Pretransplant increases in left ventricular volume and mass are associated with QT prolongation during pediatric liver transplantation.

Abstract

Structural alterations in the cirrhotic heart may contribute to electromechanical abnormalities, represented by QT prolongation. The aim of this study was to investigate the changes in QTc according to the operative stage during pediatric LT and to identify which baseline echocardiographic parameters were associated with intraoperative QTc prolongation. Data were evaluated from 39 children undergoing LT for chronic liver disease (median age 9months). In 19 patients (48.7%), baseline QTc was prolonged ≥440ms (462±19ms). Through the period of post-reperfusion, QTI, QTc, and JTI progressively increased, although values partially recovered toward the end of surgery. High LVMI (≥82.51g/m2 ) was associated with baseline QTc≥440ms (OR=1.034, P=.032). In the 5minutes post-reperfusion stage, marked QTc prolongation (defined as QTc≥500ms; n=24, 61.5%) was significantly associated with high EDVI (OR=1.060, P=.027) and SVI (OR=1.075, P=.026). In children with chronic liver disease, increased ventricular volumes and mass may increase the risk of QTc prolongation during LT, suggesting that repolarization abnormalities might be contributed by structural changes characteristic of cirrhotic cardiomyopathy.