Cardiovascular Evaluation before and after Splenectomy in Children with β Thalassemia

Background: Cardiac complications represent the leading cause of mortality and morbidity in β thalassemia, with iron overload and high output state being the main precipitating factors. Splenectomy is used in the management of β thalassemia, and its impact on cardiovascular function is an area of controversy with a paucity of data.

Objective of the Study: To evaluate the effect of splenectomy on cardiovascular function in β thalassemia.

Methodology: This proposed longitudinal observational study was carried out in the Department of Paediatric Surgery in MMCH from January 2017 to April 2018. Patients consent and permission were sought from the medical director to carry out the study on 20 β thalassemia patients who were candidates for splenectomy. Pre- and post-operation changes in hematological and echocardiographic characteristics were apparent using SPSS version 20.

Results: The mean age was of the patients at splenectomy was 8.18±2.59 years. Among the 20 cases 12 (60.00%) were male and 8 (40.00%) were female with the ratio 1.5:1, male predominant. All patients were transfusion dependent thalassemia among them maximum 16 (80%) was severe Hb E/β thalassemia and 4 (20%) was β thalassemia major. Major indication of splenectomy 14(70%) was increased requirement of blood transfusion. Mean 6-monthly pretransfusion hemoglobin was significantly increased after splenectomy from 4.19±0.92 to 8.66±0.73 g/dl (p<0.001). Postoperatively, the 6-monthly transfusion requirements were significantly reduced from 14.30±3.18 to 2.15±1.46 units (p<0.001), while blood transfusions were discontinued in 4 patients (20%). The mean serum ferritin was not significantly different after surgery (p>0.05). All 20 patients were in a high output state, with mean cardiac output being 5.85±1.72 L/min in patients versus 3.6±1.03 L/min in controls (p<0.001). Postoperatively, cardiac output was significantly reduced from 5.85±1.72 L/min to 4.99±1.64 L/min (p<0.05). Other parameters were not significantly different after surgery (p>0.05). Before splenectomy 3(15%) patient clinically developed Heart failure and after splenectomy out of 3 heart failure patients 1(5%) have features of restrictive cardiomyopathy in echocardiogram and 2(10%) have normal findings except high cardiac output.

Conclusion: Splenectomy stabilizes the hemoglobin concentration at higher levels and reduces transfusion needs, reduces high cardiac output and prevent high output failure. Though other cardiac parameters remain unchanged within the first 6 months after splenectomy, it can be assumed that removal of the spleen may contribute to the prevention of further cardiac damage.