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Arterial Blood Gases and Acid-Base Balance in Cyanotic Congenital Heart Disease

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Arterial Blood Gases and Acid-Base Balance in Cyanotic Congenital Heart Disease ARTERIAL BLOOD GASES AND ACID-BASE BALANCE IN CYANOTIC CONGENITAL HEART DISEASE Minerva Morse, Donald E. Cassels J Clin Invest. 1953;32(9):837-846. https://doi.org/10.1172/JCI102800. Research Article Find the latest version: https://jci.me/102800/pdf ARTERIAL BLOOD GASES AND ACID-BASE BALANCE IN CYANOTIC CONGENITAL HEART DISEASE' BY MINERVA MORSE AND DONALD E. CASSELS 2 (From the Department of Pediatrics, University of Chicago Clinics, Chicago, Illinois) (Submitted for publication April 16, 1953; accepted May 15, 1953) The purpose of this report is to present data pulmonary blood flow was increased by aortic- concerning the arterial blood gases and the acid- pulmonary artery anastomosis or pulmonary base balance in patients with cyanosis due to con- valvulotomy. genital heart disease. Since the study is related Certain differences in distribution with respect to cyanosis and abnormalities of the blood con- to age are evident in the data of Table I and sequent to this, no distinction is made between Figures 1 and 2. Arterial oxygen saturation be- the various anatomical defects producing cyanosis. low 50 per cent was found only in children of 7 Compensatory or adaptive mechanisms in the years and younger. The fact that all but one of presence of cyanosis related to congenital heart the adults had arterial saturations above 79 per disease have been the subject of a number of cent is misleading and an artifact of sampling. studies (1-6). The present study was undertaken Of the adult group only one was believed to have to obtain further information concerning the ar- pulmonary stenosis. It should be noted that in terial blood gases in this disease, especially in re- the reports of Talbott et al. (1), Bing, Vandam, lation to age and in respect to the influence of and Gray (8), and Suarez, Chiodi, Fasciolo, and arterial unsaturation on the acid-base balance. Taquini (3), of 33 patients with cyanotic con- Sixty cyanotic patients were studied, varying in genital heart disease who were over 18 years of age from 1 to 36 years. The methods used have age, 15 were found to have arterial saturations been described in a preceding report (7). below 75 per cent. However, only one of these patients had a saturation below 60 per cent. The RESULTS great majority of patients of our study who had Because age has been found to affect the concen- HbO2 capacities within the normal range were trations of the blood gases (7), especially the HbO2 younger children. On the other hand, the ma- capacity, the CO2 content and the alkaline reserve, jority of very high HbO2 capacities, over 32 vol. it was necessary to evaluate the results for an indi- per cent, were found in older children and adults. vidual of a given age in terms of deviations from the One child of 6 years was found to have a HbO2 mean values for that age. Normal values for chil- capacity of 32.5 vol. per cent. In regard to the dren of different ages are given in the preceding re- alkaline reserve of the plasma there seems to be no port (7). Table I gives the results of single tests on special trend with age. The lowest values were each of 60 patients with cyanotic congenital heart found in children of 7 and 8 years. It may be in disease, in terms both of absolute values and of significant that spite of the fairly high arterial oxygen saturations found in the adults of this deviations from the normal. In Figures 1 and 