The Year in Review: Anesthesia for Congenital Heart Disease 2020

2021 ◽  
pp. 108925322110113
Author(s):  
Leah M. Landsem ◽  
Faith J. Ross ◽  
Denise C. Joffe ◽  
Gregory J. Latham
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Fontan Procedure ◽  
Norwood Procedure ◽  
Neurologic Outcomes ◽  
Taking Care

This review focuses on the literature published during the calendar year 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five major themes are discussed, including COVID-19 in children with heart disease, race and outcome disparities in congenital heart disease, Norwood procedure and outcomes, Fontan procedure and outcomes, and neurotoxicity/neurologic outcomes. A total of 59 peer-reviewed articles are discussed.

scholarly journals An unusual cause of edema in a child with congenital heart disease post Fontan procedure

2019 ◽  
Vol 7 (11) ◽  
pp. 4396
Author(s):  
Minal Wade ◽  
Shweta Shettiwar ◽  
Ankita Shah
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Rare Complication ◽  
Fontan Procedure ◽  
Protein Losing Enteropathy ◽  
Common Causes ◽  
Disease Protein ◽  
The Common ◽  
Fontan Palliation

Protein Losing Enteropathy Post Fontan procedure. Protein Losing Enteropathy (PLE) is an uncommon cause of edema in children with congenital heart disease. Protein-Losing Enteropathy may be defined as excessive loss of proteins across the intestinal mucosa and is due to either a primary gastrointestinal abnormality or secondary to cardiac disease. Protein-losing enteropathy (PLE) is a rare complication of the Fontan palliation for functional single-ventricle. Although PLE occurs in about 3.5% of patients post-Fontan, it confers marked morbidity and high mortality within 5 years of diagnosis. The pathogenesis of Fontan-related PLE is not completely understood, and it is unclear why it develops in some patients post-Fontan and not others. We describe a child with Double Inlet Right Ventricle who had undergone Fontan procedure, and presented to us with generalised oedema. The child had hypoproteinaemia, the common causes for which were ruled out and was diagnosed as Protein Losing Enteropathy (PLE) related to his surgical intervention. Though, not frequently encountered it should be kept in mind as one of the causes of anasarca.

Abstract 11041: Use of Digoxin is Associated With Reduced Interstage Mortality: Results From the Pediatric Heart Network Single Ventricle Reconstruction Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Matthew Oster ◽  
Michael Kelleman ◽  
Courtney McCracken ◽  
Richard P Ohye ◽  
William T Mahle
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Right Ventricle ◽  
Congenital Heart ◽  
Single Ventricle ◽  
Norwood Procedure ◽  
Survival Models ◽  
Number Needed To Treat ◽  
Interstage Mortality ◽  
Parametric Survival

Introduction: Despite medical and surgical advances over the past few decades, mortality for infants with single ventricle congenital heart disease remains as high as 8-12% during the interstage period, the time between discharge after the Norwood procedure and before the stage II palliation. The objective of our study was to determine the effect of digoxin use on interstage mortality in infants with single ventricle congenital heart disease. Hypothesis: We hypothesized that digoxin would be associated with lower interstage mortality. Methods: We conducted a retrospective cohort study using the Pediatric Heart Network Single Ventricle Reconstruction Trial public use dataset, which includes data on infants with single right ventricle congenital heart disease randomized to receive either a Blalock-Taussig shunt or right ventricle-to-pulmonary artery shunt during the Norwood procedure at 15 institutions in North America from 2005-2008. Parametric survival models were used to compare the risk of interstage mortality between those discharged to home on digoxin vs. those discharged to home not on digoxin, adjusting for center volume, ascending aorta diameter, shunt type, and socioeconomic status. Further comparisons were made to compare the number of other adverse events in the two groups. Results: Of the 330 infants eligible for this study, 102 (31%) were discharged home on digoxin. Interstage mortality for those not on digoxin was 12.3%, compared to 2.9% among those on digoxin (Figure), with a number needed to treat of 11 patients to prevent one death. The adjusted hazard ratio was 3.5 (95%CI 1.1-11.7, p=0.04). There were no differences in complications between the two groups during the interstage period. Conclusions: Digoxin use in infants with single ventricle congenital heart disease is associated with significantly reduced interstage mortality and should be considered for all such infants unless otherwise contraindicated.

Chylothorax after surgery for congenital heart disease in children

1998 ◽  
Vol 8 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Simone Rolim Fernandes Fontes Pedra ◽  
Carlos Augusto Cardoso Pedra ◽  
Valmir Fernandes Fontes ◽  
Maria Virgínia Tavares Santana ◽  
Paulo Paredes Paulista
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Fontan Procedure ◽  
Bidirectional Glenn ◽  
Surgical Data ◽  
Considerable Morbidity ◽  
Classical Means ◽  
Hypercaloric Diet ◽  
High Output

