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Pulse oximetry home monitoring in infants with single-ventricle physiology and a surgical shunt as the only source of pulmonary blood flow

Published online by Cambridge University Press:  05 April 2012

Annika Öhman ,
Eva Strömvall-Larsson ,
Boris Nilsson  and
Mats Mellander
Annika Öhman
Affiliation:
Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
Eva Strömvall-Larsson
Affiliation:
Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Boris Nilsson
Affiliation:
Department of Paediatric Cardiac Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Mats Mellander*
Affiliation:
Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
*
Correspondence to: Dr M. Mellander, MD, PhD, Department of Paediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, Queen Silvia Children's Hospital, 41685 Gothenburg, Sweden. Tel: +46 31 3434659; Fax: +46 31 845029; E-mail: mats.mellander@vgregion.se
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Abstract

Background

Shunt occlusion is a major cause of death in children with single ventricle. We evaluated whether one daily measurement of oxygen saturation at home could detect life-threatening shunt dysfunction.

Methods

A total of 28 infants were included. Parents were instructed to measure saturation once daily and if less than or equal to 70% repeat the measurement. Home monitoring was defined as positive when a patient was admitted to Queen Silvia Children's Hospital because of saturation less than or equal to 70% on repeated measurement at home. A shunt complication was defined as arterial desaturation and a narrowing of the shunt that resulted in an intervention to relieve the obstruction or in death. Parents’ attitude towards the method was investigated using a questionnaire.

Results

A shunt complication occurred out of hospital eight times in eight patients. Home monitoring was positive in five out of eight patients. In two patients, home monitoring was probably life saving; in one of them, the shunt was replaced the same day and the other had an emergency balloon dilatation of the shunt. In three out of eight patients, home monitoring was negative; one had an earlier stage II and survived, but two died suddenly at home from thrombotic shunt occlusion. On seven occasions in three patients home monitoring was positive but there was no shunt complication. The method was well accepted by the parents according to the results of the questionnaire.

Conclusion

Home monitoring of oxygen saturation has the potential to detect some of the life-threatening shunt obstructions between stages I and II in infants with single-ventricle physiology.

Keywords

Single ventriclehypoplastic left heart syndromesurgical shunthome monitoringoxygen saturationpsychosocial aspects
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 1 , February 2013 , pp. 75 - 81
Copyright
Copyright © Cambridge University Press 2012

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