Evaluation of Hemodynamics in Infants and Small Babies after Open Heart Surgery
Abstract
The study was undertaken to establish typical hemodynamic changes and reliable clinical tests for the evaluation of these in infants after open heart surgery. The cardiac index was measured using the thermodilution technique in 56 infants. The age of the patients varied from 6 to 28 months and body weight from 4 to 15 kg. All studies were done during the first 24 hours after operation. It was shown that in a hemodynamically smooth postoperative course cardiac index exceeds 2.7 l X min-1 X m-2, toe temperature (normal 32 degrees to 34 degrees C) and rectal-skin temperature gradient (normal 2 degrees to 3 degrees C) are normalized within 6 to 9 hours postoperatively. In case of low cardiac output syndrome, the cardiac index was below 2.5 l X min-1 X m-2, toe temperature was lowered to 26 degrees to 28 degrees C and the rectal-skin temperature gradient was 8 degrees to 10 degrees C. Big toe skin temperature correlated well with the magnitude of the cardiac index (r = 0.80; n = 247; p less than 0.001); stroke index (r = 0.70; n = 247; p less than 0.001); systemic vascular resistance (r = 0.64; n = 247; p less than 0.001) and urine output (r = 0.74; n = 247; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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A central-peripheral temperature difference > 5 °C has been used as a marker in several studies, showing associations with decreased cardiac output and elevated peripheral vascular resistance.
“Additionally, a central–peripheral temperature difference > 5 °C has been used as a marker in several studies, showing associations with decreased cardiac output and elevated peripheral vascular resistance [25,31].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [31]
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Early markers of major adverse events in children after cardiac operations
Duke, T., Butt, W., South, M., & Karl, T. R. (1997) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(97)70018-7 · Cited by 152 · see citing works
Prolonged open sternotomy after pediatric open heart operation: Experience with 113 patients
Alexi-Meskishvili, V. V., Weng, Y., Uhlemann, F., et al. (1995) · The Annals of Thoracic Surgery · doi:10.1016/0003-4975(94)00840-4 · Cited by 48 · see citing works
“Open heart operation in newborns and infants is often associated with significant hemodynamic disturbances shortly after cardiopulmonary bypass [1, 2, 4, 11].”
BackgroundSchey, B. M., Williams, D. Y., & Bucknall, T. (2010) · Heart & Lung · doi:10.1016/j.hrtlng.2009.04.002 · Cited by 40 · see citing works
Delayed impairment of cerebral oxygenation after deep hypothermic circulatory arrest in children
Pesonen, E., Peltola, K., Korpela, R., et al. (1999) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(99)00320-3 · Cited by 25 · see citing works
“However, cardiac function has been reported to decrease at 4 to 8 hours after pediatric open heart operations [11, 12].”
BackgroundSanthanam, I., Pai, M., Kasturi, K., & Radhamani, M. (2002) · Pediatric Critical Care Medicine · doi:10.1097/00130478-200210000-00006 · Cited by 21 · see citing works
“The coreperipheral temperature gap is considered useful in providing information about patients’ hemodynamic status during cardiac surgery (20, 21).”
BackgroundSchey, B. M., Williams, D., & Bucknall, T. (2009) · Intensive & Critical Care Nursing · doi:10.1016/j.iccn.2008.05.003 · Cited by 20 · see citing works
“The degree of hypothermia has moderated significantly over the last 10—15 years (Lewis et al., 2002), which may explain the associations between cardiac output and CPTG found in earlier investigations (Alexi-Meskhishvili et al., 1984; Kirklin et al., 1981; Knight and Opie, 1981).”
