Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients

Background: This study explores the strategy and effect of emergency surgical treatment for total anomalous pulmonary venous connection (TAPVC). Methods: From March 2009 to February 2020, 78 patients with TAPVC underwent emergency surgical correction. There were 51 males and 27 females. The median age was 39.5 days, and the median weight was 4.0 kg. The preoperative percutaneous oxygen saturation was 80.8±4.5%. Results: Of the cases investigated, seven died during the perioperative period, 16 had delayed chest closure, 19 had early pulmonary vein obstruction, two had secondary tracheal intubation, one had a brain complication, and one had third-degree atrioventricular block. Low weight, younger age, cardiopulmonary bypass time, and aortic cross-clamp time were identified as risk factors for early mortality. During the follow-up from four to 137 months, 12 cases did not respond to follow up. Ten patients died within one to six months after discharge. One patient underwent reoperation due to pulmonary vein obstruction. The longer hospital stays after operation and intensive care unit time were identified as risk factors for late mortality. Conclusions: Emergency surgery for severe TAPVC patients after admission had achieved good results in the near future. Prenatal diagnosis should be strengthened to save more patients. The higher late mortality rate indicates that such patients should strengthen post-discharge management to reduce the occurrence of post-discharge deaths.

Download Full-text

Severe Unilateral Pulmonary Vascular Changes in Child with Polysplenia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000422 ◽

2002 ◽

Vol 10 (4) ◽

pp. 359-361 ◽

Cited By ~ 1

Author(s):

Katsuhide Maeda ◽

Shigeo Yamaki ◽

Arata Murakami ◽

Jun Nakajima ◽

Toshio Hishi ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Vein ◽

Single Ventricle ◽

Pulmonary Arteries ◽

Occlusive Disease ◽

Resected Specimen ◽

Vascular Changes ◽

Pulmonary Vein Obstruction ◽

Left Pneumonectomy

A 12-year-old boy with polysplenia and single ventricle experienced recurrent episodes of pneumonia, hemoptysis, and pulmonary hypertension. Unilateral pulmonary vein obstruction was diagnosed, and a left pneumonectomy was performed. Microscopy of the resected specimen revealed pulmonary veno-occlusive disease in the small pulmonary venules, and old arteritis in the small pulmonary arteries.

Download Full-text

Abstract 17696: Pulmonary Vein Obstruction: a European Congenital Heart Surgeons Association (ECHSA) Multicentric Study

Circulation ◽

10.1161/circ.130.suppl_2.17696 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

David Kalfa ◽

Emre Belli ◽

Emile Bacha ◽

Virginie Lambert ◽

Duccio di Carlo ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Pulmonary Vein ◽

Severity Score ◽

Poor Prognosis ◽

Cox Model ◽

Univariate Analysis ◽

Sutureless Repair ◽

Multicentric Study ◽

Pulmonary Vein Obstruction

Pulmonary vein obstruction (PVO) still has a poor prognosis and its optimal management and risk factors for pejorative outcomes remain controversial in the absence of large multicentric studies. We assessed the hypothesis that diffuse PVO and postoperative pulmonary hypertension are associated with worse outcomes while the sutureless surgical technique is associated with better outcomes. Methods: One hundred and seven patients treated for native or acquired PVO in 16 European or North-American centers (2000-2012) were included retrospectively. A specific PVO severity score (range:0-16) was developed. Endpoints were 1) PVO-related death, 2) persistence or recurrence of PVO, and 3) PV reintervention or PVO-related death. A univariate and multivariate risk analysis (logistic regression and Cox model) was performed. Mean follow-up was 34±41 months. Results: Patient characteristics, outcomes and risk analyses are summarized in Tables 1, 2 and 3 respectively. In conclusion, both native and acquired PVO still have a poor prognosis. Sutureless repair is significantly associated with lower risks of PVO recurrence and PV reoperation/PVO-related mortality in the univariate analysis. A postoperative pulmonary hypertension and a high degree of severity of the disease evaluated by a new severity score are independent risk factors for pejorative outcomes.

Download Full-text

Cut-out Risk Factor Analysis after Intramedullary Nailing for the Treatment of Extracapsular Fractures of the Proximal Femur: A Retrospective Study

10.21203/rs.3.rs-948144/v1 ◽

2021 ◽

Author(s):

Jae Youn Yoon ◽

Saehan Park ◽

Taehyun Kim ◽

Gun-Il Im

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Surgical Treatment ◽

Clinical Outcomes ◽

Univariate Analysis ◽

High Body Mass Index ◽

Positive Correlation ◽

Factors Associated ◽

Group 2 ◽

Group 1

Abstract BackgroundsThe basic method of surgical treatment for extracapsular hip fracture (ECF), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for such fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out.MethodsWe retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group.ResultsWe used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) (p=0.019), BCFs (p=0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p=0.032 and p=0.043, respectively), and anti-rotation screw pull-outs (p=0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p=0.020). In the multivariate analysis of group 1, the patients’ BMIs (p=0.024) and BCFs (p=0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out.ConclusionsThe cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.

Download Full-text

Risk factors of poor outcome after surgical treatment of chronic constrictive pericarditis in a single-centre cohort

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1367149 ◽

2014 ◽

Vol 62 (S 01) ◽

Author(s):

K. Penov ◽

C. Busch ◽

P.A. Amorim ◽

J. Garbade ◽

A. Rastan ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Constrictive Pericarditis ◽

Single Centre ◽

Poor Outcome

Download Full-text

Commentary: Relentless disease, relentless measures: treat recurrent pulmonary vein obstruction early and often.

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2021.03.094 ◽

2021 ◽

Author(s):

Joseph B. Clark

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Obstruction

Download Full-text

Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00202 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0020

Author(s):

Michael Ryan ◽

Benton Emblom ◽

E. Lyle Cain ◽

Jeffrey Dugas ◽

Marcus Rothermich

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Failure Rate ◽

Osteochondritis Dissecans ◽

Surgical Techniques ◽

The Other ◽

Return To Play ◽

Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

Download Full-text

INCIDENCE OF OBESITY, ACQUIRED CARDIOVASCULAR RISK FACTORS & ADVERSE CLINICAL OUTCOMES IN PATIENTS WITH REPAIREDTETRALOGY OFFALLOT(TOF)INCIDENCE OF OBESITY, ACQUIRED CARDIOVASCULAR RISK FACTORS & ADVERSE CLINICAL OUTCOMES IN PATIENTS WITH REPAIREDTETRALOGY OF FALLOT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02952-1 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1595

Author(s):

Justin M. Harrell ◽

Vincent Sorrell ◽

Andrew Leventhal ◽

Preeti Ramachandran ◽

Douglas Schneider

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Clinical Outcomes

Download Full-text

Risk factors and clinical outcomes associated with blood culture contamination

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.111 ◽

2021 ◽

pp. 1-7

Author(s):

Justin M. Klucher ◽

Kevin Davis ◽

Mrinmayee Lakkad ◽

Jacob T. Painter ◽

Ryan K. Dare

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Blood Culture ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Tertiary Care ◽

Blood Cultures ◽

Hospital Charges ◽

Patient Specific ◽

Contaminated Blood

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

Download Full-text