Abstract 10903: Extraction Outcomes in Patients With Congenital Heart Disease

Introduction: Patients with congenital heart disease (CHD) frequently require implantable cardiac devices. Device infection or malfunction may necessitate lead extraction. Extraction may be challenging due to long lead dwell times, anatomic abnormalities, and prior cardiac surgery. Little is known about extraction outcomes in the CHD population. Methods and Results: This retrospective study included 41 CHD patients and 82 age and gender matched controls that underwent lead extractions at two centers between 2001-2014. Only patients with leads older than 12 months were included. There were 79 leads in CHD patients and 150 in controls. Patients with CHD had a mean age of 39±17 years at extraction and on average their leads had been implanted for 81±84 months, this was not significantly different from the control group. Eighty eight percent of CHD patients had 1 or more cardiac surgeries as compared to only 22% of controls (p<0.001). The number of abandoned leads was also significantly different with 16 abandoned leads in the CHD group and 3 in controls (p<0.001). There was no statistically significant difference in extraction techniques between the groups. Complete extraction was achieved in 94% of patients in both groups. There were no CHD group complications. Control group complications included 3 SVC lacerations requiring sternotomy (one was fatal), and 1 ventricular perforations with tamponade requiring sternotomy. None of these patients had a history of cardiac surgery. The average age of leads in patients with a complication was 15.3 years which was older than the mean lead age seen in the CHD and control populations which was 6.75 and 4.6 years respectively. Conclusions: Lead extraction can be safely performed in patients with CHD. Despite anatomic abnormalities and previous cardiac surgery, the outcome of lead extraction in patients with CHD is comparable to controls. Prior cardiac surgery may lower the risk for extraction complications.

Download Full-text

Vitamin D Deficiency and Its Response to Supplementation as “Stoss Therapy” in Children with Cyanotic Congenital Heart Disease Undergoing Open Heart Surgery

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0039-1696910 ◽

2019 ◽

Vol 03 (01) ◽

pp. 17-23

Author(s):

Manoj Kumar Sahu ◽

Chalattil Bipin ◽

Harsha Vardhan Niraghatam ◽

Ameya Karanjkar ◽

Sarvesh Pal Singh ◽

...

Keyword(s):

Vitamin D ◽

Mechanical Ventilation ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Control Group ◽

Study Group ◽

Significant Difference ◽

Postoperative Convalescence

Abstract Background Data from many studies suggest that patients with congenital heart disease are vitamin D (vitD) deficient. Following cardiac surgery as a result of intraoperative institution of cardiopulmonary bypass (CPB), serum vitD levels become even low. This may affect postoperative convalescence in terms of mechanical ventilation, inotropic support, infection, and so forth. Objective We intended to study the prevalence of vitD deficiency pre and post cardiac surgery and the effect of vitD supplementation (stoss therapy) on postoperative convalescence of the children with tetralogy of Fallot (TOF) undergoing intracardiac repair (ICR). Methodology In this randomized controlled trial (RCT), 60 children younger than 18 years with TOF and serum vitD levels < 20ng/dL were randomized into two groups. The study group received vitD supplementation as “stoss therapy” at 10,000 units/kg body weight. All these children underwent ICR with CPB. Demographic data, preoperative, intraoperative, and postoperative variables were compared between the study and the control groups. Results Prevalence of severe vitD deficiency was 93.1%. When compared with the control group, study group showed higher serum vitD levels in the immediate preoperative period (p = 0.001), postoperative period following CPB (p = 0.012), and on the first postoperative day (p = 0.003). No statistically significant difference was observed in postoperative mechanical ventilation (p = 0.35), intensive care unit (ICU) stay (p = 0.15), and inotropic duration (p = 0.19). Conclusion Children with TOF are highly deficient of vitD, its level falls further after CPB, and supplementing vitD preoperatively does not influence postoperative recovery pattern. Supplementation of vitD as “stoss therapy” was useful in raising the serum levels before and after cardiac surgery.

Download Full-text

Evaluation of the school success in children with the diagnosis of congenital heart disease who underwent an intervention

Journal of Dr Behcet Uz Children s Hospital ◽

10.5222/buchd.2014.171 ◽

2014 ◽

Author(s):

