GKD Anest Yoð Bak Dern Derg. 2022; 28(4): 306-311 | DOI: 10.14744/GKDAD.2022.89106

Yenidoðanlarda Arkus Aorta Cerrahisi Sonrasý Düþük Kalp Debisi Sendromu Varlýðýnýn Ýntestinal Akýma Etkisinin Deðerlendirilmesi

Dilek Yavuzcan Öztürk¹, Halise Zeynep Genç^2
1Saðlýk Bilimleri Üniversitesi, Baþakþehir Çam ve Sakura Þehir Hastanesi, Çocuk Hastalýklarý ve Saðlýðý Anabilim Dalý, Yenidoðan Bilim Dalý, Ýstanbul, Türkiye
²Saðlýk Bilimleri Üniversitesi, Baþakþehir Çam ve Sakura Þehir Hastanesi, Çocuk Hastalýklarý ve Saðlýðý Anabilim Dalý, Çocuk Kardiyolojisi Bilim Dalý, Ýstanbul, Türkiye

Amaç: Bu çalýþmada, arkus aortaya cerrahi olarak müdahale edilmiþ yenidoðanlarda erken dönemde geliþen düþük debi varlýðýnýn doppler ultrasonografi ile intestinal kan akýmýnda olan deðiþikliklerin araþtýrýlmasý amaçlandý.
Yöntem: Çalýþma, 1 Aðustos 2021-1 Aðustos 2022 tarihleri arasýnda, operasyon sýrasýndaki yaþý 30 günden küçük ve arkus rekonstrüksiyo-nu operasyonu yapýlmýþ olan yenidoðanlarda yapýldý. Düþük kalp de-bisi sendromu geliþen ve geliþmeyen olgularýn initial, 24. ve 48. saat doppler ultrasonografi ile intestinal akýmlarý hesaplandý. Ölçüm yeri olarak çölyak (TC) arter kullanýldý. Her bir olgunun peak sistolik velosite (PSV), mean sistolik velosite (MV) ve end-diyastolik velosite (EDV) deðerleri, direnç indeksi (RI) ve pulsatilite indeksi (PI) bulgularý istatistiksel olarak deðerlendirildi.
Bulgular: Çalýþma döneminde 24 olgu mevcuttu. Olgularýn %70‘i er-kekti. Ameliyat sýrasýndaki median yaþ 15 gün (IQR 12 gün-18 gün) ve median aðýrlýk 3,2 kg (IQR 2,9-3,4) idi. Olgularýn %25’inde (n=6) LCOS saptandý. LCOS geliþen ve geliþmeyen olgularýn baþlangýç median PSV (72 vs. 76 cm/sn), EDV (27 vs. 30 cm/sn), MV (24 vs. 26), RI (0,79 vs. 0,75) ve median PI (1,60 vs. 1,75) deðerleri birbirine benzerdi. LCOS geliþen ve geliþmeyen olgularýn 24. saat median PSV (55 vs. 66 cm/sn), EDV (21 vs. 27 cm/sn), median MV (18 vs. 24), median RI (0,84 vs. 0,76) ve median PI (1,65 vs. 1,78) deðerleri arasýnda anlamlý fark vardý (p<0,05). LCOS geliþen ve geliþmeyen olgularýn 48. saat median PSV (75 vs. 80 cm/sn), EDV (30 vs. 32 cm/sn), MV (25 vs. 26), median RI (0,80 vs. 0,74) ve median PI (1,55 vs. 1,65) deðerleri birbirine benzerdi.
Sonuç: Yenidoðanlarda arkus cerrahisi sonrasýnda düþük debi sendromu geliþenlerde 24. saatte doppler ultrasonografide intestinal kan akýmýný etkileyen deðiþiklikler saptanmýþtýr.

Anahtar Kelimeler: Arkus cerrahisi, doppler ultrasonografi, intestinal akým, yenidoðan

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Evaluation of the Effect of Low Cardiac Output Syndrome on Intestinal Flow After Arcus Aorta Surgery in Newborns

Dilek Yavuzcan Öztürk¹, Halise Zeynep Genç^2
1Division of Neonatology, Department of Child Diseases and Health, University of Health Sciences, Baþakþehir Çam and Sakura City Hospital, Ýstanbul, Türkiye
²Division of Pediatric Cardiology, Department of Child Diseases and Health, University of Health Sciences, Baþaksehir Çam and Sakura City Hospital, Istanbul, Türkiye

Objectives: Dynamic changes during arch surgery in newborns may cause ischemia and tissue damage as a result of decreased blood flow in critical organs. In this study, it was aimed to investigate the changes in intestinal blood flow with Doppler ultrasonography (USG) in the presence of low cardiac output in the early period in newborns who had surgical intervention in the aortic arch.
Methods: The study was carried out between August 1, 2021, and August 1, 2022, in newborns younger than 30 days of age at the time of the operation and who had undergone arch reconstruction surgery. The presence of low cardiac output in the cases was determined by low cardiac output syndrome (LCOS) scoring. Initial, 24th and 48th h intestinal flows of the cases with and without LCOS were calculated by Doppler USG. The celiac artery (TC) was used as the measurement site. Peak systolic velocity (PSV), mean systolic velocity (MV), and end-diastolic velocity (EDV) values, resistance index (RI) and pulsatility index (PI) findings of each case were evaluated statistically.
Results: There were 24 cases during the study period. 70% of the cases were male. The median age at the time of surgery was 15 days (IQR 12–18 days) and median weight was 3.2 kg (IQR 2.9–3.4). LCOS was detected in 25% of cases (n=6). Initial median PSV (72 vs. 76 cm/sec), EDV (27 vs. 30 cm/sec), MV (24 vs. 26), RI (0.79 vs. 0.75), and median PI (1.60 vs. 1.75) values of cases with and without LCOS were similar to each other. There was a significant difference between the values of 24th hour median PSV (55 vs. 66 cm/sec), EDV (21 vs. 27 cm/sec), median MV (18 vs.24), median RI (0.84 vs. 0.76), and median PI (1.65 vs. 1.78) of cases with and without LCOS (p<0.05). 48th h median PSV (75 vs. 80 cm/sec), EDV (30 vs. 32 cm/sec), MV (25 vs. 26), median RI (0.80 vs. 0.74), and median PI (1.55 vs. 1.65) values of cases with and without LCOS were similar.
Conclusion: Changes affecting intestinal blood flow were detected in Doppler USG at the 24th h in newborns who developed LCOS after arcus surgery.

Keywords: Arch surgery, doppler USG, intestinal flow, newborn

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