Vol. 29 No. 4 (2025): Patologiya krovoobrashcheniya i kardiokhirurgiya
ANESTHESIOLOGY & RESUSCITATION

Assessment of the diagnostic potential of transpulmonary thermodilution in young children after radical correction of tetralogy of Fallot

Ilya V. Bondarenko
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Vladimir V. Lomivorotov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Ilya A. Velukhanov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Alexandra A. Krivoshapkina
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Ekaterina N. Amansakhatova
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Valery A. Nepomnyashchy
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Ilya A. Soynov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation

Published 2026-01-21

Keywords

  • transpulmonary thermodilution; tetralogy of Fallot; congenital heart defects; cardiovascular surgery

How to Cite

Bondarenko, I. V. ., Lomivorotov, V. V. ., Velukhanov, I. A. ., Krivoshapkina, A. A. ., Amansakhatova, E. N. ., Nepomnyashchy, V. A. ., Martynenkov, V. Y. ., & Soynov, I. A. . (2026). Assessment of the diagnostic potential of transpulmonary thermodilution in young children after radical correction of tetralogy of Fallot. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 29(4), 112–121. https://doi.org/10.21688/1681-3472-2025-4-112-121

Abstract

Background: In congenital heart surgery, in particular upon the radical correction of tetralogy of Fallot in children aged up to 1 year, hemodynamic indicators determined routinely often do not enable to assess in full the individual hemodynamic profile of the patient and to develop an individualized protocol for targeted hemodynamic therapy. This circumstance stipulates the use of advanced hemodynamic monitoring, and specifically the transpulmonary thermodilution (PiCCO) technique. However, the use of this technique is limited by the lack of reference values for patients with this nosological form and in this specific age group.

Objective: The study was aimed at determining reference indicators of transpulmonary thermodilution in children aged up to 1 year after radical correction of Tetralogy of Fallot to develop protocols of targeted hemodynamic therapy.

Methods: This prospective cohort study was based on the transpulmonary thermodilution data of 30 patients aged up to 1 year after radical correction of Tetralogy of Fallot performed at the Meshalkin National Medical Research Center of the Ministry of Health of Russia from 2019 to 2022.

Results: Right ventricular failure developed in 11 patients (36.7%). A risk factor for right ventricular dysfunction was pulmonary regurgitation of grade 2 or higher, which developed in 14 patients (46.7%). The average regurgitation volume was 18.8 (12.1; 19.5) ml. According to the PiCCO data, no right ventricular failure was detected in children in the early postoperative period.

Conclusion: Standard hemodynamic monitoring parameters using the PiCCO system, recommended for adult patients, cannot be applied to children, especially tender-age infants, after radical correction of tetralogy of Fallot. Transpulmonary thermodilution parameters do not enable to detect right ventricular failure after radical correction of tetralogy of Fallot in children aged up to 1 year.

