Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developin...Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developing countries. The aim of this study was to analyze the epidemiological, clinical and paraclinical aspects of congenital heart disease. Methods: This was a retrospective descriptive and analytical study based on the records of 135 patients referred for surgery and followed up in the cardiology department of the Ignace Deen University Hospital, collected in November 2022. Results: Hospital prevalence was 5%. The mean age was 71 months, ranging from 1 month to 19 years. The age group over 24 months was the most represented (62%). The M/F sex ratio was 1.36. Urban origin was predominant (58%). The rate of children not attending school or dropping out was high (16%). Siblings with fewer than 4 children were the most common (88%). A heart murmur was the most frequent sign (78%), followed by cyanosis (36%) and heart failure (29%). The association between heart murmurs and CHD was proven with a p-value Conclusion: CHDs represent the main indication for paediatric cardiac surgery and follow-up (95%). We stress the importance of implementing a screening and management strategy for congenital heart disease.展开更多
Background:Three-dimensional printing technology may become a key factor in transforming clinical practice and in significant improvement of treatment outcomes.The introduction of this technique into pediatric cardiac...Background:Three-dimensional printing technology may become a key factor in transforming clinical practice and in significant improvement of treatment outcomes.The introduction of this technique into pediatric cardiac surgery will allow us to study features of the anatomy and spatial relations of a defect and to simulate the optimal surgical repair on a printed model in every individual case.Methods:We performed the prospective cohort study which included 29 children with congenital heart defects.The hearts and the great vessels were modeled and printed out.Measurements of the same cardiac areas were taken in the same planes and points at multislice computed tomography images(group 1)and on printed 3D models of the hearts(group 2).Pre-printing treatment of the multislice computed tomography data and 3D model preparation were performed according to a newly developed algorithm.Results:The measurements taken on the 3D-printed cardiac models and the tomographic images did not differ significantly,which allowed us to conclude that the models were highly accurate and informative.The new algorithm greatly simplifies and speeds up the preparation of a 3D model for printing,while maintaining high accuracy and level of detail.Conclusions:The 3D-printed models provide an accurate preoperative assessment of the anatomy of a defect in each case.The new algorithm has several important advantages over other available programs.They enable the development of customized preliminary plans for surgical repair of each specific complex congenital heart disease,predict possible issues,determine the optimal surgical tactics,and significantly improve surgical outcomes.展开更多
Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a r...Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.展开更多
The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertio...The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.展开更多
In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care spec...In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care specialist to fully understand the preoperative anatomy and the intraoperative details of these patients. This allows a timely and appropriate treatment of general and lesion-specific complications. In this article we provide a list of commonly-performed surgical procedures and possible associated problems to be anticipated in the early postoperative period. Then it follows a discussion about the diagnosis and management of these complications, based on their pathophysiological features.展开更多
Objective:To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median sternotomy through right atrium in treatment of common congenital heart diseases.Methods:C...Objective:To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median sternotomy through right atrium in treatment of common congenital heart diseases.Methods:Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomv from May,2011 to February,2013 and 77 cases of same diseases with traditional median sternotomy in the past three years were retrospectively analyzed,including atrial septal defect,membranous ventricular septal defect and partial endocardial cushion defect.The results were compared from the two groups,including the time for operation and cardiopulmonary bypass,amount of blood transfusion,postoperative drainage,ventilation time,hospital stay,and prognosis.Results:No severe complications happened in both groups,like deaths or secondery surgery caused by bleeding.No significant differences were in CPB time and postoperative ventilator time between groups(P>0.05),while for all of the operative time,the length of incision,postoperative drainage and hospital stay,minimally invasive right axillary vertical thoracotomy was superior to median sternotomy,with statistically significant differences(P<0.05).In six-month lollowup after operation,no complications of residual deformity and pericardial effusion were found in both groups bv doing echocardiography,but mild pectus carinatum was found in X patients in the traditional median sternotomy group(traditional groupi.whereas patients in another group were well recovered.Conclusions:Minimally invasive right subaxillary vertical thoracotomv for common congenital heart diseases is as safe as traditional median sternotomy,without the increasing incidence of postoperative complications.Additionally,compared with traditional median sternotomy,minimally invasive right subaxillary vertical thoracotomv is better in the aspects of hidden incision,appearance,and postoperative recovery.展开更多
