Bloodless open-heart surgery in infants and children

Perfusion ◽  
1994 ◽  
Vol 9 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Victor T Tsang ◽  
Richard J Mullaly ◽  
Philip G Ragg ◽  
Tom R Karl ◽  
Roger BB Mee
Keyword(s):  
Heart Surgery ◽  
Septal Defect ◽  
Open Heart Surgery ◽  
Postoperative Management ◽  
Double Outlet Right Ventricle ◽  
Subaortic Stenosis ◽  
Congenital Defects ◽  
Open Heart ◽  
The Mean ◽  
Congenital Mitral Regurgitation

Between October 1984 and January 1993, seven children of Jehovah's Witnesses underwent corrective open-heart surgery for congenital defects, on cardiopulmonary bypass (CPB). Age at surgery ranged from three months to 6.5 years, and weight ranged from 4.2 kg to 23.2 kg, with two children weighing less than 10 kg. The principal cardiac anomalies were tetralogy of Fallot (two), double outlet right ventricle (one), subaortic stenosis (one), transposition of the great arteries and ventricular septal defect (one), atrial septal defect and congenital heart block (one), and congenital mitral regurgitation (one). Hypothermic CPB was used in all seven operations with crystalloid priming of the extracorporeal circuit. CPB was based on our standard perfusion protocols. All surgical procedures were done without the use of blood or blood products. The mean preoperative haematocrit (Hct) was 40.9% (range 31.0-47.8%). The mean lowest intraoperative Hct was 17.3% (range 15.0-24.3%), whereas the immediate post-CPB Hct was 19.6% (range 15.3-24.0%). The Hct progressively increased to 29.2% (range 21.0-34.2%) on the first postoperative day, and 32.3% (range 24.2-38.3%) at the time of discharge. There was no hospital mortality, and the mean hospital stay was 10 days (8-13 days). We report the safe repair of complex open-heart surgery in children, without blood transfusion, even in small infants. The successful management of these patients requires meticulous attention to surgical and perfusion technique, and sound postoperative management.

The Hemostatic Mechanism after Open-Heart Surgery

1978 ◽  
Vol 39 (02) ◽  
pp. 474-487 ◽  
Author(s):  
E R Cole ◽  
F Bachmann ◽  
C A Curry ◽  
D Roby
Keyword(s):  
Extracorporeal Circulation ◽  
Heart Surgery ◽  
Polyacrylamide Gel Electrophoresis ◽  
Open Heart Surgery ◽  
Coagulation System ◽  
Open Heart ◽  
Time Activity ◽  
Post Surgery ◽  
Plasma Fractions ◽  
The Mean

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

Axillary artery: An unanticipated choice of access in the cath lab!

2021 ◽  
pp. 021849232110264
Author(s):  
Puneet Varma ◽  
Bharath A Paraswanath ◽  
Anand Subramanian ◽  
Jayaranganath Mahimarangaiah
Keyword(s):  
Hospital Stay ◽  
Heart Surgery ◽  
Septal Defect ◽  
Axillary Artery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Rare Site

Ventricular septal defects are increasingly being closed by transcatheter technique, with lesser morbidity and shorter hospital stay compared to open heart surgery. We report a case of embolization of a duct occluder deployed in a posterior muscular septal defect. The rare site of embolization necessitated an unusual approach for retrieval prior to subsequent closure using a double-disc device.

Changes in serum iron and leukocyte count associated with open-heart surgery.