References

  1. Паромов К.В., Ленькин А.И., Кузьков В.В., Киров М.Ю. Анесте- зиолог и гемодинамика: что нам дают протоколы целена- правленной терапии. Тихоокеанский медицинский журнал. 2012;3:17-21. Paromov K.V., Lenkin A.I., Kuzkov V.V., Kirov M.Yu. Anesthesiologist and hemodynamics: what are the protocols of targeted therapy given to us? Pacific Medical Journal. 2012;3:17-21. (In Russ.)
  2. Davidson J., Tong S., Hancock H., Hauck A., da Cruz E., Kaufman J. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012;38(7):1184-1190. PMID: 22527067; PMCID: PMC4984395. https://doi.org/10.1007/s00134-012-2544-x
  3. Gaies M.G., Gurney J.G., Yen A.H., Napoli M.L., Gajarski R.J., Ohye R.G., Charpie J.R., Hirsch J.C. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11(2):234-238. PMID:19794327. https://doi.org/10.1097/PCC.0b013e3181b806fc
  4. Schiffmann H., Erdlenbruch B., Singer D., Singer S., Herting E., Hoeft A., Buhre W. Assessment of cardiac output, intravascular volume status, and extravascular lung water by transpulmonary indicator dilution in critically ill neonates and infants. J Cardiothorac Vasc Anesth. 2002;16(5):592-7. PMID: 12407612. https://doi.org/10.1053/jcan.2002.126954
  5. Basaran M., Sever K., Kafali E., Ugurlucan M., Sayin O.A., Tansel T., Alpagut U., Dayioglu E., Onursa E. Serum lactate level has prognostic significance after pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2006;20(1):43-7. PMID: 16458212. https://doi.org/10.1053/j.jvca.2004.10.010
  6. Gan T.J., Soppitt A., Maroof M., el-Moalem H., Robertson K.M., Moretti E., Dwane P., Glass P.S. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology. 2002;97(4):820-6. PMID: 12357146. https://doi.org/10.1097/00000542-200210000-00012
  7. Kapoor P.M., Kakani M., Chowdhury U., Choudhury M., Lakshmy, Kiran U. Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth. 2008;11(1):27-34. PMID: 18182756. https://doi.org/10.4103/0971-9784.38446
  8. Lenkin A.I., Kuzkov V.V., Smetkin A.A., Paromov K.V., Slastilin V., Kirov M. Goal-directed therapy guided by transpulmonary thermodilution or pulmonary artery catheter in combined valve surgery. Eur J Anaesth. 2011;28(S48):56-57. https://doi.org/0.1097/00003643-201106001-00177
  9. Lenkin A.I., Kirov M.Y., Kuzkov V.V., Paromov K.V., Smetkin A.A., Lie M., Bjertnaes L.J. Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial. Crit Care Res Pract. 2012:2012: 21218. PMID: 22611489; PMCID: PMC3350845. https://doi.org/10.1155/2012/821218
  10. Mikkelsen M.E., Gaieski D.F., Goyal M., Miltiades A.N., Munson J.C., Pines J.M., Barry D Fuchs B.D., Shah C.V., Bellamy S.L., Christie J.D. Factors associated with nonadherence to early goal-directed therapy in the ED. Chest. 2010;138(3):551-8. PMID: 20173053; PMCID: PMC2939882. https://doi.org/10.1378/chest.09-2210
  11. Branski L.K., Herndon D.N., Byrd J.F., Kinsky M.P., Lee J.O., Fagan S.P., Jeschke M.G. Transpulmonary thermodilution for hemodynamic measurements in severely burned children. Crit Care. 2011;15(2):R118. PMID: 21507260; PMCID: PMC3219401. https://doi.org/10.1186/cc10147
  12. Nusmeier A., Cecchetti C., Blohm M., van der Hoeven J., Lemson J. Near-normal values of extravascular lung water in children. Pediatr Crit Care Med. 2015;16(2):e28-33. PMID: 25647139. https://doi.org/10.1097/PCC.0000000000000312
  13. Proulx F., Lemson J., Choker G., Tibby S.M. Hemodynamic monitoring by transpulmonary thermodilution and pulse contour analysis in critically ill children. Pediatr Crit Care Med. 2011;12(4):459-66. PMID: 21263372. https://doi.org/10.1097/PCC.0b013e3182070959
  14. Grindheim G., Eidet J., Bentsen G. Transpulmonary thermodilution (PiCCO) measurements in children without cardiopulmonary dysfunction: large interindividual variation and conflicting reference values. Pediatr Anaesth. 2016;26(4):418-24. PMID: 26857433. https://doi.org/10.1111/pan.12859
  15. Hammett O., Griksaitis M.J. Management of tetralogy of Fallot in the pediatric intensive care unit. Front Pediatr. 2023;11:1104533. https://doi.org/10.3389/fped.2023.1104533
  16. Banjoko A., Seyedzenouzi G., Ashton J., Hedayat F., Smith N.N., Nixon H., Tarmahomed A., Ashry A., Harky A. Tetralogy of Fallot: stent palliation or neonatal repair? Cardiol Young. 2021;31(10):1658-1666. PMID: 33682651. https://doi.org/10.1017/S1047951121000846
  17. Adesanya A.M., Best K.E., Coats L., Rankin J. Predictors of Post- Operative Hospital Length o Stay Following Complete Repair of Tetralogy of Fallot in a Pediatric Cohort in the North of England. Pediatr Cardiol. 2024;45(1):92-99. PMID: 37698700; PMCID: PMC10776676. http://dx.doi.org/10.21688/1681-3472-2019-1-9-16
