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.

Heart surgery

2018 ◽  
Author(s):  
David Taggart ◽  
Yasir Abu-Omar
Keyword(s):  
Heart Surgery ◽  
Heart Defects ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Surgical Techniques ◽  
Circulatory Support ◽  
Mortality And Morbidity ◽  
Off Pump

Cardiac surgery is still a relatively young specialty, having been developed only in the latter half of the twentieth century with the introduction of extracorporeal circulation or ‘cardiopulmonary bypass’ (CPB). This initiated the era of open heart surgery, initially allowing the repair of congenital heart defects, then valve replacements, coronary artery bypass grafting (CABG), and, finally, heart transplantation. Over the last two decades, improvements in medical, anaesthetic, and surgical management of patients, allied to refinements in extracorporeal perfusion technology, have resulted in a decreasing mortality and morbidity from heart surgery despite the advanced age and significant comorbidity of many patients. Today, heart surgery continues to improve the prognosis and quality of lives of patients around the world. Surgical techniques and technologies continue to evolve and recent years have witnessed the emergence of, amongst others, the use of long-lasting conduits for CABG procedures, beating-heart (‘off-pump’) surgery, the use of minimally invasive and robotic techniques, and long-term mechanical circulatory support.

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.

Long-term Neurodevelopmental Outcomes of Children with Congenital Heart Defects

2021 ◽  
Author(s):  
Neil Derridj ◽  
Romain Guedj ◽  
Johanna Calderon ◽  
Lucile Houyel ◽  
Nathalie Lelong ◽  
...  
Keyword(s):  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Neurodevelopmental Outcomes

scholarly journals A National Comparative Investigation of Twins With Congenital Heart Defects for Neurodevelopmental Outcomes and Quality of Life (Same Same, but Different?): Protocol for a Prospective Observational Study (Preprint)

2020 ◽  
Author(s):  
Julia Remmele ◽  
Paul Christian Helm ◽  
Renate Oberhoffer-Fritz ◽  
Ulrike MM Bauer ◽  
Thomas Pickardt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Confounding Factors ◽  
Fourth Edition ◽  
Neurodevelopmental Outcomes ◽  
Motor Competence ◽  
Intelligence Scale

BACKGROUND Due to the increased survival rates of patients with congenital heart defects (CHD), associated disorders are an increasing focus of research. Existing studies figured out an association between CHD and its treatment, and neurodevelopmental outcomes including motor competence impairments. All these studies, however, compared their test results with reference values or results of healthy control groups. This comparison is influenced by socioeconomic and genetic aspects, which do have a known impact on neurodevelopmental outcomes. OBJECTIVE This study protocol describes a setting that aims to find out the role of CHD and its treatments on neurodevelopmental outcomes, excluding socioeconomic and genetic aspects. Only a twin comparison provides the possibility to exclude these confounding factors. METHODS In a German-wide prospective cohort study, 129 twin siblings registered in the National Register for Congenital Heart Defects will undergo testing on cognitive function (Wechsler Intelligence Tests age-dependent: Wechsler Adult Intelligence Scale, fourth edition; Wechsler Intelligence Scale for Children, fifth edition; and Wechsler Preschool and Primary Scale of Intelligence, fourth edition) and motor competence (Movement Assessment Battery for Children, second edition). Additionally, the self-reported health-related quality of life (KINDL-R for children, Short Form 36 for adults) and the parent-reported strength and difficulties of the children (Strength and Difficulties Questionnaire, German version) will be assessed by standardized questionnaires. CHD data on the specific diagnosis, surgeries, transcatheter procedures, and additional medical information will be received from patient records. RESULTS The approval of the Medical Ethics Committee Charité Mitte was obtained in June 2018. After getting funded in April 2019, the first enrollment was in August 2019. The study is still ongoing until June 2022. Final results are expected in 2022. CONCLUSIONS This study protocol provides an overview of the study design’s technical details, offering an option to exclude confounding factors on neurodevelopmental outcomes in patients with CHD. This will enable a specific analysis focusing on CHD and clinical treatments to differentiate in terms of neurodevelopmental outcomes of patients with CHD compared to twin siblings with healthy hearts. Finally, we aim to clearly define what is important to prevent patients with CHD in terms of neurodevelopmental impairments to be able to develop targeted prevention strategies for patients with CHD. CLINICALTRIAL German Clinical Trials Register DRKS00021087; https://tinyurl.com/2rdw8w67 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/26404

scholarly journals To the issue of the health comprehensive assessment of children who underwent surgical correction of congenital heart diseases

2020 ◽  
Vol 8 (4S) ◽  
pp. 42-50
Author(s):  
L. N. Igisheva ◽  
A. A. Anikeenko ◽  
S. A. Shmulevich ◽  
I. N. Sizova
Keyword(s):  
Quality Of Life ◽  
Postoperative Period ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Heart Defects ◽  
Rehabilitation Program ◽  
Comprehensive Assessment ◽  
Surgical Correction ◽  
Long Time

Aim. To find out the problems in children health in long-time postoperative period after cardiosurgery using the comprehensive method for creating rehabilitation program.Methods. A prospective investigation of group of children was done before (n = 88) and in a year (n = 115), in 2 years (n = 90) and in 3 years (n = 58) after the surgical correction of congenital heart defects on the base of Kuzbass cardiological center. The anamnesis, clinical and hemodynamic aspects were studied as well as the postoperative period, residual problems after the correction, social status of the family and the comprehensive assessment was done in the both groups.Results. Before the correction the most part of children had low and very low levels of physical functioning, but there was a positive dynamic right after the surgery: the most part of children had high and middle levels (13% and 44% in a year), while the amount of children with low and very low data were reduced. Nevertheless, in 3 years after the surgery the amount of children with low and very low data was increased while the hemodynamic became better. Such tendency was mentioned with all aspects of the health.Conclusion. Despite of hemodynamic normalization the quality of life with all aspects still suffers. It predicts dangers in development and quality of life in general.

