title: Evaluation of cardiac function during laparoscopic gastrostomy in pediatric patients with hypoplastic left heart syndrome using intraoperative transesophageal echocardiography.
abstract: BACKGROUND
  Patients with single ventricle physiology (SVP)--specifically, hypoplastic left heart syndrome (HLHS)--frequently need long-term enteral access; however, they are at an extremely high operative risk. Nothing has been published on the physiologic impact on single ventricle function during laparoscopy in this patient population. Therefore, we performed intraoperative transesophageal echocardiography (TEE) to study the physiologic effects of laparoscopic surgery in these patients.
  
  
  METHODS
  After Internal Review Board approval, patients with SVP undergoing laparoscopic gastrostomy were studied with intraoperative TEE, and fractional shortening was determined. Patients were separated into those with HLHS and others with SVP. Data are reported as mean ± standard deviation values. Analysis of variance was used for continuous variables.
  
  
  RESULTS
  From August 2011 to February 2013, in total, 11 patients with SVP underwent laparoscopic gastrostomy, including 6 with HLHS. One of the 6 HLHS patients and 1 of the SVP patients underwent concurrent fundoplication. All patients were post-first-stage palliation; two had completed post-second stage. Fractional shortening tended to decrease during insufflation and return to baseline after desufflation. There was no 30-day mortality.
  
  
  CONCLUSIONS
  Pneumoperitoneum associated with laparoscopic gastrostomy tube placement results in a reversible decrease in fractional shortening in patients with HLHS and SVP. Overall, the children tolerated pneumoperitoneum. TEE allows for real-time assessment of ventricular function and volume and may improve safety during longer procedures.
authors.affiliation: Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.forename: Jason D
authors.initials: JD
authors.lastname: Fraser
authors.forename: Hanna
authors.initials: H
authors.lastname: Alemayahu
authors.forename: William B
authors.initials: WB
authors.lastname: Drake
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Perryman
authors.forename: David
authors.initials: D
authors.lastname: Juang
mesh_terms: D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D018662:Fundoplication; D005774:Gastrostomy; D006321:Heart / Q000503:physiopathology*; D006352:Heart Ventricles; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000503:physiopathology*; D007223:Infant; D059325:Intra-Abdominal Hypertension / Q000503:physiopathology; D010535:Laparoscopy; D008297:Male; D010166:Palliative Care