Objective(s): Modified ultrafiltration has gained wide acceptance as a powerful tool against cardiopulmonary bypass morbidity in pediatric cardiac surgery. The aim of our study was to assess the importance of modified ultrafiltration within conditions of contemporary cardiopulmonary bypass characteristics. Methods: Ninety–eight patients (overall cohort) weighing less than 12 kg undergoing surgical repair with cardiopulmonary bypass were prospectively enrolled in a randomized protocol to receive modified and conventional ultrafiltration (MUF group) or just conventional ultrafiltration (non-MUF group). A special attention was paid to forty-nine neonates and infants weighing less than 5 kg (lower weight (LW) cohort). Results: Post-filtration hematocrit was significantly higher in the MUF group for both cohorts (overall cohort p = 0.001; LW cohort p = 0.04), but not at other time points. During the postoperative course, patients in the MUF group received fewer packed red blood cells, (overall cohort p = 0.01; LW cohort p = 0.07), but required more fresh frozen plasma (overall cohort p = 0.04; LW cohort p = 0.05). There was no difference between groups in hemodynamic state, chest tube output, duration of mechanical ventilation, respiratory parameters, duration of intensive care unit, and hospitalization stay. Conclusions: If conventional ultrafiltration provides adequate hemoconcentration modified ultrafiltration does not provide additional positive benefits except for reduction in blood cell transfusion, This, however, comes at the cost of needing more fresh frozen plasma. Of particular importance is that this also applies to infants with weight bellow 5 kg where modified ultrafiltration was supposed to have the greatest positive impact.

Aortic coarctation surgery in pediatric patients requires the placement of two arterial cannulas to monitor pressure gradients and surgical correction adequacy. Near-infrared spectroscopy (NIRS) monitoring provides insight into regional blood flow. This study aimed to investigate the correlation between NIRS values and invasive arterial pressures, exploring NIRS monitoring as a potential substitute for arterial cannulation. In a cohort of 21 consecutive pediatric patients undergoing aortic coarctation surgery, recordings of NIRS and invasive arterial pressure values were evaluated at various time intervals. Pearson correlation evaluated the relationship between NIRS values and invasively measured arterial pressures. Moderate to strong correlations were observed between the mean arterial pressure (MAP) of the upper and lower arteries and cerebral (rSO₂-C) and somatic (rSO₂-S) NIRS values 5 min after cross-clamp placement (r = 0.621, p = 0.003; r = 0.757, p < 0.001). Strong correlations were found 15 min after cross-clamp placement (r = 0.828, p = 0.002; r = 0.783, p = 0.004). Before transfer to the ICU, a strong correlation existed between the upper artery MAP and rSO₂-C (r = 0.730, p < 0.001), but there was no correlation between the lower artery MAP and rSO₂-S. These findings are promising, but further studies are required to validate it as a reliable substitute for invasive pressure monitoring in this patient population.

Background/Objectives: We assessed the prevalence of impaired coronary flow veloc-ity reserve (CFVR) and aimed to identify echocardiographic and clinical predictors of coronary microvascular dysfunction in adolescents after neonatal arterial switch op-eration (ASO). Methods: This single-center, cross-sectional study included patients that underwent neonatal ASO for simple D-transposition of the great arteries (D-TGA) during 1998-2013. All patients were evaluated by echocardiography with global left ventricu-lar strain measurement (GLS) and cardiac catheterization, including coronary angi-ography. Coronary flow velocity reserve was assessed by transthoracic Doppler echo-cardiography in the left anterior descending artery (LAD) using adenosine induced hyperemia. Patients were stratified into two groups according to CFVR: group with impaired CFVR (< 2.5) and group with normal CFVR (≥2.5). Spearman correlation was used to assess relationship between CFVR and echocardiographic variables. Binary lo-gistic regression was used to determine independent predictors of impaired CFVR. Results: Out of 48 patients included (median age 16 years, age range 13 to 23 years, 71% male), impaired CFVR was found in 21 patients (44%). These patients had de-creased longitudinal tricuspid annular plane systolic excursion (TAPSE), greater Z-scores for left ventricular end-systolic dimensions and higher mean pulmonary ar-tery pressures (mPAP). CFVR showed modest but significant positive correlations with tricuspid annular plane systolic excursion (TAPSE). Left pulmonary artery branch ste-nosis, reduced TAPSE and mPAP≥ 20 mmHg, were significantly associated with im-paired CFVR, while decreased TAPSE remained independent predictor in multivaria-ble analysis (odds ratio 5.6, 95% confidence interval 1.24-25.26, p=0.025). Conclusions: Impaired CFVR is highly prevalent in adolescents after neonatal ASO. Importantly, impaired CFVR is associated with right ventricular dysfunction.

Background/Objectives: We assessed the prevalence of impaired coronary flow velocity reserve (CFVR) and aimed to identify echocardiographic and clinical predictors of coronary microvascular dysfunction in adolescents after neonatal arterial switch operation (ASO). Methods: This single-center, cross-sectional study included patients that underwent neonatal ASO for simple D-transposition of the great arteries (D-TGA) during 1998–2013. All patients were evaluated by echocardiography with global left ventricular strain measurement (GLS) and cardiac catheterization, including coronary angiography. Coronary flow velocity reserve was assessed by transthoracic Doppler echocardiography in the left anterior descending artery (LAD) using adenosine induced hyperemia. Patients were stratified into two groups according to CFVR: group with impaired CFVR (<2.5) and group with normal CFVR (≥2.5). Spearman correlation was used to assess the relationship between CFVR and echocardiographic variables. Binary logistic regression was used to determine independent predictors of impaired CFVR. Results: Out of 48 patients included (median age 16 years, age range 13 to 23 years, 71% male), impaired CFVR was found in 21 patients (44%). These patients had decreased longitudinal tricuspid annular plane systolic excursion (TAPSE), greater Z scores for left ventricular end-systolic dimensions and higher mean pulmonary artery pressures (mPAP). CFVR showed modest but significant positive correlations with tricuspid annular plane systolic excursion (TAPSE). Left pulmonary artery branch stenosis, reduced TAPSE and mPAP ≥ 20 mmHg, were significantly associated with impaired CFVR, while decreased TAPSE remained independent predictor in multivariable analysis (odds ratio 5.6, 95% confidence interval 1.24–25.26, p = 0.025). Conclusions: Impaired CFVR appears to be frequently observed in adolescents after uncomplicated neonatal ASO for simple D-TGA. Importantly, impaired CFVR is associated with right ventricular dysfunction.