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Zaidi AK, Arif A, Butt M, Tebha SS, Ray I, Yosufi A, Dehgani-Mobaraki P. Coexistence of proboscis lateralis and multiple craniofacial, neurological, cardiac and spinal deformities: a one-of-a-kind case report. BMC Pediatr 2023; 23:70. [PMID: 36759785 PMCID: PMC9912482 DOI: 10.1186/s12887-023-03882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Proboscis lateralis (PL) is an uncommon congenital facial deformity marked by the protrusion of a primitive tubular structure made up of skin and soft tissue that generally emerges from the eye's medial canthus and is associated with some craniofacial deformities. We report the first case of PL with multiple craniofacial, neurological, cardiac, and spinal anomalies. CASE PRESENTATION A full-term female baby delivered by cesarean section cried immediately at birth. The mother reported having a normal pregnancy but has a history of x-ray during her first trimester. The baby was born with a rare presentation of proboscis lateralis which was accompanied by multiple anomalies, including but not limited to bilateral colpocephaly, corpus callosum agenesis, complex cyanotic congenital heart disease, and hemivertebra of the T10 body. CONCLUSION PL is an uncommon congenital condition that causes a variety of craniofacial abnormalities. Multiple additional defects affecting various organ systems should also be evaluated in a person diagnosed with PL.
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Affiliation(s)
- Asiya Kamber Zaidi
- Research Fellow, Associazione Naso Sano, Perugia, Italy ,grid.415481.d0000 0004 1767 1900MGM Medical College Indore (MP), Indore, India
| | - Aabiya Arif
- grid.413093.c0000 0004 0571 5371Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Mehwish Butt
- grid.414695.b0000 0004 0608 1163Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Sameer Saleem Tebha
- grid.414695.b0000 0004 0608 1163Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Ishita Ray
- grid.415481.d0000 0004 1767 1900MGM Medical College Indore (MP), Indore, India
| | - Abubakr Yosufi
- Department of Research, Kabul University of Medical Sciences, Kabul, Afghanistan.
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Kumar A, Joshi S, Ghumman B, Chaudhary V. Comparison of the predictive value of thromboelastography and Sonoclot analysis for postoperative bleeding in children undergoing corrective surgery for cyanotic congenital heart disease. Med J Armed Forces India 2022; 78:413-421. [PMID: 36267513 PMCID: PMC9577242 DOI: 10.1016/j.mjafi.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 08/19/2020] [Indexed: 11/20/2022] Open
Abstract
Background The aim of the study was to compare the predictive value of Sonoclot analysis and thromboelastography (TEG) for postoperative bleeding in children younger than 12 years coming for cardiac surgery for congenital cyanotic heart disease. Methods This is a prospective, observational study carried out in a single tertiary care military hospital. Ninety patients of the paediatric age group undergoing bypass cardiac surgery for correction of congenital cyanotic heart defect were included in the study. Laboratory-derived values to assess coagulation status (prothrombin time, international normalisation ratio, activated partial thromboplastin time) and point-of-care Sonoclot- and TEG-derived parameters were noted at the start of surgery and postoperatively in all patients. Bleeders were predefined on the basis of chest tube drainage. Results The incidence of bleeders was 42.2% (38/90 patients), whereas 57.8% (52/90 patients) were non-bleeders. The postoperative R value and preoperative gbPF test were predictive for postoperative bleeders on multivariate analysis. Postoperative gbPF had the highest area under the curve (0.72), with a cut-off value of 1.75, and gbPF had 82% sensitivity and 71% specificity in predicting significant postoperative bleeding in paediatric cyanotic congenital heart surgeries. Transfusion requirements and mechanical ventilation duration were higher in bleeders; however; length of intensive care unit stay, incidence of sepsis and mortality were similar in both the groups. Conclusion Bleeding in patients undergoing corrective surgery for cyanotic congenital heart disease could be predicted by the preoperative gbPF and postoperative R value. Among these, preoperative gbPF has the maximum predictive value.
