Fetal modified left myocardial performance index monitoring during open surgery for myelomeningocele repair
- 26 June 2018
- journal article
- research article
- Published by Wiley in Echocardiography
- Vol. 35 (10), 1664-1670
- https://doi.org/10.1111/echo.14056
Abstract
Objective Fetal hemodynamic changes have already been described during open myelomeningocele repair. This study aimed to access fetal myocardial performance index (MPI) during this high‐complexity surgery. Methods Open myelomeningocele repair was performed in 37 fetuses between the 24th and 27th week of gestation. MPI was calculated at specific periods: pre‐anesthesia, postanesthesia, neurosurgery (early skin manipulation, spinal cord releasing, and sintesis), and end of surgery. Mean ± standard deviation (SD) of MPI and its related times—isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET)—was determined for each period. Analysis of variance (ANOVA) with repeated measures was used to assess differences among these periods. Tukey multiple comparison times test compared global surgery stages. Results The mean of MPI in the specific time points was 0.32, 0.32, 0.34, 0.48, 0.36, and 0.32, respectively (P < .001). In the two‐tailed comparison times, neurosurgery stage presents MPI highest levels, especially on stage 3b (early skin manipulation and spinal cord releasing) related to ICT and IRT rising and ET decreased levels. Conclusion Fetal global cardiac function is altered during the open myelomeningocele repair. The neurosurgery stage represents the critical phase of the procedure.Keywords
Funding Information
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
This publication has 21 references indexed in Scilit:
- Changes in the recipient fetal Tei index in the peri‐operative period after laser photocoagulation of placental anastomoses for twin–twin transfusion syndromePrenatal Diagnosis, 2011
- Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early‐onset intrauterine growth restrictionUltrasound in Obstetrics & Gynecology, 2010
- Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgeryPediatric Anesthesia, 2010
- Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndromeUltrasound in Obstetrics & Gynecology, 2010
- Gestational‐age‐adjusted reference values for the modified myocardial performance index for evaluation of fetal left cardiac functionUltrasound in Obstetrics & Gynecology, 2007
- A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessmentUltrasound in Obstetrics & Gynecology, 2005
- The Tei Index: Methodology and Disease State ValuesEchocardiography, 2004
- Acute Cardiovascular Effects of Fetal Surgery in the HumanJournal of the American College of Cardiology, 2004
- Fetal cardiac function assessed by Doppler myocardial performance index (Tei Index)Ultrasound in Obstetrics & Gynecology, 2003
- Maternal and Fetal Cardiovascular and Acid–Base Changes during Halothane and Isoflurane Anesthesia in the Pregnant EweAnesthesiology, 1974