Key result
In children undergoing cardiopulmonary bypass for atrial septal defect repair, post-operative QTc significantly correlated with bypass time (R=0.686) and changes in coronary flow (R=0.741).
Why the study?
Does cardiopulmonary bypass surgery for ASD repair alter myocardial repolarization and coronary perfusion in children?
Observational (n=12)
No
Does cardiopulmonary bypass surgery for ASD repair alter myocardial repolarization and coronary perfusion in children?
In children undergoing ASD repair, cardiopulmonary bypass time correlates with early post-operative changes in ventricular repolarization and coronary flow.
May warrant QTc monitoring after longer pediatric bypass; leaves open causal arrhythmia links to coronary flow changes.
BACKGROUND: In adults, impaired myocardial repolarization and increased risk of arrhythmia are known consequences of open heart surgery. Little is known, however, about post-operative consequences of cardiopulmonary bypass surgery in children. The aim of this study was to assess ventricular repolarization and coronary perfusion after bypass surgery for atrial septal defect (ASD) repair in children. METHODS: Twelve patients with ASD were assessed one day before and 5-6 days after ASD repair. Myocardial repolarization (corrected QT interval, QTc, QT dispersion, QTd, and PQ interval) was determined on 12-lead electrocardiograms. Coronary flow in proximal left anterior descending artery (peak flow velocity in diastole, PFVd) was assessed by transthoracic Doppler echocardiography. RESULTS: Ten of the 12 (83%) children had normal myocardial repolarization before and after surgery. After surgery, QTc increased 1-9% in 5 (42%) patients, decreased 2-11% in 5 (42%) patients and did not change in 2 (16%) patients. Post-op QTc positively correlated with bypass time (R=0.686, p=0.014) and changes in PFVd (R=0.741, p=0.006). After surgery, QTd increased 33-67% in 4 (33%) patients, decreased 25-50% in 6 patients (50%) and did not change in 2 (16%) patients. After surgery, PQ interval increased 5-30% in 4 (33%) patients, decreased 4-29% in 6 (50%) patients and did not change in 1 (8%) patient. Post-op PQ positively correlated with bypass time (R=0.636, p=0.027). As previously reported, PFVd significantly increased after surgery (p<0.001). CONCLUSIONS: Changes in QTc, PQ and PFVd are common in young children undergoing surgery for ASD repair. Post-op QTc significantly correlates with bypass time, suggesting prolonged cardiopulmonary bypass may impair ventricular repolarization. Post-op QTc significantly correlates with PFVd changes, suggesting increased coronary flow may also impair ventricular repolarization. The clinical significance and reversibility of these alternations require further investigations.
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Aburawi et al. (2013) conducted an observational in Atrial septal defect (ASD) (n=12). Cardiopulmonary bypass surgery vs. Pre-operative baseline was evaluated on Change in QTc interval and its correlation with bypass time (R=0.686, p=0.014). In children undergoing cardiopulmonary bypass for atrial septal defect repair, post-operative QTc significantly correlated with bypass time (R=0.686) and changes in coronary flow (R=0.741).
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