AIM To study whether remote ischemic preconditioning(RIPC) has an impact on clinical outcomes, such as post-operative atrial fibrillation(POAF).METHODS This was a prospective, single-center, single-blinded,randomized ...AIM To study whether remote ischemic preconditioning(RIPC) has an impact on clinical outcomes, such as post-operative atrial fibrillation(POAF).METHODS This was a prospective, single-center, single-blinded,randomized controlled study. One hundred and two patients were randomized to receive RIPC(3 cycles of 5 min ischemia and 5 min reperfusion in the upper arm after induction of anesthesia) or no RIPC(control). Primary outcome was POAF lasting for five minutes or longer during the first seven days after surgery. Secondary outcomes included length of hospital stay, incidence of inpatient mortality, myocardial infarction, and stroke. RESULTS POAF occurred at a rate of 54% in the RIPC group and 41.2% in the control group(P = 0.23). No statistically significant differences were noted in secondary outcomes between the two groups. CONCLUSION This is the first study in the United States to suggest that RIPC does not reduce POAF in patients with elective or urgent cardiac surgery. There were no differences in adverse effects in either group. Further studies are required to assess the relationship between RIPC and POAF.展开更多
Background:Postoperative pulmonary hypertension limits the success of surgical treatment in some patients with unrestrictive congenital cardiac communications.Identifying patients at risk of developing postoperative p...Background:Postoperative pulmonary hypertension limits the success of surgical treatment in some patients with unrestrictive congenital cardiac communications.Identifying patients at risk of developing postoperative pulmonary hypertension is important to individualize follow-up strategies.Methods:We analyzed a prospective cohort of 52 pediatric patients(age 3 to 35 months)looking for perioperative predictors of mildly elevated pulmonary arterial pressure 6 months after surgery,defined as a systolic pressure greater than 30 mmHg by transthoracic echocardiography.This corresponds to a mean pulmonary arterial pressure of>20 mmHg.Clinical,echocardiographic and hemodynamic parameters were investigated.Perioperative hemodynamics was assessed by directly measuring pulmonary and systemic arterial pressures using indwelling catheters.Early postoperative pulmonary hemodynamics was defined as the mean pulmonary/systemic mean arterial pressure ratio(PAP/SAP)obtained per patient during the first 6 h of postoperative care.Results:Among the factors that were investigated as possible predictors,perioperative hemodynamics and the presence of Down syndrome were initially selected using univariate analysis(p<0.030).Early postoperative PAP/SAP was correlated with PAP/SAP obtained in the operating room just after cardiopulmonary bypass(r=0.70,p<0.001),and it was higher in subjects with Down syndrome than in nonsyndromic individuals(p=0.003).Early postoperative PAP/SAP was the only predictor selected using multivariate analysis.It was characterized as an independent predictor after adjustments for possible confounders.An early postoperative PAP/SAP of>0.35 was 76%sensitive and 74%specific at predicting a systolic pulmonary arterial pressure of>30 mmHg 6 months after surgery(hazard ratio with 95%CI 8.972[2.428–33.158],p=0.002).Conclusion:The hypertensive early postoperative behavior of the pulmonary circulation was strongly but not exclusively associated with Down syndrome,and it was characterized as an independent predictor of altered pulmonary arterial pressure after discharge from the hospital.展开更多
BACKGROUND Cornelia de Lange syndrome(CdLS)is a congenital multisystemic genetic disorder.The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent yea...BACKGROUND Cornelia de Lange syndrome(CdLS)is a congenital multisystemic genetic disorder.The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent years.However,they still more frequently undergo cardiac surgery.There are some challenges for clinicians when faced with CdLS patients.We present the perioperative management of a child with CdLS undergoing open-heart surgery.CASE SUMMARY Severe pulmonic and subpulmonic valvular stenosis,enlargement of the right side of the heart,mild tricuspid regurgitation,atrial septal defect,and patent ductus arteriosus were diagnosed in a 14-month-old boy with manifested cyanosis,developmental delay,and malnutrition.Attempted balloon valvuloplasty was unsuccessful due to a severe stenotic pulmonary valve,therefore it was decided to perform an open surgical repair.Following a successful and uncomplicated intraoperative course,the patient was extubated on postoperative day 5,and adrenalin and dopamine infusions were gradually decreased and stopped on postoperative days 6 and 10,respectively.Moderate laryngomalacia and suboptimal vocal cord movements were diagnosed,and tracheotomy and percutaneous endoscopic gastrostomy were performed under general anesthesia in the same session at postoperative day 32.The patient was discharged on postoperative day 85 after a challenging postoperative period with additional airway and nutritional problems.CONCLUSION This is the first report of the perioperative anesthetic and clinical management of a CdLS patient undergoing open-heart surgery.展开更多
