VExUS Score Is Associated with Right Ventricular-Pulmonary Arterial Coupling in Pediatric Patients Post Cardiac Surgery.

Abstract

Objectives: Right ventricular dysfunction occurs commonly post cardiac surgery and may be difficult to assess. The venous excess ultrasound (VExUS) score has demonstrated value in assessing solid organ congestion and prognostication in critically ill patients. We assessed the relationship between the venous excess ultrasound score and echocardiographic right ventricular-pulmonary arterial coupling, measured by the tricuspid annular plane systolic excursion-to-pulmonary artery systolic pressure ratio (TAPSE/PASP).

Design: A secondary analysis of a single-center prospective observational cohort.

Setting: Apollo Children's Hospital, Chennai, Tamil Nadu, India PARTICIPANTS: Patients 1 month to 17 years of age with right ventricular dysfunction admitted to the pediatric ICU immediately post cardiac surgery.

Interventions: Serial echocardiographic and VExUS exams were performed on postoperative days 1-3.

Measurements and main results: Forty-three patients were included in the study, with a median TAPSE/PASP of 0.17. VExUS score moderately correlated with TAPSE/PASP (r = -0.53). In a hierarchical linear regression model accounting for multiple measurements per patient, increasing the VExUS score worsened the expected TAPSE/PASP. Similar findings were demonstrated in a secondary analysis of the portal vein score to TAPSE/PASP, though the full VExUS score performed better.

Conclusions: There was a moderately strong association of the VExUS score with TAPSE/PASP. This may be a useful hemodynamic monitoring modality in pediatric patients post cardiac surgery.