Sternotomy versus Mini-Sternotomy in Pediatric Patients undergoing Modified Blalock-Taussig Shunt

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Azab ◽  
Ashraf A El Midany ◽  
Ayman A Doghish ◽  
Abdelfatah E Salah El-din Abugabal
Keyword(s):  
Pediatric Patients ◽  
Randomized Study ◽  
Young Infant ◽  
Cardiac Anomaly ◽  
P Value ◽  
Safe Alternative ◽  
Icu Stay ◽  
Superficial Wound ◽  
Pulmonary Arterial ◽  
Blalock Taussig Shunt

Abstract Background In the present era, primary correction is the preferred approach to the neonate or young infant with a cardiac anomaly who has two ventricles. However, when only one functional ventricle is present or pulmonary blood flow is reduced, an initial palliative systemic-to-pulmonary arterial shunt is mandatory. In this study we compare post-operative short term outcomes of sternotomy versus mini-sternotomy approaches in pediatric patients undergoing Modified Blalock Taussig Shunt. Patients and Methods A prospective randomized study was conducted on 90 patients who were schedueled for MBT shunt due to a group of cyanotic heart disease. They comprised 2 groups G1: sternotomy group (n = 45) and G2: ministernotomy group (n = 45). Results Mean age was 11± 3.39 months and mean weight was 6.75±1.96 kg in the sternotomy group, while for ministernotomy group the mean age was 10.55± 4.65 and mean weight was 7.00±2.03 kg. The change (%) between preoperative and postoperative oxygen saturation was 35.6% for sternotomy group and 43.8% for ministernotomy group. There were seven cases of mortality (15.6%) in sternotomy grouped compared to three cases of mortality (6.7%) in ministernotomy with P value of 0.314. Superficial wound infection occurred in one case (2.2%) in each group. Mean duration of ventilation was 52.53 ± 15.76 h for sternotomy group and 46.93±19.23 h for ministernotomy group with P value of 0.025, mean ICU stay was 7.42 ± 2.94 days for sternotomy group and 5.13± 2.37 days for ministernotomy with P value of < 0.001. Conclusion Upper ministernotomy is a safe alternative approach for MBT shunt in pediatric patients. It provides the advantages of less ventilation time, less post operative bleeding, and ICU stay.

scholarly journals Comparative efficacy of IV phenytoin, IV valproate and IV levetiracetam in childhood seizures

2019 ◽  
Vol 6 (4) ◽  
pp. 1592
Author(s):  
Sheeraz A. Dar ◽  
Wasim A. Wani ◽  
Mudasir Nazir ◽  
Zul Eidain Hussan
Keyword(s):  
Pediatric Patients ◽  
Seizure Control ◽  
Randomized Study ◽  
P Value ◽  
Age Group ◽  
Seizure Recurrence ◽  
Comparative Efficacy ◽  
Acute Setting ◽  
Neurologic Disorder

Background: Seizures are the most common pediatric neurologic disorder, with 4% to 10% of children suffering at least one seizure in the first 16 years of life objectives to compare efficacy of IV phenytoin, IV valproate, and IV levetiracetam in childhood seizures between 2months to 16 years of age.Methods: This prospective, randomized, study was done on pediatric patients in the age group of 2 months to 16 years who present actively convulsing to the emergency department of pediatrics.Results: At 24 hours seizures were controlled in 44 (88%) patients out of 50 patients in phenytoin group, 39 (78%) out of 50 patients in levetiracetam group and 46 (92%) out of 50 patients in valproate group (p-value 0.115). The relative risk of seizure recurrence for levetiracetam and phenytoin groups when compared to valproate was 2.75 and 1.5, respectively.Conclusions: Present study demonstrates that IV levetiracetam and IV valproate were comparable to IV phenytoin in terms of seizure control in acute setting. All the three are safe and efficacious. Time to regain consciousness was less in valproate group and long-term seizure control too was also better.

Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt

2006 ◽  
Vol 16 (5) ◽  
pp. 463-473 ◽  
Author(s):  
Ujjwal K. Chowdhury ◽  
Panangipalli Venugopal ◽  
Shyam S. Kothari ◽  
Anita Saxena ◽  
Sachin Talwar ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Pulmonary Arteries ◽  
Surgical Techniques ◽  
Great Majority ◽  
Venous Drainage ◽  
P Value ◽  
Second Stage ◽  
Pulmonary Arterial ◽  
Cavopulmonary Connection ◽  
Blalock Taussig Shunt

Background: We describe alternative surgical techniques for construction of systemic-to-pulmonary arterial shunts, and propose criterions for their application in selected patients.Patients and methods: We constructed a variety of modified systemic-to-pulmonary arterial shunts, using polytetrafluroethylene grafts, in 92 selected patients with cyanotic congenital heart disease and anomalies of the aortic arch and systemic veins. Their age ranged from 7 days to 3.6 years, with a mean of 7.08 months. We performed 88 operations through a thoracotomy. Of this cohort, 60 patients underwent a second-stage operation, with 15 receiving a superior cavopulmonary connection, 16 a total cavopulmonary connection, and 29 proceeding to biventricular repair after a mean interval of 15.6 months. We have 21 patients awaiting their second or final stage of palliation.Results: There were five early (5.4%) and six late deaths (6.8%), two of which were related to construction of the shunts. At a mean follow-up of 45.29 months, the increase in diameter of pulmonary trunk and its right and left branches was uniform and significant (p value less than 0.001). Pulmonary arterial distortion requiring correction at the time of second-stage operation was observed in 5 patients (6.1%). Adequate overall palliation was achieved in 98% of the cohort at 8 months, 91% at 12 months, and 58% at 18 months.Conclusions: Patients with a right- or left-sided aortic arch and right-sided descending thoracic aorta, those with anomalies of systemic venous drainage masking the origin of great arterial branches, and those withdisproportionately small subclavian arteries, constitute the ideal candidates for our suggested modification of the construction of a modified Blalock-Taussig shunt. The palliation provided by these shunts was satisfactory, with predictable growth of pulmonary arteries, insignificant distortion in the great majority, and easy take-down.

scholarly journals Prospective randomized study comparing outcome of myocardial protection with Del-Nido Cardioplegia versus Saint Thomas Cardioplegia in adult cardiac surgical patients

2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Muhammad Farhan Ali Rizvi ◽  
Syed Muhammad Arslan Yousuf ◽  
Attaullah Younas ◽  
Mirza Ahmad Raza Baig
Keyword(s):  
Cardiopulmonary Bypass ◽  
Sinus Rhythm ◽  
Myocardial Protection ◽  
Randomized Study ◽  
Surgical Patients ◽  
Prospective Randomized Study ◽  
P Value ◽  
Protective Agent ◽  
Icu Stay ◽  
Electrical Defibrillation

Objectives: To compare the effectiveness of Del-Nido cardioplegia as myocardial protective agent with Saint Thomas cardioplegia in adult cardiac surgical patients. Methods: This prospective randomized study was conducted in cardiac surgery department of Bahawal Victoria hospital Bahawalpur, from October 2020 to March 2021. Eighty adult patients who underwent primary Isolated coronary artery bypass grafting (CABG) or isolated Valve surgery requiring cardiopulmonary bypass were randomly divided into Del Nido (DN, n=40) and Saint Thomas (ST, n=40) groups. Data regarding operative and post-operative variables such as cardiopulmonary bypass (CPB) and aortic cross clamp (AXC) times, inotropic requirements, resumption of sinus rhythm, need for electrical defibrillation, post-operative CKMB, blood requirement and ICU stay were noted. Results: CPB and AXC times were statistically insignificantly different. Resumption of Sinus rhythm was seen significantly in more patients of DN group (95%) than in ST group (72.5%) [p-value 0.05]. Less patients of DN group (5%) were candidates of electrical defibrillation than ST group (17.5%) [p-value <0.001). Post- operative CKMB values were significantly lower in DN group as compared to ST group (30.5±22.6 IU vs 50.5±50.28 IU, p value.008). Blood transfusion was significantly lower in DN group; 50% versus 80% in ST group (p-value 0.005). Ventilation time was significantly less in DN group than ST group (165.95±48.09 minutes versus 165.95±48.09 minutes respectively, p-value 0.03). While ICU stay was also less in DN group; 5.2±0.8 days versus 6.05±1.6 days in ST group (p-value 0.003). Conclusion: Del-Nido cardioplegia is a reliable and better myocardial protective agent than Saint Thomas cardioplegia in adult cardiac surgical procedures. doi: https://doi.org/10.12669/pjms.38.3.4730 How to cite this:Rizvi MFA, Yousuf SMA, Younas A, Baig MAR. Prospective randomized study comparing outcome of myocardial protection with Del-Nido Cardioplegia versus Saint Thomas Cardioplegia in adult cardiac surgical patients. Pak J Med Sci. 2022;38(3):---------.  doi: https://doi.org/10.12669/pjms.38.3.4730 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals EXPRESS: Efficacy and Safety of Tadalafil in a Pediatric Population with Pulmonary Arterial Hypertension: Phase 3 randomized, Double Blind Placebo-Controlled Study