AIM To demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODS We retrospectively analyzed a collected database of 356 patients ...AIM To demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODS We retrospectively analyzed a collected database of 356 patients who underwent cardiac surgery using cardiopulmonary bypass(CPB) from 2010-2015. The patients were grouped into blood conservation(n = 138) and nonconservation(n = 218) groups and sub-grouped based on their ages and procedural complexity scores. RESULTS There were no statistical differences in gender,weight,pre-operative and pre-CPB hematocrit levels in both groups. Despite equivalent hematocrit levels during and after CPB for both groups,there was significantly less operative homologous blood utilized in blood conservation group across all ages and complexity levels. CONCLUSION Blood conservation surgery can be performed in con-genital patients needing cardiac surgery in all age groups and complexity categories. The above findings in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products justify blood conservation in congenital cardiac surgery.展开更多
Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery. This study examined the inci...Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery. This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery, and established a risk stratification system. Methods This retrospective observational clinical study included 482 patients aged -〉60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital. The primary outcome was MACE within 30 days after surgery. Risk factors were evaluated using multivariate Logistic regression analysis. Results Perioperative MACE occurred in 61(12.66%) of the study patients. Five independent risk factors for perioperative MACE were identified: history of heart failure, preoperative arrhythmia, preoperative diastolic blood pressure 〈75 mmHg, American Society of Anesthesiologists grade 3 or higher, and intraoperative blood transfusion. The area under the receiver operating characteristic curve for the risk-index score was 0.710+0.037. Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk. Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE. Five independent risk factors for perioperative MACE were identified. Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.展开更多
Background Atrial fibrillation(AF) is the most common arrhythmia in patients with rheumatic heart disease(RHD). The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients...Background Atrial fibrillation(AF) is the most common arrhythmia in patients with rheumatic heart disease(RHD). The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery(CVS) is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence(30/135, 22.2%) was higher than that in the control group(45/427, 10.5%, P 〈 0.05). Compared with patients in the control group,incidence of rapid AF(19.3% vs 27.4%) and ventricular arrhythmias(6.7% vs 12.1%) in the amiodarone group were significantly lower(P 〈 0.05). Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group(P 〈 0.05). The sinus rhythm conversion rate of the patients with total dosage of above 10 g(14/43, 32.6%) was significantly higher than that of the patients receiving less than 10 g(16/92, 17.4%) amiodarone(P 〈 0.05). Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.展开更多
From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9...From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9.31%. On the basis of our clinical experience, it is important that the accurate diagnosis was made promptly in neonate with complex CHDs. The surgical results can be improved by the use of PGEI and balloon atrial septostomy in the cyanotic neonate. For the congestive CHDs, the operation must be per formed in the early life to prevent pulmonary hypertension. Improved methods of preoperative and postoperative care have contributed to these results.展开更多
Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications...Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications after pulmonary valve replacement or the Rastelli procedure at a single tertiary centre were retrospectively analysed.Results:Coronary artery complications were identified in 20 patients who underwent right ventricular outflow tract reconstruction surgery.The median age at diagnosis of coronary artery complication was 21 years(interquartile range:13–25 years).Mechanisms of coronary artery complications were compression by adjacent materials in 12 patients,dynamic compression of intramural course of coronary artery in two patients,and intraoperative injury in six patients.Congenital coronary artery anomalies were identified in 50%(10/20)of patients.Four patients presented with early postoperative haemodynamic instability.Fourteen patients showed late onset symptoms or signs of coronary insufficiency,including chest pain,ventricular dysfunction,or ventricular arrhythmias.Coronary artery stenosis was incidentally found on cardiac computed tomography angiography in two asymptomatic patients.Four patients underwent surgical interventions,and one patient underwent percutaneous coronary intervention for coronary stenosis.One patient with recurrent ventricular tachycardia required an implantable cardioverter-defibrillator.There were two deaths in patients with intraoperative coronary injury.Conclusion:Preoperative coronary evaluation and long-term follow-up for the development of coronary artery complications are required in patients undergoing right ventricular outflow tract reconstruction surgery to prevent ventricular dysfunction,arrhythmias,and death,especially among those with congenital coronary anomalies.展开更多
Objectives To measure circulating B-type natriuretic peptide (BNP) levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level...Objectives To measure circulating B-type natriuretic peptide (BNP) levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level and cardiac events after surgical intervention. Methods Subjects comprised 232 patients with heart disease undergoing elective major non- cardiac surgery. Patients were classified into two groups based on BNP concentrations before surgery: those with BNP plasma levels ≤ 100 pg/mL ( Group A, n = 170) ; and those with BNP plasma levels 〉 100 pg/mL ( Group B, n = 62 ). Preoperative BNP sampling was undertaken 24h before surgery, and postoperative 2 h after surgery. Screening for cardiac events was performed using clinical criteria, cardiac tropnin I analysis and serial electrocardiography. Results There was no significant difference in BNP concentrations between before surgery (73.5 ± 20. 6) pg/mL and after non- cardiac surgery (69.3 ± 27.5 ) pg/mL in group A (P 〉 0. 05 ), while there was a significant difference in BNP concentrations between before surgery ( 149.3 ± 73.5 ) pg/mL and after non-cardiac surgery ( 341.5 ± 162. 4 ) pg/mL in group B (P 〈 0. 001 ). Patients with postoperative cardiac events had significantly higher BNP levels (207.3 ± 99. 1 ) pg/mL before and (416. 9 ± 202. 8) pg/mL after non-cardiac surgery than those in patients with no cardiac events in group B. There was a significant difference in cardiac events between group A, in which no patient had cardiac events, and group B, in which 15 patients had cardiac events ( P 〈 0. 001 ). Conclusions The changes in BNP levels after non- cardiac surgery were influenced by the preoperative levels of BNP, and relative to cardiac events.展开更多
BACKGROUND Cardiovascular disease is the leading cause of death in patients with Turner syndrome(TS),and cardiovascular surgery is frequently required for management of these patients.TS is associated with medical com...BACKGROUND Cardiovascular disease is the leading cause of death in patients with Turner syndrome(TS),and cardiovascular surgery is frequently required for management of these patients.TS is associated with medical comorbidities than can complicate the care of this patient population.AIM To describe the cardiovascular surgical outcomes of patients with TS.METHODS A retrospective case series was compiled of 51 consecutive TS patients who had at least one cardiovascular surgery at Mayo Clinic Rochester from 1977-2017.The baseline clinical data of these patients were reviewed including demographics,medical comorbidities,congenital heart disease history,and medications.Echocardiographic reports were analyzed in detail.Operative reports and surgical hospital courses were reviewed.Long-term mortality was determined using medical records and the Social Security Death Index.Survival analysis was performed with the Kaplan Meier method.RESULTS The cohort comprised 51 TS patients,average age at the time of surgery at Mayo Clinic was 28(8-41)years,and 23(45%)patients were under the age of 18.At the time of first Mayo Clinic surgery,18(35%)patients had previously undergone cardiac surgery at another institution.The most common procedures were repair of aortic coarctation in 14(28%)patients,aortic valve replacement in 6(12%)patients,and composite aortic root/ascending aorta replacement in 7(14%)patients,with 7 patients undergoing repair of more than one lesion.Aortic dissection required operative intervention in 5 patients.After initial Mayo Clinic surgery,subsequent operations were required in 6(13%)patients.Average hospital length of stay was 6±2 d.There were 4(8%)early surgical deaths.Freedom from death was 97%and 89%at 10 and 20 years,and the freedom from reoperation was 93%and 81%at 10 and 20 years.CONCLUSION Cardiovascular surgery is associated with 8%early mortality given the medical complexity of TS patients.Those who survive to dismissal have good survival.Later cardiovascular reoperations are not rare.展开更多
