Evaluation of cardiac function during laparoscopic gastrostomy in pediatric patients with hypoplastic left heart syndrome using intraoperative transesophageal echocardiography

Patients with single ventricle physiology (SVP)--specifically, hypoplastic left heart syndrome (HLHS)--frequently need long-term enteral access; however, they are at an extremely high operative risk. Nothing has been published on the physiologic impact on single ventricle function during laparoscopy...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 24; no. 10; p. 738
Main Authors:	Knott, E Marty, Fraser, Jason D, Alemayahu, Hanna, Drake, William B, St Peter, Shawn D, Perryman, Kathy M, Juang, David
Format:	Journal Article
Language:	English
Published:	United States 01-10-2014
Subjects:	Child, Preschool Echocardiography, Transesophageal Female Fundoplication Gastrostomy Heart - physiopathology Heart Ventricles Humans Hypoplastic Left Heart Syndrome - complications Hypoplastic Left Heart Syndrome - physiopathology Infant Intra-Abdominal Hypertension - physiopathology Laparoscopy Male Palliative Care
Online Access:	Get more information
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Patients with single ventricle physiology (SVP)--specifically, hypoplastic left heart syndrome (HLHS)--frequently need long-term enteral access; however, they are at an extremely high operative risk. Nothing has been published on the physiologic impact on single ventricle function during laparoscopy in this patient population. Therefore, we performed intraoperative transesophageal echocardiography (TEE) to study the physiologic effects of laparoscopic surgery in these patients. After Internal Review Board approval, patients with SVP undergoing laparoscopic gastrostomy were studied with intraoperative TEE, and fractional shortening was determined. Patients were separated into those with HLHS and others with SVP. Data are reported as mean ± standard deviation values. Analysis of variance was used for continuous variables. From August 2011 to February 2013, in total, 11 patients with SVP underwent laparoscopic gastrostomy, including 6 with HLHS. One of the 6 HLHS patients and 1 of the SVP patients underwent concurrent fundoplication. All patients were post-first-stage palliation; two had completed post-second stage. Fractional shortening tended to decrease during insufflation and return to baseline after desufflation. There was no 30-day mortality. Pneumoperitoneum associated with laparoscopic gastrostomy tube placement results in a reversible decrease in fractional shortening in patients with HLHS and SVP. Overall, the children tolerated pneumoperitoneum. TEE allows for real-time assessment of ventricular function and volume and may improve safety during longer procedures.
ISSN:	1557-9034
DOI:	10.1089/lap.2014.0287