Surgical Correction of Congenital Malformations of the Coronary Circulation

1982 ◽  
Vol 75 (12) ◽  
pp. 1508-1516 ◽  
Author(s):  
JAMES E. LOWE ◽  
DAVID C. SABISTON
Keyword(s):  
Congenital Malformations ◽  
Coronary Circulation ◽  
Surgical Correction

scholarly journals Efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children

2020 ◽  
pp. 43-51
Author(s):  
A. M. Karamyshev ◽  
G. V. Ilukevich ◽  
T. V. Lyzikova
Keyword(s):  
Congenital Malformations ◽  
Early Postoperative Period ◽  
Surgical Correction ◽  
Laryngeal Mask ◽  
Anesthetic Technique ◽  
Urogenital System ◽  
Inhalation Anesthesia ◽  
Combined Anesthesia ◽  
Group 2 ◽  
Caudal Blockade

Objective: to assess the efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children by means of the performance of the comparative analysis of perioperative adverse events and complications, consumption of the inhalation anesthetic sevoflurane and the cost of anesthesia, and also the course of the early postoperative period. Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with 0.25% bupivacaine solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of 0.25% bupivacaine solution and adjuvant (group 3, n = 45). Results. The performed analysis has not revealed any statistically significant distinctions in the assessment of anesthesia complications but it has found some significant distinctions in the consumption of sevoflurane, depth of anesthesia and its cost, as well as the necessity for postoperative anesthesia and introduction of analgesics, which testifies to the efficiency and safety of combined anesthesia and its economic benefit. Conclusion. The most effective, safe, and economically reasonable is the technique of combined anesthesia with the application of caudal blockade with local anesthetic solution and 0.1% adjuvant of morphine solution during surgical correction of congenital malformations of the lower parts of the urogenital system in children.

scholarly journals Analysis of risk factors for different types of anesthetic support of newborns and infants with surgical pathology

2020 ◽  
pp. 28-34
Author(s):  
V.I. Snisar ◽  
◽  
O.O. Vlasov ◽  
I.A. Makedonskyy ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Logistic Regression ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Congenital Malformations ◽  
Fatal Case ◽  
The Body ◽  
Surgical Correction ◽  
Simple Logistic

High-quality anesthetic support during surgical correction of congenital malformations of internal organs and the postoperative period in newborns and infants is complicated by concomitant diseases, significantly affects the processes of metabolism, gas exchange, homeostasis, cerebral, peripheral hemodynamics, etc. before, during and after the surgical intervention. Purpose — to identify the leading risk factors associated with death in various types of anesthetic support for newborns and infants during surgical correction of congenital malformations. Materials and methods. The retrospective study included newborns with congenital malformations of the surgical profile, as well as infants who received and continued stepwise surgical treatment for congenital malformations, depending on the chosen combined anesthetic accompaniment (inhalation + regional anesthesia and inhalation + intravenous anesthesia). The study was carried out in the following stages: 1) to conduct surgical treatment and anesthetic support, 2) introduction of the child into anesthesia, 3) the traumatic stage of the operation, 4) within 1 hour after the operation, 5) 24 hours after the operation. Risk factors were determined by simple logistic regression with the calculation of the odds ratio, 95% confidence interval (95% CI). Results. Among the functional indicators of the vital functions of the body of children with congenital disorders before, during, immediately and 24 hours after surgery against the background of combined anesthesia, with a simple logistic regression analysis, the chance of a fatal case increases with deviations from the norm of peripheral saturation — at all stages of surgical support (7.8–15.0 times); cerebral oxygenation of the child — at the moments of induction into anesthesia and in the postoperative period (10.8 at the stage 2, 72.0 times at the stage 4); increased diastolic blood pressure at the stage of induction of the child into anesthesia (1.6 times). Conclusions. To prevent the chances of death under various types of anesthesia for children with congenital malformations during surgical treatment, it is advisable to more closely monitor blood pressure, cerebral, peripheral oximetry and promptly correct the impaired condition of the child. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: newborns, infants, congenital malformations, anesthesia, risk factors.

scholarly journals Knee joint instability in conditions of congenital malformations of the lower extremities

