Use of Subcutaneous Port Catheter in Childhood Malignancies

Background: The port catheters are used to give long-term total parenteral nutrition, intravenous fluids, blood and blood products, or to be preferred for oncology and hematological diseases. In this study, we sought to review our results concerning the subcutaneous port catheter appliance in childhood malignancies. Methods: Two hundred ten subcutaneous port catheters applied to 192 patients between November 2010 and October 2015 were examined retrospectively in a cross- sectional study. Information such as demographic data, primary diagnoses, port types and implantation durations were recorded. Localization of the intervention, surgical technique, early and late complications and causes of port removal were evaluated. Results: Mean age of patients was 6.4 ± 4.9 years (1 month - 17 years), 77 (40.1%) were female and 115 (59.9%) male. One hundred twenty nine ports were inserted from the right internal jugular vein, 59 to right subclavian vein, 14 to left subclavian vein and 8 to left internal jugular vein. Total duration of implantation was 55,492 days and median duration was 289 days. Early complications were: 1 (0.5%) hemothorax, 1 (0.5%) pneumothorax, 1 (0.5%) carotid artery injury, 1 (0.5%) arrhythmia and in 2 (1%) cases port mal-positioning. Late complications were: 9 (4.3%) infection and 8 (3.8%) mechanical problems, 7 (3.3%) thrombosis, and in 1 (0.5%) port fracture was detected. Port catheter was removed in 18 (8.6%) cases. No significant difference was found when jugular and subclavian vein implantation was compared in terms of all complications, especially infection and thrombosis. Conclusion: Use of port catheter is a safe option in children who are receiving a long-term chemotherapy. Education of the medical team will diminish the complication rate in port catheter insertions.

Carotid Artery Cut-Down in Pediatric Cardiac Catheterization: When and How?

Background:Vascular access used for pediatric cardiac catheterization is one of the most important factors that affects the success of the procedure.We aimed to compare the effect,success,and complications of cardiac catheterizations performed by carotid cut-down or femoral puncture in newborns or young infants.Methods:We included who underwent catheterization in our department between 28 January 2017 and 15 April 2021.These patients underwent balloon aortic valvuloplasty,balloon coarctation angioplasty,ductal stenting,diagnostic procedures for aortic arch pathologies,and modified Blalock-Taussig in-shunt intervention.Patients were divided into two groups:femoral puncture(group=1)and carotid cut-down(CC,group=2).Results:Seventy-two catheterization procedures were performed in 64 patients;32(44.4%)were performed via the femoral approach and 40(55.6%)were performed via the carotid approach.Sixteen(22.2%)procedures were diagnostic and 56(77.8%)procedures were interventional.CC was performed in 13(32.5%)patients with failed femoral intervention.Patients in the CC group had shorter durations of procedure,vascular access,and anesthesia,compared with the femoral access group(80.9 and 116.2 min,p=0.001;12.9 and 22.5 min,p=0.001;140.9 and 166.6 min,p=0.001,respectively).Patients who underwent CC had fewer complications than did patients in the femoral access group(2.5%and 21.8%,respectively;p=0.01);larger sheats were used in CC patients(p=0.028).Conclusion:The carotid artery can be successfully used as a primary catheterization route,particularly in patients with small body weight and patients who require rapid vascular access,or stenting of the vertical duct.

Short-Term Outcomes of Two Surgical Techniques for the Treatment of Coarctation of the Aorta in Infants: Subclavian Flap Repair and Resection with Extended End-to-End Anastomosis Technique

Background: The aims of the study were to analyze the importance of two different surgical procedures, and to determine outcomes for neonates with coarctation of the aorta in two newly established centers. Methods: Outcomes of two different surgical repairs for coarctation of the aorta in 43 infants were evaluated retrospectively. The study was designed as a nonrandomized, cross-sectional study. The subclavian flap repair was applied to 22 patients (51%) and resection with extended end-to-end anastomosis technique to 21 patients (49%). After all operative survivors were followed up with a mean follow-up of 1.8 ± 0.8 years, data analyzed with t-test and the p value < 0.05 were considered statistically significant. Results: The overall mortality rate was 4.6%. Forty mmHg gradients were determined in a patient from Resection Group postoperatively in the fifteenth month. After the balloon angioplasty, the gradient decreased to 25 mmHg. The presence of ventricular septal defect (p = 0.094) was the only significant predictor of adverse short-term outcome among the associated cardiac defects analyzed. The first-year survival rate was 100% in both groups in isolated coarctation (p = 0.965), however;such rate was found as 100% and 93.25% in Waldhausen Group and Resection Group, respectively in complex coarctation (p = 0.294). Conclusions: Both the subclavian flap repair and resection with extended end-to-end anastomosis for coarctation of the aorta in infants provide excellent short-term outcomes with lower recurrence rates requiring surgery or angioplasty.