Successful treatment of medically refractory ventricular fibrillation with emergency cardiopulmonary bypass in an adolescent with corrected complex congenital heart disease

Background: Previous studies describing the neurocognitive (neuro) effects of cardiopulmonary bypass (CPB) have been performed following surgery in infancy for complex congenital heart disease (CHD) and in adults with acquired heart disease. These patients (pts) have many causes for adverse neuro outcomes with conflicting results regarding the contribution of CPB. The impact of CPB in children with less complex CHD is unknown. We sought to describe the effects of CPB on neuro function in children following repair of acyanotic CHD. Methods: We performed a prospective cohort study of pts 5–18 yrs of age undergoing primary repair of CHD. Neuro testing battery included assessment of intellectual function (IQ), memory, motor skills, attention, executive function, and an evaluation by a pediatric neurologist pre- and 6 months post-CPB. Non-CPB effects of surgery were assessed by similarly testing pts undergoing repair of pectus excavatum (non-CPB). Practice effects of serial testing were controlled by enrolling non-surgical pts (mild CHD) and creating a reliability-stability index to adjust surgical group scores. Anxiety was assessed as a covariate. Results: CPB pts ( n =41) included repair of atrial [17] or ventricular [6] septal defect, coronary anomaly [8], aortic valve [5] or other [5]. Control pts included pectus repair ( n =20) and non-surgical CHD pts ( n =16). Groups were similar in age, gender, race, socioeconomic status and baseline scores. Neurological exams before and after surgery were not different between groups. Controlling for the effects of serial testing, there were no significant (p<.05) changes in the mean scores of either surgical group in areas of IQ, memory, motor skills, attention, or executive function. In addition, there were no differences in the percentage of patients in either surgical group that had a significant (>1 SD) decline in scores after surgery. Conclusions : When controlling for the non-CPB effects of surgery (hospitalization, anxiety, etc.) and the practice effects of serial testing, there were no independent effects of CPB on neuro status 6 months after repair of acyanotic CHD. We believe that the potential neuro sequelae of CPB should not be a major factor in the decision to recommend CHD surgery in otherwise healthy children.

Download Full-text

The effect of red cell washing on serum biochemistry in neonates and infants undergoing surgery for complex congenital heart disease with cardiopulmonary bypass

http://isrctn.org/> ◽

10.1186/isrctn54081245 ◽

2013 ◽

Author(s):

Christine Swindell

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Congenital Heart ◽

Serum Biochemistry ◽

Complex Congenital Heart Disease ◽

Red Cell ◽

Neonates And Infants

Download Full-text

Cardiopulmonary bypass venous cannulation challenges in a paediatric patient with complex congenital heart disease: a case report

Perfusion ◽

10.1177/026765919701200310 ◽

1997 ◽

Vol 12 (3) ◽

pp. 203-206 ◽

Cited By ~ 4

Author(s):

Rich Manzer ◽

Robin G Sutton ◽

James Ploessl ◽

Scott Niles ◽

Douglas Behrendt

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Congenital Heart ◽

Venous Return ◽

Activity Level ◽

Complex Congenital Heart Disease ◽

Atrioventricular Canal ◽

Paediatric Patients ◽

Complex Anatomy

When choosing cannulae for cardiac surgery the two most important factors to be considered are the proposed procedure and the patient anatomy. These factors are especially crucial in paediatric patients with congenital heart disease. A 3-year-old, 14-kg male presented to the University of Iowa Hospitals and Clinics with dextro-transposition of the great arteries, atrioventricular canal, left pulmonary stenosis, azygous continuation, bilateral superior vena cavae, partial anomalous pulmonary venous return, left aortic arch and status post-right Blalock-Taussig shunt. The complex anatomy presented a surgical dilemma. The course of surgical intervention was determined, a variation of the modified Fontan procedure, and the anatomy of the patient was directly viewed. The surgeon concluded that four venous cannulae were required to provide adequate venous return for the cardiopulmonary bypass (CPB) circuit and a bloodless surgical field. The operation was successfully performed under mild hypothermia with no complications. The patient fully recovered with only mild restrictions on his activity level. This case acutely illustrates the importance of anatomical and procedural awareness when choosing cannulae and cannulation sites for CPB in paediatric patients with congenital heart disease.

Download Full-text