2021 ◽  
pp. 80-85
Author(s):  
Sergij Khmyzov ◽  
Yevgen Yakushkin ◽  
Yelizaveta Katsalap
Keyword(s):  
Surgical Treatment ◽  
Knee Joint ◽  
Lower Extremity ◽  
Congenital Malformations ◽  
Joint Instability ◽  
Clinical Manifestations ◽  
Lower Extremities ◽  
Structural Features ◽  
Surgical Correction ◽  
Number Of Patients

It is impossible to find out the number of patients with knee joint instability (KJI) in case of congenital malformations of the lower extremities (CMLE). Children, adolescents and young people usually adapt well to this abnormality, so they rarely present with symptoms of instability, even with positive tests. The main reasons for the manifestation of KJI in CMLE are inadequate loading, injuries of the lower extremity and surgical correction. Objective. Based on the assessment of the scientific literature to define the KJI terminology, to identify the main causes of its development and clinical manifestations in conditions of CMLE, to identify trends in the treatment tactics. Methods. More than 500 articles from international libraries PubMed, NCBI, Google Scholar, Medscape, MedlinePlus were searched and analyzed. Taken into account the rarity of the abnormality and the small amount of research in recent years, the depth of the search was 25 years. Results. KJI in children with CMLE may be a consequence of congenital structural features of the lower extremity (isolated malformation in the form of agenesis of the cruciate ligaments or inferiority of the ligament of the knee joint in complex abnormality) and complication of surgical correction of longitudinal defects of the extremities. As the abnormality is not well studied, the tactics for such patients still remain the topic of discussion. The expediency of surgical stabilization of the knee joint has not been conclusively proven due to the fact that in the case of its anomalies certain adaptive mechanisms are formed, which on the one hand are not appropriate to violate, and on the other hand, the current level of medicine allows to promote patients’ functional capabilities, inducing KJI progressing. Conclusions. Children with CMLE adapt well to the concomitant KJI, so in everyday life and prior to surgical correction of CMLE, it does not bother patients. Particular attention should be paid to the stability of the knee joint both before and during prolongation and correction of deformity. The variability and severity of CMLE determines the implementation of multi-stage surgical treatment and surgical stabilization of the knee joint to improve extremity function may be one of them. Key words. Children, knee joint instability, congenital malformations, lower extremities, surgical treatment.

scholarly journals VACTERL-H SYNDROME – A CASE REPORT

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Priya Singh ◽  
Prof. Dr. Ghazi Sharique Ahmad ◽  
Prof. Dr. Ahmad Rizwan Karim
Keyword(s):  
Congenital Malformations ◽  
Failure To Thrive ◽  
Facial Asymmetry ◽  
Postnatal Period ◽  
The Body ◽  
Surgical Correction ◽  
Vacterl Association ◽  
Anal Atresia ◽  
Vater Association ◽  
Ear Malformations

The exact cause of VACTERL association is unknown; most cases occur randomly, for no apparent reason. In rare cases, VACTERL association has occurred in more than one family member. VACTERL association is an association of birth defects that affects multiple parts of the body. It includes vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects. Other features may include (less frequently) growth deficiencies and failure to thrive; facial asymmetry (hemifacial microsomia); external ear malformations; intestinal malrotation; and genital anomalies. Intelligence is usually normal. The diagnosis of VACTERL-H Syndrome is majorly based upon the complete physical examination and a few specialized tests to ascertain the features of the syndrome. The treatment of VACTERL-H is directed towards the specific symptoms that are apparent in each individual, which often varies greatly. The management of patients with VACTERL/VATER association typically centers around surgical correction of the specific congenital anomalies (typically anal atresia, certain types of cardiac malformations, and/or tracheo-esophageal fistula) in the immediate postnatal period, followed by long-term medical management of sequelae of the congenital malformations. If optimal surgical correction is achievable, the prognosis can be relatively positive. Hence early diagnosis and early interventions are needed to prevent morbidity and mortality. Key words: VACTERL-H syndrome, congenital malformations, clinical examinations

scholarly journals Problems with diagnostics in newborn having the combined pathology of gastric membrane and intestinal atresia