文摘Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developing countries. The aim of this study was to analyze the epidemiological, clinical and paraclinical aspects of congenital heart disease. Methods: This was a retrospective descriptive and analytical study based on the records of 135 patients referred for surgery and followed up in the cardiology department of the Ignace Deen University Hospital, collected in November 2022. Results: Hospital prevalence was 5%. The mean age was 71 months, ranging from 1 month to 19 years. The age group over 24 months was the most represented (62%). The M/F sex ratio was 1.36. Urban origin was predominant (58%). The rate of children not attending school or dropping out was high (16%). Siblings with fewer than 4 children were the most common (88%). A heart murmur was the most frequent sign (78%), followed by cyanosis (36%) and heart failure (29%). The association between heart murmurs and CHD was proven with a p-value Conclusion: CHDs represent the main indication for paediatric cardiac surgery and follow-up (95%). We stress the importance of implementing a screening and management strategy for congenital heart disease.
基金funded by the Ministry of Science and Higher Education of the Russian Federation as part of the World-Class Research Center Program:Advanced Digital Technologies(Contract No.075-15-2022-311,dated 20.04.2022).
文摘Background:Three-dimensional printing technology may become a key factor in transforming clinical practice and in significant improvement of treatment outcomes.The introduction of this technique into pediatric cardiac surgery will allow us to study features of the anatomy and spatial relations of a defect and to simulate the optimal surgical repair on a printed model in every individual case.Methods:We performed the prospective cohort study which included 29 children with congenital heart defects.The hearts and the great vessels were modeled and printed out.Measurements of the same cardiac areas were taken in the same planes and points at multislice computed tomography images(group 1)and on printed 3D models of the hearts(group 2).Pre-printing treatment of the multislice computed tomography data and 3D model preparation were performed according to a newly developed algorithm.Results:The measurements taken on the 3D-printed cardiac models and the tomographic images did not differ significantly,which allowed us to conclude that the models were highly accurate and informative.The new algorithm greatly simplifies and speeds up the preparation of a 3D model for printing,while maintaining high accuracy and level of detail.Conclusions:The 3D-printed models provide an accurate preoperative assessment of the anatomy of a defect in each case.The new algorithm has several important advantages over other available programs.They enable the development of customized preliminary plans for surgical repair of each specific complex congenital heart disease,predict possible issues,determine the optimal surgical tactics,and significantly improve surgical outcomes.
文摘Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.
文摘The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.
文摘In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care specialist to fully understand the preoperative anatomy and the intraoperative details of these patients. This allows a timely and appropriate treatment of general and lesion-specific complications. In this article we provide a list of commonly-performed surgical procedures and possible associated problems to be anticipated in the early postoperative period. Then it follows a discussion about the diagnosis and management of these complications, based on their pathophysiological features.
基金supported by college medical journal clinicalspecial funds(11321587)
文摘Objective:To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median sternotomy through right atrium in treatment of common congenital heart diseases.Methods:Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomv from May,2011 to February,2013 and 77 cases of same diseases with traditional median sternotomy in the past three years were retrospectively analyzed,including atrial septal defect,membranous ventricular septal defect and partial endocardial cushion defect.The results were compared from the two groups,including the time for operation and cardiopulmonary bypass,amount of blood transfusion,postoperative drainage,ventilation time,hospital stay,and prognosis.Results:No severe complications happened in both groups,like deaths or secondery surgery caused by bleeding.No significant differences were in CPB time and postoperative ventilator time between groups(P>0.05),while for all of the operative time,the length of incision,postoperative drainage and hospital stay,minimally invasive right axillary vertical thoracotomy was superior to median sternotomy,with statistically significant differences(P<0.05).In six-month lollowup after operation,no complications of residual deformity and pericardial effusion were found in both groups bv doing echocardiography,but mild pectus carinatum was found in X patients in the traditional median sternotomy group(traditional groupi.whereas patients in another group were well recovered.Conclusions:Minimally invasive right subaxillary vertical thoracotomv for common congenital heart diseases is as safe as traditional median sternotomy,without the increasing incidence of postoperative complications.Additionally,compared with traditional median sternotomy,minimally invasive right subaxillary vertical thoracotomv is better in the aspects of hidden incision,appearance,and postoperative recovery.
