• Thilo Fleck, Stefan Schubert, Matthias Redlin, Brigitte Stiller, Peter Ewert, Felix Berger, and Nicole Nagdyman.
• Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin, Germany. thilofleck@web.de
• Paediatr Anaesth. 2010 Jun 1;20(6):553-8.

BackgroundThe brain of children in the early period after repair of congenital heart defects with cardiopulmonary bypass (CPB) may be more vulnerable to hemodynamic changes because of impaired cerebral autoregulation. During postoperative testing of the external temporary safety pacer, we performed desynchronizing ventricular pacing (VVI) while monitoring cerebral oxygenation using near-infrared spectroscopy (NIRS).MethodsWe prospectively investigated 11 children (6 girls, 5 boys). Mean age was 6.1 months (+/-3.8 months) and mean weight: 5.3 kg (+/-1.5 kg). We performed measurements at four study steps: baseline I, VVI pacing, baseline II and atrial pacing (AOO) to exclude effects of higher heart rate. We continuously measured the effects on hemodynamic and respiratory parameters as well as on cerebral tissue oxygenation index (TOI). Hemoglobin difference (HbD) was calculated as a parameter for cerebral blood flow (CBF).ResultsVentricular pacing leads to a significant decrease in arterial blood pressure and central venous saturation accompanied by an immediate and significant decrease in TOI (63.3% +/- 7.6% to 61.5% +/- 8.4% [P < 0.05]) and HbD (0.51 +/- 1.8 micromol.l(-1) to -2.9 +/- 4.7 micromol.l(-1) [P < 0.05]).ConclusionCardiac desynchronization after CPB seems to reduce CBF and cerebral oxygenation in children.

24 keywords...

hide…