ResultPerioperative determinants and outcome of cardiopulmonary arrest in children after heart surgery
Suominen, P., Palo, R., Sairanen, H. I., Olkkola, K. T., & Räsänen, J. (2001) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/s1010-7940(00)00650-3 · Cited by 20 · see citing works
Pesonen, E. J., Korpela, R., Leijala, M. A., et al. (1996) · Intensive Care Medicine · doi:10.1007/bf01712176 · Cited by 16 · see citing works
“However, the late increase in granulocyte activation, and hypoxanthine and free radical production 6 10 h after declamping, is strikingly similar to the time pattern of cardiac dysfunction after correction of congenital cardiac defects [5, 24].”
BackgroundGhanayem, N. S., Ahmed, M., Anders, M. M., Tume, S. C., Vu, E. L., & Hoffman, G. M. (2018) · Elsevier eBooks · doi:10.1016/b978-1-4557-0760-7.00022-x · Cited by 12 · see citing works
Kimura, S., & Butt, W. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.05.018 · Cited by 7 · see citing works
Bridier, A., Shcherbakova, M., Kawaguchi, A., Poirier, N., Said, C., Noumeir, R., & Jouvet, P. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1083962 · Cited by 6 · see citing works
“Older studies found an increase in thermal gradient correlated with an increase in systemic vascular resistance, a decrease in cardiac output, stroke index, and urine output (7, 18, 19).”
BackgroundHemodynamic Monitoring Modalities in Pediatric Cardiac Surgical Patients
Elixson, E. M. (1989) · Critical Care Nursing Clinics of North America · doi:10.1016/s0899-5885(18)30897-9 · Cited by 5 · see citing works
Skin Temperature and Limb Blood Flow as Predictors of Cardiac Index
Sommers, M. S., Stevenson, J. S., Hamlin, R. L., & Ivey, T. D. (1995) · Clinical Nursing Research · doi:10.1177/105477389500400104 · Cited by 4 · see citing works
Care Following Surgical Treatment of Congenital Heart Disease
Steven, J. M., & Raphaely, R. C. (1992) · Springer eBooks · doi:10.1007/978-1-4471-3400-8_82 · Cited by 3 · see citing works
Idei, M., & Nomura, T. (2019) · Institutional Repositories DataBase (IRDB) · doi:10.24488/twmuj.2019003 · Cited by 2 · see citing works
Nedelcu, C., Ionescu, N. S., Bizubac, A. M., Filip, C., & Cirstoveanu, C. (2025) · Life · doi:10.3390/life15101621 · Cited by 2 · see citing works
Abdul‐Khaliq, H., Gamillscheg, A., Uhlemann, F., Alexi-Meskishvili, V. V., Weng, Y., Hetzer, R., & Lange, P. E. (1997) · Steinkopff eBooks · doi:10.1007/978-3-642-95987-5_13
- Authors
- Alexi-Meskhishvili, V., Popov, S., & Nikoljuk, A.
- Affiliations
- Bakulev Scientific Center for Cardiovascular Surgery Russian Academy of Medical Sciences (RU)
- Venue
- The Thoracic and Cardiovascular Surgeon
- Publisher
- Georg Thieme Verlag KG
- Published
- 1984-02
- Volume
- 32
- Issue
- 01
- Pages
- 4-9
- ISSN
- 0171-6425 (ISSN-L)
- 1439-1902
- OpenAlex
- W1986466892
- Cited by
- 17
- References
- 0
- Citations by year
- 2025: 1 · 2023: 1 · 2021: 1 · 2019: 1 · 2018: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Thoracic and Cardiovascular Surgeon (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- hemodynamics, infants, cardiac index, thermodilution, low cardiac output syndrome, toe temperature, systemic vascular resistance, stroke volume index, urine output, postoperative monitoring, congenital heart surgery
- MeSH terms
- Blood Pressure, Body Temperature, Cardiac Output, Cardiopulmonary Bypass, Child, Preschool, Heart, Heart Defects, Congenital, Cardiac Surgical Procedures, Hemodynamics, Humans, Hypothermia, Induced, Infant, Postoperative Period, Stroke Volume, Vascular Resistance
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