scholarly journals Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease

2020 ◽  
Author(s):  
Melinda Barkhuizen ◽  
Raul Abella ◽  
J. S. Hans Vles ◽  
Luc J. I. Zimmermann ◽  
Diego Gazzolo ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Defects ◽  
Circulatory Arrest ◽  
Surgical Techniques ◽  
Fetal Brain ◽  
Neurological Injury ◽  
Genetic Syndromes ◽  
Term Infants ◽  
Flow Disturbances ◽  
Neurological Injuries

AbstractCongenital heart defects (CHD) is one of the most common types of birth defects. Thanks to advances in surgical techniques and intensive care, the majority of children with severe forms of CHD survive into adulthood. However, this increase in survival comes with a cost. CHD survivors have neurological functioning at the bottom of the normal range. A large spectrum of central nervous system dysmaturation leads to the deficits seen in critical CHD. The heart develops early during gestation, and CHD has a profound effect on fetal brain development for the remainder of gestation. Term infants with critical CHD are born with an immature brain, which is highly susceptible to hypoxic-ischemic injuries. Perioperative blood flow disturbances due to the CHD and the use of cardiopulmonary bypass or circulatory arrest during surgery cause additional neurological injuries. Innate patient factors, such as genetic syndromes and preterm birth, and postoperative complications play a larger role in neurological injury than perioperative factors. Strategies to reduce the disability burden in critical CHD survivors are urgently needed.

Mechanisms of injury and methods of protection of the brain during cardiac surgery in neonates and infants

1993 ◽  
Vol 3 (3) ◽  
pp. 317-330 ◽  
Author(s):  
William J. Greeley ◽  
Frank H. Kern ◽  
James R. Mault ◽  
Lynn A. Skaryak ◽  
Ross M. Ungerleider
Keyword(s):  
Congenital Heart ◽  
Heart Defects ◽  
Circulatory Arrest ◽  
Surgical Techniques ◽  
Developmental Abnormalities ◽  
Cardiac Morbidity ◽  
Neonates And Infants ◽  
Total Circulatory Arrest

With substantial effort and research devoted to improving surgical techniques and myocardial protection, superb results have been achieved for repair of complex congenital heart defects in children. As a result, investigative efforts now have begun to examine the quality of life for patients surviving these operations. Because these neonates and infants are exposed to severe physiologic extremes of temperature (15–18 °C) and severe alterations from normal perfusion (total circulatory arrest), the nature of long-term neuropsychological outcome has been a prominent concern. Recent preliminary reports suggest that transient and permanent neuropsychologic injury occur in as many as 25% of all infants undergoing hypothermic cardiopulmonary bypass with circulatory arrest.'Since improved surgical techniques have significantly reduced rates of operative mortality and cardiac morbidity, one of the greatest risks remaining for the patient with congenital heart disease may be long term neuropsychologic and developmental abnormalities.

scholarly journals Genetic syndromes and congenital heart defects: how is surgical management affected?

2009 ◽  
Vol 35 (4) ◽  
pp. 606-614 ◽  
Author(s):  
Roberto Formigari ◽  
Guido Michielon ◽  
Maria Cristina Digilio ◽  
Gerardo Piacentini ◽  
Adriano Carotti ◽  
...  
Keyword(s):  
Surgical Management ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Genetic Syndromes

scholarly journals Treatment of systemic inflammatory response syndrome following on-pump pediatric congenital heart surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 113-124
Author(s):  
D. V. Borisenko ◽  
A. A. Ivkin ◽  
D. L. Shukevich
Keyword(s):  
Cardiopulmonary Bypass ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Surgical Techniques ◽  
Congenital Heart Surgery ◽  
Systemic Inflammatory Response ◽  
Preventive Strategies

Highlights. The article discusses the pathophysiological aspects of cardiopulmonary bypass and the mechanisms underlying the development of the systemic inflammatory response in children following congenital heart surgery. We summarize and report the most relevant preventive strategies aimed at reducing the systemic inflammatory response, including both, CPB-related methods and pharmacological ones.The growing number of children with congenital heart defects requires the development of more advanced technologies for their surgical treatment. However, cardiopulmonary bypass is required in almost all surgical techniques. Despite the tremendous progress and recent advances in cardiopulmonary bypass techniques, the systemic inflammatory response syndrome associated with these surgeries remains unresolved. The review summarizes the causes and mechanisms underlying its development. The most commonly used preventive strategies are reported, including standard and modified ultrafiltration, leukocyte filters, and pharmacological agents (systemic glucocorticoids, aprotinin, and antioxidants).The role of cardioplegia and hypothermia in the reduction of systemic inflammation is defined. Cardiac surgery centers around the world use a variety of techniques and pharmacological approaches, drawing on the results of randomized clinical studies. However, there are no clear and definite clinical guidelines aimed at reducing the systemic inflammatory response during cardiopulmonary bypass in children. It remains a significant problem for pediatric intensive care by aggravating their postoperative status, prolonging the length of the in-hospital stay, and reducing the survival rates.

