Hemodynamic characteristics of neonates following first stage palliation for hypoplastic left heart syndrome.
BACKGROUND
It is widely held that the postoperative course of patients with hypoplastic left heart syndrome (HLHS) after stage 1 palliation is characterized by hemodynamic instability, which in part may be due to excessive pulmonary blood flow. Hence, avoidance of alkalosis and the use of minimally oxygen-enriched inspiratory gas are thought by many to be important, although there is little pertinent published data. This study was undertaken to characterize the postoperative course and to determine whether the FIO2 and blood pH are related to indices of hemodynamic stability in these infants.


RESULTS
The postoperative course of 25 consecutive infants undergoing first stage palliation for HLHS were retrospectively reviewed and the following data were obtained: arterial pressure, arterial blood gas measurements, the inotropic agents used, and multiple respiratory parameters. There was one operative death, and 2 patients died within 2 days, but 22 were extubated (mean, 5.2 +/- 4.1 days after surgery). Hospital mortality was 24%. Mean pH was > or = 7.51 for the first 9 hours after surgery and was > or = 7.45 for the entire period. The mean FIO2 was > or = 50% for the first 18 hours. The PaO2 was appropriate (37 +/- 6 mm Hg at 1 hour after surgery, increasing to 45 +/- 5 mm Hg by hour 73). Only modest inotropic support was needed to maintain appropriate blood pressure.


CONCLUSIONS
These data suggest that neither alkalosis nor relatively high inspired oxygen necessarily cause hemodynamic instability in these patients. To what extent these results are generalizable is unclear, but they suggest that there is nothing inherent with HLHS that mandates postoperative hemodynamic instability or unacceptable mortality.
Mosca
R S
RS
Department of Surgery, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor 48109-0204, USA.
Bove
E L
EL
Crowley
D C
DC
Sandhu
S K
SK
Schork
M A
MA
Kulik
T J
TJ
D001158:Arteries; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005740:Gases / Q000097:blood; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D007231:Infant, Newborn; D010166:Palliative Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D005740:Gases