title: Is an increase in lactate concentration associated with cardiac dysfunction after the Fontan procedure?
abstract: OBJECTIVE
  To investigate how blood lactate concentration changes in the early postoperative course after the Fontan procedure, and whether such a change is associated with postoperative hemodynamics.
  
  
  METHODS
  Eight pediatric patients who underwent the Fontan procedure for congenital heart disease were included. Enrollment criteria were body weight >10 kg and staged Fontan procedure following the bidirectional Glenn procedure. Blood lactate concentration and central venous oxygen saturation (SvO2) were measured at five points: before skin incision, upon intensive care unit (ICU) admission, 15 minutes before, 15 minutes after, and 2 hours after extubation. Cardiac index (CI) was continuously monitored using the pulse contour technique.
  
  
  RESULTS
  Lactate concentration increased in the ICU, peaking from 15 minutes before (2.7+/-1.3 mmol/L) to 15 minutes after (3.0+/-1.3 mmol/L) extubation. Values returned to normal parameters (1.0+/-0.1 mmol/L) within 48 hours. The CI values were also higher immediately after extubation (4.0+/-0.6 L/min/m2) than at ICU admission (3.3+/-0.6 L/min/m2) and before extubation (3.6+/-0.6 L/min/m2) (p=0.012). No significant change in central SvO2 or blood pressure (BP) was evident during the study period.
  
  
  CONCLUSIONS
  In the early postoperative period after the Fontan procedure, blood lactate concentration increased temporarily around the time of extubation but the increase was not associated with hemodynamic deterioration.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Hamamoto
authors.forename: Hideaki
authors.initials: H
authors.lastname: Imanaka
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
authors.forename: Masaji
authors.initials: M
authors.lastname: Nishimura
mesh_terms: D000293:Adolescent; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000097:blood*; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood
chemical_list: D019344:Lactic Acid; D010100:Oxygen