1
|
Khainza RE, Oketcho M, Aliku T, Namuyonga J, Ndagire E, Mwambu T, Muhoozi RM, Obongnyinge B, Tumwebaze H, Mbabazi N, Akech T, Nakato A, Killen A, Ofumbi GO, Lwabi P, Omagino J, Lubega S. Primary surgical repair of tetralogy of fallot at the Uganda Heart Institute: a ten-year review of 30day mortality and morbidity. BMC Cardiovasc Disord 2024; 24:322. [PMID: 38918721 PMCID: PMC11202334 DOI: 10.1186/s12872-024-03991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD) worldwide. It accounts for 7% of CHD cases in Uganda and leads to fatal outcomes in the long term without surgery. Surgery is often delayed in developing countries like Uganda due to limited resources. OBJECTIVE This study aimed to determine the early surgical outcomes of patients with TOF who underwent primary intracardiac repair at the Uganda Heart Institute (UHI) and to identify factors associated. METHODOLOGY This retrospective chart review evaluated outcomes of primary TOF repair patients at UHI from February 2012 to October 2022. Patient outcomes were assessed from surgery until 30 days post-operation. RESULTS Out of the 104 patients who underwent primary TOF repair at UHI, records of 88 patients (84.6%) were available for review. Males accounted for 48.9% (n = 43). The median age at the time of operation was 4 years (with an interquartile range of 2.5-8.0 years), ranging from 9 months to 16 years. Genetic syndromes were present in 5/88 (5.7%). These included 2 patients with trisomy 21, 2 with Noonan's, and 1 with 22q11.2 deletion syndrome. Early postoperative outcomes for patients included: residual ventricular septal defects in 35/88 (39.8%), right ventricular dysfunction in 33/88 (37.5%), residual pulmonary regurgitation in 27/88 (30.7%), residual right ventricular outflow tract obstruction in 27/88 (30.0%), pleural effusion in 24/88 (27.3%), arrhythmias in 24/88(27.3%), post-operative infections in 23/88(26.1%) and left ventricular systolic dysfunction in 9/88 (10.2%). Out of the children who underwent surgery after one year of age, 8% (7 children) died within the first 30 days. There was a correlation between mortality and post-operative ventilation time, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, preoperative oxygen saturations, RV and LV dysfunction and the operating team. CONCLUSION The most frequent outcomes after surgery were residual ventricular septal defects and right ventricular failure. In our study, the 30-day mortality rate following TOF repair was 8%. Deceased patients had lower pre-operative oxygen levels, longer CPB and cross-clamp times, longer post-operative ventilation, RV/LV dysfunction, and were more likely operated by the local team.
Collapse
Affiliation(s)
- Rebecca Esther Khainza
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda.
- Department of paediatrics, Mulago National Referral Hospital, Kampala, Uganda.
| | - Michael Oketcho
- Department of Cardiovascular and Thoracic Surgery UHI, Kampala, Uganda
| | - Twalib Aliku
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
- Uganda Christian University School of Medicine, Mukono, Uganda
| | - Judith Namuyonga
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
- Department of Paediatrics, Makerere University, Kampala, Uganda
| | - Emma Ndagire
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| | - Tom Mwambu
- Department of Cardiovascular and Thoracic Surgery UHI, Kampala, Uganda
| | | | - Bernard Obongnyinge
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| | - Hilda Tumwebaze
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| | - Nestor Mbabazi
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
- Department of paediatrics, Mulago National Referral Hospital, Kampala, Uganda
| | - Teddy Akech
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| | - Aisha Nakato
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| | - Angelline Killen
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| | | | - Peter Lwabi
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| | - John Omagino
- Department of Cardiovascular and Thoracic Surgery UHI, Kampala, Uganda
| | - Sulaiman Lubega
- Department of Paediatric Cardiology, Uganda Heart Institute (UHI), Kampala, Uganda
| |
Collapse
|
2
|
Romeo JL, Etnel JR, Takkenberg JJ, Roos-Hesselink JW, Helbing WA, van de Woestijne P, Bogers AJ, Mokhles MM. Outcome after surgical repair of tetralogy of Fallot: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2020. [DOI: 10.1016/j.jtcvs.2019.08.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
