Left ventricular volume as a predictor of postoperative hemodynamics and a criterion for total correction of tetralogy of Fallot.
The effect of preoperative left ventricular end-diastolic volume on hemodynamics after repair and the safety limit of left ventricular end-diastolic volume for total correction of tetralogy of Fallot were studied. Preoperative left ventricular volume was determined in 38 patients according to the area-length method from biplane cineangiocardiograms. The mean left ventricular end-diastolic volume of the 38 patients was 83% +/- 23% of normal. The left ventricular end-diastolic volume of 20 corrected patients (90% +/- 22% of normal) was significantly larger (p less than 0.05) than that of 18 with a systemic-pulmonary shunt (75% +/- 22% of normal). In the corrected patients, the total amount of dopamine required in the postoperative period showed an excellent inverse exponential correlation with the preoperative left ventricular end-diastolic volume (r = -0.826); it showed a poor inverse correlation with the ratio of pulmonary artery to aortic diameter (r = -0.587) and with myocardial ischemic time (r = -0.487); and it showed no correlation with postoperative right to left ventricular systolic pressure ratio (determined at the time of the chest closure) and residual right ventricular-pulmonary arterial pressure gradients. The patients with a left ventricular end-diastolic volume under 70% of normal had severe low-output syndrome after total correction. We recommend a left ventricular end-diastolic volume of 60% of normal as a safety limit for total correction in patients under 2 years of age. In patients over 2 years of age, the safety limit may be larger because there are more collaterals with increasing age.
D002302:Cardiac Output / Q000187:drug effects; D002303:Cardiac Output, Low / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004298:Dopamine / Q000494:pharmacology / Q000627:therapeutic use; D006352:Heart Ventricles / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011184:Postoperative Period; D013318:Stroke Volume / Q000187:drug effects; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*
D004298:Dopamine