Early assessment of hemodynamic status after repair of tetralogy of Fallot: A comparison of 24 hour (intensive care unit) and 1 year postoperative data in 98 patients

Abstract

Hemodynamic data obtained in the intensive care unit, immediately after repair of tetralogy of Fallot, were compared with measurements obtained at 1 year postoperative catheterization in 98 infants and children. Eight of 12 patients who had pulmonary artery oxygen saturation of 80 % or greater in the intensive care unit had a pulmonary to systemic flow ratio greater than 1.5 at catheterization; all 79 patients who had a pulmonary artery oxygen saturation of less than 80% in the intensive care unit had a pulmonary to systemic flow ratio of 1.5 or less at catheterization. Five of six patients who had a right ventricular outflow tract pressure gradient greater than 40 mm Hg in the intensive care unit had a gradient greater than 40 mm Hg at catheterization; 7 of 61 patients who had a right ventricular outflow tract gradient of 40 mm Hg or less in the intensive care unit had a gradient greater than 40 mm Hg at catheterization. The addition of measurements of right ventricular pressure and the right ventricular to systemic arterial pressure ratio in the intensive care unit did not improve sensitivity in identifying patients with a right ventricular outflow tract gradient greater than 40 mm Hg at catheterization. Intensive care unit measurement of pulmonary artery oxygen saturation is valuable for determining the presence or absence of a significant left to right shunt after repair of tetralogy of Fallot and should be considered an adjunct to patient management. Intensive care unit measurement of the right ventricular outflow tract gradient identifies patients with a significant right ventricular outflow tract gradient at catheterization but is not highly sensitive.