Background: Assessment of cardiac function is crucial in pediatric patients undergoing cardiovascular surgery, monitoring cardiac output and changing hemodynamic conditions during surgery accordingly is important to improve post-surgical outcome. We aimed to measure cardiac index (CI) and maximal rate of the increase of left ventricular pressure d p/d t (max) with the pressure recording analytic method (PRAM, MostCare ®) and compared it with transthoracic echocardiographic cardiac index estimation in infants with transposition of the great arteries (TGA) undergoing surgical correction.
Methods: We enrolled 74 infants with TGA consecutively into this study. CI and dp/dt (max) were measured with PRAM and echocardiography at 0, 4, 8, 12, 24 and 48 h postoperatively. Blood brain natriuretic peptide (BNP) and blood lactate (Lac) were measured at baseline and after operation.
Results: The median age at surgery was 13 days (range 1-25 days) with an average weight of 3.24 kg (range 2.31-4.17 kg). CI estimated by PRAM was 1.11 ¡À 0.12 L/min/m 2 (range 0.69-1.36) and by Doppler echocardiography was 1.13 ¡À 0.13 L/min/m 2 (range 0.76-1.40). dp/dt (max) estimated by PRAM was 1.31 ¡À 0.03 mmHg/s (range 1.23-1.43) and by Doppler echocardiography was 1.31 ¡À 0.04 L/min/m 2 (range 1.25-1.47). CI ( r = 0.817, P < 0.001) and d p/d t (max) ( r = 0.794, P < 0.001) measured by two methods were highly correlated with a linear relation. Blood BNP and lactate increased to the highest level at 8-12 h post-operatively. Conclusions: In the early post-operative period, PRAM provides reliable estimates of cardiac index and dp/dt (max) value compared with echocardiographic measurements. PRAM through mostcare® is a reliable continuous monitoring method for peri-operative management in children with congenital heart disease.
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