文摘AIM To study whether remote ischemic preconditioning(RIPC) has an impact on clinical outcomes, such as post-operative atrial fibrillation(POAF).METHODS This was a prospective, single-center, single-blinded,randomized controlled study. One hundred and two patients were randomized to receive RIPC(3 cycles of 5 min ischemia and 5 min reperfusion in the upper arm after induction of anesthesia) or no RIPC(control). Primary outcome was POAF lasting for five minutes or longer during the first seven days after surgery. Secondary outcomes included length of hospital stay, incidence of inpatient mortality, myocardial infarction, and stroke. RESULTS POAF occurred at a rate of 54% in the RIPC group and 41.2% in the control group(P = 0.23). No statistically significant differences were noted in secondary outcomes between the two groups. CONCLUSION This is the first study in the United States to suggest that RIPC does not reduce POAF in patients with elective or urgent cardiac surgery. There were no differences in adverse effects in either group. Further studies are required to assess the relationship between RIPC and POAF.
基金This work was supported by FAPESP-Foundation for Research Support of the State of São Paulo,São Paulo,Brazil[Grant#2015/21587-5].
文摘Background:Postoperative pulmonary hypertension limits the success of surgical treatment in some patients with unrestrictive congenital cardiac communications.Identifying patients at risk of developing postoperative pulmonary hypertension is important to individualize follow-up strategies.Methods:We analyzed a prospective cohort of 52 pediatric patients(age 3 to 35 months)looking for perioperative predictors of mildly elevated pulmonary arterial pressure 6 months after surgery,defined as a systolic pressure greater than 30 mmHg by transthoracic echocardiography.This corresponds to a mean pulmonary arterial pressure of>20 mmHg.Clinical,echocardiographic and hemodynamic parameters were investigated.Perioperative hemodynamics was assessed by directly measuring pulmonary and systemic arterial pressures using indwelling catheters.Early postoperative pulmonary hemodynamics was defined as the mean pulmonary/systemic mean arterial pressure ratio(PAP/SAP)obtained per patient during the first 6 h of postoperative care.Results:Among the factors that were investigated as possible predictors,perioperative hemodynamics and the presence of Down syndrome were initially selected using univariate analysis(p<0.030).Early postoperative PAP/SAP was correlated with PAP/SAP obtained in the operating room just after cardiopulmonary bypass(r=0.70,p<0.001),and it was higher in subjects with Down syndrome than in nonsyndromic individuals(p=0.003).Early postoperative PAP/SAP was the only predictor selected using multivariate analysis.It was characterized as an independent predictor after adjustments for possible confounders.An early postoperative PAP/SAP of>0.35 was 76%sensitive and 74%specific at predicting a systolic pulmonary arterial pressure of>30 mmHg 6 months after surgery(hazard ratio with 95%CI 8.972[2.428–33.158],p=0.002).Conclusion:The hypertensive early postoperative behavior of the pulmonary circulation was strongly but not exclusively associated with Down syndrome,and it was characterized as an independent predictor of altered pulmonary arterial pressure after discharge from the hospital.
文摘BACKGROUND Cornelia de Lange syndrome(CdLS)is a congenital multisystemic genetic disorder.The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent years.However,they still more frequently undergo cardiac surgery.There are some challenges for clinicians when faced with CdLS patients.We present the perioperative management of a child with CdLS undergoing open-heart surgery.CASE SUMMARY Severe pulmonic and subpulmonic valvular stenosis,enlargement of the right side of the heart,mild tricuspid regurgitation,atrial septal defect,and patent ductus arteriosus were diagnosed in a 14-month-old boy with manifested cyanosis,developmental delay,and malnutrition.Attempted balloon valvuloplasty was unsuccessful due to a severe stenotic pulmonary valve,therefore it was decided to perform an open surgical repair.Following a successful and uncomplicated intraoperative course,the patient was extubated on postoperative day 5,and adrenalin and dopamine infusions were gradually decreased and stopped on postoperative days 6 and 10,respectively.Moderate laryngomalacia and suboptimal vocal cord movements were diagnosed,and tracheotomy and percutaneous endoscopic gastrostomy were performed under general anesthesia in the same session at postoperative day 32.The patient was discharged on postoperative day 85 after a challenging postoperative period with additional airway and nutritional problems.CONCLUSION This is the first report of the perioperative anesthetic and clinical management of a CdLS patient undergoing open-heart surgery.