3
|
Isorni MA, Martins D, Ben Moussa N, Monnot S, Boddaert N, Bonnet D, Hascoet S, Raimondi F. 4D flow MRI versus conventional 2D for measuring pulmonary flow after Tetralogy of Fallot repair. Int J Cardiol 2019; 300:132-136. [PMID: 31676117 DOI: 10.1016/j.ijcard.2019.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND After tetralogy of Fallot (TOF) repair, pulmonary regurgitation and right ventricular function must be monitored. Conventional (2D) cardiac magnetic resonance (CMR) is currently the clinical reference method for measuring pulmonary regurgitation. However, 4DFlow CMR has been reported to provide a more comprehensive flow analysis than 2D CMR. We aimed to compare 4DFlow CMR to 2D CMR for assessing pulmonary regurgitation and flow, as well as aortic flow, in children and adults after surgical repair of TOF. METHODS Retrospective analysis of patients with repaired TOF admitted for cardiac MRI with 4DFlow acquisition from 2016 to 2018. Linear regression was used to assess correlations and Bland-Altman analyses were performed. RESULTS The 60 included patients had a mean age of 18.2 ± 10.4 years (range, 2-54 years). Significant correlations between the two techniques were found for pulmonary regurgitant fraction (R [2] = 0.6642, p < 0.0001), net pulmonary flow (R [2] = 0.6782, p < 0.0001), forward pulmonary flow (R [2] = 0.6185, p < 0.0001), backward pulmonary flow (R [2] = 0.8192, p < 0.0001), and aortic valve flow (R [2] = 0.6494, p < 0.0001). The Bland-Altman analysis showed no significant bias, narrow limits of agreement, and few scattered points. The correlation between pulmonary and aortic flow was better with 4DFlow CMR than with 2D CMR (R [2] = 0.8564, p < 0.0001 versus R [2] = 0.4393, p < 0,0001, respectively). Interobserver reliability was good. CONCLUSION These results establish the feasibility and reliability of 4DFlow CMR for assessing pulmonary flow in a large paediatric and adult population with repaired TOF. 4DFlow CMR may be more reliable than 2D MRI for pulmonary flow assessment after TOF repair.
Collapse
Affiliation(s)
- M A Isorni
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - D Martins
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France; Pediatric Cardiology Unit, Hospital de Santa Cruz, Lisboa, Portugal
| | - N Ben Moussa
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - S Monnot
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - N Boddaert
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France
| | - D Bonnet
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France
| | - S Hascoet
- Unité de radiologie diagnostique et thérapeutique, Hôpital Marie Lannelongue, 133, avenue de la résistance, 92350, Le Plessis Robinson, France
| | - F Raimondi
- Unité médicochirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France; Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris, Cedex 15, France.
| |
Collapse
|
4
|
Yao C, Wang X, Zhang J, Qiu L, Ye W, Wang C. Dextrocardia with complete AV block and the implantation of a temporary pacemaker before cesarean section: A case report. Medicine (Baltimore) 2019; 98:e15211. [PMID: 31027067 PMCID: PMC6831432 DOI: 10.1097/md.0000000000015211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Patients with situs inversus totalis (SIT) and complete atrioventricular (AV) block are extremely rare, and only few cases have been reported up to now. Due to the rarity of such condition and its anatomical complexity, we reported this case as a reference for obstetricians, providing valuable insights into potential clinical treatment. PATIENT CONCERNS We reported a case of 30-year-old patient with complete AV block, and her heart rate was only about 45 beats per minute. DIAGNOSES The patient was diagnosed with term delivery with SIT and complete AV block. INTERVENTIONS A temporary pacemaker (TPM) was implanted before cesarean section (CS) because of complete AV block. OUTCOMES CS was performed successfully after the implantation of a TPM. The heart rate remained stable, and the 24-hour blood loss was limited. LESSONS This study presents a complex heart disease case which needed more frequent antenatal examination and restriction of physical activity. To reduce the risk of pregnancy, basic disease needed to be cured before pregnancy. Our findings could provide guidance for future clinical studies.
Collapse
Affiliation(s)
| | | | | | - Lan Qiu
- Department of Anesthesia, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu, China
| | | | | |
Collapse
|