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Affiliation(s)
- Alok Kumar
- Classified Specialist (Anaesthesia & CT Anaesthesia), Army Hospital (R&R), New Delhi, India
| | - Saajan Joshi
- Senior Adviser (Anaesthesia & Trained in Paed Anaesthesia), Army Hospital (R&R), India
| | - B.P.S. Ghumman
- Consultant (Anaesthesia & CT Anaesthesia), Fortis Hospital, Mohali, India
| | - Vishal Chaudhary
- Senior Adviser & HOD (Anaesthesia & CT Anaesthesia), AICTS, Pune, India
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Muto M, Sugita K, Matsuba T, Kedoin C, Matsui M, Ikoma S, Murakami M, Yano K, Onishi S, Harumatsu T, Yamada K, Yamada W, Matsukubo M, Kawano T, Machigashira S, Torikai M, Kaji T, Ibara S, Imoto Y, Soga Y, Ieiri S. How should we treat representative neonatal surgical diseases with congenital heart disease? Pediatr Surg Int 2022; 38:1235-1240. [PMID: 35838788 DOI: 10.1007/s00383-022-05178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Representative neonatal surgical diseases are often complicated by congenital heart disease (CHD). We reviewed our decade of experience from the perspective of the prognosis and report on the management of infants with CHD. METHODS Cases with and without CHD between 2011 and 2020 were retrospectively compared. Qualitative data were analyzed using a chi-square test with Yates' correction, and quantitative data were compared using Student's t-test. RESULTS Of the 275 neonatal surgical cases, 36 had CHD (13.1%). Ventricular septal defect was the most common cardiac anomaly, followed by atrial septal defect. Esophageal atresia showed the highest complication rate of CHD (43.8%, 14/32) followed by duodenal atresia (38.5%, 10/26). The mortality rates of patients with and without CHD (22.2% [8/36] vs. 1.3% [3/239]) were significantly different (χ2 = 30.6, p < 0.0001). Of the eight deaths with CHD, six patients had cyanotic complex CHD. Notably, four of these patients died from progression of inappropriate hemodynamics in the remote period after definitive non-cardiac surgery. CONCLUSION Considering its high-mortality, the presence of CHD, especially cyanotic heart disease, is an important issue to consider in the treatment of neonatal surgical diseases. Pediatric surgeons should be alert for changes in hemodynamics after surgery, as these may affect mortality.
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Affiliation(s)
- Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan.
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Tomoyuki Matsuba
- Department of Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Shinichiro Ikoma
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Makoto Matsukubo
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Seiro Machigashira
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Satoshi Ibara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Yutaka Imoto
- Department of Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890 -8520, Japan
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De Rubens-Figueroa J, Ceballos-Cantú JC, López-Ornelas AF, Vazquéz-Perdomo M, Pablos-Hach JL. [Frecuencia de cardiopatías congénitas y adquiridas en 4,544 niños. Estudio basado en ecocardiografía]. Arch Cardiol Mex 2021; 91:407-414. [PMID: 33328689 PMCID: PMC8641468 DOI: 10.24875/acm.20000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objetivo: Mostrar la frecuencia de las cardiopatías congénitas y adquiridas en nuestra institución. Material y métodos: Se realizó un estudio retrospectivo, transversal y descriptivo donde se revisaron las libretas de los estudios ecocardiográficos, realizados en pacientes cuyas edades fueron de recién nacidos a 18 años y se agruparon por tipos de cardiopatías. En el análisis estadístico obtuvimos la frecuencia de ocurrencia, el valor de la proporción de cada cardiopatía. Resultados: En los últimos 10 años ingresaron 4,544 pacientes con cardiopatía. Las 14 cardiopatías más frecuentes correspondieron al 89.21% de la estadística. La cardiopatía más frecuente fue la persistencia del conducto arterioso con 896 pacientes (19%) y la cardiopatía adquirida más frecuente fue la miocardiopatía, con 116 pacientes (2.5%). La tetralogía de Fallot fue la cardiopatía cianógena más frecuente, con 139 pacientes (3%), a diferencia de otros países. Conclusiones: La frecuencia de cardiopatías congénitas y adquiridas es variable en diferentes áreas étnicas y geográficas.