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.

Immediate and long-term outcomes in children with prenatal diagnosis of selected isolated congenital heart defects

2007 ◽  
Vol 29 (1) ◽  
pp. 38-43 ◽  
Author(s):  
I. B. Fuchs ◽  
H. Müller ◽  
H. Abdul-Khaliq ◽  
T. Harder ◽  
J. W. Dudenhausen ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Long Term Outcomes

Abstract 18284: Incidence of Epilepsy is Elevated in Children and Young Adults With Congenital Heart Defects Compared With the General Population: A Nationwide Cohort Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Morten Olsen ◽  
Bradley S Marino ◽  
Michelle Leisner ◽  
Jessica G Woo ◽  
Nicolas L Madsen
Keyword(s):  
Young Adults ◽  
Preterm Birth ◽  
General Population ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Birth Registry ◽  
Registration System ◽  
Children And Young Adults

Perioperative seizures related to surgery for congenital heart defects (CHD) are well described; however, few data exist on the long-term risk of epilepsy in patients with CHD. We aimed to estimate the incidence of epilepsy in children and young adults with CHD compared with the general population. Methods: Utilizing data from the Danish National Registry of Patients (DNRP) we identified all patients diagnosed with CHD before the age of 15 years between 1980 and 2010 who were born during the same period. The DNRP is a nationwide hospital discharge registry covering all Danish hospitals. Previously validated methodology using the DNRP was applied to measure the outcome, epilepsy, as well as presence of extra cardiac defects (ECD) and/or syndromes. We used the Danish Medical Birth Registry to identify preterm birth (gestational age<37 weeks). For each CHD subject, we identified 10 controls from the general population using the Danish Civil Registration System, matched by sex and birth year. A unique personal identifier assigned at birth and used in all Danish public registries enabled virtually complete follow up for migration, death, or epilepsy until January 1, 2013. We computed cumulative incidences and hazard ratios (HR) (split at 5 years of age to obtain proportional hazards) of time from CHD diagnosis (index date for controls) to epilepsy. Results: We identified 14,665 CHD subjects with a median age at diagnosis of 2 (IQR 19) months. By 15 years of age, the cumulative incidence of epilepsy was 4% among CHD subjects. The HR of epilepsy among CHD subjects compared with the control cohort was 3.7 (95% CI: 3.2-4.3) below 5 years of age, and 2.4 (95% CI: 2.1-2.7) from 5 to 33 years of age. In the older age group, HR for patients with severe CHD was 2.8 (95% CI: 2.3-3.5), and for mild and moderate CHD was 2.2 (95% CI: 1.8-2.6). After exclusion of all subjects with ECDs and/or syndromes and preterm birth, corresponding HRs were 2.2 (95% CI: 1.6-3.0) and 1.7 (95% CI: 1.3-2.2), respectively. Conclusion: The epilepsy risk was markedly increased in CHD subjects compared with the age and gender matched controls. These findings add evidence to support the importance of developing neuro-protective measures and potentially long-term epilepsy surveillance strategies in the CHD population.

Cardiovascular Disorders

2019 ◽  
pp. 309-326
Author(s):  
Lyla E. Hampton ◽  
Abigail C. Demianczyk ◽  
Casey Hoffman
Keyword(s):  
Quality Of Life ◽  
Birth Defects ◽  
Neurodevelopmental Disorders ◽  
Congenital Heart ◽  
Heart Defects ◽  
School Setting ◽  
The United States ◽  
Intervention Strategies ◽  
School Based

Congenital heart disease (CHD) is one of the most common birth defects in the United States, affecting approximately 1% of births per year, with most children surviving into adulthood. Despite improved survival, individuals with CHD remain at high risk for neurological, cognitive, and psychosocial challenges that affect quality of life across the lifespan and have specific implications for working with children with CHD in the school setting. This chapter describes several common complications of CHD, as well as acquired heart defects, that have implications for how children with the conditions present in the school setting. The chapter also provides information about common neurodevelopmental disorders associated with these medical conditions and the effects of the conditions on psychological adjustment and quality of life in children. Finally, the chapter concludes with a review of intervention strategies that school-based professionals may adopt when working with children with heart conditions.

Locally Advanced Head and Neck Cancer

2013 ◽  
pp. 237-244
Author(s):  
Anthony J. Cmelak ◽  
Kyle Arneson ◽  
Nicole G. Chau ◽  
Ralph W. Gilbert ◽  
Robert I. Haddad
Keyword(s):  
Head And Neck ◽  
Multidisciplinary Approach ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Squamous Cell Carcinomas ◽  
Advanced Head ◽  
Organ Function ◽  
Definitive Therapy

Treatment of locally advanced head and neck squamous cell carcinomas requires a multidisciplinary approach to be able to offer patients definitive therapy while aiming to preserve organ function and minimize acute and long-term toxicities. Advances in surgical techniques will be reviewed for both primary sites and the neck and also in the salvage settings. Recent data on concurrent versus sequential chemoradiotherapy in these patients will be reviewed, with emphasis on identification of appropriate patients for sequential chemoradiotherapy. Finally, advances in modern radiotherapy modalities that have resulted in improved dosimetry and quality of life following treatment will be reviewed.

Sign in / Sign up

Export Citation Format

Share Document