Prevalence of Culture-Negative Fever in Infants With Down Syndrome Undergoing Cardiac Surgery

Background: Children with Down syndrome (DS) often have congenital heart disease that requires surgical repair in the first year. Anecdotally, we have noted that patients with DS seem to have a higher rate of culture-negative postoperative fever. The objective was to evaluate the prevalence of postoperative fever and recovery among patients with DS undergoing cardiac surgery. Methods: We conducted a retrospective, case–control study of all patients at our institution less than one year of age with DS undergoing surgical repair of an atrioventricular septal defect or ventricular septal defect between 2010 and 2016. The control group was patients with no chromosomal anomalies who were age and surgery matched to the DS group. Temperatures were recorded for the first 72 hours postoperatively, with duration and degree of fever being assessed using the area under the curve. Results: Patients with DS (n = 34) had a significantly higher prevalence of fever than the control group (59% vs 24%, P = .003), longer ventilator time, and longer length of stay. Among the DS group, those who developed fever tended to be older at the time of surgery (146 ± 63 vs 103 ± 45 days, P = .04). The DS group with fever had similar cardiopulmonary bypass times, intensive care unit and total lengths of stay, ventilator days, and hospital costs compared to patients with DS without fever. Conclusions: Patients with DS have a higher incidence of culture-negative fever within the first 72 hours. The presence of fever in these patients, however, does not affect their overall postoperative course.

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A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951110001915 ◽

2011 ◽

Vol 21 (3) ◽

pp. 266-270 ◽

Cited By ~ 24

Author(s):

Wanjun Luo ◽

Ming Zhu ◽

Rimao Huang ◽

Yangde Zhang

Keyword(s):

Creatine Kinase ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Myocardial Protection ◽

Septal Defect ◽

Troponin I ◽

Control Group ◽

Conditioning Group ◽

Cardioplegic Arrest ◽

Creatine Kinase Mb

AbstractBackgroundRemote ischaemic pre-conditioning and cardiac ischaemic post-conditioning provide myocardial protection in cardiac surgery. However, these two endogenous strategies have not been directly compared in a clinical setting. The purpose of this study was to compare the efficacy of remote ischaemic pre-conditioning and post-conditioning in providing myocardial protection to children undergoing cardiopulmonary bypass for surgical repair of ventricular septal defect.MethodsWe randomly assigned 60 paediatric patients scheduled for surgical correction of congenital ventricular septal defect to the post-conditioning group (n = 20), remote pre-conditioning group (n = 20), or control group (n = 20). Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of reperfusion achieved by clamping and unclamping the aorta, repeated three times over 3 minutes immediately after cardioplegic arrest. Remote ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia followed by 5 minutes of reperfusion using a blood-pressure cuff inflated to a pressure of 200 millimetres of mercury, also repeated three times over 30 minutes. We assayed creatine kinase-MB, troponin I.ResultsMean age, cardiopulmonary bypass times, and aortic cross-clamp times were matched across groups. Both post-conditioning and remote ischaemic pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre, respectively, versus 111.0 plus or minus 44.6 units per litre in the control, p less than 0.05) and troponin I (0.28 plus or minus 0.10 nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per millilitre in the control group, p less than 0.05).ConclusionsOur study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.

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Cardiac surgery in a girl with trisomy 13

Cardiology in the Young ◽

10.1017/s1047951100008945 ◽

2000 ◽

Vol 10 (6) ◽

pp. 638-640 ◽

Cited By ~ 6

Author(s):

Petter Strømme ◽

Erik Thaulow ◽

Odd Geiran

Keyword(s):

Heart Failure ◽

Cardiac Surgery ◽

Ventricular Septal Defect ◽

Medical Treatment ◽

Septal Defect ◽

Surgical Repair ◽

Trisomy 13 ◽

Cardiac Defect ◽

Short Survival ◽

Infant Girl

AbstractWe describe a profoundly retarded infant girl with multiple anomalies caused by trisomy 13. Due to heart failure, which was resistant to medical treatment, we closed successfully a ventricular septal defect at three months of age. She died at 10 months of age. Despite the short survival, we believe that the patient benefitted significantly from the surgical repair of her cardiac defect.