1983 ◽  
Vol 29 (11) ◽  
pp. 1984-1986 ◽  
Author(s):  
E J Fitzsimons ◽  
G H Ballantyne
Keyword(s):  
Serum Iron ◽  
Heart Surgery ◽  
Leukocyte Count ◽  
Iron Concentration ◽  
Open Heart Surgery ◽  
Stressful Events ◽  
Initial Increase ◽  
Open Heart ◽  
Ferritin Concentration ◽  
The Mean

Abstract Rapid and pronounced changes in serum iron concentration and leukocyte count in association with open-heart surgery were observed in each of 58 patients. We examined the temporal aspects of these alterations. An initial increase in Fe concentration from a mean of 0.94 mg/L before surgery to 1.20 mg/L was observed within 6 h of the start of surgery. Decreased Fe concentration, a phenomenon previously associated with physiologically stressful events, became apparent 12 h after surgery, by which time the mean Fe concentration had declined to 0.26 mg/L. An increase in the mean leukocyte count, from 7.1 to 15.2 X 1000/mm3 was observed within 6 h of the start of surgery. An increase in ferritin concentration in serum was concurrent with decreased iron concentration.

scholarly journals CONGENITALABSENCE OF LEFT PERICARDIUM AND MEDIASTINAL PLEURA: A RARE INCIDENTAL FINDING DURING OPEN HEART SURGERY.

2020 ◽  
pp. 36-37
Author(s):  
Varuna Varma ◽  
Ankit Thukral
Keyword(s):  
Heart Surgery ◽  
Septal Defect ◽  
Pleural Cavity ◽  
Incidental Finding ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Atrial Septal Defect Closure ◽  
Pericardial Defect ◽  
Left Pleural Cavity ◽  
Mediastinal Pleura

9 Year old male child planned for elective Atrial Septal Defect closure Surgery.He had a incidental Intra Operative finding of Partial pericardial defect on left side with Pericardial Herniation in left pleural cavity.

scholarly journals A hybrid procedure for the closure of a large muscular ventricular septal defect in a 6-month-old infant

2020 ◽  
Author(s):  
Dijana Popevski ◽  
Ivan Milev ◽  
Simona Despotovska ◽  
Rodney Alexander Rosalia ◽  
Steven Bibevski ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Heart Surgery ◽  
Septal Defect ◽  
Open Heart Surgery ◽  
Hybrid Procedure ◽  
Open Heart ◽  
Device Closure ◽  
Invasive Approach ◽  
Muscular Vsd

Abstract Background: Transthoracic device closure (TTDC), also known as a Hybrid procedure, has been proposed as an alternative, less invasive approach compared to open-heart surgery for the treatment of ventricular septal defect (VSD). Case Presentation: We present our first national case of TTDC in a 6-month-old female baby with a muscular 8mm ventricular septal defect, 3 mm atrial defect, enlarged right and left ventricle and a dilated pulmonary artery complicated by severe pulmonary hypertension.Treatment consisted of two pulmonary artery banding attempts at the age of 2 months to control pulmonary hypertension – the interventions were combined with diuretics and angiotensin-converting enzymes inhibitors. Yet, the initial approach was suboptimal as we noticed a failure to thrive continuous sweating and tachypnea. Because of the worsening condition at the age of 6 months, and a weight of 6.6 kg, we performed TTDC. After median sternotomy, a 10mm muscular VSD occluder was implanted under trans-oesophagal echocardiography guidance on the beating heart. The procedure lasted 90 min and was performed without incident; the hemodynamics were stable with only a minor residual VSD. The child was extubated after 2 hours and discharged after five days from the hospital.Conclusions: Transthoracic device closure (TTDC) is a promising treatment modality for large muscular VSD in small infants with low weight. TTDC is feasible in cases with heavy myocardial right ventricle trabeculae and who previously underwent open-heart surgery.

scholarly journals The Anesthesia & Anesthetists of the First Open Heart Surgery of Bangladesh

2021 ◽  
Vol 36 (1) ◽  
pp. 55-60
Author(s):  
Suman Nazmul Hosain ◽  
Farzana Amin ◽  
Shahnaz Ferdous
Keyword(s):  
College Student ◽  
Cardiovascular Diseases ◽  
Human Resources ◽  
Heart Surgery ◽  
Septal Defect ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Success Story ◽  
Direct Closure ◽  
Over Time