2021 ◽  
Vol 25 (3) ◽  
pp. 205-208
Author(s):  
A. A. Gumerov ◽  
I. I. Galimov ◽  
R. A. Nafikova ◽  
A. E. Neudachin ◽  
A. A. Miniakhmetov
Keyword(s):  
Congenital Malformations ◽  
Surgical Intervention ◽  
Full Range ◽  
Surgical Care ◽  
Intestinal Atresia ◽  
Duodenal Atresia ◽  
Surgical Correction ◽  
General State ◽  
Diagnostic Measures ◽  
Abdominal Organs

Introduction. Congenital malformations of the gastrointestinal tract (GIT) are one of the most common causes of intestinal obstruction and require urgent surgical care in the neonatal period. In the overall structure of GIT, gastrointestinal defects amount up to 25%. Duodenal atresia accounts for 1 case per 7,000–10,000 newborns; jejunal and ileac atresia - 1 case per 1,000–3,000 newborns. Often, the diagnosis is made antenatal. In most cases, diagnostics of intestinal atresia is not difficult, and treatment is carried out in a timely manner. However, in rare cases, intestinal atresia is combined with other congenital malformations in GIT, for example, stomach or duodenum webs. In such a case, if during the atresia surgical correction, a gastric membrane was not suspected, then in the postoperative period there may be problems with treatment requiring additional diagnostics. As a result, web surgical correction is postponed, and the child’s general state can worsen.Material and methods. The authors discuss two cases and their treatment in newborn children who had membranes in their stomach and duodenum combined with the intestinal atresia.Results. The authors also discuss problems which they faced in the diagnostics and treatment. They give their recommendations how to improve diagnostics in children with combined congenital malformations in their gastro-intestinal tract.Conclusion. The full range of diagnostic measures before surgery and a thorough revision of abdominal organs during surgery are key issues in children with gastric and duodenal abnormalities. Undiagnosed and undetected malformations during the first surgical intervention may require a repeated surgical intervention which can worsen the child’s general state.  

STATE OF SYSTEMIC HEMODYNAMICS FOR CHILDREN WITH CONGENITAL SURGICAL PATHOLOGY IN DIFFERENT COMBINED ANESTHESIA TYPES

2021 ◽  
pp. 27-30
Author(s):  
O. O. Vlasov
Keyword(s):  
Blood Pressure ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Systemic Hemodynamics ◽  
Intravenous Anesthesia ◽  
Abdominal Tumors ◽  
Intravenous Drugs ◽  
Different Types ◽  
Combined Anesthesia ◽  
The Impact

General anesthesia for a surgical correction of congenital malformations in children is accompanied, in particular, by the disorders of systemic hemodynamics. In order to assess the impact of different types of combined anesthesia on the state of systemic hemodynamics in surgical correction of congenital malformations, a retrospective study of the treatment of 150 newborns and infants was conducted. These were children with various congenital malformations, but the most common were intestinal obstruction and abdominal tumors. Three groups of patients were formed depending on the type of combined anesthesia during surgical correction of abnormalities: I − inhalation (sevorane) + regional anesthesia; II − inhalation (sevorane) + intravenous anesthesia (fentanyl); III − total intravenous anesthesia with two drugs: analgesic (fentanyl) and drug sleep on the background of intravenous injection of hypnotics (20 % sodium oxybutyrate). There were preformed the surgeries: thoracic, urological, abdominal. The study was retrospectively evaluated in five stages. The analysis of systemic hemodynamics showed a tendency to reduce diastolic blood pressure in children treated with anesthesia with two intravenous drugs (hypnotic and fentanyl), during all observation stages and a significant decrease in this index at the most painful and traumatic period. At the time of induction of anesthesia in children there was a decrease in heart rate. According to the research results, it is concluded that when using the pre−hypnotics as part of combined anesthesia in children with congenital malformations during surgery there is a risk of complications from central hemodynamics in the form of vasodilation, which leads to a drop in blood pressure and increases compensatively the heart contractions. Key words: infants, congenital malformations, anesthesia, hemodynamics.