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Effect of the COVID-19 pandemic on complications and mortality of patients with cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01744-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xue Wang ◽

Heng Gao ◽

Zhanqin Zhang ◽

Chao Deng ◽

Yang Yan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Area Under The Curve ◽

Admission Rate ◽

Emergency Admission ◽

Control Group ◽

Short Term ◽

Short Term Mortality ◽

Complications And Mortality

Abstract Objectives The purpose of this study was to assess changes in cardiovascular disease severity, types, postoperative complications and prognosis during the COVID-19 pandemic and to explore possible influencing factors. Methods A total of 422 patients were enrolled in this study, and hospitalization and short-term follow-up data were retained. The patient population included 273 men and 149 women. Patients had a median (IQR) age of 54 (45–62) years and were divided into an observation group (130) and a control group (292), primarily according to severity of disease, disease types, baseline indexes, biochemical indexes, cardiac function indexes, complications and prognosis. Results During the COVID-19 pandemic, compared with the same period last year, there was a significant increase in patients with aortic dissection (27.69% vs 5.82%), a significant decrease in patients with valvular heart disease (43.08% vs 66.78%), and significantly increased emergency admission (50.00% vs 21.23%) and severity (54.62% vs 27.40%). Family company (76.37% vs 64.62%) was decreased, EuroSCORE [6.5 (2–9) vs 2 (0–5)] score, Pro-BNP [857.50 (241.00–2222.50) vs 542.40 (113.45–1776.75)] ng/L, six months mortality rate (18.46% vs 8.90%), and postoperative complications, including infected patients, atelectasis, pulmonary edema, and so on were increased, with longer length of stay in the ICU and hospital in COVID-19 pandemic. Survival analysis curve further demonstrated that it had an impact on the deaths of patients during the COVID-19 pandemic period. Through ROC analysis of the death factors of patients, it was concluded that Family company affected the death of patients, and the area under the curve was 0.654 (P < 0.05). Conclusions In this study, we found that the admission rate of critically ill patients with cardiovascular disease, complications of cardiac surgery, and short-term mortality of patients all exhibited a short-term increase, family company may be a risk factors for short-term mortality, that may be related to public pressure caused by the COVID-19 pandemic.

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The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

International Orthopaedics ◽

10.1007/s00264-021-05104-3 ◽

2021 ◽

Author(s):

Yuan Deng ◽

Zhong Zheng ◽

Shi Cheng ◽

Yuan Lin ◽

Duanyang Wang ◽

...

Keyword(s):

Hip Fracture ◽

Nosocomial Infection ◽

Hip Fractures ◽

Area Under The Curve ◽

The Elderly ◽

Chronic Respiratory Disease ◽

Fracture Pattern ◽

Control Group ◽

Retrospective Case ◽

Elderly Cohort

Abstract Purpose This is a retrospective case–control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. Methods A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. Results A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. Conclusions Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.

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How Normal Is a ‘Normal' Heart in Fetuses and Infants with Down Syndrome?

Fetal Diagnosis and Therapy ◽

10.1159/000381710 ◽

2015 ◽

Vol 39 (1) ◽

pp. 13-20 ◽

Cited By ~ 8

Author(s):

Emmeline Calkoen ◽

Bauke Adriaanse ◽

Monique Haak ◽

Margot Bartelings ◽

Adam Kolesnik ◽

...

Keyword(s):

Down Syndrome ◽

Congenital Heart ◽

Septal Defect ◽

Heart Defects ◽

Normal Population ◽

Ventricular Septum ◽

Control Group ◽

Ultrasound Images ◽

And Control ◽

Membranous Septum

Background: Congenital heart disease is present in 44-56% of fetuses with Down syndrome (DS). There are, however, signs that hearts in DS without apparent structural heart defects also differ from those in the normal population. We aimed to compare the atrioventricular (AV) septum and valves in 3 groups: DS without AV septal defect (DS no-AVSD), DS with AVSD (DS AVSD) and control hearts. Methods: The ventricular septum, membranous septum and AV valves were examined and measured in histological sections of 15 DS no-AVSD, 8 DS AVSD and 34 control hearts. In addition, the ventricular septum length was measured on ultrasound images of fetal (6 DS AVSD, 9 controls) and infant (10 DS no-AVSD, 10 DS AVSD, 10 controls) hearts. Results: The membranous septum was 3 times larger in DS no-AVSD fetuses compared to control fetuses, and valve dysplasia was frequently (64%) observed. The ventricular septum was shorter in patients with DS both with and without AVSD, as compared to the control group. Conclusion: DS no-AVSD hearts are not normal as they have a larger membranous septum, shorter ventricular septum and dysplasia of the AV valves as compared to control hearts.

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Predicting Postoperative Hypertension Among Patients With Ventricular Septal Defect in Infants

10.21203/rs.3.rs-776171/v1 ◽

2021 ◽

Author(s):

Junpei Kawamura ◽

Kentaro Ueno ◽

Tsubasa Shimozono ◽

Yoshihiro Takahashi ◽

Koji Nakae ◽

...

