Abstract
Background: Congenital heart disease (CHD) is one of the main causes of morbidity and mortality in children. Microcirculatory changes in CHD patients have previously been investigated using a variety of techniques. Handheld videomicroscopy enables non-invasive direct visualization of the microcirculatory bed. The aim of our study was to determine if there are microcirculatory differences among CHD patients based on age and the presence of cyanosis.Methods: A prospective observational study was carried out. Patients with CHD undergoing corrective surgery were evaluated after anesthetic induction prior to surgery. Microcirculation was evaluated using sidestream dark field (SDF) imaging. Hemodynamics and respiratory, biochemical, and tissue perfusion parameters were analyzed.Results: A total of 30 patients were included, of whom 14 were classified as cyanotic and 16 as non-cyanotic. Cyanotic patients had a higher total vessel density (TVD) (p = 0.016), small vessel density (p = 0.004), and perfused small vessel density (p = 0.013), while their microvascular flow index (MFI) was lower (p = 0.013). After adjustment for age and PaO2, cyanotic patients showed increased TVD (p = 0.023), and small vessel density (p = 0.025) compared to non-cyanotic patients but there were no differences on the MFI. Age was directly correlated with total MFI (spearman's rho = 0.499, p = 0.005) and small vessel MFI (spearman's rho = 0.420, p = 0.021). After adjustment for the type of CHD (cyanotic vs. non-cyanotic) patients with MFI and small MFI vessels <3 were younger than those with values ≥3 (p = 0.033 and p = 0.037).Conclusions: SDF-based evaluation of microcirculation in CHD patients showed that patients with cyanotic defects had higher vascular density, as compared to patients with non-cyanotic defects. Younger patients were more likely to have a low MFI regardless of their type of CHD.
Highlights
The microcirculation involves those small blood vessels in which oxygen is released to the tissues
The purpose of this study was to assess potential microcirculatory differences between Congenital heart disease (CHD) patients based on age and the presence of cyanosis
A total of 30 patients were recruited during the period of inclusion, 16 of which were classified as non-cyanotic and 14 as cyanotic (Table 2)
Summary
The microcirculation involves those small blood vessels in which oxygen is released to the tissues. Different videomicroscopy techniques have been used for the evaluation of microcirculation in adult patients and children, as videomicroscopy enables direct in vivo observation of the microvascular vessel network. Video sequences in which microcirculatory blood vessels are outlined by the cells running through them are recorded. Based on these recordings, a variety of microcirculatory parameters can be evaluated [2]. Microvascularity of the sublingual mucosa has been proposed as an ideal place to measure microcirculation in critically ill patients. It shares a common embryogenic origin with the digestive mucosa, and it is accessible, especially in patients under sedation. The aim of our study was to determine if there are microcirculatory differences among CHD patients based on age and the presence of cyanosis
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