Gülben İrem Kanberoğlu ◽

Önder Doksöz ◽

Özlem Bağ ◽

Serpil Ece Aras Öztürk

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Academic Success ◽

Patient Group ◽

Social Life ◽

Congenital Heart ◽

School Success ◽

Control Group ◽

Significant Difference ◽

Behavioral Attitudes

OBJECTIVE: Congenital heart disease is one of the most common childhood diseases that affect both the children's and their families social life, quality of life and the children's academic achievement. The aim of this study is to evaluate the school performance of children suffering from congenital heart disease who underwent surgical or catheter based interventions. METHODS: The study group included 50 patients with congenital heart disease underwent surgical or catheter based interventions attending to secondary school (aged 12-15 years old) and 50 healthy controls. The academic success validation from official school grades of lessons Turkish, Mathematics, Science, Social Sciences lessons and behavioral attitudes were obtained from the Ministry of Education ‘’e-school’’ parent information system printouts. The patient group consisted of both cyanotic and acyanotic patients and each groups were compared with controls. RESULTS: Turkish, mathematics, physical education classes and behavioral attitudes note in the patient group was significantly lower than in the control group. The school success in Cyanotic group was significantly lower than the control group in Turkish, mathematics, education lessons and behavioral attitudes grades. Significant difference was not determined in science and social science lessons. CONCLUSION: Cyanotic group's success in mathematic and turkish lessons are lower in children with congenital heart disease especially in cyanotic group. We suggest that providing supportive teaching pragrammes for children with congenital hearth disease are needed in order to maintain academic success.

Download Full-text

Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Journal of Healthcare Engineering ◽

10.1155/2021/4650291 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Zhigang Qin ◽

Younian Xu

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Treatment Group ◽

Cardiac Function ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Control Group ◽

Muscle Rigidity ◽

Significant Difference

In this study, we have investigated feasibility of remifentanil and sufentanil anesthesia in children with congenital heart disease surgery and its effects on cardiac function and serological parameters. For this purpose, a retrospective study was conducted on 120 children with congenital heart disease who underwent repair of ventricular septum or atrial septum in our hospital, specifically from January 2016 to January 2018, and 60 patients in each group were randomly divided into the control and treatment groups, respectively. The control group was anesthetized with sufentanil, and the treatment group was anesthetized with remifentanil. The heart function, serological indexes, and adverse reactions were observed and compared. We have observed that there was no significant difference in HR levels between these groups ( P > 0.05 ), but SDP and DBP values of the two groups were decreased after anesthetic induction ( P < 0.05 ). ACH, cortisol, and lactic acid in the treatment group were significantly lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). The incidence of bradycardia, nausea and vomiting, hypotension, muscle rigidity, and respiratory depression in the treatment group was 16.67% lower than that in the control group ( P < 0.05 ). Remifentanil has less influence on hemodynamics and a better analgesic effect than fentanyl in inhibiting stress response in congenital heart surgery, which provides reference and basis for children congenital heart surgery.

Download Full-text

The level of superoxide dismutase and catalase in acyanotic congenital heart disease children with heart failur

GSC Biological and Pharmaceutical Sciences ◽

10.30574/gscbps.2021.16.1.0206 ◽

2021 ◽

Vol 16 (1) ◽

pp. 150-156

Author(s):

Henry Wicaksono ◽

Mahrus A Rahman ◽

Roedi Irawan ◽

I Ketut Alit Utamayasa ◽

Teddy Ontoseno ◽

...

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Superoxide Dismutase ◽

Heart Disease ◽

Congenital Heart ◽

Control Group ◽

Case Group ◽

Significant Difference ◽

The Difference ◽

Acyanotic Congenital Heart Disease

Background: The most common complication in acyanotic congenital heart disease (CHD) is heart failure which definitive diagnosis and therapy remain unsatisfactory. Heart failure’s progression is often associated with oxidative stress process. Superoxide dismutase (SOD) is the first line antioxidant of defense against superoxide anion. While Catalase (CAT) breaks down hydrogen peroxide into water and oxygen molecules which complements previous detoxification carried out by SOD. Objective: This study aimed to compare the differences of SOD and CAT levels in acyanotic CHD patients between those with and without heart failure. Methods: A case-control study was conducted on three to ten years old children with a left-to-right shunt acyanotic CHD with and without heart failure in the Pediatric Cardiology outpatient clinic, ward, and emergency room of Dr. Soetomo Hospital Surabaya from April-July 2020. Echocardiography was used to establish the diagnosis of CHD, while Pediatric Heart Failure Score (PHFS) criteria was used to indicate heart failure. T-test was undertaken for analysing the difference between both groups. Results: The total samples were 41 children, consisted of 29 subjects in the case group (CHD with heart failure) and 12 subjects in the control group (without heart failure). The level of SOD in CHD with heart failure was lower (74.670+15.705) than those without it (109.163+3.111) (p<0.05). In contrast, level of CAT in CHD with heart failure was higher (25.895) than those without it (13.976) (p<0.05). Conclusion: There was a significant difference of SOD and CAT levels in acyanotic CHD between those with and without heart failure.

