Estimation of intracardiac shunts in young children with a novel indicator dilution technology

Abstract

clinical evaluation of intracardiac shunts in children is not straightforward. echocardiography can only diagnose the presence of a shunt but does not estimate the shunt ratio. this can be a critical factor that influences treatment options. In this single-center, prospective, observational, method-comparison study, we validate the ability of a novel monitoring device COstatus to estimate the intracardiac shunt ratio (Qp/Qs) of pulmonary (Qp) to systemic (Qs) blood flow in young children before and after corrective cardiac surgery. the indicator dilution technology costatus monitor was compared to two other more invasive reference techniques, perivascular ultrasonic flow probes (placed around the pulmonary truncus and ascending aorta) and the oximetric shunt equation (using arterial and venous blood gases). our study revealed that the costatus monitor detected intracardiac shunts with high sensitivity and specificity but there was some underestimation of the shunt ratios compared to the reference techniques.

Indexing haemodynamic variables in young children

“…Alternatively, this may also have been due to the difficulty of the program algorithm in exactly defining the right limits of the dilution curve, which was delayed in the presence of a shunt. 25 Our results raise a concern regarding the traditional way hae- under-represented in larger haemodynamic studies that therefore give an inaccurate overall picture. 1,30 In our opinion, the number of patients presented in this study was sufficient to give an overall view of haemodynamic values in these weight groups after heart surgery.…”

“…Alternatively, this may also have been due to the difficulty of the program algorithm in exactly defining the right limits of the dilution curve, which was delayed in the presence of a shunt. 25 Our results raise a concern regarding the traditional way hae- under-represented in larger haemodynamic studies that therefore…”

“…This may have been caused by a more pronounced ventilator‐dependent circulatory variability with an existing shunt. Alternatively, this may also have been due to the difficulty of the program algorithm in exactly defining the right limits of the dilution curve, which was delayed in the presence of a shunt 25 …”