scholarly journals “Bowel Management” program for children with congenital malformations and neurogenic bowel after surgery

2021 ◽  
Vol 11 (3) ◽  
pp. 325-338
Author(s):  
Evgeniya S. Pimenova ◽  
Grigoriy A. Korolev ◽  
Maxim V. Klementyev ◽  
Kulyash M. Kezhenbayeva ◽  
Olga E. Romanova ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Congenital Malformations ◽  
Anorectal Malformations ◽  
Management Program ◽  
Water Soluble ◽  
Surgical Correction ◽  
Bowel Management ◽  
Group I ◽  
Defecation Disorders ◽  
Hirschsprungs Disease

BACKGROUND: After the surgical treatment of children for anorectal malformations, spinal pathology, and Hirschsprungs disease, their quality of life is significantly reduced due to fecal incontinence. For patients with persistent defecation disorders, the Bowel Management program is offered. AIM: This study analyzes the Bowel Management program implemented in the clinic. MATERIALS AND METHODS: A prospective analysis of the program used in children after surgical correction of malformations was conducted. The program comprised the following components: lectures for patients/parents, hospitalization, irrigography with water-soluble contrast, teaching patients/parents about cleansing enemas, keeping a bowel movement diary, plain abdominal X-ray, changing the recipe for enema solution, monitoring the effectiveness, and correcting recommendations. RESULTS: A total of 66 children from 1.5 to 17 years old were treated. Three groups were identified: (I) anorectal malformations (n = 26), (II) spinal pathology (n = 30), and (III) Hirschsprungs disease (n = 10). The results were considered satisfactory if the bowel cleansing procedure was painless for the child and did not cause stress reactions; the parents were satisfied with the result of the prescribed program if after the enema a sufficient amount of stool was removed within 45 minutes, there were no episodes of defecation during the day. With the help of the Rome IV revision criteria, fecal incontinence was noted in all cases against the background of stool retention. In 11 (16.7%), there was no fecal incontinence even in cases of prolonged stool retention. A correlation was found between high lesions (in the lumbar spine) in spinal hernias with the absence of fecal incontinence with prolonged stool retention compared with the low sacral localization of the hernia. In group I, 91.7% had spinal cord fixation. In group II, 86.7% had it, and none were present in group III. The effectiveness of the program was 83.3%. CONCLUSION: The Bowel Management is easy to use and effective in 83% of patients. It can be recommended for the rehabilitation of children with defecation disorders, fecal incontinence after surgical correction of congenital malformations (anorectal malformations, spinal pathology and Hirschsprung's disease).

scholarly journals Role of Caudal Blockade in the Modulation of Stress Response in the Surgical Correction of Congenital Malformations of the Lower Parts of the Urogenital System in Children

2020 ◽  
pp. 20-28
Author(s):  
A. M. Karamyshev
Keyword(s):  
Adverse Effects ◽  
Local Anesthetic ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Laryngeal Mask ◽  
Anesthetic Technique ◽  
Urogenital System ◽  
Anesthetic Solution ◽  
Caudal Blockade ◽  
Local Anesthetic Solution

Objective: to assess the efficiency and safety of an anesthetic technique during the surgical correction of congenital malformations of the lower departments of the urogenital system in children by means of the comparative analysis of laboratory and hemodynamic indices, as well as the course of the early postoperative period, development of adverse effects during the anesthesia.Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with a local anesthetic solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of a local anesthetic solution and adjuvant (group 3, n = 45).Results. The performed analysis of the parameters of hemodynamics, levels of cortisol, glucose, lactate and interleukin-6 (IL-6), as well as the quality, duration, depth of anesthesia and the necessity for an inhalation anesthetic, the assessment of complications and the adverse effects have revealed statistically significant differences indicative of a more effective blockade of the pain sensitivity in the combined application of general and regional anesthesia.Conclusion. The technique of combined anesthesia with the application of the combination of 0.25 % bupivacaine solution and adjuvant to 0.1 % morphine has shown the best efficiency and safety during the surgical correction of congenital malformations of the lower departments of the urogenital system in the children.

Sign in / Sign up

Export Citation Format

Share Document