Download Full-text

Analysis of 85 Cases of Minimal Media Lower Hemisternotomy for Congenital Cardiac Surgery Under Cardiopulmonary Bypass in Infants

The Heart Surgery Forum ◽

10.1532/hsf.3577 ◽

2021 ◽

Vol 24 (3) ◽

pp. E502-E505

Author(s):

Yuehu Han ◽

Jie Su ◽

Zhifa Wang ◽

Dongming Wei ◽

Yanjie Guo ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Congenital Heart ◽

Operation Time ◽

Surgical Interventions ◽

Small Incision ◽

Significant Difference ◽

Minimal Media

Objective: To investigate the feasibility and effect of minimal media lower hemisternotomy for cardiac surgery under cardiopulmonary bypass (CPB) in infant congenital heart disease. Methods: In our hospital from May 2019 to October 2019, 170 infants with congenital heart disease underwent surgical treatment (median age 6.6 months; weight 6.0 kg). They were divided into 2 groups: those with conventional chest median incision and those with minimal sternotomy. Minimal lower hemisternotomy began from the third intercostal level and ended 0.5 cm above the xiphoid, just enough to insert a small sternal distractor. Results: There was no significant difference between the 2 groups in CPB time. The operation time of small incision group was slightly longer (P < .05). There was no difference in prognosis between the 2 groups, but the wound length of the small incision group was significantly reduced (4.0 ± 0.5 versus 7.8 ± 0.8 cm, P < .05). Time of intensive care unit and hospital stay was shorter among hemisternotomy patients at a statistically significant level (P < .05). Conclusion: Minimal media lower hemisternotomy with the basic advantages of the sternal incision can expose the various parts of the heart, which meets most cardiac exploration and surgical operation needs, and the incision may still be extended if necessary. Lower hemisternotomy appears to be a safe, effective, and versatile alternative for many surgical interventions in infants with congenital heart disease.

Download Full-text

ADHD symptomatology of children with congenital heart disease 10 years after cardiac surgery: the role of age at operation

BMC Psychiatry ◽

10.1186/s12888-021-03324-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nikoletta R. Czobor ◽

Zsófia Ocsovszky ◽

György Roth ◽

Szabolcs Takács ◽

Márta Csabai ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Adhd Symptom ◽

Symptom Severity ◽

Congenital Heart ◽

Self Report ◽

Control Group ◽

Healthy Controls ◽

Adhd Symptomatology

Abstract Background The aim of the present study was to investigate the differences in ADHD symptomatology between healthy controls and children who underwent cardiac surgery at different ages. Methods Altogether, 133 children (54 patients with congenital heart disease undergoing first cardiac surgery under 3 years of age, 26 operated at the age of 3 or later, and 53 healthy controls) were examined. Patients completed the Youth Self Report (YSR), while their parents completed the Child Behaviour Checklist (CBCL) and the ADHD Rating Scale-IV. Results Children receiving surgery for the first time under the age of 3 years were more likely diagnosed with cyanotic type malformation and have undergone to a greater number of operations. However, ADHD symptoms of those treated surgically at or above 3 years of age were more severe than that of the control group or those who were treated surgically at a younger age. The control group and those treated surgically below the age of three did not differ across any of the ADHD symptom severity indicators. Conclusions The age at the time of cardiac surgery might be associated with later ADHD symptom severity – with lower age at operation associated with better outcomes. Further, adequately powered studies are needed to confirm these exploratory findings and investigate the moderators of this relationship.

Download Full-text

Evaluation of urinary NGAL level in children with congenital heart disease as a possible early indicator of nephropathy

Journal of Nephropharmacology ◽

10.34172/npj.2021.14 ◽

2020 ◽

Vol 10 (2) ◽

pp. e14-e14

Author(s):

Hossein Emad Momtaz ◽

Asadolah Tanasan ◽

Majid Godini

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Early Detection ◽

Congenital Heart ◽

Control Group ◽

Healthy Children ◽

Urinary Ngal ◽

Ngal Level ◽

Potential Biomarker ◽

Significant Difference

Introduction: Nephropathy as a consequence of congenital heart disease (CHD), especially cyanotic heart disease, has been detected since past decades. However, lack of a diagnostic method at early stages of the disease, caused patients referring when nephropathy is established and also complicated with severe proteinuria and renal failure. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is known as one of the newest biomarkers for early detection of renal parenchymal damage. In this study, we attempted to evaluate the role of urinary NGAL level in early detection of nephropathy in pediatrics with CHD. Objectives: The aim of this study was to evaluate urinary NGAL as a potential biomarker for the early detection of renal involvement in children with CHD. Patients and Methods: In this case–control study, urinary NGAL levels of 42 children with CHD (case group) and 42 healthy children (control group) with the matched ages were measured. Afterward, we compared mean urinary NGAL levels between these two groups to find a possible significant difference. Results: In this study, mean urinary NGAL level in patients with CHD and healthy children was 3.83 μg/mL and 1.87 μg/mL, respectively. Although the mean urine NGAL level was higher in children with CHD compared to healthy children, this difference was not statistically significant. Conclusion: in this study, it can be concluded that, urinary NGAL level cannot be used as an early diagnostic test of nephropathy in children with CHD.

