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The novel and slowest arterial pressure waves: clinical implications in children with congenital heart disease following cardiovascular surgery

Published online by Cambridge University Press:  03 October 2024

Li Ma ,
Linyang Yu ,
Yingying Liu ,
Rouyi Lin ,
Jinqing Feng ,
Yanqin Cui ,
Jianbin Li ,
Lijuan Li ,
Shuyao Ning  and
Minghui Zou
...Show all authors
Li Ma
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Clinical Physiology Laboratory, Institute of Pediatrics; Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Linyang Yu
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Clinical Physiology Laboratory, Institute of Pediatrics; Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Yingying Liu
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Clinical Physiology Laboratory, Institute of Pediatrics; Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Rouyi Lin
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Clinical Physiology Laboratory, Institute of Pediatrics; Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Jinqing Feng
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Clinical Physiology Laboratory, Institute of Pediatrics; Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Yanqin Cui
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Jianbin Li
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Lijuan Li
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Shuyao Ning
Affiliation:
Department of Electroneurophysiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
Minghui Zou
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Guodong Huang
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Huaizhen Wang
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Xinxin Chen
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
Jia Li*
Affiliation:
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China Clinical Physiology Laboratory, Institute of Pediatrics; Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
*
Corresponding author: Jia Li; Email: [email protected]
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Abstract

Objectives:

Certain rhythmic arterial pressure waves in humans and animals have been noticed for over one century. We found the novel and slowest arterial pressure waves in children following surgical repair for CHD, and examined their characteristics and clinical implications.

Methods:

We enrolled 212 children with 22 types of CHD within postoperative 48 h. We monitored haemodynamics (blood pressure, cardiac cycle efficiency, dP/dTmax), cerebral (ScO2), and renal (SrO2) oxygen saturation every 6 s. Electroencephalogram was continuously monitored. Mean blood flow velocity (Vm) of the middle cerebral artery was measured at 24 h.

Results:

We found the waves with a frequency of ∼ 90 s immediately following surgical repair in 46 patients in 12 types of CHD (21.7%), being most prevalent in patients with aortic arch abnormalities (Aorta Group, n = 24, 42.3%) or ventricular septal defect (Ventricular Septal Defect Group, n = 12, 23.5%). In Aorta and Ventricular Septal Defect Groups, the occurrence of the waves was associated with lower blood pressures, dP/dTmax, cardiac cycle efficiency, ScO2, SrO2, Vm, worse electroencephalogram background abnormalities, higher number of electroencephalogram sharp waves, and serum lactate (Ps <0.0001–0.07), and were accompanied with fluctuations of ScO2 and SrO2 in 80.6% and 69.6% of patients, respectively.

Conclusions:

The waves observed in children following cardiovascular surgery are the slowest ever reported, occurring most frequently in patients with aortic arch abnormalities or ventricular septal defect. While the occurrence of the waves was associated with statistically worse and fluctuated ScO2 and SrO2, worse systemic haemodynamics, and electroencephalogram abnormalities, at present these waves have no known clinical relevance.

Keywords

Arterial pressure wavesystemic haemodynamicselectroencephalogramCHDcardiovascular surgeryregional oxygen saturation
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 11 , November 2024 , pp. 2398 - 2405
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Copyright
© Guangzhou Women and Children’s Medical Center, 2024. Published by Cambridge University Press

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Footnotes

Li Ma and Linyang Yu had equal contributions to this manuscript.

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