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Affiliation(s)
- Jesús De Rubens-Figueroa
- Servicio de Cardiología, Laboratorio de Ecocardiografía, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Juan C Ceballos-Cantú
- Curso de pregrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Ana F López-Ornelas
- Curso de pregrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - José L Pablos-Hach
- Instituto Tecnológico y de Estudios Superiores de Monterrey. Ciudad de México, México
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Ezzeldin DA, Hafez MS, Mansour A. Multidetector computed tomography for patients with congenital heart disease: a multi-center registry from Africa and Middle East; patients' characteristics and procedural safety. Egypt Heart J 2021; 73:90. [PMID: 34655343 PMCID: PMC8520552 DOI: 10.1186/s43044-021-00217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background We aimed to establish a clinical registry for patients with congenital heart disease who referred to multidetector computed tomography in our country, to describe the pattern and clinical profile of such patients and document the safety and efficacy of the procedure in our daily practice. Results A total 2310 studies were analyzed after excluding studies with missed, and lost data. Half of our study population—1215 patients—52.5% were males. The median age of the patients was 12 months (IQR 37 months), and the youngest patient was 3 days old. The eldest patient was 50 years old. 68.27% of the patients were less than 2 years old, and two-third of the whole studied population 66.7% had cyanotic heart disease. Minor local access complications, complications related to anesthetic drugs, and allergic reactions were the most commonly encountered complications, with only single mortality mainly due to multiple associated multisystem congenital malformation. Conclusions Most of our patients with congenital heart disease referred for MDCT study were infants and young children. The majority of them had complex cyanotic heart disease. The study is safe, with excellent diagnostic yield and safe with very low incidence of complications.
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Affiliation(s)
- Dina Adel Ezzeldin
- Cardiology Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya Square, Next to Alnour Mosque, Cairo, 11591, Egypt.
| | - Mohamed Saber Hafez
- Cardiology Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya Square, Next to Alnour Mosque, Cairo, 11591, Egypt
| | - Amr Mansour
- Cardiology Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya Square, Next to Alnour Mosque, Cairo, 11591, Egypt
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Barwad P, Prasad K, Vijay J, Naganur S. Is there a transcatheter solution for a sick neonate with hypoplastic right heart syndrome?: Pulmonary valve perforation in a neonate with hypoplastic right ventricle with pulmonary atresia, restrictive VSD-a case report. Egypt Heart J 2020; 72:64. [PMID: 32990873 PMCID: PMC7524925 DOI: 10.1186/s43044-020-00097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypoplastic right heart syndrome with pulmonary atresia is a rare cyanotic heart disease with poor prognosis requiring urgent intervention to establish the pulmonary blood flow. Pulmonary blood flow is achieved by BT shunt or percutaneous techniques like PDA stenting or pulmonary valve perforation. Various series have shown that early surgical intervention causes high mortality in these patients. Pulmonary valve perforation is a suitable, physiological alternative to surgical techniques in selected patients. CASE PRESENTATION We report a case of hypoplastic right heart syndrome with pulmonary atresia and restrictive VSD presenting with cyanosis from birth and underwent pulmonary valve perforation successfully. CONCLUSION Duct-dependent pulmonary circulation is a pediatric emergency, palliative procedure for establishing adequate pulmonary blood flow is essential early in the life. In the management of duct-dependent pulmonary circulation, RVOT perforation is an effective and safe option in suitable high-risk subgroups. The induced pulmonary regurgitation along with established physiological antegrade flow would be beneficial in the remodeling of tripartite/hypertrophied small RV.
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Affiliation(s)
- Parag Barwad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, 160 012, India
| | - Krishna Prasad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, 160 012, India
| | - Jyothi Vijay
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, 160 012, India
| | - Sanjeev Naganur
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, 160 012, India.