Download Full-text

P3654Location of the coronary origins in transposition patients following anatomical repair: Implications for invasive coronary angiography and intervention

European Heart Journal ◽

10.1093/eurheartj/ehz745.0511 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A H Constantine ◽

T Segura ◽

E Nicol ◽

A H Kempny ◽

I Rafiq ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Statistical Significance ◽

Ct Imaging ◽

Circular Data ◽

Control Group ◽

Complex Anatomy ◽

Significant Difference ◽

Coronary Ostia

Abstract Background Surgical repair of transposition of the great arteries (TGA) is most commonly via the arterial switch operation (ASO). This involves translocation of the aorta and pulmonary trunk, typically with anastomosis of the branch pulmonary arteries anteriorly (LeCompte manoeuvre) and re-implantation of the coronary arteries onto the posterior neo-aorta. As such, the position of the coronary ostia may differ from their expected locations. Purpose To use ECG-gated CT angiography to describe the anatomic position of coronary ostia in post-switch TGA patients guiding potential catheter interventions in this population. Methods All post ASO patients who underwent CT imaging between 2008–2018 were identified. Patients with complex anatomy such as double outlet right ventricle were excluded. The positions of the coronary ostia were measured in degrees from vertical on a double-oblique reconstruction in the aortic valve plane. Ostium positions were compared to those of patients with no congenital heart disease via Watson's two-sample test of homogeneity for circular data. Angular dispersion was compared between groups via the Wallraff test. P<0.05 indicated statistical significance. Results Of 206 adult patients with TGA and ASO followed in our adult congenital heart disease centre, 38 (18.4%) had CT imaging available for analysis during the study period (mean age 24±6.8, 75% male). The control group consisted of 15 patients investigated for chest pain (mean age 54±15.1, 73% male). In the control group, the right and left coronary ostia arose at a mean angle of −19 and +125 degrees from vertical (figure 1a). This was significantly different to the mean ASO coronary ostia clustered at mean angles of −70 and +29 degrees from vertical (Watson p<0.001) (figure 1b, with stenosis at the left coronary anastomosis). There was no significant difference in spread of left ostia (Rho 0.9 vs 0.99, p=0.12), but right ostia were significantly more variable in ASO patients than controls (0.71 vs 0.96, p=0.003). Figure 1 Conclusions Coronary ostial positions in the neo-aorta of post-ASO patients differ significantly from those of normal controls, with considerable variability, especially in right coronary position. CT can demonstrate coronary ostia in 3D space and derive appropriate tube angles to guide catheterisation in post-operative congenital cardiac patients, optimise catheter selection, reduce catheterisation tome, radiation and contrast dose.

Download Full-text

Cerebral Emboli during Cardiac Surgery in Children

Anesthesiology ◽

10.1097/00000542-199711000-00009 ◽

1997 ◽

Vol 87 (5) ◽

pp. 1063-1069 ◽

Cited By ~ 35

Author(s):

James J. O'Brien ◽

John Butterworth ◽

John W. Hammon ◽

Kristin J. Morris ◽

Julia M. Phipps ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

High Risk ◽

Congenital Heart ◽

Risk Group ◽

Heart Defects ◽

Low Risk ◽

Time Interval ◽

Significant Difference

Background Microemboli occur commonly during cardiac surgery in adults, and, when present, increase the risk of neuropsychological deficits. Their incidence and significance during correction of congenital heart disease is unknown. The authors hypothesized that microemboli would occur before bypass with right-to-left cardiac shunts and would also occur in large numbers when the aortic crossclamp was released in children during repair of congenital heart defects. Methods In 25 children studied with carotid artery Doppler, embolic signals were counted and timed in relation to 13 intraoperative events. Patients were classified as either at high risk (obligate right-to-left shunt or uncorrected transposition of the great arteries) or at low risk (net left-to-right shunt or simple obstructive lesions) for paradoxical (venous to arterial) emboli. Results The median number of emboli detected was 122 (range, 2-2,664). Forty-two percent of all emboli were detected within 3 min of release of the aortic crossclamp. The high-risk group had significantly more emboli (median, 66; range, 0-116) during the time interval before cardiopulmonary bypass than did the low-risk group (median, 8; range, 0-73), with P < 0.01. There was no significant difference between the high- and low-risk groups in the total number of emboli detected. There was no apparent association between number of emboli and gross neurologic deficits. Conclusions Microemboli can be detected in the carotid arteries of children undergoing repair of congenital heart disease and are especially prevalent immediately after release of the aortic crossclamp. The role of emboli in causing neurologic injury in children undergoing repair of congenital heart disease remains to be determined.

Download Full-text