Pulse Oxygen Saturation Measured in Standing and Squatting Positions May Be Useful in Evaluating Tetralogy of Fallot
Background: Left-ventricular end-diastolic volume index (LVEDVI) and Nakata index, which in most cases are evaluated by echocardiography and cardiac catheterization, are 2 important predictors for the prognosis of surgical correction of tetralogy of Fallot (TOF). Nonetheless, performing these procedures on TOF patients is not always feasible. We therefore investigated whether the difference in transcutaneous pulse oxygen saturation between the standing position and squatting position (?SPO2) reflected the LVEDVI and Nakata index, allowing ?SPO2 to be used as a supplement to echocardiography and cardiac catheter evaluation.
Methods: Nineteen TOF patients (11 boys, 8 girls; median age 6 years) were randomly selected for this study. In each patient, we used a pulse oximeter placed on the left index finger to measure transcutaneous pulse oxygen saturation, first with the patient in a standing position and then with the patient in a squatting position. We then performed correlational analyses of ?SPO2 and the LVEDVI or Nakata index.
Results: The mean SPO2 was 79% ± 4% in standing patients and 84% ± 4% in squatting patients, and the mean ?SPO2 was 5% ± 3%. The LVEDVI was 41 ± 5 mL/m2, and the Nakata index was 188 ± 37 mm2/m2. ?SPO2 correlated with both LVEDVI (? = 0.854, P < .05) and the Nakata index (? = 0.641, P < .05).
Conclusion: For patients with TOF, the ?SPO2 between SPO2 measured in a standing and squatting position has a positive correlation with the LVEDVI and Nakata index. Thus these measurements may be used as supplemental factors in evaluating LV function and performing a preoperative assessment of the pulmonary artery.
Bertranou EG, Blackstone EH, Hazelrig JB, Turner ME, Kirklin JW. 1978. Life expectancy without surgery in tetralogy of Fallot. Am J Cardiol 42(3):458-66.nBoechat MI, Ratib O, Williams PL, Gomes AS, Child JS, Allada V. 2005. Cardiac MR imaging and MR angiography for assessment of complex tetralogy of Fallot and pulmonary atresia. Radiographics 25(6): 1535-46.nBoxt LM, Reagan K, Katz J. 1994. Angiocardiography in the diagnosis of congenital heart disease. Radiol Clin North Am 32(3):435-60.nD'Cruz IA, Aboulatta H, Killam H, Bradley A, Hand RC. 1989. Quantitative two-dimensional echocardiographic assessment of left ventricular shape in ischemic heart disease. J Clin Ultrasound 17(8):569-72.nGhai A, Silversides C, Harris L, Webb GD, Siu SC, Therrien J. 2002. Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol. 40(9):1675-80.nGiannopoulos NM, Chatzis AK, Karros P, et al. 2002. Early results after transatrial/transpulmonary repair of tetralogy of Fallot. Eur J Cardiothorac Surg 22(4):582-6.nGopal AS, Keller AM, Rigling R, King DL Jr, King DL. 1993. Left ventricular volume and endocardial surface area by three-dimensional echocardiography: comparison with two-dimensional echocardiography and nuclear magnetic resonance imaging in normal subjects. J Am Coll Cardiol 22(1):258-70.nGraham TP Jr, Faulkner S, Bender H Jr, Wender CM. 1977. Hypoplasia of the left ventricle: rare cause of postoperative mortality in tetralogy of Fallot. Am J Cardiol 40(3):454-7.nHorneffer PJ, Zahka KG, Rowe SA, et al. 1990. Long-term results of total repair of tetralogy of Fallot in childhood. Ann Thorac Surg 50(2):179-83.nKarl TR, Sano S, Pornviliwan S, Mee RB. 1992. Tetralogy of Fallot: favorable outcome of nonneonatal transatrial, transpulmonary repair. Ann Thorac Surg 54(5):903-7.nKirklin JW, Blackstone EH, Jonas RA, et al. 1992. Morphologic and surgical determinants of outcome events after repair of tetralogy of Fallot and pulmonary stenosis: a two-institution study. J Thorac Cardiovasc Surg 103(4):706-23.nKnott-Craig, CJ, Elkins RC, Lane MM, Holz J, McCue C, Ward KE. 1998. A 26-year experience with surgical management of tetralogy of Fallot: risk analysis for mortality or late reintervention. Ann Thorac Surg 66(2):506-11.nKrabill KA, Ring WS, Foker JE, et al. 1987. Echocardiographic versus cardiac catheterization diagnosis of infants with congenital heart disease requiring cardiac surgery. Am J Cardiol 60(4):351-4.nLillehei CW, Cohen M, Warden HE, et al. 1955. Direct vision intracardiac surgical correction of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary atresia defects; report of first ten cases. Ann Surg 142(3):418-42.nLillehei CW, Varco RL, Cohen M, et al. 1986. The first open heart corrections of tetralogy of Fallot: a 26-31 year follow-up of 106 patients. Ann Surg 204(4):490-502.nNakata S, Imai Y, Takanashi Y, et al. 1984. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow: J Thorac Cardiovasc Surg 88(4):610-9.nNeill CA, Clark EB. 1994. Tetralogy of Fallot: the first 300 years. Tex Heart Inst J 21(4):272-9.nNomoto S, Muraoka R, Yokota M, Aoshima M, Kyoku I, Nakano H. 1984. Left ventricular volume as a predictor of postoperative hemodynamics and a criterion for total correction of tetralogy of Fallot. J Thorac Cardiovasc Surg 88(3):389-94.nPotapov E, exi-Meskishvili VV, Dahnert I, Ivanitskaia EA, Lange PE, Hetzer R. 2001. Development of pulmonary arteries after central aortopulmonary shunt in newborns. Ann Thorac Surg 71(3):899-905.nPozzi M, Trivedi DB, Kitchiner D, Arnold RA. 2000. Tetralogy of Fallot: what operation, at which age? Eur J Cardiothorac Surg 17(6):631-6.nJonas RA. 2004. Tetralogy of Fallot with pulmonary stenosis. In: Comprehensive surgical management of congenital heart disease. Oxford, UK: Oxford University Press. p. 294-5.nSharma SN, Sharma S, Shrivastava S, Rajani M, Tandon R. 1989. Pulmonary arterial anatomy in tetralogy of Fallot. Int J Cardiol 25(1):33-7.nWu Q. 1996. Indication and technique of total correction of tetralogy of Fallot in 228 patients. Ann Thorac Surg 61(6):1769-74.n
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