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Yamashita K, Kibe T, Kohjitani A, Higa Y, Niiro A, Uchino M, Aoyama K, Shidou R, Hashiguchi K, Sugimura M. General Anesthesia During Lip Repair and Palatoplasty After Glenn Surgery. Anesth Prog 2020; 67:107-108. [PMID: 32633768 DOI: 10.2344/anpr-67-02-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/24/2019] [Indexed: 11/11/2022] Open
Abstract
We performed general anesthesia for a lip repair and palatoplasty in a patient with left ventricular hypoplasia following a Glenn procedure. Preoperative examination revealed hemorrhagic diathesis, hypoxemia, and secondary polycythemia. After completion of the palatoplasty, hypoxemia and intraoral bleeding were observed, and reintubation was required. The bleeding risk was likely increased in this patient due to several factors including the surgical procedure and concurrent antithrombotic therapy. In conclusion, the risks associated with hypoxemia and increased bleeding must be considered for the safe provision of general anesthesia during palatoplasty procedures in patients with cyanotic heart disease.
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Affiliation(s)
- Kaoru Yamashita
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Toshiro Kibe
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Surgery, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsushi Kohjitani
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yurina Higa
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ayako Niiro
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Minako Uchino
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kanae Aoyama
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Rumi Shidou
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kohei Hashiguchi
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsutaka Sugimura
- Department of Dental Anesthesiology, Field of Oral Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Willems A, Patte P, De Groote F, Van der Linden P. Cyanotic heart disease is an independent predicting factor for fresh frozen plasma and platelet transfusion after cardiac surgery. Transfus Apher Sci 2019; 58:304-309. [PMID: 30904398 DOI: 10.1016/j.transci.2019.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/04/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Cyanotic heart disease is associated with increased risk of bleeding in children undergoing cardiac surgery. We studied if the presence of a cyanotic heart disease was an independent predictive factor for fresh frozen plasma (FFP) and platelets transfusion in these patients. In children with ROTEM measurements, we also tried to characterize the coagulation profile between both groups. DESIGN Retrospective observational study. SETTING Tertiary university hospital; single center. PARTICIPANTS All consecutive children admitted for cardiac surgery with cardiopulmonary bypass (CPB) from January 2006 to December 2014. Patients who received FFP in the CPB priming were excluded. Multivariate logistic regression was used to determine the predictive factors for FFP and platelet transfusions. INTERVENTION none. MEASUREMENTS AND MAIN RESULTS From the 1846 patients included for analysis: 1063 were acyanotic and 783 were cyanotic. The presence of cyanotic heart disease was an independent predicting factor for both FFP (OR: 2.09; 95%CI: 1.44-3.02) and platelets (OR:3.98; 95%CI: 2.28-6.70) transfusion. Cyanotic children exhibited also higher perioperative blood losses [Intraoperative: 31.1 (17.6-50.4) versus 26.7 (14.8-44.7); P < 0.001 and Postoperative: 31.2 (19.1-51.9) versus 16.9 (10.4-26.9); P < 0.001]. Thromboelastometry assays after separation from CPB and heparin reversal revealed more complex coagulation disturbances in cyanotic than acyanotic children. CONCLUSION Children with a cyanotic heart disease are at higher risk of FFP and platelet transfusion after cardiac surgery. Intraoperative monitoring should be used to guide administration of blood and haemostatic product in this population at high risk of postoperative bleeding.