2 study, all values for alkaline reserve were below deviations from the normal are plotted for each the normal range of variation. In the case of the age group against a background which represents arterial pCO2, about a third of the children of 12 the range of variation found in normal, healthy years and younger had values above the normal individuals of the same age group. Table II gives mean, whereas in children above that age and in the results of repeated tests on seven individuals. adults all values but one lay below the normal It includes cases of pulmonary stenosis in which mean. The great majority of the lower than normal values were found in children between I This work was conducted under a grant from the pH. Douglas Smith Foundation at the University of Chicago. 6 and 10 years. 2Present address: Bobs Roberts Memorial Hospital, Since the data of Table I are arranged in the 920 East 59th Street, Chicago, Ill. order of increasing arterial saturation, it can be 837 838 MINERVA MORSE AND DONALD E. CASSELS TABLE I Oxygen saturation, HbO2 capacity, pkssma CO2 T4o0* pCO2 and pH. of arterial blood of patients with cyanotic congenital heart disease HbO2 capacity Plasma C02 Tso* Arterial pCO2 Arterial pHs Dev. Dev. Dev. Dev. Arterial Value from Value from Value from Value from No. Subject Age Sex saturation found normal found normal found normal found normal yr. per cent Vo. % Vol. % oi. % Vol. % mm. mm. 1 S.D. 2 F 21.0 14.5 - 2.0 37.3 -11.1 41.7 + 4.4 7.227 -.122 2 R.E. 2 M 21.4 28.6 +12.1 37.4 -11.0 40.2 + 2.9 7.266 -.083 3 P.S. 1 F 21.6 18.0 + 1.5 39.6 - 8.8 42.1 + 4.8 7.257 -.092 4 R.B. 6 M 40.5 28.6 + 10.2 35.7 -18.9 37.8 - 0.2 7.244 - .155 5 J.M. 7 M 40.6 31.1 +12.7 34.6 -20.0 35.9 - 2.1 7.244 -.1S5 6 J.A. 2 M 41.7 25.6 + 9.1 37.3 -11.1 35.0 - 2.3 7.279 -.070 7 H.R. 2 M 46.9 14.0 - 2.5 42.6 - 5.8 25.5 -11.8 7.423 +.074 8 J.G. 4 F 49.8 30.9 +13.2 41.5 -12.0 39.3 + 2.0 7.297 - .093 9 M.P. 14 M 52.0 33.8 +15.4 43.3 -12.2 40.8 - 0.5 7.308 -.073 10 J.W. 9 M 58.7 32.8 +14.4 33.6 -21.0 38.3 + 0.3 7.203 -.201 11 S.X. 15 M 59.1 35.1 +16.7 41.6 -13.9 31.6 - 9.7 7.348 -.033 12 V.S. 7 F 61.8 26.6 + 8.2 45.3 - 9.3 37.9 - 0.1 7.334 -.065 13 W.B. 6 M 63.2 28.4 +10.0 40.8 -12.7 32.9 - 4.4 7.322 -.077 14 M. M. 36 F 63.4 35.1 +14.6 45.6 -12.6 30.2 -10.9 7.399 -.003 15 L.C. 14 F 65.4 32.4 + 14.0 41.2 -14.3 32.8 - 8.5 7.328 -.053 16 C.F. 6 M 65.6 32.5 +14.1 42.4 -11.1 41.6 + 4.3 7.283 -.107 17 J.R. 10 F 65.7 25.0 + 6.6 50.6 - 4.0 39.5 + 1.5 7.369 -.034 18 V.J. 3 F 68.3 19.7 + 2.0 43.6 - 4.8 40.7 - 3.4 7.289 -.060 19 N.H. 4 M 68.6 29.9 +11.5 46.4 - 7.1 29.4 - 7.9 7.407 +.017 20 A.F. 5 M 70.4 27.8 + 9.4 49.4 - 4.1 34.5 - 2.8 7.392 +.002 21 B.G. 7 M 70.6 27.8 + 9.4 45.9 - 8.7 37.8 - 0.2 7.333 -.066 22 L.S. 17 M 71.2 26.4 + 6.7 49.5 - 6.3 29.7 -11.6 7.434 +.053 23 J.S. 10 M 72.1 27.3 + 8.9 49.0 - 5.6 33.4 - 4.6 7.398 -.006 24 B. M. 13 M 72.2 22.7 + 4.3 54.2 - 1.3 27.5 -13.8 7.502 +.121 25 C.L. 2 M 73.0 16.6 - 0.1 49.1 + 0.7 32.4 - 4.9 7.407 +.058 26 P. M. 5 F 73.3 21.0 + 2.6 45.9 - 7.6 29.4 - 7.9 7.401 +.011 27 S. D. 10 M 74.2 31.2 +12.8 46.2 - 8.4 38.4 + 0.4 7.333 - .071 28 R. B. 8 M 74.3 28.1 + 9.7 48.9 - 5.7 39.4 + 1.4 7.351 - .053 29 R.J. 2 M 74.9 19.1 + 2.6 43.6 - 4.8 34.7 - 2.6 7.330 - .019 30 P. K. 5 F 75.4 22.7 + 4.3 45.5 - 8.0 37.7 + 0.4 7.328 - .062 31 R.F. 4 M 76.8 24.6 + 6.9 42.5 -11.0 35.2 - 2.1 7.313 - .077 32 R. D. 10 M 77.0 36.5 +18.1 43.8 -10.8 27.7 -10.3 7.391 +.013 33 R. M. 6 M 77.4 17.4 - 1.0 49.6 - 3.9 44.7 + 7.4 7.311 -.092 34 L.Z. 24 F 79.0 22.7 + 2.2 55.5 - 2.9 28.5 -12.6 7.496 +.094 35 E.V. 11 M 79.3 25.3 + 6.9 46.1 - 9.4 34.4 - 3.6 7.355 -.049 36 G.H.
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