Keyword(s):

Cardiac Surgery ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Multivariate Logistic Regression Analysis ◽

Area Under The Curve ◽

Right Atrial ◽

General Function ◽

Echocardiographic Parameters ◽

Postoperative Hypertension ◽

Rv Function

Abstract Purpose: Patients with strong pulmonary vascular occlusive lesions are at risk of developing postoperative pulmonary hypertension (PH). We aimed to evaluate preoperative right ventricular (RV) function in patients with ventricular septal defect (VSD) who required cardiac surgery during infancy and consequently developed postoperative PH and to determine whether we could preliminarily evaluate postoperative PH in these patients.Methods: We retrospectively analyzed 55 infants with VSD who underwent cardiac surgery between March 2014 and April 2020. We evaluated the measurements of preoperative atrial/ventricular general function and 2D atrial/ventricular strain between these two groups: a group with postoperative PH (post-PH) and a group without postoperative PH (post-NPH). Results: Post-PH patients had a significantly lower tricuspid annular plane systolic excursion (TAPSE) (11.2 mm) and TAPSERA (the proportion of TAPSE due to RA contraction alone) (6.6 mm) than the post-NPH patients (14.1 mm, 8.5 mm). Furthermore, the post-PH group had a significantly lower peak right atrial (RA) longitudinal strain (PRALS) (31.0%) than the post-NPH group (43.0%). Multivariate logistic regression analysis identified that PRALS and TAPSERA were independent echocardiographic parameters for the presence of post-PH. The sensitivity and specificity of predicting post-PH for ≤38% of the PRALS were 83.0% and 100.0%, respectively, with an area under the curve of 0.94 (p < 0.01).Conclusion: Preoperative RA function and RV diastolic function decreased in the post-PH group. The RA strain and TAPSERA could be useful factors for predicting postoperative PH.

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A ten year review of atrioventricular septal defects

Cardiology in the Young ◽

10.1017/s1047951104001040 ◽

2004 ◽

Vol 14 (1) ◽

pp. 15-23 ◽

Cited By ~ 12

Author(s):

Kathryn A. Dunlop ◽

H. Connor Mulholland ◽

Frank A. Casey ◽

Brain Craig ◽

Dennis J. Gladstone

Keyword(s):

Cardiac Surgery ◽

Septal Defect ◽

Operative Mortality ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Atrioventricular Septal Defect ◽

Retrospective Case ◽

Atrioventricular Septal Defects ◽

Septal Defects

Objectives:To review all cases of atrioventricular septal defects in Northern Ireland from January 1990 to February 1999, examining clinical and morphological features, management, and outcome.Methods:A retrospective case note analysis of 106 subjects with comparisons between subgroups.Results:An atrioventricular septal defect was part of a more complex abnormality in 50 of the patients (47%). Down's syndrome was present in 57 (54%). Cardiac surgery was performed in 81%. The defects were unrestrictive in 69 patients (65%), 45 of whom had Down's syndrome. Complex associated abnormalities existed in 36 patients, and 10 of these died without cardiac surgery. Operative mortality was 9.5% for those with co-existing Down's syndrome group, and 14.3% for the chromosomally normal patients. The ventricular components of the septal defect were restrictive in 23 patients (22%), with 9 having Down's syndrome. Spontaneous closure occurred in more than half of these patients. Mortality was zero. The septal defect was exclusively at atrial level in 14 patients (“primum” defects – 13%), and 3 of these had Down's syndrome. Operative mortality was again zero. Median duration of postoperative follow-up was 3 and a half years. Overall, moderate to severe left atrioventricular valvar regurgitation was observed postoperatively in 23% at follow-up.Conclusions:Mortality was highest in the atrioventricular septal defects with an unrestrictive ventricular component. Uncomplicated cases had good outcomes. Patients without Down's syndrome tended to have more associated cardiac abnormalities, and to have more postoperative arrhythmias. Approximately half of the defects with restrictive ventricular components closed spontaneously. Moderate postoperative left atrioventricular valvar regurgitation was commonest in patients with the defect exclusively at atrial level.

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Against all odds—late repair of multiple shunt lesions in a patient with Down syndrome: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab234 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Alexandra Arvanitaki ◽

Katarzyna Januszewska ◽

Edward Malec ◽

Helmut Baumgartner ◽

Hans-Gerd Kehl ◽

...

