Predictors of Pericardial Effusion in Patients Undergoing Pulmonary Artery Banding
Predictors of Pericardial Effusion in Patients Undergoing Pulmonary Artery Banding
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DOI：
10.1177/2150135118754523
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发表时间：
2018-03
影响因子：
0.9
通讯作者：
M. Noma;M. Matsubara;C. Tokunaga;T. Nakajima;Bryan J. Mathis;H. Sakamoto;Y. Hiramatsu
中科院分区：
文献类型：
--
作者：
M. Noma;M. Matsubara;C. Tokunaga;T. Nakajima;Bryan J. Mathis;H. Sakamoto;Y. Hiramatsu
背景：虽然肺动脉绑扎术（PAB）是一种常见的小儿心脏畸形姑息治疗方法，但人们担心右心室压力超载和伴随的免疫反应会导致术后并发症，如心包积液。目前，尚未广泛传播关于潜在风险因素或手术禁忌的明确指南。因此，我们进行了一项研究，以检查广泛的因素，以寻找术后心包积液形成风险的潜在生物标志物。方法：回顾性研究8年来所有心脏手术，主要纳入标准为PAB术后出现心包积液，需要手术引流。然后将9例患者与对照组的45例患者进行对比分析，包括身体测量、伴随手术、基因筛查、实验室检查结果和心功能参数。结果：21三体与PAB术后严重心包积液的发生密切相关，21三体患者术后血清白蛋白水平与心包积液的发生相关。其他参数与心包积液无明显相关性。结论：我们的数据表明21三体与PAB术后需要引流的心包积液有很强的相关性，这与转化研究结果一致。PAB造成的压力过载可能在严重心包积液的形成中起作用，而心脏结构缺陷通常与21三体相关，从而加重了心包积液的形成。因此，在PAB病例中，手术团队应谨慎并计划实施引流，术后血清白蛋白可作为心包积液形成的有用生物标志物。
Background: Although pulmonary artery banding (PAB) is a common palliative procedure for pediatric heart malformation, there are concerns of pressure overload and concomitant immune reactions in the right ventricle causing postsurgical complications such as pericardial effusion. At this time, no clear guidelines as to potential risk factors or procedural contraindications have been widely disseminated. Therefore, a study was undertaken to examine wide-ranging factors to find potential biomarkers for postsurgical pericardial effusion formation risk. Methods: A retrospective study was conducted on all cardiac surgeries performed over an eight-year period, and the main inclusion criterion was pericardial effusion development after PAB that required surgical drainage. Nine cases were then analyzed against a control group of 45 cases with respect to body measurements, concomitant surgeries, genetic screens, laboratory tests results, and cardiac function parameters. Results: Trisomy 21 was strongly associated with the development of severe pericardial effusion after PAB, and postoperative serum albumin levels in patients with trisomy 21 were associated with pericardial effusion development. Other parameters showed no significant correlation with pericardial effusion development. Conclusions: Our data indicate a strong association between trisomy 21 and pericardial effusion requiring drainage after PAB, which is in line with translational research findings. Pressure overload from PAB may play a role in the formation of severe pericardial effusion that is exacerbated by cardiac structural defects commonly associated with trisomy 21. Surgical teams should therefore use caution and plan to implement drainage in PAB cases, and postoperative serum albumin may serve as a useful biomarker for pericardial effusion formation.