文摘AIM To demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODS We retrospectively analyzed a collected database of 356 patients who underwent cardiac surgery using cardiopulmonary bypass(CPB) from 2010-2015. The patients were grouped into blood conservation(n = 138) and nonconservation(n = 218) groups and sub-grouped based on their ages and procedural complexity scores. RESULTS There were no statistical differences in gender,weight,pre-operative and pre-CPB hematocrit levels in both groups. Despite equivalent hematocrit levels during and after CPB for both groups,there was significantly less operative homologous blood utilized in blood conservation group across all ages and complexity levels. CONCLUSION Blood conservation surgery can be performed in con-genital patients needing cardiac surgery in all age groups and complexity categories. The above findings in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products justify blood conservation in congenital cardiac surgery.
文摘Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery. This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery, and established a risk stratification system. Methods This retrospective observational clinical study included 482 patients aged -〉60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital. The primary outcome was MACE within 30 days after surgery. Risk factors were evaluated using multivariate Logistic regression analysis. Results Perioperative MACE occurred in 61(12.66%) of the study patients. Five independent risk factors for perioperative MACE were identified: history of heart failure, preoperative arrhythmia, preoperative diastolic blood pressure 〈75 mmHg, American Society of Anesthesiologists grade 3 or higher, and intraoperative blood transfusion. The area under the receiver operating characteristic curve for the risk-index score was 0.710+0.037. Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk. Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE. Five independent risk factors for perioperative MACE were identified. Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.
基金supported by National Key Technology Research and Development Program(No.2011BAI11B22)Medical Scientific Research Foundation of Guangdong Province(No.B2012002)Guangdong Population and Family Planning Foundation(No.2012264)
文摘Background Atrial fibrillation(AF) is the most common arrhythmia in patients with rheumatic heart disease(RHD). The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery(CVS) is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence(30/135, 22.2%) was higher than that in the control group(45/427, 10.5%, P 〈 0.05). Compared with patients in the control group,incidence of rapid AF(19.3% vs 27.4%) and ventricular arrhythmias(6.7% vs 12.1%) in the amiodarone group were significantly lower(P 〈 0.05). Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group(P 〈 0.05). The sinus rhythm conversion rate of the patients with total dosage of above 10 g(14/43, 32.6%) was significantly higher than that of the patients receiving less than 10 g(16/92, 17.4%) amiodarone(P 〈 0.05). Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.
文摘From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9.31%. On the basis of our clinical experience, it is important that the accurate diagnosis was made promptly in neonate with complex CHDs. The surgical results can be improved by the use of PGEI and balloon atrial septostomy in the cyanotic neonate. For the congestive CHDs, the operation must be per formed in the early life to prevent pulmonary hypertension. Improved methods of preoperative and postoperative care have contributed to these results.
文摘Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications after pulmonary valve replacement or the Rastelli procedure at a single tertiary centre were retrospectively analysed.Results:Coronary artery complications were identified in 20 patients who underwent right ventricular outflow tract reconstruction surgery.The median age at diagnosis of coronary artery complication was 21 years(interquartile range:13–25 years).Mechanisms of coronary artery complications were compression by adjacent materials in 12 patients,dynamic compression of intramural course of coronary artery in two patients,and intraoperative injury in six patients.Congenital coronary artery anomalies were identified in 50%(10/20)of patients.Four patients presented with early postoperative haemodynamic instability.Fourteen patients showed late onset symptoms or signs of coronary insufficiency,including chest pain,ventricular dysfunction,or ventricular arrhythmias.Coronary artery stenosis was incidentally found on cardiac computed tomography angiography in two asymptomatic patients.Four patients underwent surgical interventions,and one patient underwent percutaneous coronary intervention for coronary stenosis.One patient with recurrent ventricular tachycardia required an implantable cardioverter-defibrillator.There were two deaths in patients with intraoperative coronary injury.Conclusion:Preoperative coronary evaluation and long-term follow-up for the development of coronary artery complications are required in patients undergoing right ventricular outflow tract reconstruction surgery to prevent ventricular dysfunction,arrhythmias,and death,especially among those with congenital coronary anomalies.
