Cargando…

Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair

BACKGROUND: Intra-cardiac repair for tetralogy of Fallot has some degree of residual right ventricular outflow tract (RVOT) obstruction. However, the measurement of this gradient intra-operatively might get affected by the depth of anesthesia which is important for the long-term outcome. AIMS: The p...

Descripción completa

Detalles Bibliográficos
Autores principales: Toshkhani, Dheemta, Arya, Virendra Kumar, Kajal, Kamal, Thingnam, Shyam K. S., Rana, Sandeep Singh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918014/
https://www.ncbi.nlm.nih.gov/pubmed/33679057
http://dx.doi.org/10.4103/apc.APC_147_19
_version_ 1783657831047626752
author Toshkhani, Dheemta
Arya, Virendra Kumar
Kajal, Kamal
Thingnam, Shyam K. S.
Rana, Sandeep Singh
author_facet Toshkhani, Dheemta
Arya, Virendra Kumar
Kajal, Kamal
Thingnam, Shyam K. S.
Rana, Sandeep Singh
author_sort Toshkhani, Dheemta
collection PubMed
description BACKGROUND: Intra-cardiac repair for tetralogy of Fallot has some degree of residual right ventricular outflow tract (RVOT) obstruction. However, the measurement of this gradient intra-operatively might get affected by the depth of anesthesia which is important for the long-term outcome. AIMS: The primary aim was to compare intraoperative RVOT gradient post repair under two different anesthetic depths of 1% and 2% end-tidal sevoflurane. The secondary objective was to follow up the changes in RVOT gradient till 1 month postoperatively. Design: Observational study. Setting : Advanced Cardiac Centre of PGIMER, Chandigarh. METHODS: Following intracardiac repair, RVOT gradient was measured directly by placing needle into the right ventricle and pulmonary artery at sevoflurane 1%, and subsequently, at 2% end.tidal concentration while maintaining hemodynamic stability. These gradients were also measured using transesophageal echocardiography (TEE) (ClinicalTrials.gov NCT03234582). RESULTS: Twenty-one patients were included in this study that had intra-cardiac repair, of which pulmonary annulus was preserved for 15 cases. Mean RVOT gradients measured invasively and by TEE at end-tidal sevoflurane concentration of 1% and 2% were not significantly different (6.67 ± 4.16 mmHg vs. 6.76 ± 3.82 mmHg, P > 0.05 invasively and 13.01 ± 7.40 mmHg vs. 12.53 ± 7.11 mmHg, P > 0.05 by TEE, respectively). RVOT gradient measured by trans-thoracic echocardiography (TTE) postoperatively at the time of extubation and during follow-up at 1 month showed significant reduction (11.37 ± 6.00 mmHg, P < 0.05 and 9.23 ± 4.92 mmHg, P < 0.01 respectively). Six patients who underwent repair with transannular patch had significant pulmonary regurgitation (PR) following surgery, with no significant change in PR severity or RVOT gradient on increasing anesthetic depth. CONCLUSIONS: Postoperative RVOT gradient was not altered by changing depth of anesthesia provided systemic blood pressure was maintained. One month postrepair RVOT gradients were significantly reduced as compared to the intraoperative values.
format Online
Article
Text
id pubmed-7918014
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-79180142021-03-05 Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair Toshkhani, Dheemta Arya, Virendra Kumar Kajal, Kamal Thingnam, Shyam K. S. Rana, Sandeep Singh Ann Pediatr Cardiol Original Article BACKGROUND: Intra-cardiac repair for tetralogy of Fallot has some degree of residual right ventricular outflow tract (RVOT) obstruction. However, the measurement of this gradient intra-operatively might get affected by the depth of anesthesia which is important for the long-term outcome. AIMS: The primary aim was to compare intraoperative RVOT gradient post repair under two different anesthetic depths of 1% and 2% end-tidal sevoflurane. The secondary objective was to follow up the changes in RVOT gradient till 1 month postoperatively. Design: Observational study. Setting : Advanced Cardiac Centre of PGIMER, Chandigarh. METHODS: Following intracardiac repair, RVOT gradient was measured directly by placing needle into the right ventricle and pulmonary artery at sevoflurane 1%, and subsequently, at 2% end.tidal concentration while maintaining hemodynamic stability. These gradients were also measured using transesophageal echocardiography (TEE) (ClinicalTrials.gov NCT03234582). RESULTS: Twenty-one patients were included in this study that had intra-cardiac repair, of which pulmonary annulus was preserved for 15 cases. Mean RVOT gradients measured invasively and by TEE at end-tidal sevoflurane concentration of 1% and 2% were not significantly different (6.67 ± 4.16 mmHg vs. 6.76 ± 3.82 mmHg, P > 0.05 invasively and 13.01 ± 7.40 mmHg vs. 12.53 ± 7.11 mmHg, P > 0.05 by TEE, respectively). RVOT gradient measured by trans-thoracic echocardiography (TTE) postoperatively at the time of extubation and during follow-up at 1 month showed significant reduction (11.37 ± 6.00 mmHg, P < 0.05 and 9.23 ± 4.92 mmHg, P < 0.01 respectively). Six patients who underwent repair with transannular patch had significant pulmonary regurgitation (PR) following surgery, with no significant change in PR severity or RVOT gradient on increasing anesthetic depth. CONCLUSIONS: Postoperative RVOT gradient was not altered by changing depth of anesthesia provided systemic blood pressure was maintained. One month postrepair RVOT gradients were significantly reduced as compared to the intraoperative values. Wolters Kluwer - Medknow 2021 2020-10-19 /pmc/articles/PMC7918014/ /pubmed/33679057 http://dx.doi.org/10.4103/apc.APC_147_19 Text en Copyright: © 2020 Annals of Pediatric Cardiology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Toshkhani, Dheemta
Arya, Virendra Kumar
Kajal, Kamal
Thingnam, Shyam K. S.
Rana, Sandeep Singh
Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair
title Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair
title_full Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair
title_fullStr Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair
title_full_unstemmed Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair
title_short Comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of Fallot repair
title_sort comparison of right ventricular outflow tract gradient under anesthesia with post-operative gradient in patients undergoing tetralogy of fallot repair
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918014/
https://www.ncbi.nlm.nih.gov/pubmed/33679057
http://dx.doi.org/10.4103/apc.APC_147_19
work_keys_str_mv AT toshkhanidheemta comparisonofrightventricularoutflowtractgradientunderanesthesiawithpostoperativegradientinpatientsundergoingtetralogyoffallotrepair
AT aryavirendrakumar comparisonofrightventricularoutflowtractgradientunderanesthesiawithpostoperativegradientinpatientsundergoingtetralogyoffallotrepair
AT kajalkamal comparisonofrightventricularoutflowtractgradientunderanesthesiawithpostoperativegradientinpatientsundergoingtetralogyoffallotrepair
AT thingnamshyamks comparisonofrightventricularoutflowtractgradientunderanesthesiawithpostoperativegradientinpatientsundergoingtetralogyoffallotrepair
AT ranasandeepsingh comparisonofrightventricularoutflowtractgradientunderanesthesiawithpostoperativegradientinpatientsundergoingtetralogyoffallotrepair