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Relevance of the measurement of the concentration of lactate in the serum subsequent to the Fontan procedure in small children

Published online by Cambridge University Press:  26 May 2006

Masaki Hamamoto
Department of Cardiovascular Surgery, Onomichi General Hospital, Hiroshima, Japan
Hideki Uemura
Department of Cardio-Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
Hideaki Imanaka
Department of Cardiovascular Surgery and Intensive Care Unit, National Cardiovascular Center, Osaka, Japan
Toshikatsu Yagihara
Department of Cardiovascular Surgery and Intensive Care Unit, National Cardiovascular Center, Osaka, Japan


Background: To determine the clinical relevance of change in the level of lactate in the serum as a meanings of establishing the efficacy of the circulation immediately after the Fontan procedure in small children. Methods: We measured the concentration of lactate in the serum consecutively in 30 patients undergoing the Fontan procedure, without fenestration, under the age of 2 years. Of these, we did not use cardiopulmonary bypass in 13. Results: Concentrations gradually increased during the first several hours after establishment of the Fontan circulation, and then eventually decreased, reaching the normal range within 48 hours, with specific values of 0.9 plus or minus 0.3 pre-operatively, 2.3 plus or minus 1.1 immediately after creation of the Fontan circulation, 4.0 plus or minus 2.4 at 6 hours, 1.6 plus or minus 0.6 at 24 hours, and finally 1.3 plus or minus 0.4 millimoles per litre at 48 hours. This trend was irrespective of use or no use of cardiopulmonary bypass. The higher initial level in the intensive care unit was related to higher systemic venous pressure, higher transpulmonary pressure gradient, higher maximal level of alanine transaminase and blood urea nitrogen, and longer duration of peritoneal drainage, the latter as a monitor of sequestration of fluid rather than peritoneal dialysis. In patients with initial levels greater than 3.0 millimoles per litre, there was extended duration of endotracheal intubation. Conclusions: Postoperative changes in the levels of lactate in the serum subsequent to creation of the Fontan procedure were peculiar, not necessarily correlated with the cardiac output, but relevant to the clinical course.

Original Article
© 2006 Cambridge University Press

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Bakker J, Gris P. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996; 171: 221226.Google Scholar
Beca JP, Scopes JW. Serial determinations of blood lactate in respiratory distress syndrome. Arch Dis child 1972; 47: 550557.Google Scholar
Mizock BA. Lactic acidosis in critical illness. Crit Care Med 1992; 20: 8093.Google Scholar
Duke T, Butt W, South M, Karl TR. Early markers of major adverse event in children after cardiac operations. J Thorac Cardiovasc Surg 1997; 114: 10421052.Google Scholar
Munoz R, Laussen PC, Palacio G, Zienko L, Piercey G, Wessel DL. Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: an early indicator of morbidity and mortality. J Thorac Cardiovasc Surg 2000; 119: 155162.Google Scholar
Charpie JR, Dekeon MK, Goldberg CS, Mosca RS, Bove EL, Kulik TJ. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. J Thorac Cardiovasc Surg 2000; 120: 7380.Google Scholar
Cheifetz IM, Kern FH, Schulman SR, Greeley WJ, Ungerleider RM, Meliones JN. Serum lactates correlate with mortality after operations for complex congenital heart disease. Ann Thorac Surg 1997; 64: 735738.Google Scholar
Siegel LB, Dalton HJ, Hertzog RA, Hannan RL, Hauser GF. Initial postoperative serum lactate levels predict survival in children after open heart surgery. Intensive Care Med 1996; 22: 14181423.Google Scholar
Hatherill M, Sajjanhar T, Tibby SM, et al. Serum lactate as a predictor of mortality after paediatric cardiac surgery. Arch Dis Child 1997; 77: 235238.Google Scholar
Rao V, Ivanov J, Weisel RD, Cohen G, Borger MA, Mickle DA. Lactate release during reperfusion predicts low cardiac output syndrome after coronary bypass surgery. Ann Thorac Surg 2001; 71: 19251930.Google Scholar
Uemura H, Yagihara T, Yamashita K, Ishizaka T, Yoshizumi K, Kawahira Y. Establishment of total cavopulmonary connection without use of cardiopulmonary bypass. Eur J Cardiothorac Surg 1998; 13: 504508.Google Scholar
Uemura H, Yagihara T, Kawashima Y, et al. What factors affect ventricular performance after a Fontan-type operation? J Thorac Cardiovasc Surg 1995; 110: 405415.Google Scholar
Nakata S, Imai Y, Takanashi Y, et al. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88: 610619.Google Scholar
Kelley JR, Mack GW, Fahey JT. Diminished venous vascular capacitance in patients with univentricular hearts after the Fontan operation. Am J Cardiol 1995; 76: 158163.Google Scholar
de la Rocha AG, Edmonds JF, Williams WG, Poirier C, Trusler RN. Importance of mixed venous oxygen saturation in the care of critically ill patients. Can J Surg 1978; 21: 227229.Google Scholar