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Helal AM, Baho HA, Elmahrouk AF, Mashali MH. PR and QRS interval changes after transcatheter pulmonary valve replacement in children. Egypt Heart J 2023; 75:66. [PMID: 37486586 PMCID: PMC10366049 DOI: 10.1186/s43044-023-00394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Changes in PR intervals after transcatheter pulmonary valve replacement (TCPVR) have not been thoroughly evaluated in children. This study evaluated the changes in PR and QRS intervals six months after TCPVR in children with congenital heart disease. RESULTS This study included 41 patients who underwent TCPVR from 2010 to 2022. ECG of patients was reviewed before and six months after TCPVR, and the PR and QRS intervals were reported. Right ventricular systolic pressure (RVSP) was retrieved indirectly from echocardiography and compared pre- and 6-months after TPVR. The median age was 13 years (25th-75th percentiles: 11-16), and 61% were males. The preoperative diagnosis was tetralogy of Fallot (n = 29, 71%), transposition of great vessels (n = 4, 10%), common arterial trunk (n = 3, 7%), pulmonary valve stenosis (n = 3, 7%) and pulmonary atresia (n = 2, 5%). The Melody valve was used in 30 patients, and Edwards Sapien was used in 11 patients. RVSP was significantly reduced six months after the procedure (pre-RVSP 40 (30-55) mmHg vs. post-RVSP 25 (20-35) mmHg; P < 0.001). The PR interval was 142 (132-174) msec before TPVR and 146 (132-168) msec post-TCPVR (P = 0.442). Post-TPVR PR was positively related to the pre-PR (β: 0.79 (0.66-0.93), P < 0.001) and inversely related to the right ventricular outflow tract size (- 1.48 (- 2.76 to - 0.21), P = 0.023). The pre-TPVR QRS was 130 (102-146) msec, and the post-TPVR QRS was 136 (106-144) msec (P = 0.668). CONCLUSIONS In children undergoing TCPVR, the PR and QRS intervals did not change significantly during a 6-month follow-up.
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Affiliation(s)
- Abdelmonem M Helal
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Haysam A Baho
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, 21499, Jeddah, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Mohamed H Mashali
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
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Yousef AA, Elmahrouk AF, Hamouda TE, Helal AM, Dohain AM, Alama A, Shihata MS, Al-Radi OO, Jamjoom AA, Mashali MH. Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center. Egypt Heart J 2023; 75:53. [PMID: 37378691 DOI: 10.1186/s43044-023-00381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Despite the improved management of patients with a single ventricle, the long-term outcomes are not optimal. We reported the outcomes of the bidirectional Glenn procedure (BDG) and factors affecting the length of hospital stay, operative mortality, and Nakata index before Fontan completion. RESULTS This retrospective study included 259 patients who underwent BDG shunt from 2002 to 2020. The primary study outcomes were operative mortality, duration of hospital stay, and Nakata index before Fontan. Mortality occurred in 10 patients after BDG shunt (3.86%). By univariable logistic regression analysis, postoperative mortality after BDG shunt was associated with high preoperative mean pulmonary artery pressure (OR: 1.06 (95% CI 1.01-1.23); P = 0.02). The median duration of hospital stay after BDG shunt was 12 (9-19) days. Multivariable analysis indicated that Norwood palliation before BDG shunt was significantly associated with prolonged hospital stay (β: 0.53 (95% CI 0.12-0.95), P = 0.01). Fontan completion was performed in 144 patients (50.03%), and the pre-Fontan Nataka index was 173 (130.92-225.34) mm2/m2. Norwood palliation (β: - 0.61 (95% CI 62.63-20.18), P = 0.003) and preoperative saturation (β: - 2.38 (95% CI - 4.49-0.26), P = 0.03) were inversely associated with pre-Fontan Nakata index in patients who had Fontan completion. CONCLUSIONS BDG had a low mortality rate. Pulmonary artery pressure, Norwood palliation, cardiopulmonary bypass time, and pre-BDG shunt saturation were key factors associated with post-BDG outcomes in our series.
