Restrictive lung function (RLF) is common in patients with congenital heart disease (CHD) and is associated with surgical intervention. A study of 1,163 CHD patients found that RLF prevalence increased with the number of surgical interventions a patient underwent, especially if the interventions occurred before age 1. Surgical procedures were found to reduce lung volume and compliance over time. The study concludes that cardiac surgery, particularly at a young age, contributes to the development of RLF in CHD patients.

1. dr. Zakky Hazami
DEPARTMENT OF PEDIATRICS
HARAPAN KITA WOMEN AND CHILDREN HOSPITAL
AUGUST 2018

2. Background
Objective
Methods
Result
Discussion
Conclusion
Critical Appraisal

3. BACKGROUND
Restrictive pattern has been shown
associated with Congentital heart
Disease (CHD)
Pulmonary Function testing in
large study never been studied
Routine Spirometry examination in
this center before Cardio
Pulmonary ExerciseTesting (CPET)

4. OBJECTIVE
,
To describe prevalence
of restrictive lung
function (RLF) in CHD
To determine the
effect of cardiothoracic
surgical intervention

5. METHODS
• 1163 cases
• 677 patients CHD
• 876 complete test
result
• Compared data to
220 matched controls
Retrospective
data CPET and
spirometry from
des 2002-Jan
2011
• Divided into subgroup (left-
sided lession, right-sided
lession, septal defect and
other primary lesion)
• Number of surgical
interventions
Statictical Analysis
System (SAS)

6. RESULT

7. RESULT

8. RESULT

9. RESULT

10. RESULT

11. DISCUSSION
Post operativeASD have been shown reduce expiratory reserve
volume and FVC in strenotomy vs percutaneous closure
Lung volume and compliance reduces inVSD,TGA,TOF and
post fontan
RLF without surgical intervention found in congential PS and
AS
Assocoation between surgical interventions and RLF
Restrictive thoracic cage is highly suspected etiology of RLF

12. DISCUSSION
Limitation
Retrospecti
ve study
All patient CPET
already has symptoms
Obtaining infant
pulmonary function
tes is ideal but
impractical in hwom
srugical intervention
performed urgently or
early in life
Lack of doing
spirometry in more
severe CHD

13. CRITICAL APPRAISAL

14. Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes

15. VALIDITY
Cause and effect causality?
Design: Retrospective Study design (case control study)
Similiar characteristic
No Similiar concomitant intervention (different surgical procedure)
Biological Plausibility and consistency?
4 study has been done
Asociation ? P<0,05 and OR 25,%
Surgical intervention associated with RLF

16. APLACABILITY
Spirometry as screening and follow up lung
capacity is very favorable approach for CHD
patients

17. IMPORTANCE
This research shows assocation between
CHD and surgical intervention in CHD with
RLF

18. CONCLUSION
• Surgical Intervention Associated with development of RLF
• The prevalence of RLF increased if surgical intervention
performed in younger age <1 year
• More prospective research is needed to perform pulmonary
function test before and after cardiac surgery