Microcirculatory changes in children undergoing cardiac surgery: A prospective observational study
Open accessAbstract
Background The effects of cardiac surgery on the microcirculation of children are unknown. The aim of this study was to assess the microcirculatory changes in children undergoing surgery for correction of congenital heart disease.Methods We used a videomicroscope (Sidestream Dark Field, SDF) in a convenience sample of 24 children <five yr old. Total vascular density (TVD, vessels mm(-2)), microvascular flow index (MFI, arbitrary units), proportion of perfused small vessels (PPV, percentage), and perfused vessel density (PVD) were obtained after induction of anaesthesia (T1), at the end of the surgical procedure (T2), after intensive care unit (ICU) admission (T3), and at six h (T4) and 12h (T5) after ICU admission.Results Microcirculatory variables did not significantly change over time. Haemodynamic parameters and microcirculatory variables were not correlated. In a subanalysis conducted for cyanotic (n=7) and acyanotic (n=17) children, repeated measures ANOVA showed a significant interaction between time and the presence of cyanosis for PPV (P=0.03), TVD (P=0.03), and PVD (P=0.03). Weak inverse correlations were found between storage time of transfused red blood cell (RBCs) and MFI at T3 (r=-0.63, P=0.01) and T4 (r=-0.53, P=0.03).Conclusions Microcirculatory variables have a different time-related trend in cyanotic and acyanotic children undergoing cardiac surgery. The storage time of transfused RBCs seems to negatively impact the microcirculation. Further and larger studies are warranted to prove the potential implications of this study.
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Infants with cyanotic congenital heart disease showed significant reductions in total vessel density and proportion of perfused vessels.
“Scolletta et al. evaluated sublingual microcirculation in infants with cyanotic and acyanotic CHD using SDF, noting that while acyanotic infants maintained stable microvascular parameters, those with cyanotic CHD showed significant reductions in total vessel density (TVD) and proportion of perfused vessels (PPV) [86].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [86]
The Table 2 results report a significant increase in PPV over time in cyanotic children and an increase, not a reduction, in TVD. The paper does describe comparatively stable PPV in acyanotic children, but its findings run contrary to the claimed reductions in the cyanotic group. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn infants with cyanotic and acyanotic congenital heart disease, acyanotic infants maintained stable sublingual microvascular parameters.
“Scolletta et al. evaluated sublingual microcirculation in infants with cyanotic and acyanotic CHD using SDF, noting that while acyanotic infants maintained stable microvascular parameters, those with cyanotic CHD showed significant reductions in total vessel density (TVD) and proportion of perfused vessels (PPV) [86].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [86]
The subgroup results (Table 2) describe relatively stable PPV and PVD in acyanotic children, but report that their TVD decreased over time, so not all microvascular parameters remained stable. The study included children under five years old, not exclusively infants. The full citing sentence also reverses the reported cyanotic trend: TVD and PPV increased rather than decreased. (LLM, conf=0.87)
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“…sublingual microcirculation in infants with cyanotic and acyanotic CHD using SDF, noting that while acyanotic infants maintained stable microvascular parameters, those with cyanotic CHD showed significant reductions in total vessel density (TVD) and proportion of perfused vessels (PPV) [86].”
- Authors
- Scolletta, S., Marianello, D., Isgrò, G., Dapoto, A., Terranova, V., Franchi, F., Baryshnikova, E., Carlucci, C., & Ranucci, M.
- Affiliations
- Azienda Ospedaliera Universitaria Senese (IT)
- University of Siena (IT)
- IRCCS Policlinico San Donato (IT)
- Corresponding author
- Scolletta, S.
- Venue
- British Journal of Anaesthesia
- Publisher
- Elsevier BV
- Published
- 2016-08
- Volume
- 117
- Issue
- 2
- Pages
- 206-213
- ISSN
- 0007-0912 (ISSN-L)
- OpenAlex
- W2500307637
- Cited by
- 17
- References
- 38
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 1
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- British Journal of Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Use Siena air (University of Siena) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Keywords
- microcirculation, pediatric cardiac surgery, congenital heart disease, sidestream dark field imaging, microvascular flow index, perfused vessel density, cyanotic congenital heart disease, acyanotic congenital heart disease, postoperative intensive care
- MeSH terms
- Blood Flow Velocity, Child, Preschool, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Hemodynamics, Humans, Infant, Italy, Male, Microcirculation, Prospective Studies, Sensitivity and Specificity, Microscopy, Video
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