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Affiliation(s)
- Aly A Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Tamer E Hamouda
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Abdelmonem M Helal
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed M Dohain
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulhadi Alama
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohammad S Shihata
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiac Surgery Section, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohamed H Mashali
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Heidendael JF, Engele LJ, Bouma BJ, Dipchand AI, Thorne SA, McCrindle BW, Mulder BJM. Coagulation and Anticoagulation in Fontan Patients. Can J Cardiol 2022; 38:1024-1035. [PMID: 35122939 DOI: 10.1016/j.cjca.2022.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 01/22/2023] Open
Abstract
Patients with a Fontan circulation for single-ventricle physiology are at increased risk of developing thromboembolic events. Thromboembolic events can lead to failure of the Fontan circulation, chronic sequelae in case of stroke, and early mortality. Controversies exist regarding the substrates, risk factors, and optimal detection methods for thromboembolic events. Despite the major clinical implications, there is currently no consensus regarding the optimal antithrombotic therapy to prevent or treat thromboembolic events after the Fontan procedure. In this review we aimed to untangle the available literature regarding antithrombotic prophylaxis and treatment for pediatric and adult Fontan patients. A decision-tree algorithm for thromboprophylaxis in Fontan patients is proposed. Additionally, the current state of knowledge is reviewed with respect to the epidemiology, pathophysiology, and detection of thromboembolic events in Fontan patients, and important evidence gaps are highlighted.
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Affiliation(s)
- Josephine F Heidendael
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Leo J Engele
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Anne I Dipchand
- Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sara A Thorne
- Department of Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Bahaidarah S, Al-Ata J, Abdelmohsen G, Alkhushi N, Abdelsalam M, Mujahed M, Al-Radi O, Elassal A, Zaher Z, Azhar A, Dohain AM. Cardiac catheterization addressing early post-operative complications in congenital heart surgery-a single-center experience. Egypt Heart J 2020; 72:83. [PMID: 33226532 PMCID: PMC7683629 DOI: 10.1186/s43044-020-00117-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. All patients who underwent cardiac catheterization after congenital heart surgery during the same admission of cardiac surgery from November 2015 to May 2018 were included in the study. RESULTS Thirty procedures were performed for 27 patients (20 interventional and 10 diagnostic). The median age of the patients was 15 months (15 days to 20 years), median weight was 8.2 kg (3.4 to 53 kg), and median time from surgery was 3 days (0-32 days). Eleven procedures were performed for 11 patients on extracorporeal membrane oxygenation (ECMO) support. The main indications for catheterization included the inability to wean from ECMO (10 procedures) and cyanosis (10 procedures). Interventional procedures included angioplasty using stents (10 procedures, success rate of 90%), angioplasty using only balloons (2 procedures, success rate of 50%), and occlusion for residual shunts (8 procedures, success rate of 100%). No mortality was recorded during any procedure. Vasoactive-inotropic score had significantly decreased 48 h after catheterization when compared to pre-catheterization scores (p = 0.0001). Moreover, 72% of patients connected to ECMO support were successfully weaned from ECMO after catheterization. Procedural complications were recorded in 3 interventional procedures. Survival to hospital discharge was 55.5% and overall survival was 52%. Patients on ECMO support had a higher mortality than other patients. CONCLUSION Cardiac catheterization can be performed safely in the early post-operative period, and it could improve the outcome of the patient (depending on the complexity of the cardiac lesions involved).
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Affiliation(s)
- Saud Bahaidarah
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia
| | - Jameel Al-Ata
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia
| | - Gaser Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia. .,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt.
