Abstract 18280: Mucociliary Clearance Deficit and Reduced Pulmonary Function in Congenital Heart Disease Infants Undergoing Surgery With Cardiopulmonary Bypass
Introduction: Postoperative pulmonary complications are common after congenital cardiac surgery requiring cardiopulmonary bypass (CPB). Given our previous finding of a high prevalence of airway ciliary dysfunction (CD) in congenital heart disease (CHD) patients, we hypothesized CHD patients with CD may exhibit a greater reduction in post-CPB pulmonary function.
Methods: We recruited 14 CHD infants (<2 years) requiring cardiac surgery with CPB. Nasal scrapes were obtained to assess respiratory ciliary motion by videomicroscopy. Either pre- or postop mucociliary clearance (MCC) scans were conducted at the bedside using technetium sulfur colloid with a portable gamma camera. Spirometry was assessed using a forced deflation (FD) technique.
Results: MCC scans were conducted on 14 CHD infants (3 pre- and 11 postop, most within 48 hours of surgery). MCC scans postop showed significantly less airway clearance than preop scans (2.8% ±4.2 vs. 21.3% ±7.5; p=<0.0001) (Figure 1). This difference did not correlate with CD. Respiratory compliance was significantly less postop as compared to preop (0.9 ml/cmH2O/kg ±0.47 [n=6] vs. 2.16 ml/cmH2O/kg ±0.53 [n=7]; p=0.001). Infants with CD had lower pulmonary compliance (0.76 ml/cmH2O/kg ±0.41 vs. 1.97 ml/cmH2O/kg ±0.63, p=0.012) and trended toward higher resistance (81.63 cmH2O/L/sec ±11.34 vs. 58.38 cmH2O/L/sec ±20.24, p=0.094). Consistent with this, the degree of CD and respiratory compliance showed a negative correlation (r= -0.52, p=0.082).
Discussion: This is the first study to assess MCC and spirometry in CHD infants undergoing cardiac surgery with CPB. The finding of significantly depressed MCC in the immediate postop period indicates postop outcomes may be improved with pulmonary therapies to enhance infant MCC. The lower pulmonary compliance seen in CHD infants with CD would suggest further studies are needed to investigate the effects of CD on postsurgical pulmonary outcomes in CHD patients.
- Pulmonary function
- Congenital heart surgery, pediatric
- Cardiopulmonary bypass
Author Disclosures: P.S. Adams: Research Grant; Significant; T32GM075770. T.E. Corcoran: None. D.J. Weiner: None. M. Zahid: None. A. Saville: None. S.A. Walczak: None. O. Khalifa: None. M.S. Czachowski: None. Y. Domnina: None. M.S. Sharma: None. B. Blasiole: None. P.M. Callahan: None. I. Lin: None. J. Sanchez-de-Toledo: None. C.W. Lo: Research Grant; Significant; Department of Defense Grant W81XWH-15-1-0649.
- © 2016 by American Heart Association, Inc.