Regional cerebral oxygenation (rSaO2) in infants during the early postoperative period following corrective cardiac surgery of congenital heart defects. † 241

Background. The optimal tactics of surgical treatment of aortic arch hypoplasia combined with other congenital heart defects remain controversial. In recent years, the leading clinics of the world prefer one-stage repair of such a combination, however, two-stage treatment is still used by cardiac surgeons and remains one of the variants of surgical tactics. The aim. To analyze immediate and long-term results of a two-stage repair of aortic arch hypoplasia with other con-genital heart defects in newborns and infants. Materials and methods. The study included 138 infants who were selected for a two-stage repair of aortic arch hy-poplasia with other congenital heart defects. There were 79 (57.2%) male and 59 (42.8%) female patients. The mean age of the patients was 1.4 ± 0.7 months, mean body weight was 4.1 ± 2.0 kg. The main method of the defect diagnosis and evaluation of immediate and long-term results was echocardiographic examination. The aortic arch segment was consid-ered hypoplastic if the Z-score deviation was less than –2.0. Results. The hospital mortality rate was 5.8% (n = 8). Two patients (1.4%) had delayed sternal closure in the early postoperative period. As a result of severe myocardial failure, two patients underwent extracorporeal membrane oxy-genation (ECMO). According to echocardiography before discharge, the mean pressure gradient at the site of aortic arch repair was 16 ± 6 mmHg. There was one death in the follow-up period. In 16 (11.5%) patients, aortic arch restenosis developed in the postoperative period. In total, 20 re-interventions were performed: 11 endovascular balloon dilatations and 9 surgical re-interventions. In the early postoperative period, aortopexia was performed in two patients (1.4%) due to compression of the left main bronchus. Conclusions. Two-stage repair of aortic arch hypoplasia with other congenital heart defects in newborns and infants is effective and safe treatment with good immediate and long-term results. This study shows that this surgical strategy can be effectively used in this complex pathology.

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Treatment of right ventricular failure in the near postoperative period in older children with congenital heart defects who underwent open heart surgery

Clinical Physiology of Circulation ◽

10.24022/1814-6910-2019-16-1-36-44 ◽

2019 ◽

Vol 16 (1) ◽

pp. 36-44

Author(s):

E.S. Nikitin ◽

P.V. Yudin ◽

I.M. Makrushin ◽

M.M. Titov

Keyword(s):

Congenital Heart Defects ◽

Postoperative Period ◽

Congenital Heart ◽

Heart Surgery ◽

Heart Defects ◽

Open Heart Surgery ◽

Right Ventricular Failure ◽

Open Heart ◽

Older Children ◽

Ventricular Failure

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Role of toll-like receptors in complications of cardiac surgery for congenital heart defects in children

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-3-34-42 ◽

2021 ◽

Vol 25 (3) ◽

pp. 34

Author(s):

A. V. Tsepokina ◽

A. A. Anikeenko ◽

S. A. Shmulevich ◽

A. V. Ponasenko ◽

A. V. Shabaldin

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Gene Interaction ◽

Infectious Complications ◽

Toll Like Receptors ◽

Cytokines And Chemokines ◽

Polymorphic Variants

Background. Cardiac surgery in combination with hypothermia, ischaemia and reperfusion leads to an inflammatory response causing postoperative complications. Toll-like receptors are signalling molecules through which some functions of innate immunity can be activated, and polymorphic variants in the TLR-family genes can be predictors of complications after cardiac surgery. Aim. To study the associations of TLR-family genes with infectious and non-infectious complications of cardiac surgery for congenital heart defects. Methods. The study included 89 children (44 girls and 45 boys) with congenital heart defects who underwent cardiac surgery. Complications occurred in 47 children 47 days after cardiac surgery. There were no complications in 42 children. Genotyping was performed by real-time PCR using TaqMan probes. Results. A two-locus model of gene-gene interaction between TLR1 rs5743551 and TLR2 rs3804099 was the best fit, accounting for 4.01% of phenotypic entropy. The TLR2 gene polymorphic variant rs5743708 had the highest predictive potential (2.59%). Conclusion. The development of postoperative complications of cardiac surgical treatment for congenital heart defects can be due to the synergistic effect of the polymorphic variants rs5743551 in the TLR1 gene and rs3804099 in the TLR2 gene. This effect occurs through the features of TLR1 and TLR2 transcription, the subsequent expression of receptors on cells and signalling which activates the synthesis of proinflammatory cytokines and chemokines.Received 25 February 2021. Revised 11 May 2021. Accepted 12 May 2021.Funding: The work is supported by the complex program of fundamental research of the Siberian Branch of the Russian Academy of Sciences (No. 0554-2019-0002).Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors Conception and study design: A.V. Shabaldin, A.V. Ponasenko, A.V. Tsepokina Data collection and analysis: A.A. Anikeenko, A.V. Tsepokina, S.A. Shmulevich Statistical analysis: A.V. Shabaldin, A.V. Tsepokina Drafting the article: A.V. Shabaldin, A.V. Tsepokina, A.V. Ponasenko Critical revision of the article: A.V. Tsepokina Final approval of the version to be published: A.V. Tsepokina, A.A. Anikeenko, S.A. Shmulevich, A.V. Ponasenko, A.V. Shabaldin

