Page 99 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
connecting left branch of portal vein with left hepatic vein through an aneurysm. Liver function test was deranged and serum ammonia level was 175 micromol/ litre. Septic profile was negative. In catheterisation lab after securing right internal jugular vein access left hepatic vein injection reconfirmed the diagnosis of intrahepatic porto- systemic shunt arising from the summit of the aneurysm. Shunt was crossed with 0.014 PTCA but inspite of repeated attempts microcatheter was unable to track though the aneurysm across shunt into the portal vein. Hence apply- ing the principal of cerebral aneurysm closure, portal aneurysm was closed applying basket principal using mul- tiple V Trek Microplex 18 coils (Terumo Corporation, Japan). Proximally the aneurysm connection with hepatic vein was sealed using three 0.035 4-4 Embolization coils ( Cook Medical Indiana, USA). Developed femoral artery thrombosis after the procedure, treated with hepa- rin infusion for 72 hours followed by LMWH for 10 weeks. Extubated on day four of procedure and off CPAP and oxy- gen on day 9 of procedure. Repeated echocardiography revealed normal PA pressure and preserved cardiac func- tion. Discharged in a stable condition and 6 months follow up showed asymptomatic status with normal liver function and no evidence of pulmonary hypertension
Conclusion: This case highlights the importance of need to look beyond the heart and lung for persistent PAH and cardiomegaly. Intrahepatic portosystemic shunt is a rare congenital anomaly with type 3 being the rarest type reported in literature. This is probably the only reported case for Type III portosystemic shunt which was diag- nosed and treated in a neonatal period.
131. EFFECT OF AIRWAY TYPE ON DIFFERENCES IN MEASURED VS LAFARGE VO2 FOR PATIENTS IN THE PEDIATRIC CATHETERIZATION LABORATORY
Kari Erickson, Kathryn Soule, Gurumurthy Hiremath University of Minnesota Masonic Children's Hospital, Minneapolis, USA
Background: Consumed oxygen (VO2) is a critical com- ponent of determining cardiac index in pediatric patients during heart catheterization. Traditionally, VO2 has been obtained from LaFarge tables that list standardized mea- surements of VO2 obtained from awake patients aged 3 to 29 years. There are considerable differences between VO2 estimations in these tables compared to actual measure- ments in sedated pediatric patients with congenital heart disease in multiple studies. This study sought to further examine the role of airway type in determining differences between measured and LaFarge VO2.
Methods: 224 consecutive patients for whom VO2 could be measured in our catheterization laboratory had mea- sured VO2 values compared with assumed VO2 using the LaFarge method. Patients were not randomly assigned airway types. Correlational coefficients and Bland Altman plots were used to compare and to obtain baseline dif- ferences for measured vs assumed VO2 for all patients. Correlational coefficients, Bland Altman plots, and one way ANOVA were also used to compare measured vs assumed VO2 and to evaluate VO2 differences in all patients in 3 air- way sub groups: 1) native airway; 2) laryngeo-mask airway (LMA); and 3) endotracheal tube airway (ETT).
Results: Ages of patients ranged from 4.8 months to 34 years with a mean age of 9.8 years. There were 102 male and 122 female patients. There were 141 patients in the intubated airway group, 39 patients in the LMA group, and 44 patients in the native airway group. There were no sig- nificant differences in patient mean age, weight, height, or sex between airway types. By Pearson’s correlational coefficients, and Bland Altman plots, this data confirmed previous work showing on average the LaFarge method statistically significantly overestimated VO2 by 12% for all patients (p<0.001). When these differences were fur- ther analyzed by airway type, all three groups showed statistically significant differences between assumed and measured VO2 (p<.005). None of the airway groups had sig- nificant correlations between LaFarge and measured VO2. Correlations between LaFarge and measured VO2 were as follows: intubated patients r2=0.4, native airway patients r2= 0.2, and LMA patients r2=0.1. A one-way ANOVA with post hoc Tukey test revealed that the difference between measured and assumed VO2 was less, although still signif- icant, in patients with an ETT airway (5.2 ± 2.3 ml/min/m2, p=.016) compared to an LMA airway (18 ± 3.6 ml/min/m2, p=.691), or a native airway (13.8 ± 3.6 ml/min/m2, p=.138).
Conclusions: While patients with an ETT airway may have shown a smaller difference between assumed and mea- sured VO2, the difference is still significant. The signifi- cant differences in LaFarge compared to measured VO2 is not dependent on airway type. The small effect size for airway type and unequal number of patients in the three airway groups warrants further study with a larger sample size. This data further supports using measured VO2 for patients in the cath lab in order to obtain the most accu- rate VO2 for hemodynamic calculations regardless of their airway status.
Hijazi, Z
22nd Annual PICS/AICS Meeting