World journal for pediatric & congenital heart surgery
-
World J Pediatr Congenit Heart Surg · Apr 2014
Surgical treatment of common arterial trunk in patients beyond the first year of life.
Common arterial trunk (persistent truncus arteriosus) is a rare cardiac defect requiring surgical repair early in life because of the fast development of pulmonary vascular obstructive disease. We present our institutional experience with patients having common arterial trunk who are diagnosed after one year of age. ⋯ Complete repair of common arterial trunk in patients older than one year of age is feasible in appropriately selected cases. Preoperative cardiac catheterization to assess reactivity of the pulmonary vascular bed is important as are appropriate strategies for postoperative management. Together, these elements make it possible to achieve primary repair with excellent outcomes despite late presentation.
-
World J Pediatr Congenit Heart Surg · Apr 2014
Troponin I levels in extracorporeal membrane oxygenation following congenital heart surgery.
Correlating postcardiotomy extracorporeal membrane oxygenation (ECMO) troponin I (TnI) levels and outcomes. ⋯ Postcardiotomy ECMO was most commonly required after aortic arch repair. In the absence of ongoing myocardial insult due to ECMO hardware issues, coronary insufficiency or residual lesions, plateau TnI levels at 48 hours may seem to indicate an unfavorable outcome due to irreversible myocardial damage.
-
World J Pediatr Congenit Heart Surg · Jan 2014
Comparative Study Observational StudyPerioperative levels of tumor necrosis factor-α correlate with outcomes in children and adults with tetralogy of Fallot undergoing corrective surgery.
Previous studies reporting on tumor necrosis factor-α (TNF-α) as a marker of inflammatory response (IR) in patients with congenital heart disease were limited by small sample size and variability in diagnosis. We report perioperative changes in TNF-α levels and their correlation with preoperative factors and clinical outcomes in a large homogenous group of patients with tetralogy of Fallot (TOF) undergoing definitive repair at a tertiary care center. ⋯ We demonstrated a rise in serum TNF-α levels in patients with TOF undergoing definitive repair on CPB, which correlated with preoperative severity of cyanosis, nutritional status, and adverse clinical outcomes. The TNF-α levels may be monitored to identify cyanotic patients at an increased risk of exhibiting augmented IR to CPB.
-
World J Pediatr Congenit Heart Surg · Jan 2014
Multicenter StudyRelationship between risk-adjustment tools and the pediatric logistic organ dysfunction score.
The Risk-Adjusted Classification for Congenital Heart Surgery (RACHS-1) method and Aristotle Basic Complexity (ABC) scores correlate with mortality. However, low mortality rates in congenital heart disease (CHD) make use of mortality as the primary outcome measure insufficient. Demonstrating correlation between risk-adjustment tools and the Pediatric Logistic Organ Dysfunction (PELOD) score might allow for risk-adjusted comparison of an outcome measure other than mortality. ⋯ Risk-Adjusted Classification for Congenital Heart Surgery categories and ABC levels correlate with postoperative organ dysfunction as measured by PELOD. However, the correlation was weak, potentially due to limitations of the PELOD score itself. Identification of a more accurate metric of morbidity for the congenital heart disease population is needed.
-
World J Pediatr Congenit Heart Surg · Jan 2014
Comparative StudyA complete extracorporeal circulation-free approach to patients with functionally univentricular hearts provides superior early outcomes.
We compared the early outcomes of patients undergoing extracardiac total cavopulmonary connection (TCPC) with or without cardiopulmonary bypass (CPB). ⋯ The TCPC without CPB is easy to perform, is cost-effective, and is associated with superior early postoperative outcomes as compared to TCPC on CPB. With appropriate modifications, this operation can be performed in almost all morphological subsets of patients who do not need an associated intracardiac procedure.