基金supported by Research Foundation of the Second Affiliated Hospital of Chinese PLA General Hospital
文摘Objectives To measure circulating B-type natriuretic peptide (BNP) levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level and cardiac events after surgical intervention. Methods Subjects comprised 232 patients with heart disease undergoing elective major non- cardiac surgery. Patients were classified into two groups based on BNP concentrations before surgery: those with BNP plasma levels ≤ 100 pg/mL ( Group A, n = 170) ; and those with BNP plasma levels 〉 100 pg/mL ( Group B, n = 62 ). Preoperative BNP sampling was undertaken 24h before surgery, and postoperative 2 h after surgery. Screening for cardiac events was performed using clinical criteria, cardiac tropnin I analysis and serial electrocardiography. Results There was no significant difference in BNP concentrations between before surgery (73.5 ± 20. 6) pg/mL and after non- cardiac surgery (69.3 ± 27.5 ) pg/mL in group A (P 〉 0. 05 ), while there was a significant difference in BNP concentrations between before surgery ( 149.3 ± 73.5 ) pg/mL and after non-cardiac surgery ( 341.5 ± 162. 4 ) pg/mL in group B (P 〈 0. 001 ). Patients with postoperative cardiac events had significantly higher BNP levels (207.3 ± 99. 1 ) pg/mL before and (416. 9 ± 202. 8) pg/mL after non-cardiac surgery than those in patients with no cardiac events in group B. There was a significant difference in cardiac events between group A, in which no patient had cardiac events, and group B, in which 15 patients had cardiac events ( P 〈 0. 001 ). Conclusions The changes in BNP levels after non- cardiac surgery were influenced by the preoperative levels of BNP, and relative to cardiac events.
文摘BACKGROUND Cardiovascular disease is the leading cause of death in patients with Turner syndrome(TS),and cardiovascular surgery is frequently required for management of these patients.TS is associated with medical comorbidities than can complicate the care of this patient population.AIM To describe the cardiovascular surgical outcomes of patients with TS.METHODS A retrospective case series was compiled of 51 consecutive TS patients who had at least one cardiovascular surgery at Mayo Clinic Rochester from 1977-2017.The baseline clinical data of these patients were reviewed including demographics,medical comorbidities,congenital heart disease history,and medications.Echocardiographic reports were analyzed in detail.Operative reports and surgical hospital courses were reviewed.Long-term mortality was determined using medical records and the Social Security Death Index.Survival analysis was performed with the Kaplan Meier method.RESULTS The cohort comprised 51 TS patients,average age at the time of surgery at Mayo Clinic was 28(8-41)years,and 23(45%)patients were under the age of 18.At the time of first Mayo Clinic surgery,18(35%)patients had previously undergone cardiac surgery at another institution.The most common procedures were repair of aortic coarctation in 14(28%)patients,aortic valve replacement in 6(12%)patients,and composite aortic root/ascending aorta replacement in 7(14%)patients,with 7 patients undergoing repair of more than one lesion.Aortic dissection required operative intervention in 5 patients.After initial Mayo Clinic surgery,subsequent operations were required in 6(13%)patients.Average hospital length of stay was 6±2 d.There were 4(8%)early surgical deaths.Freedom from death was 97%and 89%at 10 and 20 years,and the freedom from reoperation was 93%and 81%at 10 and 20 years.CONCLUSION Cardiovascular surgery is associated with 8%early mortality given the medical complexity of TS patients.Those who survive to dismissal have good survival.Later cardiovascular reoperations are not rare.