AbstractWe reviewed retrospectively the clinical and surgical data from 9 children with postoperative chylothorax secondary to cardiac surgery for congenital heart disease seen over a 3 year period. Mean age was 26 months and 6 patients were female. The procedures performed were 2 Blalock-Taussig shunts, 6 Bidirectional Glenn anastomoses and 1 modified Fontan procedure. Diagnosis of chylothorax was made by classical means. The overall incidence of chylothorax was 0.8%, with the relative incidences being 2.5% for Blalock-Taussig, 2.7% for Fontan, and 11.7% for the Glenn procedures. All patients were initially treated conservatively with chest tube drainage and hypercaloric diet suplemented with medium chain triglycerides. Parenteral nutrition was needed in 2 patients, one because of sepsis and the other because of progressive malnourishment. High output fistulas and long periods of drainage were noted after cavo-pulmonary procedures. Up to 12% weight loss was observed in 6 patients, one patient was successfully treated of pneumonia and another died ofPseudomonas aeruginosasepsis. Two patients required chemical pleurodesis because of unabated drainage, with the others being successfully treated conservatively. Chylothorax is a common complication after bidirectional Glenn procedures, and is associated with considerable morbidity and mortality. Earlier operative intervention may be required in these patients. Pleurodesis is a simple, safe, and effective procedure to stop chylous flow.

The Year in Review: Anesthesia for Congenital Heart Disease 2019

2020 ◽  
Vol 24 (2) ◽  
pp. 175-186
Author(s):  
Nicholas M. Houska ◽  
Lawrence I. Schwartz
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Time Period ◽  
Taking Care

This review focuses on the literature published from January 2019 to February 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five themes are addressed during this time period, and 59 peer-reviewed articles are discussed.

Understanding the Fontan Procedure in Congenital Heart Disease Patients and the Importance of Early Hepatology Referrals: A Case Study

2018 ◽  
Vol 11 (2) ◽  
pp. 95-99
Author(s):  
Alice Chan
Keyword(s):  
Primary Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Nurse Practitioners ◽  
Congenital Heart ◽  
Care Setting ◽  
Primary Care Setting ◽  
Fontan Procedure ◽  
Early Screening

Background: Patients with congenital heart disease are surviving into adulthood because of new surgeries developed over the recent decades. One surgery is the Fontan procedure, which is used in patients with only one functioning ventricle. Although it has been saving lives, in the recent years multiple complications have been noted. Objective: To discuss the Fontan procedure and inform nurse practitioners in the primary care setting the importance of early screening and referral because of increasing number of liver complications in these patients. This case study highlights the dilemmas a patient with the Fontan procedure faces as a young adult. Methods: Evidence-based articles from the PubMed and Embase databases were used to support the case study. Results: Patients with the low-pressure Fontan circulation are under chronic passive congestion and have known liver complications such as liver fibrosis, cirrhosis, and protein-losing enteropathy. This can lead to a high-risk dual organ heart–liver transplant. Conclusions: Early screening and referral to a hepatologist are critical in these patients. Implications for Nursing: Since patients with congenital heart disease often present to the primary care setting, nurse practitioners in this area should understand the Fontan procedure and its associated complications so they can effectively manage these patients.

scholarly journals Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV), Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus

2016 ◽  
pp. 157-61
Author(s):  
Sylvie Sakasasmita ◽  
Ganesja M Harimurti ◽  
Dicky Fakhri ◽  
Venty Venty
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Left Ventricle ◽  
Patent Ductus Arteriosus ◽  
Congenital Heart ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Fontan Procedure ◽  
Double Inlet Left Ventricle ◽  
Patent Ductus

Congenital heart disease is an interesting area which present a great various arrangement of the cardiac stucture. We present a rare case of 11 months old male with complex congenital heart disease consisted of Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV) with Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus (PDA).Patient was an eleven months old male who was admitted in our institution for cardiac operation. He was diagnosed with congenital heart disease since three days old with initial presentation of cyanosis when he was crying. His physical growth was retarded but his developmental Milestones was considered normal. On admission, his oxygen saturation was 88% with ambient air. The diagnosis was confirmed by echocardiography. He was planned to undergo staging surgery which would end to Fontan Procedure. Pulmonary Artery (PA) banding was performed to reduce blood flow to pulmonary circulation, distribute more blood from the left ventricle to aorta and systemic circulation and prepare for bidirectional Glenn Shunt procedure one year later and Fontan procedure a year after that.

scholarly journals Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV), Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus

2017 ◽  
pp. 28-32
Author(s):  
Sylvie Sakasasmita ◽  
Ganesja M. Harimurti ◽  
Dicky Fakhri ◽  
Venty Venty
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Left Ventricle ◽  
Patent Ductus Arteriosus ◽  
Congenital Heart ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Fontan Procedure ◽  
Double Inlet Left Ventricle ◽  
Patent Ductus

Congenital heart disease is an interesting area which present a great various arrangement of the cardiac stucture. We present a rare case of 11 months old male with complex congenital heart disease consisted of Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV) with Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus (PDA).Patient was an eleven months old male who was admitted in our institution for cardiac operation. He was diagnosed with congenital heart disease since three days old with initial presentation of cyanosis when he was crying. His physical growth was retarded but his developmental Milestones was considered normal. On admission, his oxygen saturation was 88% with ambient air. The diagnosis was confirmed by echocardiography. He was planned to undergo staging surgery which would end to Fontan Procedure. Pulmonary Artery (PA) banding was performed to reduce blood flow to pulmonary circulation, distribute more blood from the left ventricle to aorta and systemic circulation and prepare for bidirectional Glenn Shunt procedure one year later and Fontan procedure a year after that.

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