{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T02:52:11Z","timestamp":1784861531802,"version":"3.55.0"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,10,26]]},"abstract":"\n Background<\/jats:title>\n \n Systemic vasodilation using \u03b1\u2010receptor blockade has been shown to decrease the incidence of postoperative cardiac arrest following stage 1 palliation (S1P), primarily when utilizing the modified Blalock\u2010Taussig shunt. We studied the effects of a protocol in which milrinone was primarily used to lower systemic vascular resistance (\n SVR<\/jats:styled-content>\n ) following S1P using the right ventricular to pulmonary artery shunt, measuring its effects on oxygen delivery (\n DO<\/jats:styled-content>\n 2<\/jats:sub>\n ) profiles and clinical outcomes. We also correlated Fick\u2010based assessments of\n DO<\/jats:styled-content>\n 2<\/jats:sub>\n with commonly used surrogate measures.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Neonates undergoing S1P were treated according to best clinical judgment prior to (n=32) and following (n=24) implementation of a protocol that guided operative, anesthetic, and postoperative management, particularly as it related to\n SVR<\/jats:styled-content>\n . A majority of the subjects (n=51) received a modified right ventricular to pulmonary artery shunt. In a subset of these patients (n=21), oxygen consumption (\n VO<\/jats:styled-content>\n 2<\/jats:sub>\n ) was measured and used to calculate\n SVR<\/jats:styled-content>\n ,\n DO<\/jats:styled-content>\n 2<\/jats:sub>\n , and oxygen debt. Neonates treated with the protocol had significantly lower\n SVR<\/jats:styled-content>\n (\n P<\/jats:italic>\n =0.02), serum lactate (\n P<\/jats:italic>\n <0.001), and Sa\u2010v\n O<\/jats:styled-content>\n 2<\/jats:sub>\n difference (\n P<\/jats:italic>\n <0.001) and a lower incidence of\n CPR<\/jats:styled-content>\n requiring extracorporeal membrane oxygenation (E\u2010\n CPR<\/jats:styled-content>\n ,\n P<\/jats:italic>\n =0.02) within the first 72 postoperative hours.\n DO<\/jats:styled-content>\n 2<\/jats:sub>\n was closely associated with\n SVR<\/jats:styled-content>\n (r\n 2<\/jats:sup>\n =0.78) but correlated poorly with arterial (SaO\n 2<\/jats:sub>\n ) and venous (SvO\n 2<\/jats:sub>\n ) oxyhemoglobin concentrations, the Sa\u2010v\n O<\/jats:styled-content>\n 2<\/jats:sub>\n difference, and blood pressure.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n A vasodilator protocol utilizing milrinone following S1P effectively decreased\n SVR<\/jats:styled-content>\n , improved serum lactate, and decreased postoperative cardiac arrest.\n DO<\/jats:styled-content>\n 2<\/jats:sub>\n correlated more closely with\n SVR<\/jats:styled-content>\n than with Sa\u2010v\n O<\/jats:styled-content>\n 2<\/jats:sub>\n difference, highlighting the importance of measuring\n VO<\/jats:styled-content>\n 2<\/jats:sub>\n in this population.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 02184169.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.116.003554","type":"journal-article","created":{"date-parts":[[2016,11,3]],"date-time":"2016-11-03T01:34:03Z","timestamp":1478136843000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Phosphodiesterase Inhibitor\u2010Based Vasodilation Improves Oxygen Delivery and Clinical Outcomes Following Stage 1 Palliation"],"prefix":"10.1161","volume":"5","author":[{"given":"Kimberly I.","family":"Mills","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital, Boston, MA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya K.","family":"Kaza","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, MA"},{"name":"Department of Surgery, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian K.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary C.","family":"Bond","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"Ford","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital, Boston, MA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wypij","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital, Boston, MA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi R.","family":"Thiagarajan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital, Boston, MA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melvin C.","family":"Almodovar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children's Hospital, Boston, MA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis G.","family":"Quinonez","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, MA"},{"name":"Department of Surgery, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher 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