanding of the physiology of blood circulation after anastomosis and determine systemic oxygen saturation of blood and optimal time to perform surgery.   The aim. To determine volumetric blood flow in the SVC, calculate pulmonary to systemic blood flow ratio in children after bidirectional cavapulmonary anastomosis, and evaluate its contribution to cardiac output and oxygen saturation in systemic blood flow. Materials and methods. In the period from January 2010 to June 2021, 51 patients with congenital heart defects with depleted pulmonary blood flow underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 29 male patients (57%) and 22 female patients (43%). The mean age of the patients at the time of the surgery was 34 ± 18.2 months (2 to 120 months), the mean age of patients at the time of examination was 43.5 ± 28.4 months (12 to 134 months). The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities. To evaluate the optimization of pulmonary/systemic blood flow we used equations obtained using the Fick method. Pulmonary to systemic blood flow ratio was calculated separately for 35 patients. Among the examined 35 patients, 18 children were older than 2.5 years, so all the examined patients were conveniently divided into 2 age groups: I group (n = 17) up to 2.5 years, II group (n = 18) older than 2.5 years to assess the contribution of SVC to the systemic circulation depending on age. Results. Pulmonary to systemic blood flow ratio was calculated for 35 patients Qp/Qs = (82% – 66%) / (97% – 66%) = 0.52. The calculated cardiac index according to echocardiography was 4.0 ± 0.85 L/min/m2 which corresponds to the SVC saturation (r = 0.60, p = <0.001). The flow in the superior vena cava = 2.08 L/min/m2. There was a very interesting trend towards decrease in the average rate of systemic saturation in patients after bidirectional cavapulmonary anastomosis depending on age and duration of surgery. Thus, in 17 patients of group I, the calculated Qp/Qs was (84% – 67%) / (97% – 67%) = 0.57. In patients of group II, the average systemic oxygen saturation was 78 ± 2% (from 65% to 81%). Calculated Qp/Qs for 18 patients of group II = (78% – 66%) / (97% – 66%) = 0.39, which indicates a decrease in pulmonary to systemic ratio with the growth of the child. Decreased systemic saturation after bidirectional cavapulmonary anastomosis in patients with increasing age and body surface area is associated with a decrease in the proportional flow from the superior vena cava. Therefore, in our clinical material, we confirmed the phenomenon of change in pulmonary to systemic ratio depending on age, which was described by Salim et al. according to a study conducted on healthy babies. Conclusions. The contribution of SVC flow to total cardiac output after bidirectional cavapulmonary anastomosis is directly associated with the patient’s age and gradually decreases in older patients, as indicated by a decrease in systemic saturation, so the clinical effect of bidirectional cavapulmonary anastomosis may be significantly better when performing surgery in early childhood.

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