The novel and slowest arterial pressure waves: clinical implications in children with congenital heart disease following cardiovascular surgery.

Objectives: Certain rhythmic arterial pressure waves in humans and animals have been noticed for over one century. We found the novel and slowest arterial pressure waves in children following surgical repair for CHD, and examined their characteristics and clinical implications.

Methods: We enrolled 212 children with 22 types of CHD within postoperative 48 h. We monitored haemodynamics (blood pressure, cardiac cycle efficiency, dP/dTmax), cerebral (ScO), and renal (SrO) oxygen saturation every 6 s. Electroencephalogram was continuously monitored. Mean blood flow velocity (Vm) of the middle cerebral artery was measured at 24 h.

Results: We found the waves with a frequency of ∼ 90 s immediately following surgical repair in 46 patients in 12 types of CHD (21.7%), being most prevalent in patients with aortic arch abnormalities (Aorta Group, = 24, 42.3%) or ventricular septal defect (Ventricular Septal Defect Group, = 12, 23.5%). In Aorta and Ventricular Septal Defect Groups, the occurrence of the waves was associated with lower blood pressures, dP/dTmax, cardiac cycle efficiency, ScO, SrO Vm, worse electroencephalogram background abnormalities, higher number of electroencephalogram sharp waves, and serum lactate (s <0.0001-0.07), and were accompanied with fluctuations of ScO and SrO in 80.6% and 69.6% of patients, respectively.

Conclusions: The waves observed in children following cardiovascular surgery are the slowest ever reported, occurring most frequently in patients with aortic arch abnormalities or ventricular septal defect. While the occurrence of the waves was associated with statistically worse and fluctuated ScO and SrO worse systemic haemodynamics, and electroencephalogram abnormalities, at present these waves have no known clinical relevance.