  18. Козырев И.А., Морозов А.А., Грехов Е.В., Аверкин И.И., Горде- ев М.Л., Латыпов А.К. Непосредственные результаты клапан- сохраняющей радикальной коррекции тетрады Фалло. Па- тология кровообращения и кардиохирургия. 2019;23(1):9-16. https://doi.org/10.21688/1681-3472-2019-1-9-16 Kozyrev I.A., Morozov A.A., Grekhov E.V., Averkin I.A., Gordeev M.L., Latypov A.K. The immediate results of valve-sparing complete repair of tetralogy of Fallot. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2019;23(1):9-16. (In Russ.) https://doi.org/10.21688/1681-3472-2019-1-9-16
  19. Miller J.R., Stephens E.H., Goldstone A.B., Glatz A.C., Kane L., Van Arsdell G.S., Stellin G., Barron D.J., d’Udekem Y., Benson L., Quintessenza J., Ohye R.G., Talwar S., Fremes S.E., Emani S.M., Eghtesady P. The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: Management of infants and neonates with tetralogy of Fallot. J Thorac Cardiovasc Surg. 2023;165(1):221-250. PMID: 36522807. https://doi.org/10.1016/j.jtcvs.2022.07.025
  20. Al Mosa A., Bernier P.L., Tchervenkov C.I. Considerations in Timing of Surgical Repair in Tetralogy of Fallot. CJC Pediatr Congenit Heart Dis. 2023;2(6Part A):361-367. PMID: 38161680; PMCID: PMC10755837.https://doi.org/10.1016/j.cjcpc.2023.10.006
  21. Mekenbayeva R., Sarsembayeva A., Nurkeyev B., Kursanova Z., Mekenbayeva N., Akseitov A. Clinical case of a patient with the natural flow of Fallot’s tetrad. J Clin Med Kaz. 2019;2(52):68-71. https://doi.org/10.23950/1812-2892-JCMK-00682
  22. Свободов А.А., Левченко Е.Г., Неталиева Г.А., Костава В.Т., Зе- ливянская М.В., Разумовский В.С. Использование заплаты из яремной вены быка с собственной створкой в хирургии те- трады Фалло. Патология кровообращения и кардиохирургия. 2020;24(4):42-49. https://dx.doi.org/10.21688/1681-3472-2020-4-42-49 Svobodov A.A., Levchenko E.G., Netalieva G.S., Kostava V.T., Zelivyanskaya M.V., Rasumovsky V.S. Bovine monocusp in surgery for tetralogy of Fallot. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2020;24(4):42-49. (In Russ.) https://dx.doi.org/10.21688/1681-3472-2020-4-42-49
  23. Омельченко А.Ю., Сойнов И.А., Горбатых Ю.Н., Кулябин Ю.Ю., Горбатых А.В., Ничай Н.Р., Войтов А.В., Богочев-Прокофьев А.В. Дисфункция правого желудочка у пациентов после коррек- ции тетрады Фалло: все ли вопросы решены? Хирургия. Жур- нал им. Н.И. Пирогова. 2017;(6):84-90. https://doi.org/10.17116/hirurgia2017684-90 Omel’chenko A.Iu., Soynov I.A., Gorbatykh Iu.N., Kulyabin Yu.Yu., Gorbatykh A.V., Nichay N.R., Voytov A.V., Bogochev-Prokofyev A.V. Right ventricular dysfunction after tetralogy of Fallot repair: are all questions resolved? Pirogov Russian Journal of Surgery. 2017;(6):84-90. (In Russ.) https://doi.org/10.17116/hirurgia2017684-90
  24. Точило С.А., Дудко В.А., Марочков А.В., Никифорова Ю.Г., Бондаренко А.А., Ливинская В.А. Мониторинг центральной гемодинамики у пациентов с синдромом полиорганной не- достаточности. Журнал Гродненского государственного меди- цинского университета. 2021;19(2):187-93. https://doi.org/10.25298/2221-8785-2021-19-2-187-193 Tochylo A.S., Dudko V.A., Marochkov A.V., Nikiforova Yu.G., Bondarenko A.A., Livinskaya V.A. Monitoring of central hemodynamics in patients with multiple organ dysfunction syndrome. Journal of the Grodno State Medical University. 2021;19(2):187-193. (In Russ.) https://doi.org/10.25298/2221-8785-2021-19-2-187-193
  25. Gamble J.J., McKay W.P., Ambros B., Miller G.G., Camargo A.V., Norton J., Cowan J., du Rand J., McNair E.D., Milbrandt K., Gérard M., Carrozzo M.V. A performance comparison of the most commonly used minimally invasive monitors of cardiac output. Comparaison des performances des moniteurs minimalement invasifs du débit cardiaque les plus couramment utilisés. Can J Anaesth = Journal canadien d’anesthesie. 2021;68(11):1668– 1682. https://doi.org/10.1007/s12630-021-02085-0
  26. GanterM.T.,GeisenM.,HartnackS.,DzemaliO.,HoferC.K.Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters. BMC anesthesiology. 2018;18(1):55. PMID: 29788919; PMCID: PMC5964892. https://doi.org/10.1186/s12871-018-0520-x
  27. Lamia B., Kim H.K., Severyn D.A., Pinsky M.R. Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter. J Clin Monit Comput. 2018;32(1):33–43. PMID: 28188408. https://doi.org/10.1007/s10877-017-9983-4
  28. Andrei M., Dragoescu N.A., Stanculescu A., Chiutu L., Dragoescu O., Istratoaie O. PiCCO or Cardiac Ultrasound? Which Is Better for Hemodynamic Monitoring in ICU? Medicina (Kaunas). 2024;60(11):1884. PMID: 39597069; PMCID: PMC11596616. https://doi.org/10.3390/medicina60111884
  29. Kan C.F.K., Skaggs J.D. Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal- Directed Fluid Therapy: A Review. Yale J Biol Med. 2023;96(1):107-123. https://doi.org/10.59249/JOAP6662