title: Preoperative management in patients with single-ventricle physiology.
abstract: OBJECTIVE
  Advancements in the preoperative management of patients with single-ventricle physiology continue to evolve. Previous reports have questioned the benefit of using inhaled nitrogen in single-ventricle patients, suggesting that this therapeutic modality may not provide adequate systemic cardiac output. The objective of this study was to review our institutional experience managing preoperative patients with single-ventricle physiology using a combination of afterload reduction and inhaled hypoxemic therapy.
  
  
  METHODS
  This is a retrospective review of 49 consecutive single-ventricle patients admitted preoperatively between July 2004 and January 2009, to the cardiac intensive care unit at Children's Hospital of Pittsburgh who underwent single-ventricle palliation, and treated preoperatively with milrinone and inhaled nitrogen. Therapeutic interventions and indirect indicators of cardiac output were collected on day of admission (time 0) and compared with those collected on the morning of surgery (time 1); data included clinical assessment, hemodynamic measurements, and laboratory values.
  
  
  RESULTS
  When comparing time 0 to time 1, there was a statistically significant decrease in lactate (from 2.2 to 1.8 mEq/L [P < 0.001]) and an increase in pH (from 7.36 to 7.41 [P < 0.001]), serum bicarbonate (from 24.16 to 27.55 mmol/L [P < 0.001]) and arterial PaO2 (from 38.10 to 41.82 mm Hg [P = 0.027]). Preoperatively, there were no deaths, and only two patients had an evidence of multiorgan dysfunction on day of surgery (time 1).
  
  
  CONCLUSIONS
  Our results suggest that a combination of afterload reduction and hypoxemic therapy was able to maintain an appropriate distribution of the cardiac output in the majority of preoperative patients with single-ventricle physiology. An adequate balance of systemic and pulmonary blood flow was successfully achieved with an increase in arterial PaO2 values.
authors: Department of Pediatrics, Division of Cardiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15201, USA. evonne.krushansky@chp.edu
authors: Evonne
authors: E
authors: Krushansky
authors: Nelson
authors: N
authors: Burbano
authors: Victor
authors: V
authors: Morell
authors: Diego
authors: D
authors: Moguillansky
authors: Yeon
authors: Y
authors: Kim
authors: Richard
authors: R
authors: Orr
authors: Constantinos
authors: C
authors: Chrysostomou
authors: Ricardo
authors: R
authors: Munoz
mesh_terms: D000280:Administration, Inhalation; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D006330:Heart Defects, Congenital / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D007231:Infant, Newborn; D020105:Milrinone / Q000627:therapeutic use*; D009584:Nitrogen / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D011300:Preoperative Care / Q000379:methods*; D011652:Pulmonary Circulation / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone; D009584:Nitrogen; D010100:Oxygen