Echocardiography in the Assessment of Left Atrial Pressure After Pediatric Heart Surgery: A Comparison Study With Measurements Obtained From Left Atrial Catheter

Automatic quantitative measurement of left atrial pressure using mitral regurgitation spectrum: clinical study on comparison with floating catheter

Introduction

To explore how to measure LAPEq accurately and quantitatively, that is, the left atrial pressure (LAP) measured and calculated by equation method using mitral regurgitation spectrum.

Methods

The mitral regurgitation spectrum, pulmonary arteriolar wedge pressure (PAWP) and invasive arterial systolic pressure of radial artery of 28 patients were collected simultaneously, including 3 patients with rheumatic heart disease, 15 patients with mitral valve prolapse and 10 patients with coronary artery bypass grafting, patients with moderate or above aortic stenosis were excluded. LAPBp (Doppler sphygmomanometer method), LAPEq (Equation method) and LAPC (Catheter method) were measured synchronously, and the measurement results of the three methods were compared and analyzed. A special intelligent Doppler spectrum analysis software was self-designed to accurately measure LAPEq. This study had been approved by the ethics committee of the Northern Theater General Hospital (K-2019-17), and applied for clinical trial (No. Chictr 190023812).

Results

It was found that there was no significant statistical difference between the measurement results of LAPC and LAPEq (t = 0.954, P = 0.348), and significant correlation between the two methods [r = 0.908(0.844, 0.964), P < 0.001]. Although the measurement results of LAPC and LAPBP are consistent in the condition of non-severe eccentric mitral regurgitation, there are significant differences in the overall case and weak correlation between the two methods [r = 0.210, (−0.101, 0.510), P = 0.090]. In MVP patients with P1 or P3 prolapse, the peak pressure difference of MR was underestimated due to the serious eccentricity of MR, which affected the accuracy of LAPBP measurement.

Conclusions

It was shown that there is a good correlation between LAPEq and LAPC, which verifies that the non-invasive and direct quantitative measurement of left atrial pressure based on mitral regurgitation spectrum is feasible and has a good application prospect.

Fluid-Structure Interaction Model for Predicting Surgical Result of Total Anomalous Pulmonary Venous Connection and Estimating Pulmonary Venous Properties

OBJECTIVES

To build a fluid-structure interaction model of pulmonary veins with total anomalous pulmonary venous connection, which can be used to predict the result of surgical treatment and at the same time to estimate the elastic properties of pulmonary veins based on patient-specific data and clinic postoperative results.

METHODS

The fluid-structure interaction (FSI) model was used to simulate the anastomosis on pulmonary veins based on computed tomography angiography data collected from three children with total anomalous pulmonary venous connection (TAPVC), supra-cardiac type. The deformation and the stress of anastomosis, and also the velocity of blood flow were calculated in fluid-structure coupling algorithm. During the simulation the variable boundary conditions were applied, including the thickness of vessel wall and the vessel elasticity for which was selected a range of values. The calculation results were finally compared to postoperative results of same patients and discussed. The corresponding outcomes are given in the conclusions section.

RESULTS

The blood flow velocity through the outlet will vary depending on the properties of vessels, including physical properties and thickness of vessel wall. The stress on vessel is lower for smaller values of Young's modulus. The calculated blood flow velocity correlates well with the postoperative results for the Young's modulus of vessels ranging from 0.5 to 1.0 MPa.

CONCLUSIONS

The FSI model has high potential to predict the result of surgery for TAPVC and to estimate the physical properties of pulmonary vein. This model also has potential to guide the strategy for surgical treatment.

Recommendations for hemodynamic monitoring for critically ill children-expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

BACKGROUND

Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children.

METHODS

Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature-a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document.

RESULTS

Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached "strong agreement," 20 "weak agreement," and 2 had "no agreement." Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus.

CONCLUSIONS

These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.