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37 Growth and neurodevelopment in early childhood of preterm infants with complex congenital heart defects following open cardiac surgery

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.036 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e14-e15

Author(s):

Po-Yin Cheung ◽

Morteza Hajihosseini ◽

Irina Dinu ◽

Heather Switzer ◽

Charlene M T Robertson

Keyword(s):

Early Childhood ◽

Hearing Loss ◽

Cardiac Surgery ◽

Cerebral Palsy ◽

Preterm Infants ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Neurodevelopmental Outcome ◽

Neurodevelopmental Outcomes

Abstract Background Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestational age and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. Specific details related to the neurodevelopmental outcome of these infants remain unpublished. Objectives To describe the growth, disability, functional, and neurodevelopmental outcome in early childhood of preterm infants (born at <37+0 weeks gestation) with CCHD and neonatal OHS. Design/Methods We studied all infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. In the Western Canadian Complex Pediatric Therapies Follow-up Program, comprehensive neurodevelopmental assessments at a corrected age of 18-24 months were done by multidisciplinary teams at the original referral sites. In addition to demographic and clinical data, standardized age-appropriate outcome measures included physical growth with calculated Z-scores, disabilities including cerebral palsy, visual impairment, sensorineural hearing loss; adaptive function (Adaptive Behavioural Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Results From 1996 to 2016, 115 preterm infants (34±2 weeks gestation, 2339±637g, 64% males) with CCHD had OHS with 11(10%) deaths before first discharge and 21 (18%) by 2 years. Prior to the first surgery, 7 (6%) neonates had cerebral injuries. Overall, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. All 94 surviving infants received comprehensive evaluation at 2 years corrected age; Eighteen (19%) had congenital syndromes who had worse functional and neurodevelopmental outcomes compared to those (n=76) without syndromal abnormalities (SA) (Table). Conclusion For preterm neonates with CCHD and early OHS, the mortality was significant, but the short-term neonatal morbidity was not increased. Compared with published preterm outcomes, the early outcome suggests more cerebral palsy but not sensorineural hearing loss, and greater neurodevelopmental delay. This information is important for management care of the infants, parental counselling and the decision-making process.

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Congenital cardiovascular disease and cardiac surgery in childhood: Part 1. Cyanotic congenital heart defects

Current Opinion in Cardiology ◽

10.1097/00001573-199501000-00011 ◽

1995 ◽

Vol 10 (1) ◽

pp. 58-67 ◽

Cited By ~ 1

Author(s):

Brenda E. Armstrong

Keyword(s):

Cardiovascular Disease ◽

Cardiac Surgery ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects

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Optimizing response of the neonate and infant to cardiopulmonary bypass

Cardiology in the Young ◽

10.1017/s1047951105001186 ◽

2005 ◽

Vol 15 (S1) ◽

pp. 142-148 ◽

Cited By ~ 8

Author(s):

Ross M. Ungerleider

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Normal Anatomy ◽

Complete Repair ◽

Innovative Techniques

The evolution of cardiac surgery has led to increasing emphasis on complete repair of congenital heart defects early in life, nowadays increasingly performed in neonates or small infants. Good results have been achieved because of innovative techniques permitting reconstruction of normal anatomy, and restoration of normal physiology, before either the heart or the patient undergo deleterious adaptation to the congenitally abnormal physiology. Despite the ability surgically to correct complex defects in such small patients, limitations in outcome are sometimes encountered related to the systems necessary for repair. In particular, exposure to cardiopulmonary bypass may present the greatest challenge for these tiny patients.

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