Novel approach for Recanalization and Limb Saving Following Acute Thrombosis of Upper Limb Arteries in Two Neonates After Congenital Heart Surgery

2020 ◽  
Author(s):  
Jameel Al- Ata ◽  
Gaser Abdelmohsen ◽  
Saud Bahaidarah ◽  
Naif Alkhushi ◽  
Zaher Zaher
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Output ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Congenital Heart Surgery ◽  
Low Cardiac Output ◽  
Vascular Thrombosis ◽  
Acute Thrombosis ◽  
Novel Approach

IntroductionNeonates with congenital heart disease are at a high risk of vascular thrombosis. Thrombosis may occur due to vascular injury, increased blood viscosity secondary to polycythemia associated with congenital cyanotic heart diseases, or stasis of blood flow associated with low cardiac output (Schmidt B & Andrew M., Pediatrics 1995; 96: 939–943. Veldman A et al.,Vasc Health Risk Manag 2008; 4: 1337–1348).

Circulating cyclic adenosine monophosphate concentrations in milrinone treated paediatric patients after congenital heart surgery

2021 ◽  
pp. 1-8
Author(s):  
Katja M. Gist ◽  
Armin Korst ◽  
Stephanie J. Nakano ◽  
Brian L. Stauffer ◽  
Anis Karimpour-Fard ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Cyclic Adenosine Monophosphate ◽  
Adenosine Monophosphate ◽  
Congenital Heart Surgery ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Paediatric Patients ◽  
Phosphodiesterase Type

Abstract Background: Milrinone is a phosphodiesterase type 3 inhibitor that results in a positive inotropic effect in the heart through an increase in cyclic adenosine monophosphate. The purpose of this study was to evaluate circulating cyclic adenosine monophosphate and milrinone concentrations in milrinone treated paediatric patients undergoing congenital heart surgery. Methods: Single-centre prospective observational pilot study from January 2015 to December 2017 including children aged birth to 18 years. Milrinone and circulating cyclic adenosine monophosphate concentrations were measured at four time points through the first post-operative day and compared between patients with and without low cardiac output syndrome, defined using clinical and laboratory criteria. Results: Fifty patients were included. Nine (18%) developed low cardiac output syndrome. For all patients, 22% had single ventricle heart disease. The density and distribution of cyclic adenosine monophosphate concentrations varied between those with and without low cardiac output syndrome but were not significantly different. Milrinone concentrations increased in all patients. Paired t-tests demonstrated an increase in circulating cyclic adenosine monophosphate concentrations during the post-operative period among patients without low cardiac output syndrome. Conclusions: In this prospective observational study, circulating cyclic adenosine monophosphate concentrations increased in those without low cardiac output syndrome during the first 24 post-operative hours and milrinone concentrations increased in all patients. Further study of the utility of cyclic adenosine monophosphate concentrations in milrinone treated patients is necessary.

An Elevated Low Cardiac Output Syndrome Score Is Associated With Morbidity in Infants After Congenital Heart Surgery*

2017 ◽  
Vol 18 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Kalia P. Ulate ◽  
Ofer Yanay ◽  
Howard Jeffries ◽  
Harris Baden ◽  
Jane L. Di Gennaro ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

Pre-operative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery

2020 ◽  
Vol 30 (4) ◽  
pp. 521-525 ◽  
Author(s):  
Ilias Iliopoulos ◽  
Matthew N. Alder ◽  
David S. Cooper ◽  
Enrique G. Villarreal ◽  
Rohit Loomba ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Low Cardiac Output ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Cell Counts