scholarly journals P18.09: Added value of fetal brain magnetic resonance after a systematic neurosonography in congenital heart defects

2019 ◽  
Vol 54 (S1) ◽  
pp. 215-216
Author(s):  
E. Eixarch ◽  
M. Pérez‐Cruz ◽  
M. Gibert ◽  
N. Masoller ◽  
M. Bennasar ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Fetal Brain ◽  
Added Value

scholarly journals Sudden Death in Congenital Heart Disease: The Role of the Autopsy in Determining the Actual Cause

2020 ◽  
Vol 7 (4) ◽  
pp. 58
Author(s):  
Mary N. Sheppard
Keyword(s):  
Congenital Heart ◽  
Cardiac Fibrosis ◽  
Heart Defects ◽  
Surgical Techniques ◽  
Large Change ◽  
Percutaneous Procedures ◽  
Improved Outcomes ◽  
Increased Risk ◽  
The Family

Congenital heart defects (CHDs) have undergone a large change in epidemiology due to prenatal screening and improved outcomes with surgery and percutaneous procedures. In patients with complex CHD there is an increased risk of sudden cardiac death (SCD) and up to 11% of all SCDs in the young occur in people with CHD. It is essential for clinicians to be aware of the risk factors, and for all patients to be followed up in specialised centres. When an SCD occurs, it is important that an autopsy is done and for the pathologist to have an in-depth knowledge of the particular defect and the corrective surgical techniques employed, as well as any complications due to these procedures. Both pathologist and cardiologist should work closely together to explain the cause of death to the family. A terminal cardiac arrhythmia explains many of the SCD cases, often with underlying cardiac fibrosis due to previous procedures. SCD may also be the first presentation of CHD, so great care is required when examining such cases and referral for a detailed expert opinion is recommended in all CHD-SCD cases.

scholarly journals Patent Ductus Arteriosus: An Overview

2007 ◽  
Vol 12 (3) ◽  
pp. 138-146 ◽  
Author(s):  
James E. Dice ◽  
Jatinder Bhatia
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Congenital Heart ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Clinical Signs ◽  
Medical Intervention ◽  
Fluid Restriction ◽  
Term Infants ◽  
Patent Ductus

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects, accounting for 5%–10% of all congenital heart disease in term infants. The occurrence of PDA is inversely related to gestational age and weight, with an even greater incidence in preterm infants. The maintenance of ductal patency is essential for the normal development of the fetus. In the neonate, however, persistent patency of the ductus arteriosus (DA) is associated with significant morbidity and mortality. Normally, at birth, the DA constricts, resulting in intraluminal ischemic hypoxia, which eventually leads to closure and remodeling of the ductus. PDA in term infants is usually associated with a functional defect, whereas in preterm infants it is associated with immaturity. Normal physiologic mechanisms contributing to closure - oxygen tension and decreased prostaglandins—are altered in prematurity. Clinical signs of ductal patency include murmur, tachycardia, bounding peripheral pulses, and congestive heart failure and associated symptoms. Symptoms are not always present; therefore, diagnostic imaging is critical if a PDA is suspected on clinical grounds. Three management strategies are currently available for PDA: fluid restriction and diuretics (as clinically appropriate), medical intervention, and surgical ligation. Pharmacologic closure can be achieved via administration of intravenous indomethacin or ibuprofen lysine. While both agents have shown similar efficacy, ibuprofen lysine has demonstrated an improved safety profile, particularly in terms of renal effects, compared to indomethacin.

scholarly journals Fetal brain imaging in isolated congenital heart defects - a systematic review and meta-analysis

2016 ◽  
Vol 36 (7) ◽  
pp. 601-613 ◽  
Author(s):  
Fenna A. R. Jansen ◽  
Sheila M. P. Everwijn ◽  
Robert Scheepjens ◽  
Theo Stijnen ◽  
Cacha M. P. C. D. Peeters-Scholte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Imaging ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Meta Analysis ◽  
Fetal Brain
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