| | - Naif Alkhushi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia
| | - Mohamed Abdelsalam
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia.,Cardiology Department, Benha University, Benha, Egypt
| | - Mohammed Mujahed
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia
| | - Osman Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Elassal
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.,Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt
| | - Zaher Zaher
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmad Azhar
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed M Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia.,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt
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Dohain AM, Ismail MF, Elmahrouk AF, Hamouda TE, Arafat AA, Helal A, Edrees A, Alamri RM, Al-Mojaddidi AMA, Abdelmotaleb ME, Elassal AA, Al-Radi OO, Jamjoom AA. The outcomes of bidirectional Glenn before and after 4 months of age: A comparative study. J Card Surg 2020; 35:3326-3333. [PMID: 33032371 DOI: 10.1111/jocs.15055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aim to present our experience with the bidirectional Glenn (BDG) in patients less than 4 months of age and to compare their outcomes with the patients who underwent BDG after the age of 4 months. METHODS A retrospective review of data was performed for patients who underwent the BDG procedure from 2002 to 2018 at our institutions. We reviewed the patients' demographics, echocardiographic findings, cardiac catheterization data, operative details, postoperative data, and outcome variables. RESULTS The study was conducted on 213 patients. At the time of the BDG operation, 32 patients were younger than 4 months (younger group) and 181 patients were older than 4 months (older group). The preoperative mean pulmonary artery pressure was significantly higher in the younger group (p = .035) but there were no significant differences between both groups in Qp/Qs, ventricular end-diastolic pressure, indexed pulmonary vascular resistance, and preoperative oxygen saturation. However, the initial postoperative oxygen saturation of the younger group was lower than the older group (p = .007). The duration of mechanical ventilation, duration of pleural drainage, ICU stay, and hospital stay after BDG were significantly longer in the younger group compared to the older group. The early mortality was higher in the younger group, but this difference did not reach statistical significance (p = .283). CONCLUSION Performing BDG procedure in infants less than 4 months of age is safe, with favorable outcomes. Early BDG is associated with a less-smooth postoperative course without a significant increase in early or late mortality.
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Affiliation(s)
- Ahmed M Dohain
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Mohamed F Ismail
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Mansoura University, Mansoura, Egypt
| | - Ahmed F Elmahrouk
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Tamer E Hamouda
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Abdelmonem Helal
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt.,Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Azzahra Edrees
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawan M Alamri
- Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M A Al-Mojaddidi
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed E Abdelmotaleb
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Elassal
- Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt
| | - Osman O Al-Radi
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Elmahrouk AF, Ismail MF, Arafat AA, Dohain AM, Helal AM, Hamouda TE, Galal M, Edrees AM, Al-Radi OO, Jamjoom AA. Outcomes of biventricular repair for shone's complex. J Card Surg 2020; 36:12-20. [PMID: 33032391 DOI: 10.1111/jocs.15090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shone's complex is a rare lesion affecting the mitral valve (MV) and left ventricular outflow tract (LVOT). The objective of this study is to report the outcomes after Shone's complex repair, the growth of mitral and aortic valve and LVOT, and long-term survival. METHODS This retrospective study included all patients diagnosed with Shone's complex, who underwent biventricular repair. Data including patients' characteristics, type of the MV lesion and the associated lesions were collected. Patients were followed up regularly with echocardiography, and the changes in mitral and aortic valve z-score and LVOT z-score were recorded. RESULTS Thirty-seven patients were included in the study, the median age was 3.4 months, and 11 patients (30.6%) had pulmonary hypertension. The main procedure performed during the first surgical intervention was coarctation repair in 26 patients (70%). Twelve patients had MV repair, and five had MV replacement. Operative mortality occurred in 1 patient (2.7%), median follow up was 52 (25-75th percentile: 22-84) months. Survival at 1, 5, and 10 years was 94.4%, 90%, and 76.9%, respectively. Reoperation was required in 13 patients, mainly for LVOT repair (n = 8). Reoperation was significantly associated with associated aortic valve lesion (p = .044). The growth of the MV z-score was 0.35 per year; p < .001, aortic valve z-score 0.086 per year; p = 0.422, and the LVOT z-score was 0.53 per year; p = .01. CONCLUSION Biventricular repair of Shone's complex has good outcomes. Reoperation is frequently encountered, especially with low aortic valve z-score. The MV and LVOT have significant growth following Shone's complex repair.
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Affiliation(s)
- Ahmed F Elmahrouk
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Mohamed F Ismail
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Mansoura University, Mansoura, Egypt
| | - Amr A Arafat
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Ahmed M Dohain
- Department of Pediatric Cardiology, Cairo University, Giza, Egypt.,Department of Pediatric Cardiology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdelmonem M Helal
- Department of Pediatric Cardiology, Cairo University, Giza, Egypt.,Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Tamer E Hamouda
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Benha University, Benha, Egypt
| | - Mohamed Galal
- Department of Cardiac Surgery, Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Azzahra M Edrees
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Cardiac Surgery Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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