Deep Tracheal Extubation Using Dexmedetomidine in Children With Congenital Heart Disease Undergoing Cardiac Catheterization: Advantages and Complications

2019 ◽  
Vol 23 (4) ◽  
pp. 387-392 ◽  
Author(s):  
Nischal K. Gautam ◽  
Kayla Bober ◽  
James A. Pierre ◽  
Olga Pawelek ◽  
Evelyn Griffin
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Cardiac Catheterization ◽  
Odds Ratio ◽  
Congenital Heart ◽  
Noninvasive Positive Pressure Ventilation ◽  
Tracheal Extubation ◽  
Postoperative Recovery ◽  
Positive Pressure

Objective. Deep tracheal extubation using dexmedetomidine is safe and provides smooth recovery in children with congenital heart disease undergoing cardiac catheterization. Design. Single-institution, retrospective study of prospectively collected data. Participants. All patients aged between 1 month and 5 years who underwent general endotracheal anesthesia for diagnostic and interventional cardiac catheterizations in the cardiac catheterization suite from January 2015 (change in standard operating procedure) through October 2016 (approval of institutional review board for study). Measurement and Main Results. One hundred and eighty-nine patients (81%) of the 232 patients who underwent cardiac catheterization during the study period were noted to undergo deep tracheal extubation. Cyanotic heart disease was present in 87 patients (46%), history of prematurity in 51 (27%), and pulmonary hypertension in 26 (14%) patients. A documented smooth recovery in the postoperative care unit (PACU) requiring no additional analgesics or sedatives was observed in 91% of the patients. The majority of patients required no airway support after deep extubation (n = 140, 74%, P = .136). The presence of pulmonary hypertension (odds ratio = 4.45, P = .035) and presence of a cough on the day of the procedure (odds ratio = 7.10, P = .03) were significantly associated with the use of oxygen or use of oral airway for greater than 20 minutes in the PACU. After extubation, there were no reported events of aspiration, the use of noninvasive positive pressure ventilation, reintubation, heart block, or systemic hypotension requiring treatment or cardiac arrest. Conclusions. Deep extubation using dexmedetomidine in infants and toddlers after cardiac catheterization is feasible and enables smooth postoperative recovery with minimal adverse effects.

Aortic Saturation Predicted Operability in Acyanotic Congenital Heart Disease with Left-to-Right Shunt

2021 ◽  
Vol 104 (5) ◽  
pp. 740-745
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Oxygen Saturation ◽  
Cardiac Catheterization ◽  
Congenital Heart ◽  
Diagnostic Yield ◽  
Invasive Procedure ◽  
Roc Curve Analysis ◽  
Acyanotic Congenital Heart Disease

Background: Cardiac catheterization is the gold standard to determine operability in patients with congenital heart disease (CHD) with left to right shunt and pulmonary hypertension. Objective: To determine if systemic oxygen saturation could be used as a screening tool for acyanotic CHD patients who are operable without having to undergo an invasive procedure. Materials and Methods: All cardiac catheterization data at the King Chulalongkorn Memorial Hospital between 2002 and 2017 were retrospectively reviewed. The inclusion criteria were acyanotic lesion with left-to-right shunt, mean pulmonary artery pressure of 25 mmHg or more, pulmonary overcirculation (Qp:Qs greater than 1), and absence of significant left sided heart disease (LAP or PCWP of less than 15 mmHg). Operability was defined as Rpi of 6 WU.m² or less and Rp:Rs of less than 0.3 in room air. The value of aortic saturation as diagnostic test for operability was analyzed by ROC curve analysis. Results: Two hundred twenty-six patients, with a median age of two years old, (IQR 0.11, 6.00) were divided into pre-tricuspid shunt (ASD, PAPVR, 9.7%), complete atrioventricular (AV) canal defect (13%), and other post-tricuspid lesion (VSD, PDA, 77%). Aortic saturation cut-off values to predict operability with 100% specificity were 98.5% in pre-tricuspid shunt, 100% in post-tricuspid shunt group, and 94.5% in complete AV canal group. Conclusion: In the present study population, aortic saturation may be used to determine operability in acyanotic CHD patients with pulmonary overcirculation. Diagnostic yield is best in patients with complete AV canal defect in whom oxygen saturation of 95% or above identified operability with close to 100% specificity. In other lesions, there appears to be no oxygen saturation that is safe to preclude cardiac catheterization. Keywords: Congenital heart disease, Acyanotic heart disease, Non-cyanotic heart lesions, Pulmonary hypertension, Operability, Aortic saturation

scholarly journals Solely MRI-Guided Cardiac Catheterization for Assessment of Pulmonary Hypertension in a Pregnant Lady with Undiagnosed Congenital Heart Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Aphrodite Tzifa ◽  
Ioannis Polymerou ◽  
Dimitra Loggitsi
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Mortality Rate ◽  
Adverse Effects ◽  
Risk Stratification ◽  
Cardiac Catheterization ◽  
Congenital Heart ◽  
Complex Congenital Heart Disease ◽  
Mri Guided

Pregnancy in women with complex congenital heart disease (CHD) can be poorly tolerated. Amongst pregnant women with CHD and pulmonary hypertension (PH), the mortality rate can be as high as 30%. Cardiac catheterization procedures for assessment of haemodynamics and pulmonary vascular resistance (PVR) are often required in this patient population for risk stratification. However, during the first few weeks of pregnancy, this should better be avoided due to the known adverse effects of the ionizing radiation to the immature fetus. In this setting, a solely MRI-guided catheterization may present as a better alternative.

scholarly journals Prevalence and profile of congenital heart disease and pulmonary hypertension in Down syndrome in a pediatric cardiology service

2014 ◽  
Vol 32 (2) ◽  
pp. 159-163 ◽  
Author(s):  
Felipe Alves Mourato ◽  
Lúcia Roberta R. Villachan ◽  
Sandra da Silva Mattos
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Down Syndrome ◽  
Heart Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Heart Diseases ◽  
Heart Defects ◽  
Descriptive Analysis ◽  
Atrioventricular Septal Defect

OBJECTIVE:To determine the frequence and profile of congenital heart defects in Down syndrome patients referred to a pediatric cardiologic center, considering the age of referral, gender, type of heart disease diagnosed by transthoracic echocardiography and its association with pulmonary hypertension at the initial diagnosis.METHODS:Cross-sectional study with retrospective data collection of 138 patients with Down syndrome from a total of 17,873 records. Descriptive analysis of the data was performed, using Epi-Info version 7.RESULTS: Among the 138 patients with Down syndrome, females prevailed (56.1%) and 112 (81.2%) were diagnosed with congenital heart disease. The most common lesion was ostium secundum atrial septal defect, present in 51.8%, followed by atrioventricular septal defect, in 46.4%. Ventricular septal defects were present in 27.7%, while tetralogy of Fallot represented 6.3% of the cases. Other cardiac malformations corresponded to 12.5%. Pulmonary hypertension was associated with 37.5% of the heart diseases. Only 35.5% of the patients were referred before six months of age.CONCLUSIONS: The low percentage of referral until six months of age highlights the need for a better tracking of patients with Down syndrome in the context of congenital heart disease, due to the high frequency and progression of pulmonary hypertension.

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