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Affiliation(s)
- Ariane Willems
- Leids Universitair Medisch Centrum, Pediatric Intensive Care Unit, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Philippe Patte
- Hôpital Civil Marie Curie, Department of Anesthesiology, Chausée de Bruxelles 140, 6042 Lodelinsart, Belgium
| | - Françoise De Groote
- Hôpital des Enfants Reine Fabiola, Department of Anesthesiology, Avenue J.J. Crocq, 1020 Bruxelles, Belgium
| | - Philippe Van der Linden
- Hôpital des Enfants Reine Fabiola, Department of Anesthesiology, Avenue J.J. Crocq, 1020 Bruxelles, Belgium
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9
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Ashfaq A, Soroya MS, Iyengar A, Federman M, Reemtsen BL. Heparin-Coated Grafts Reduce Mortality in Pediatric Patients Receiving Systemic-to-Pulmonary Shunts. Pediatr Cardiol 2018; 39:473-477. [PMID: 29332215 DOI: 10.1007/s00246-017-1776-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022]
Abstract
We aimed to evaluate the outcomes of systemic-to-pulmonary (SP) shunt procedures utilizing heparin-coated (HC) polytetrafluoroethylene (PTFE) vascular grafts compared to uncoated (non-HC) grafts, in order to observe any benefits in pediatric patients. Our institution switched from using non-HC grafts to HC grafts in March 2011. We conducted a retrospective review of consecutive pediatric patients receiving SP shunts from May 2008 to December 2015. Perioperative variables including baseline characteristics, morbidity, mortality, and blood product utilization were evaluated between the HC and non-HC groups. A total of 142 pediatric patients received SP shunts during the study period: 69 patients received HC shunts and 73 patients received non-HC shunts. The HC group had significantly fewer desaturation or arrest events (P < 0.01), fewer shunt occlusions/thromboses (P < 0.01). There was no statistically significant difference in unplanned reoperations between groups (P = 0.18). The HC group demonstrated significantly lower overall 30-day mortality (P < 0.01), as well as shunt-related mortality (P < 0.01). The HC group had significantly lower postoperative packed red blood cell utilization as compared to the non-HC group (P < 0.01). In this study, pediatric patients receiving HC PTFE grafts in SP shunts demonstrated significantly lower shunt-related mortality. The majority of HC grafts remained patent. These findings suggest that HC grafts used in SP shunt procedures may benefit pediatric patients in terms of efficacy and outcomes.
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Affiliation(s)
- Adeel Ashfaq
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Amit Iyengar
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Brian L Reemtsen
- Mattel Children's Hospital, Los Angeles, CA, USA. .,UCLA Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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10
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Srivastava NT, Parent JJ, Schamberger MS. Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease. Ann Pediatr Cardiol 2017; 10:298-300. [PMID: 28928620 PMCID: PMC5594945 DOI: 10.4103/apc.apc_51_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Feeding difficulty has been reported at a higher incidence in infants with cyanotic heart disease and single ventricle physiology necessitating specialized feeding strategies. However, structural causes of feed intolerance in this subset of patients should not be ignored. This case series highlights three recent cases of pyloric stenosis in infants with left-sided obstructive lesions at our institution. In all three cases, the initial presumed diagnosis was feeding intolerance related to heart disease, and there was significant clinical improvement following identification and correction of pyloric stenosis.
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Affiliation(s)
- Nayan T Srivastava
- Department of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John J Parent
- Department of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marcus S Schamberger
- Department of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
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11
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Krüger MU, Wünschmann A, Ward C, Stauthammer CD. Pulmonary atresia with intact ventricular septum and hypoplastic right ventricle in an Arabian foal. J Vet Cardiol 2016; 18:284-289. [PMID: 27283083 DOI: 10.1016/j.jvc.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/21/2016] [Accepted: 04/18/2016] [Indexed: 12/26/2022]
Abstract
Pulmonary atresia with intact ventricular septum, rudimentary tricuspid valve, hypoplastic right ventricle, and right-to-left atrial shunting were identified in a four-day-old, male Arabian foal with clinical signs of cyanotic heart disease. Pulmonary blood flow was apparently derived from a ductus arteriosus. Echocardiographic evaluation revealed the majority of cardiac abnormalities and also findings compatible with right-sided congestive heart failure. Congenital cardiac defects have a high incidence in this breed, and this is the first description of this combination of congenital cardiac defects.
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Affiliation(s)
- M U Krüger
- Veterinary Medical Center, College of Veterinary Medicine, University of Minnesota, MN 55108, USA; Veterinary Health Center, College of Veterinary Medicine, University of Missouri, MO 65211, USA.