Keyword(s):

Down Syndrome ◽

Septal Defect ◽

Surgical Repair ◽

Heart Defects ◽

Ductus Arteriosus ◽

Resistance Index ◽

Late Presentation ◽

Careful Consideration ◽

Pulmonary Vascular Disease

Abstract Background Children with congenital heart defects (CHD) usually undergo elective surgical repair of haemodynamically relevant shunt lesions within the first year of life. Due to susceptibility for pulmonary arterial hypertension (PAH) in patients with Down syndrome, repair is usually aimed for no later than 6 months of life. However, with rising immigration from developing countries to Europe, more patients with unrepaired CHD are diagnosed at a later age. Anatomical repair may be precluded, when advanced pulmonary vascular disease has been established. Case summary We report a 39-month-old male patient with Down syndrome with a large non-restrictive perimembranous ventricular septal defect, a large patent ductus arteriosus, and a secundum-type atrial septal defect with a prominent left-to-right shunting. Haemodynamic assessment revealed only a mild increase of pulmonary artery pressures (mPAP) with low pulmonary vascular resistance index (PVRi). Vasodilator testing led to a further increase of the left-to-right shunt and decrease of PVRi, suggesting operability. After careful consideration, the patient underwent complete surgical repair with a good post-operative clinical outcome. Cardiac catheterization 6 months after corrective repair showed a normal mPAP. No signs of PAH have been detected in the medium-term follow-up. Discussion Expertise, increased physician awareness, and a thorough pre-operative multidisciplinary evaluation are paramount to determine the best treatment approach for patients, who may present late with multiple shunts, and—in our case—underlying Down syndrome. Long-term close post-surgical follow-up in an expert centre is warranted to promptly diagnose and treat a possible late presentation of PAH appropriately.

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Predicting postoperative hypertension among patients with ventricular septal defect in infants.

10.22541/au.163252985.57677966/v1 ◽

2021 ◽

Author(s):

Junpei Kawamura ◽

Kentaro Ueno ◽

Tsubasa Shimozono ◽

Yoshihiro Takahashi ◽

Koji Nakae ◽

...

Keyword(s):

Cardiac Surgery ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Area Under The Curve ◽

Right Atrial ◽

Multivariate Logistic Regression Model ◽

General Function ◽

2D Strain ◽

Echocardiographic Parameters ◽

Postoperative Hypertension

Background: Patients with strong pulmonary vascular occlusive lesions are at risk of developing postoperative pulmonary hypertension (PH). We aimed to evaluate preoperative right ventricular (RV) function in patients with ventricular septal defect (VSD) who required cardiac surgery during infancy and consequently developed postoperative PH and to determine whether we could preliminarily evaluate postoperative PH in these patients. Methods: We retrospectively analyzed 55 infants with VSD who underwent cardiac surgery between March 2014 and April 2020. We evaluated the measurements of preoperative general function and 2D strain between these two groups: a group with postoperative PH (post-PH, n=10) and a group without postoperative PH (post-NPH, n=45). Results: Post-PH patients had a significantly lower tricuspid annular plane systolic excursion (TAPSE) (11.1 mm), TAPSERA (the proportion of TAPSE due to right atrial (RA) contraction alone) (7.0 mm), RA ejection fraction (36.1 %) and RA expansion index (56.4 %) than the post-NPH patients. Furthermore, the post-PH group had a significantly lower peak RA longitudinal strain (PRALS) (32.0 %) than the post-NPH group (43.0%). Multivariate logistic regression model demonstrated that PRALS was independent echocardiographic parameters for the presence of post-PH (OR 1.18, 95% CI: 1.02 - 1.36, p = 0.03) . The sensitivity and specificity of predicting post-PH for ≤ 35 % of the PRALS were 88.9 % and 70.0 %, respectively, with an area under the curve of 0.85 (p < 0.01). Conclusion: RA parameters demonstrated preoperative RV diastolic dysfunction in the post-PH group. PRALS could be useful factors for predicting postoperative PH.

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Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

The Heart Surgery Forum ◽

10.1532/hsf98.2013293 ◽

2014 ◽

Vol 17 (3) ◽

pp. 154 ◽

Cited By ~ 10

Author(s):

Arıtürk Cem ◽

Ustalar Serpil ◽

Toraman Fevzi ◽

Ökten Murat ◽

Güllü Ümit ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Surgery ◽

Blood Lactate ◽

Near Infrared ◽

Bypass Graft ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Infrared Spectrometry ◽

Control Group ◽

Near Infrared Spectrometry

Introduction: Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO2) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).Methods: The prospective observational study involved patients who underwent cerebral rSO2 monitoring by NIRS during elective isolated first-time CABG: an anemic group (N=15) (minimum Hemoglobin (Hb) N=15) (Hb >8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO2, pO2 at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.Results: The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; P = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a >20% decrease in cerebral rSO2. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO2.Conclusions: In this study, the changes in cerebral rSO2 in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO2 can assist in decision making related to blood transfusion and dilutional anemia during CPB.

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