• Iliona Malaspinas, Ferenc Petak, Lionel Chok, Anne Perrin, Anne-Laure Martin, Maurice Beghetti, and Walid Habre.
• Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland; †Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
• J. Cardiothorac. Vasc. Anesth. 2016 Oct 1; 30 (5): 1286-95.

ObjectiveTo assess the profile of changes in airway and respiratory tissue mechanics within a follow-up study performed in children with mitral valve disease, before and after surgical valve repair.DesignPerioperative measurements in a prospective, consecutive cross-sectional study.SettingUniversity hospital, tertiary care teaching hospitalParticipantsThe study comprised 24 children with congenital or post-rheumatic mitral valve insufficiency.InterventionsInput impedance of the respiratory system during spontaneous breathing was measured before and 5 days and 3 weeks after mitral valve surgery. In addition, airway and respiratory tissue mechanics and pulmonary arterial pressure were assessed with the patient under general anesthesia preoperatively and immediately postoperatively. Respiratory tissue elastance and changes in airway measurements were estimated from forced oscillatory impedance data by fitting an appropriate model.Measurement And Main ResultsRelating airway and respiratory tissue mechanics to previously established reference values obtained in age-matched healthy control patients revealed abnormal respiratory function (135±6.2% and 148±13% in respiratory elastance and resistance, respectively; p<0.001). Improvement in the airway properties was observed immediately after surgery (-15.2±3.4%; p<0.005) and lasted for the study period (-19±4.1%; p<0.001). Respiratory tissue elastance, which correlated preoperatively to the diastolic pulmonary arterial pressure, decreased only 5 days postoperatively (-20.6±4.1%; p<0.005). However, there was no evidence of a clear, immediate effect of surgery on the tissue mechanical parameters measured intraoperatively despite a decrease in diastolic pulmonary pressure.ConclusionsMitral valve disease in children leads to abnormal airway and respiratory tissue mechanics. Even though surgical repair of mitral insufficiency alleviates abnormal airway function, residual lung tissue stiffening may persist even weeks after the surgery, contributing to a sustained impairment in lung function.Copyright © 2016 Elsevier Inc. All rights reserved.

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