| | - A Wünschmann
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Minnesota, MN 55108, USA
| | - C Ward
- Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, MN 55108, USA
| | - C D Stauthammer
- Veterinary Medical Center, College of Veterinary Medicine, University of Minnesota, MN 55108, USA
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Fernández PB, Suárez JP, Messing-Jünger AM. Case-based update: primary intraventricular brain abscess in a 10-year-old child. Childs Nerv Syst 2015; 31:2235-8. [PMID: 26280627 DOI: 10.1007/s00381-015-2856-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/26/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraventricular abscesses are very rare and usually result from secondary rupture of a brain abscess. In the few published cases, clinical presentation was subacute and different pathogens were found. The diagnosis might be mistaken as an intraventricular tumor. CASE REPORT This is a case of a 10-year-old girl suffering from cyanotic heart disease that was presented with subacute onset of headache, vomiting, and some signs of inflammation. Symptoms lead to early brain imaging (CT/MRI) demonstrating left ventricular horn lesion affecting adjacent brain structures. Neuroradiologists suspected an intraventricular tumor, but cardiac history and signs of inflammation led to lumbar puncture and evidence of CNS infection, and intraventricular abscess was suspected. Navigated aspiration was performed, and multi-sensitive Eikenella corrodens was cultivated. Broad antibiotic treatment and dexamethasone were initiated, and symptoms disappeared. Follow-up imaging demonstrated gradual regression of the intraventricular abscess. The girl underwent regular professional teeth cleaning which was discussed as possible cause of infection. CONCLUSIONS Although an isolated intraventricular abscess is a very rare event, typical predisposing cardiac history together with central nervous symptoms and an intracranial contrasting mass should always lead to the differential diagnosis of a brain abscess and be biopsied first. E. corrodens is a typical organism of the mouth flora, but a rare cause for a brain abscess. Harmless teeth cleaning procedures may cause hematogenic spread and lead to CNS infections, e.g., in patients with predisposing diseases. To our knowledge, there are only six previous reports of primary intraventricular brain abscess.
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Affiliation(s)
| | | | - A Martina Messing-Jünger
- Abteilung für Pädiatrische Neurochirurgie, Asklepios Klinik, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Germany.
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Abstract
Access is gained through a midline sternotomy, the thymus partially excised and the superior part of the pericardium is opened. The innominate vein is retracted and the innominate artery is mobilized up to the bifurcation. The aorta is retracted to the left, the superior vena cavae to the right and the right atrial appendage inferiorly. The adventitia around the right pulmonary artery (PA) is dissected, taking care to incise the bulky pericardial reflection between the superior vena cavae and the trachea. Heparin is administrated. An occlusive clamp is applied to the right PA to test for haemodynamic tolerance prior to proceeding with the interposition of a suitable size artificial vascular prosthesis, based on the weight of the patient, between the innominate artery, or proximal subclavian artery and the right PA. Alternatively, if a sufficient main PA is present and adequate flow from a patent ductus arteriosus an end-to-side interposition shunt may be constructed between the ascending aorta and the main PA, provided the patient is stable with the test occlusion of the main PA. The management of the patent arterial ductus depends on whether or not there is forward flow through the PA.
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Affiliation(s)
- Andre Brooks
- Chris Barnard Division of Cardiothoracic Surgery at Red Cross Children's Hospital, Cape Heart Centre, University of Cape Town, Cape Town, South Africa
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Pizarro C, Bhat MA, Temple J. Cone reconstruction and ventricular septal defect closure for neonatal Ebstein's anomaly. Multimed Man Cardiothorac Surg 2014; 2012:mms014. [PMID: 24414717 DOI: 10.1093/mmcts/mms014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Neonatal presentation of Ebstein's anomaly is associated with significant morbidity and mortality. We illustrate the technical aspects of the cone procedure and the closure of a ventricular septal defect, to achieve biventricular repair in a neonate. This includes the assessment of the leaftlet apparatus, detachment, division of chordae, annular plication, leaflet rotation and reinsertion in the neoannulus.
