Iranian Heart Journal

Iranian Heart Journal

Evaluation of the Correlations Between Sodium Fluctuations and Clinical Outcomes in Children Undergoing Cardiopulmonary Bypass

Document Type : Original Article

Authors
mohsen ziyaeifard 1
masoomeh valipour 1
Naser Kachoueian 2
meysam mortazian 3
Saeid Heidari nia 1
Farhad Gorjipour 1
1 Cardio-Oncology reasearch Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Department of Cardiac Surgery, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
3 AJA University of Medical Sciences Tehran Iran AJA University of Medical Sciences, Tehran, IR Iran.
Abstract
Introduction: Sodium abnormalities constitute some of the most common electrolyte disorders during cardiopulmonary bypass (CPB), and they exhibit a rise for various reasons during CPB. The use of CPB for correcting congenital heart diseases in infants has profound physiological effects on most organs. The devastating effects of CPB are often more pronounced in infants. This study aimed to determine the relationship between sodium fluctuations and clinical outcomes in infants undergoing CPB.
 
Methods: This cross-sectional study (correlational) was conducted on 473 children who underwent CPB in 2016 according to our inclusion criteria. The samples were divided into 2 groups according to sodium fluctuations with a cutoff point of 15 mEq/L, and the clinical outcomes were compared between the 2 groups. The data were analyzed by SPSS, version 16, and presented as descriptive and inferential statistics.
 
Results:The incidence of cardiac (P<0.001), pulmonary (P=0.005), renal (P=0.02), neurologic (P=0.001), and hemorrhagic (P=0.02) outcomes were significantly different between the 2 groups. Gastrointestinal outcomes, infection outcomes, intubation time, intensive care unit stay, hospital stay, and mortality were not significantly different between the 2 groups.
 
Conclusions: Sodium fluctuations of 15 mEq/L or higher, as an independent factor, exacerbated cardiac, pulmonary, neurologic, renal, and hemorrhagic outcomes. (Iranian Heart Journal 2021; 22(2): 27-37)
Keywords
Sodium oscillations
Pediatric cardiac surgery
Cardiopulmonary bypass
Clinical outcomes
  1. Wunderlich NC, Beigel R, Siegel RJ. Management of mitral stenosis using 2D and 3D echo-Doppler imaging. JACC Cardiovasc Imaging. 2013Nov; 6(11):1191-205. DOI: 10.1016/j.jcmg.2013.07.008.
  2. Rheumatic fever and rheumatic heart disease. Report of a WHO Expert Consultation. World Health Organization, Geneva, 2001 (Technical Report Series No. 923).
  3. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63(22):2438-88. https://doi.org/10.1016/j.jacc.2014.02.537.
  4. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28:1-39. https://doi.org/10.1016/j.echo.2014.10.003.
  5. Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence, and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single-center experience. Indian Heart J. 2014 May-Jun; 66(3):320-6. doi: 10.1016/j.ihj.2014.03.010. Epub 2014 Apr 14. PMID: 24973838
  6. Movahed MR, Ahmadi-Kashani M, Kasravi B, Saito Y. Increased prevalence of mitral stenosis in women. J Am Soc Echocardiogr. 2006; 19:911-913. https://doi.org/10.1016/j.echo.2006.01.017.
  7. Negi PC, Sondhi S, Rana V, Rathore S, Kumar R, Kolte N, et al. Prevalence, risk determinants, and consequences of atrial fibrillation in rheumatic heart disease: 6 years hospital based-Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry. Indian Heart J. 2018 Dec; 70 Suppl 3(Suppl 3): S68-S73. doi: 10.1016/j.ihj.2018.05.013.
  8. Pourafkari L, Ghaffari S, Bancroft GR, Tajlil A, Nader ND. Factors associated with atrial fibrillation in rheumatic mitral stenosis. Asian Cardiovascular and Thoracic Annals, 2015; 23(1), 17–23. https://doi.org/10.1177/0218492314530134,  PMID: 24696100
  9. Kim HJ, Cho GY, Kim YJ. Development of atrial fibrillation in patients with rheumatic mitral valve disease in sinus rhythm. Int J Cardiovasc Imaging. 2015; 31(4):735-42. doi: 10.1007/s10554-015-0613-2.
  10. Faletra F, Pezzano A Jr, Fusco R, Mantero A, Corno R, Crivellaro W, et al. Measurement of mitral valve area in mitral stenosis: four echocardiographic methods compared with direct measurement of anatomic orifices. J Am Coll Cardiol. 1996; 28:1190-7.
  11. Nishimura RA, Rihal CS, Tajik AJ, Holmes DR Jr. Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol. 1994; 24:152-8.
  12.  Lloyd G, Badiani S, Costa M, Armado K, Bhattacharyya S. Mitral stenosis in 2019: changing approaches for changing times, Expert Review of Cardiovascular Therapy. 2019; 17(7): 473-77. DOI: 10.1080/14779072.2019.1632190
  13. Arı H, Arı S, Karakuş A, Camcı S, Doğanay K, Tütüncü A, et al. The impact of cardiac rhythm on the mitral valve area and gradient in patients with mitral stenosis. Anatol J Cardiol. 2017 Aug; 18(2):90-98. DOI: 10.14744/AnatolJCardiol.2017.7614,
  14. Bassan R, Rocha AS, Baldwin BJ. Hemodynamic profile of mitral stenosis. Correlation with valve area. Arq Bras Cardiol. 1986; 47(1):41‐48.
  15. Neema PK, Rathod RC. Pulmonary artery hypertension in mitral stenosis: Role of right ventricular stroke volume, atrioventricular compliance, and pulmonary venous compliance. J Anaesthesiol Clin Pharmacol. 2012 Apr; 28(2):261-2. DOI: 10.4103/0970-9185.94916.
  16. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994; 89(2):724‐730. DOI:10.1161/01.cir.89.2.724
  17. Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997; 96 (7):2455‐2461. DOI:10.1161/01.cir.96.7.2455
Iranian Heart Journal
Volume 22, Issue 2
Spring 2021
Pages 27-37