The novel and slowest arterial pressure waves: clinical implications in children with congenital heart disease following cardiovascular surgery

Abstract

Abstract Objective Certain rhythmic arterial pressure waves in humans and animals have been noticed over one century. We found the noval and slowest arterial pressure waves in children following surgerical repair for congenital heart disease (CHD), and examined their characteristics and clinical implications. Methods We enrooled 212 children with 22 types of CHD during and in the first postoperative 48 hours. We monitored hemodynamics, including blood pressure, heart rate, cardiac cycle efficiency (CCE), and dP/dTmax using pressure recording analytical method by MostCare, and cerebral (ScO2) and renal (SrO2) oxygen saturation using near-infrared spectroscopy every 6 seconds. EEG was continuously monitored. Transcranial Doppler was used to measure the mean blood flow velocity (Vm) of the middle cerebral artery at the 24th hours. Results We found the waves with a frequency of ~ 90 seconds immediately following surgical repair in 46 patients in 12 types of CHD (21.7%), being most prevalent in patients with aortic arch abnormalities (Aorta Group, n = 24, 42.3%) or with ventricular septal defect (VSD) (VSD Group, n = 12, 23.5%). In Aorta and VSD Groups, the occurrence of the waves was asscoated with lower blood pressures, dP/dTmax, CCE, ScO2 and SrO2, Vm and worse EEG background abnormalities and higher number of EEG sharp waves, and serum lactate (Ps < 0.0001-0.07). The waves were accompanied with fluctuations of ScO2 and SrO2 in 80.6% and 69.6% of patients respectively. Conclusions The waves observed in children with CHD following cardiovascular surgery are the slowest ever reported, occurring most frequently in patients with aortic arch abnormalities or VSD. The presence of the waves was associated with worse and fluctuated ScO2 and SrO2, worse systemic hemodynamics and EEG abnormalities.