2021 ◽  
pp. 204589402110249
Author(s):  
David D Ivy ◽  
Damien Bonnet ◽  
Rolf MF Berger ◽  
Gisela Meyer ◽  
Simin Baygani ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Statistical Significance ◽  
Significance Testing ◽  
Efficacy And Safety ◽  
Phase 3 ◽  
Statistical Significance Testing ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Treatment Groups ◽  
Pulmonary Arterial

Objective: This study evaluated the efficacy and safety of tadalafil in pediatric patients with pulmonary arterial hypertension (PAH). Methods: This phase-3, international, randomized, multicenter (24 weeks double-blind placebo controlled period; 2-year, open-labelled extension period), add-on (patient’s current endothelin receptor antagonist therapy) study included pediatric patients aged <18 years with PAH. Patients received tadalafil 20 mg or 40 mg based on their weight (Heavy-weight: ≥40 kg; Middle-weight: ≥25—<40 kg) or placebo orally QD for 24 weeks. Primary endpoint was change from baseline in 6-minute walk (6MW) distance in patients aged ≥6 years at Week 24. Sample size was amended from 134 to ≥34 patients, due to serious recruitment challenges. Therefore, statistical significance testing was not performed between treatment groups. Results: Patient demographics and baseline characteristics (N=35; tadalafil=17; placebo=18) were comparable between treatment groups; median age was 14.2 years (6.2 to 17.9 years) and majority (71.4%, n=25) of patients were in HW cohort. Least square mean (SE) changes from baseline in 6MW distance at Week 24 was numerically greater with tadalafil versus placebo (60.48 [20.41] vs 36.60 [20.78] meters; placebo-adjusted mean difference [SD] 23.88 [29.11]). Safety of tadalafil treatment was as expected without any new safety concerns. During study period 1, two patients (1 in each group) discontinued due to investigator’s reported clinical worsening, and no deaths were reported. Conclusions: The statistical significance testing was not performed between the treatment groups due to low sample size, however, the study results show positive trend in improvement in non invasive measurements, commonly utilized by clinicians to evaluate the disease status for children with PAH. Safety of tadalafil treatment was as expected without any new safety signals.

scholarly journals The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Pi-Chang Lee ◽  
Betau Hwang ◽  
Wen-Jue Soong ◽  
C. C. Laura Meng
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Cor Pulmonale ◽  
Arousal Index ◽  
Obstructive Sleep ◽  
Hemodynamic Characteristics ◽  
Pulmonary Arterial

Background.The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA.Methods.Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale.Results.The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery.Conclusion.This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

Sugammadex for reversal of neuromuscular blockade in pediatric patients: results from a phase IV randomized study

2021 ◽  
Author(s):  
Tiffini Voss ◽  
Aobo Wang ◽  
Matthew DeAngelis ◽  
Marcel Speek ◽  
Vera Saldien ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Pediatric Patients ◽  
Randomized Study ◽  
Phase Iv
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