Perm Medical JournalPerm Medical JournalПермский медицинский журнал (сетевое издание "Perm medical journal")0136-14492687-1408Eco-Vector62587010.17816/pmj40674-89Methods of diagnosis and technologiesМетоды диагностики и технологииResearch ArticlePossibilities of predicting early postoperative complications after surgical correction in infants of the first year of life with ventricular septal defectВозможности прогнозирования осложнений в раннем послеоперационном периоде после хирургической коррекции порока у детей первого года жизни с дефектом межжелудочковой перегородкиLazarkovP. V.ЛазарьковП. В.
Russian Federation

postgraduate student of the Department of Hospital Therapy and Cardiology, cardiovascular surgeon

аспирант кафедры госпитальной терапии и кардиологии, сердечно-сосудистый хирург

pvlazarkov@gmail.comOrekhovaЕ. N.ОреховаЕ. Н.
Russian Federation

MD, PhD, Associate Professor, Department of Hospital Therapy and Cardiology

доктор медицинских наук, доцент кафедры госпитальной терапии и кардиологии

pvlazarkov@gmail.comKhovaevaYa .B.ХоваеваЯ. Б.
Russian Federation

MD, PhD, Professor, Head of the Department of Internal Diseases and Family Medicine

доктор медицинских наук, профессор, заведующая кафедрой внутренних болезней и семейной медицины

pvlazarkov@gmail.comBelovV. А.БеловВ. А.
Russian Federation

Chief Physician

главный врач

pvlazarkov@gmail.comSolovievО. V.СоловьевО. В.
Russian Federation

MD, PhD, Professor, Head of the Department of Faculty Therapy

доктор медицинских наук, профессор, заведующий кафедрой факультетской терапии

pvlazarkov@gmail.comE.A. Vagner Perm State Medical UniversityПермский государственный медицинский университет имени академика Е.А. ВагнераS.G. Sukhanov Federal Center for Cardiovascular SurgeryФедеральный центр сердечно-сосудистой хирургии имени С.Г. СухановаKirov State Medical UniversityКировский государственный медицинский университет2012202340674892201202422012024Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0/https://permmedjournal.ru/PMJ/article/view/625870

Objective. To study the echocardiographic (Echo-CG) indicators in infants of the first year of life with ventricular septal defect (VSD) in the early postoperative period after surgical correction of the defect.

Materials and methods. Examination of 205 infants with VSD was carried out. Complex examination before the surgery, 6, 24 hours and the day 10th after the surgery was fulfilled.

Results. In the early postoperative period, myocardial dysfunction (MD) was detected in 30.2 % of cases (n = 62). The patients were longer subjected to artificial lung ventilation (p = 0.04), had a longer period of staying in the intensive care unit (p = 0.002) and hospital (p = 0.004). The data, predicting the postoperative MD were revealed including VSD area index (OR 2.7; р = 0.00001), longitudinal deformation of the left ventricle (SLV; OR 2.69; р = 0.00001), longitudinal deformation of the free wall of the right ventricle (SRV; OR 1.04; р = 0.0001) and the average estimated pressure in the lung artery (OR 1.6; р = 0.0001).

Conclusions. 1. After the surgery, MD was detected in 30.2 % of cases. 2. SLV and SRV in infants with MD demonstrate the aggravation of ventricular contractility earlier than traditional indicators of the systolic function. 3. Preoperative SLV > «–» 12 %, SRV > «–» 6 %, VSD area index > 100,5 mm2/m2, average estimated pressure in the lung artery > 38 mm Hg are independent predictors of complications accompanied by MD during the first day after the VSD closure. 4. Complications, connected with longer ALV, are associated with duration of staying in the intensive care unit and hospital.

Цель. Изучить эхокардиографические показатели у детей первого года жизни с дефектом межжелудочковой перегородки (ДМЖП) в раннем послеоперационном периоде после хирургической коррекции порока.

Материалы и методы. Обследовано 205 детей с ДМЖП. Проведено комплексное обследование до операции, через 6, 24 ч и на 10-е сут после операции. Группа контроля – 125 здоровых детей.

Результаты. В раннем послеоперационном периоде миокардиальная дисфункция была выявлена в 30,2 % случаев (n = 62). Пациенты дольше находились на искусственной вентиляции лёгких (p = 0,04), более длительно пребывали в отделении интенсивной терапии (p = 0,002) и стационаре (p = 0,004). Выявлены переменные, прогнозирующие послеоперационную миокардиальную дисфункцию: индекс площади ДМЖП (ОШ = 2,7; р = 0,00001), продольная деформация левого желудочка (SLV; ОШ = 2,69; р = 0,00001), продольная деформация свободной стенки правого желудочка (SRV; ОШ = 1,04; р = 0,0001) и среднее расчётное давление в лёгочной артерии (ОШ = 1,6; р = 0,0001).

Выводы. После операции миокардиальная дисфункция выявлена в 30,2 % случаев. SLV и SRV у детей с миокардиальной дисфункцией демонстрируют ухудшение контрактильности желудочков раньше, чем традиционные показатели систолической функции. Дооперационные SLV > «–» 12 %, SRV > «–» 6 %, индекс площади ДМЖП > 100,5 мм2/м2, среднее расчётное давление в лёгочной артерии > 38 мм рт. ст. являются независимыми предикторами осложнений, сопровождающихся миокардиальной дисфункцией в первые сутки после закрытия ДМЖП. 4. Осложнения, связанные с миокардиальной дисфункцией, ассоциированы с более длительной ИВЛ, продолжительностью пребывания в отделении интенсивной терапии и стационаре.

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