Author + information
- Received June 5, 1984
- Revision received September 4, 1984
- Accepted September 20, 1984
- Published online February 1, 1985.
- Robert H. Beekman, MD, FACCa and
- Dwight T. Tuuri, MD, FACC
- ↵aCurrent address and address for reprints: Robert H. Beckman, MD, Division of Pediatric Cardiology, Box 66, C. S. Mott Children's Hospital, Ann Arbor, Michigan 48109.
The short-term effects of increasing hemoglobin concentration were evaluated at cardiac catheterization in seven children (aged 0.3 to 7.5 years) with a right to left ventricular shunt and relative anemia. Diagnoses were tetralogy of Fallot in six and L-transposition of the great vessels with ventricular septal defect and pulmonary stenosis in one. Before and 20 minutes after isovolumic partial exchange transfusion with 20 ml/kg packed red cells, the following variables were measured: hemoglobin, partial pressure of oxygen (PO2), oxygen consumption, oxygen saturation and pressure in the aorta, superior vena cava and right and left atria. After partial exchange transfusion, hemoglobin increased from 13.7 ± 0.5 to 16.4 ± 0.4 g/100 ml (p < 0.001, mean ± SEM). Aortic Pot increased from 55.0 ± 3.5 to 62.0 ± 4.1 mm Hg (p < 0.01) and aortic oxygen saturation increased from 84.3 ± 2.3 to 90.9 ± 1.3% (p < 0.002). Effective pulmonary blood flow increased by 17% from 2.72 ± 0.10 to 3.17 ± 0.101iters/min per m2(p < 0.01), and right to left shunt decreased by 59% from 1.44 ± 0.29 to 0.59 ± 0.10 liters/min per m2(p < 0.01). Systemic oxygen transport increased from 658 ± 48 to 738 ± 46 ml/min per m2(p < 0.002). After partial exchange transfusion, systemic vascular resistance increased from 15.9 ± 1.1 to 20.0 ± 1.4 units (p < 0.01). A significant relation was found between the percent increase in systemic resistance and both the percent decrease in right to left shunt (y = 20.44x0.32, r = 0.90, p < 0.01) and the percent increase in PO2(y = 0.36x + 2.88, r = 0.83, p < 0.02).
Thus, an increased hemoglobin concentration in seven children with right to left ventricular shunt and relative anemia decreased the right to left shunt and increased effective pulmonary blood flow, aortic oxygen saturation, PO2and oxygen transport. These short-term effects appear to be related to the increase in systemic resistance after partial exchange transfusion. Correction of relative anemia in children with a right to left ventricular shunt may have significant hemodynamic benefits.
This study was supported in part by the Miami Valley Chapter of the American Heart Association, Dayton, Ohio.
- Received June 5, 1984.
- Revision received September 4, 1984.
- Accepted September 20, 1984.
- American College of Cardiology Foundation