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Nassef YE, Hamed MA, Aly HF. Inflammatory cytokines, apoptotic, tissue injury and remodeling biomarkers in children with congenital heart disease. Indian J Clin Biochem 2014; 29:145-9. [PMID: 24757294 DOI: 10.1007/s12291-013-0341-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 05/13/2013] [Indexed: 12/16/2022]
Abstract
The present study aims to evaluate specific biomarkers involved in congenital heart disease (CHD), and whether there is a significant differences between the levels of these biomarkers in the cyanotic CHD (CCHD) and acyanotic CHD (ACHD). We prospectively measured tumor necrosis factor (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), vasoendothelial growth factor (VEGF), troponin T, creatin kinase MB (CKMB), and Caspase 3 levels in 120 consecutive children with CHD (60 cyanotic and 60 a cyanotic with age 1:4 years), and 30 healthy control children. Significant elevated levels of inflammatory markers; TNF-α, IL-6 and CRP was detected in CHD, with percentage increase in cyanotic than a cyanotic subjects as compared to the normal one. Apoptotic biomarker; caspase 3 showed also significant increases in CCHD than ACHD. In addition, tissue injury mechanisms included troponin T and CKMB, exhibited significant increase in cyanotic than a cyanotic CHD. The present results demonstrate also, significant enhancement in remodeling process (VEGF), in cyanotic than a cyanotic patients. Thus, it could be concluded that, the children with CCHD were shown to have elevated levels of inflammatory cytokines, caspase 3, troponin T, and CKMB as these biomarkers may implicated in cardiac functional status.
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Alwi M, Mood MC. Stenting of Lesions in Patent Ductus Arteriosus with Duct-Dependent Pulmonary Blood Flow: Focus on Case Selection, Techniques and Outcome. Interv Cardiol Clin 2012; 2:93-113. [PMID: 28581990 DOI: 10.1016/j.iccl.2012.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Stenting of patent ductus arteriosus (PDA) is an attractive alternative to the surgical aortopulmonary shunt in the palliation of cyanotic congenital heart disease. However, the diverse morphology of PDA in this setting limits its role, as stenting an overly tortuous duct may not be feasible, and in a significant number of patients, ductus-related pulmonary artery stenosis contraindicates this procedure. The major acute complications are stent migration, thrombosis, and cardiac failure. Early failure of palliation caused by in-stent stenosis is another limitation of this procedure.
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Affiliation(s)
- Mazeni Alwi
- Department of Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, Kuala Lumpur 50400, Malaysia.
| | - Marhisham Che Mood
- Department of Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, Kuala Lumpur 50400, Malaysia
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Abstract
Ductal stenting is an attractive alternative to conventional shunt surgery in duct dependent congenital heart disease as it avoids thoracotomy and its related problems. With today's generation of coronary stents which have better profile, flexibility and trackability, ductal stenting may be achieved safely and with considerably less difficulty than previously described.As in Blalock-Taussig (BT) shunt, ductal stenting is indicated mainly in duct-dependent cyanotic lesions chiefly in the neonatal period. Unlike the Patent ductus arteriosus (PDA) as an isolated lesion, the ductus in cyanotic heart disease has a remarkable morphologic variability. The ductus tends to arise more proximally under the aortic arch, giving rise to a vertical ductus or occasionally it may arise from the subclavian artery. It also tends to be long and sometimes very tortuous, rendering stent implantation technically impossible. The ductus in these patients may also insert onto one of the branch pulmonary arteries with some stenosis at the site of insertion. The ductus in Tetralogy of Fallot with pulmonary atresia (TOF-PA) tend to exhibit these morphologic features and to a lesser degree in transposition of great arteries with ventricular septal defect and pulmonary atresia (TGA-VSD-PA) and the more complex forms of univentricular hearts. In the preliminary angiographic evaluation, it is important to delineate these morphologic features as the basis for case selection.Ductal stenting may be done by the retrograde femoral artery route or the antegrade transvenous route depending on the ductus morphology and the underlying cardiac lesion. The detailed techniques and essential hardware are described. Finally, major potential complications of the procedure are described. Acute stent thrombosis is the most serious and potentially catastrophic. Emergent treatment with thrombolytic therapy and mechanical disruption of thrombus are required. With proper case selection, appropriate technique and the right hardware ductal stenting provides reasonable short-medium term palliation in duct-dependent cyanotic heart disease.
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Affiliation(s)
- Mazeni Alwi
- Department of Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), Jalan Tun Razak, Kuala Lumpur, Malaysia
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