Although a few closed heart operations were performed in the late 1960s, well organized approach to open heart surgery began in Bangladesh only after establishment of Institute of Cardiovascular Diseases (ICVD) in 1978. A Japanese team of surgeons, anesthetists, nurses and technicians provided extensive support in capacity building of the local human resources. Ultimately the first open heart surgery of Bangladesh, the direct closure of Atrial Septal Defect of an 18 year old college student, was performed on 18th September 1981. It was great news of that time. People came to know about the success story of the ICVD director then Colonel M Abdul Malik, a renowned cardiologist cum team leader and the Bangladeshi surgeon duo Dr M Nabi Alam Khan and Dr S R Khan. But somehow the anesthetists, an important part of the team were out of focus and have been forgotten over time. Led by Prof Khalilur Rahman, the anesthetist team of the day included Dr Nurul Islam, Dr Abdul Hadi, Dr Delowar Hossain, Dr A Y F Ellahi Chowdhury and Dr Monir Hossain. This article is an attempt to remind their contribution and expressing respect and gratitude to the anesthetists of that pioneering team. Bangladesh Heart Journal 2021; 36(1) : 55-60

Comparative assessment of risk of development of purulent septic infections in children after open and closed cardiac operations for congenital diseases

2021 ◽  
pp. 41-44
Author(s):  
L. G. Kudryavtseva ◽  
P. V. Lazarkov ◽  
V. I. Sergevnin
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Lung Ventilation ◽  
Comparative Assessment ◽  
Congenital Defects ◽  
Open Heart ◽  
Case Definitions ◽  
Standard Case ◽  
Congenital Diseases ◽  
Endovascular Interventions

Purpose of the study. Comparative assessment of the incidence of nosocomial purulent-septic infections (PSI) in children after open and closed heart surgery for congenital defects.Materials and methods. 503 medical records of children after cardiac surgery were studied. GSI was identified according to epidemiological standard case definitions.Results. It turned out that the incidence rate of PSI in children after open heart surgery is an order of magnitude higher than after minimally invasive endovascular interventions. Hospital-acquired pneumonia most often occurs in children after operations.Conclusion. The increased incidence of PSI after open heart surgery, as compared to endovascular surgery, is due to a longer surgical intervention and the subsequent longer stay of patients in the intensive care unit, where such an epidemiologically significant procedure as artificial lung ventilation is performed.

Surgical palliation of hypoplastic left heart syndrome: is there a role for hypothermic circulatory arrest?

2004 ◽  
Vol 14 (S1) ◽  
pp. 65-69 ◽  
Author(s):  
Marshall L. Jacobs
Keyword(s):  
Cardiac Surgery ◽  
Soviet Union ◽  
Heart Surgery ◽  
Septal Defect ◽  
Circulatory Arrest ◽  
Large Fraction ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Inflow Occlusion ◽  
Open Operation

The technique of deep hypothermia with circulatory arrest has been important in the history of the evolution of cardiac surgery. Wilfred G. Bigelow, working in Toronto in the late 1940s, performed pioneering research on hypothermia, and developed a workable technique of hypothermia in human cardiac surgery.1Based upon Bigelow's experimental premises, F. John Lewis, at the University of Minnesota, also conducted a number of experiments utilizing hypothermia. On September 2, 1942, Lewis operated on a 5-year-old girl with an atrial septal defect under general hypothermia with inflow occlusion. He was assisted by Richard Varco, Mansur Taufic, and C. Walton Lillehei. Rubberized refrigerated blankets were used to cool the patient to 28°C. The septal defect was closed during five and a half minutes of inflow occlusion. This was the world's first successful open operation on the human heart performed under direct vision, and marked the beginning of the era of open heart surgery. Now, as amazing and as primitive as that methodology may seem, those of you who read Life magazine, or watch the Discovery Channel on television, are aware that, in parts of the Soviet Union, a large fraction of today's open heart surgery is performed not using the technique of cardiopulmonary bypass, but rather using the methodology of immersion hypothermia from the 1950s, with surprisingly good results.

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