Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Measurement of pulmonary saturation as a method of rapid assessment of the functional viability of the subclavian-pulmonary anastomosis in children under the age of 1 year

Authors: Lomakin M.V., Rybka M.M., Kodzokova Z.A., Loseva A.S.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2023-20-2-164-172

UDC: 612.111.14:616.145.4-089.843

Link: Clinical Physiology of Blood Circulaiton. 2023; 3 (20): 164-172

Quote as: Lomakin M.V., Rybka M.M., Kodzokova Z.A., Loseva A.S. Measurement of pulmonary saturation as a method of rapid assessment of the functional viability of the subclavian-pulmonary anastomosis in children under the age of 1 year. Clinical Physiology of Circulation. 2023; 20 (2): 164–72 (in Russ.). DOI: 10.24022/ 1814-6910-2023-20-2-164-172

Received / Accepted:  11.05.2023 / 26.06.2023

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Abstract

Introduction. The problem of plain and non-invasive assessment of blood flow in the lungs in patients with congenital heart diseases in the intraoperative or early postoperative period remains significant. For an objective assessment of the subclavian-pulmonary shunt function in newborns and children under one year old, the method of near-infrared spectroscopy (NIRS) can be used. Objective. Approbation of express method for assessing blood flow in pulmonary circulation by measuring the oxygen saturation of lung tissues after intra- and postoperatively in children under 1 year of age.

Material and methods. During 2017–2022, in Bakoulev National Medical Research Center of Cardiovascular Surgery 250 children under 1 year old with congenital heart disease characterized by depleted pulmonary blood flow were included in prospective observational study. All of them underwent subclavian-pulmonary shunt procedure. Changes in saturation over symmetrical lung areas after subclavian-pulmonary shunt were studied. Sensors were positioned at the middle third of the anterolateral surface of the chest in the projection of the 2nd intercostal space. Taking into account antiseptics demands near the skin incision such sensors position suitable for continuous monitoring of the shunt function both intraoperatively and in the postoperative period.

Results. At the initial values of the pulmonal saturation of 64.8 ± 12.4%, three types of their changes were observed after the subclavian-pulmonary anastomosis was applied. The majority (n = 246) of patients after anastomosis had a difference in pulmonal oximetry in symmetrical areas, amounting to 11.1 ± 5.5 (p < 0.001). It is noteworthy that in 76% of cases, the value from the side of the anastomosis was lower. Increased oximetry on the part of the anastomosis is noted in patients with complex congenital heart defects, combined with of the pulmonary artery stenosis or its hypoplasia on the contralateral side of the anastomosis. In four patients from the general group, the asymmetry of oximetry over the lungs did not appear.

Conclusion. The method of assessing the functional viability of subclavian-pulmonary shunt by NIRS spectroscopy in children in the age group up to 1 year has confirmed its clinical importance in analyzing the effectiveness of the performed subclavian-pulmonary anastomosis.

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About Authors

  • Maksim V. Lomakin, Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Professor, Head of Department of Anesthesiology and Intensive Care Unit; ORCID
  • Zera A. Kodzokova, Anesthesiologist-Intensivist; ORCID
  • Anna S. Loseva, Anesthesiologist-Intensivist; ORCID

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