AbstractNeutrophil–lymphocyte ratio has been associated with clinical outcomes in several groups of cardiac patients, including patients with coronary artery disease, cardiac failure, and cardiac transplant recipients. We hypothesised that pre- and/or post-operative haematological cell counts are associated with clinical outcomes in children undergoing cardiac surgery for CHD. We performed a post hoc analysis of data collected as part of a prospective observational cohort study (n = 83, data available n = 47) of children evaluated for glucocorticoid receptor levels after cardiac surgery (July 2015–January 2016). The association of neutrophil–lymphocyte ratio with low cardiac output syndrome, time to inotrope free, and vasoactive-inotropic score was examined using proportional odds analysis, cox regression, and linear regression models, respectively. A majority (80%) of patients were infants (median/interquartile range 4.1/0.2–7.6 months) with conotruncal (36%) and left-sided obstructed lesions (28%). Two patients required mechanical circulatory support and three died. Higher pre-operative neutrophil–lymphocyte ratio was associated with higher cumulative odds of severe/moderate versus mild low cardiac output on post-operative day 1 (odds ratio 2.86; 95% confidence interval 1.18–6.93; p = 0.02). Pre-operative neutrophil–lymphocyte ratio was not significantly associated with time to inotrope free or vasoactive-inotrope score. Post-operative neutrophil–lymphocyte ratio was also not associated with outcomes. In children after congenital heart surgery, higher pre-operative neutrophil–lymphocyte ratio was associated with a higher chance of low cardiac output in the early post-operative period. Pre-operative neutrophil–lymphocyte ratio maybe a useful prognostic marker in children undergoing congenital heart surgery.

Early outcomes of usage of cryoFORM® probe for cryomaze procedure in congenital heart surgery

2020 ◽  
Vol 30 (12) ◽  
pp. 1874-1879
Author(s):  
Firat H. Altin ◽  
Sevket Balli ◽  
Murat Cicek ◽  
Okan Yurdakok ◽  
Oktay Korun ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Electrophysiological Study ◽  
Congenital Heart Surgery ◽  
Maze Procedure ◽  
Right Atrial ◽  
Complex Anatomy ◽  
Pacemaker Placement ◽  
The Right

AbstractObjectives:This study aimed to evaluate the early outcomes of patients who underwent a concomitant therapeutic maze procedure for congenital heart surgery.Materials and Methods:Between 2019 and 2020, eight patients underwent surgical cryoablation by using the same type of cryoablation probe.Results:Three patients had atrial flutter, two had Wolf–Parkinson–White syndrome, two intra-atrial reentrant tachycardia, and one had atrial fibrillation. Four patients underwent electrophysiological study. Preoperatively, one patient was on 3, two were on 2, five were on 1 antiarrhythmic drug. Six patients underwent right atrial maze and two underwent bilateral atrial maze. Five out of six right atrial maze patients underwent right atrial reduction. Nine different lesion sets were used. Some of the lesions were combined and applied as one lesion. In Ebstein’s anomaly patients, the lesion from coronary sinus to displaced tricuspid annulus was delicately performed. The single ventricle patient with heterotaxy had junctional rhythm at the time of discharge and was the only patient who experienced atrial extrasystoles 2 months after discharge. Seven of the eight patients were on sinus rhythm. No patient needed permanent pacemaker placement.Conclusion:Cryomaze procedure can be applied in congenital heart diseases with acceptable arrhythmia-free rates by selecting the appropriate materials and suitable lesion sets. The application of cryomaze in heterotaxy patients can be challenging due to differences in the conduction system and complex anatomy. Consensus with the electrophysiology team about the choice of the right–left or biatrial maze procedure is mandatory for operational success.

The elephant in the room: ethical issues associated with rare and expensive medical conditions

2015 ◽  
Vol 25 (8) ◽  
pp. 1621-1625 ◽  
Author(s):  
Constantine D. Mavroudis ◽  
Constantine Mavroudis ◽  
Jeffrey P. Jacobs
Keyword(s):  
Resource Allocation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Ethical Issues ◽  
Healthcare Resource ◽  
Congenital Heart Surgery ◽  
Medical Conditions ◽  
Economic Perspectives

AbstractThe treatment of rare and expensive medical conditions is one of the defining qualities of paediatric cardiology and congenital heart surgery. Increasing concerns over healthcare resource allocation are challenging the merits of treating more expensive forms of congenital heart disease, and this trend will almost certainly continue. In this manuscript, the problems of resource allocation for rare and expensive medical conditions are described from philosophical and economic perspectives. The argument is made that current economic models are limited in the ability to assess the value of treating expensive and rare forms of congenital heart disease. Further, multi-disciplinary approaches are necessary to best determine the merits of treating a patient population such as those with significant congenital heart disease that sometimes requires enormous healthcare resources.

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