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Utility of portal vein pulsatility fraction in patients undergoing corrective surgery for tetralogy of Fallot

Published online by Cambridge University Press:  13 March 2023

Hiteshi Aggarwal ,
Rajarajan Ganesan Open the ORCID record for Rajarajan Ganesan [Opens in a new window] ,
Banashree Mandal Open the ORCID record for Banashree Mandal [Opens in a new window] ,
Rohit M. Kumar ,
Vidur Bansal Open the ORCID record for Vidur Bansal [Opens in a new window] ,
Shyam K.S. Thingnam  and
Goverdhan Dutt Puri Open the ORCID record for Goverdhan Dutt Puri [Opens in a new window]
Hiteshi Aggarwal
Affiliation:
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Rajarajan Ganesan
Affiliation:
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Banashree Mandal
Affiliation:
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Rohit M. Kumar
Affiliation:
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Vidur Bansal
Affiliation:
Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Shyam K.S. Thingnam
Affiliation:
Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Goverdhan Dutt Puri*
Affiliation:
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
*
Author for correspondence: Goverdhan Dutt Puri, Department of Anaesthesia and Intensive Care, 4018, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. Email: gdpuri007@hotmail.com
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Abstract

Background:

Right ventricle dysfunction is common after corrective surgery for tetralogy of Fallot and is associated with significant morbidity and mortality. We aimed to determine whether an increased portal vein pulsatility fraction (PVPF) was associated with worse clinical outcomes.

Methods:

In a prospective, observational, single-centre study, PVPF and other commonly used parameters of right ventricle function were assessed in patients of all ages undergoing corrective surgery for tetralogy of Fallot intraoperatively, with transesophageal echocardiography, before and after bypass, and post-operatively, with transthoracic echocardiography, at days 1, 2, at extubation, and at ICU discharge. The correlation was tested between PVPF and mechanical ventilation duration, prolonged ICU stay, mortality, and right ventricle function.

Results:

The study included 52 patients, and mortality was in 3 patients. PVPF measurement was feasible in 96% of the examinations. PVPF in the immediate post-operative period had sensitivity of 73.3% and a specificity of 74.3% in predicting the occurrence of the composite outcome of prolonged mechanical ventilation, ICU stay, or mortality. There was a moderate negative correlation of PVPF with right ventricle fractional area change and right ventricle global longitudinal strain (r = −0.577, p < 0.001 and r = 0.465, p < 0.001, respectively) and a strong positive correlation with abnormal hepatic vein waveform (rho = 0.749, p < 0.001).

Conclusion:

PVPF is an easily obtainable bedside parameter to assess right ventricular dysfunction and predict prolonged mechanical ventilation, prolonged ICU stay, and mortality.

Keywords

Portal veintetrology of Fallotright ventricleechocardiographytransesophagealcardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2357 - 2362
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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