Report from the Japanese Society of Pediatric Cardiology and Cardiac Surgery Research Committee on Cardiovascular Function in Adult Patients with Congenital Heart Disease; Mechanism of Aortic Root Dilation and Cardiovascular Function in Patients with Tetralogy of Fallot

Abstract Background We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. Methods A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. Results We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). Conclusion For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.

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Is alternative cardiac surgery an option in adults with congenital heart disease referred for thoracic organ transplantation?†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezs240 ◽

2012 ◽

Vol 43 (2) ◽

pp. 344-351 ◽

Cited By ~ 20

Author(s):

Andrew Robert Harper ◽

David Steven Crossland ◽

Gianluigi Perri ◽

John Jude O'Sullivan ◽

Milind Pralhad Chaudhari ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Organ Transplantation ◽

Congenital Heart ◽

Thoracic Organ

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Down syndrome and congenital heart disease: perioperative planning and management

Journal of Congenital Cardiology ◽

10.1186/s40949-021-00061-3 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Dennis R. Delany ◽

Stephanie S. Gaydos ◽

Deborah A. Romeo ◽

Heather T. Henderson ◽

Kristi L. Fogg ◽

...

Keyword(s):

Congenital Heart Disease ◽

Down Syndrome ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Single Ventricle ◽

Heart Defects ◽

Careful Consideration ◽

Children With Down Syndrome ◽

Perioperative Planning

AbstractApproximately 50% of newborns with Down syndrome have congenital heart disease. Non-cardiac comorbidities may also be present. Many of the principles and strategies of perioperative evaluation and management for patients with congenital heart disease apply to those with Down syndrome. Nevertheless, careful planning for cardiac surgery is required, evaluating for both cardiac and noncardiac disease, with careful consideration of the risk for pulmonary hypertension. In this manuscript, for children with Down syndrome and hemodynamically significant congenital heart disease, we will summarize the epidemiology of heart defects that warrant intervention. We will review perioperative planning for this unique population, including anesthetic considerations, common postoperative issues, nutritional strategies, and discharge planning. Special considerations for single ventricle palliation and heart transplantation evaluation will also be discussed. Overall, the risk of mortality with cardiac surgery in pediatric patients with Down syndrome is no more than the general population, except for those with functional single ventricle heart defects. Underlying comorbidities may contribute to postoperative complications and increased length of stay. A strong understanding of cardiac and non-cardiac considerations in children with Down syndrome will help clinicians optimize perioperative care and long-term outcomes.

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Monitoring of cerebral high intensity transient signals during catheter interventions and surgery for congenital heart disease in infants using NeoDoppler

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.403 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Leth-Olsen ◽

G Doehlen ◽

H Torp ◽

SA Nyrnes

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

High Intensity ◽

Congenital Heart ◽

Frame Rate ◽

Intensity Increase ◽

Research Committee ◽

Transient Signals ◽

Ultrasound Beam ◽

High Intensity Signal

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Joint Research Committee between St. Olavs Hospital and the faculty of Medicine, NTNU. The Norwegian Association for Children with Congenital Heart Disease Research Foundation, FFHB Background There is a risk of gaseous- and solid micro embolus formation during transcatheter procedures (CATH) and surgery in children with congenital heart disease (CHD). Silent strokes during surgery or CATH may contribute to neurological impairment. NeoDoppler is a non-invasive ultrasound system based on plane wave transmissions to continuously monitor cerebral blood flow in infants with an open fontanelle. Gaseous- and solid micro embolus passing through the ultrasound beam create High Intensity Transient Signals (HITS) in the Doppler signal. Purpose We aimed to study the amount of HITS during CATH and surgery in infants using NeoDoppler. Methods The NeoDoppler probe operates at a frequency of 7.8 MHz. The frame rate is 300 fps and the beam covers a wide cylindrical area (10/35mm width/depth). The system displays a color M-mode Doppler and a spectrogram. The broad ultrasound beam permits prolonged scanning time of each event as the HITS move through the ultrasound beam. The high framerate and color M-mode allows for tracking of embolies in depth. In this study the NeoDoppler probe was attached to the anterior fontanelle of infants with CHD during CATH (n = 15) and cardiac surgery (n = 13). HITS were defined as high intensity signal creating skewed lines in the color M-mode Doppler moving away or towards the probe (blue/red) with a corresponding high intensity signal in the spectrogram. HITS were grouped into single HITS and HITS with curtain effect. Single HITS were defined as single skewed lines in the color M-mode Doppler and spectrogram. HITS with curtain effect were defined as skewed broad lines or multiple intensity increase lines in the color M-mode Doppler with corresponding intensity increase that filled the entire doppler curve. HITS with curtain effect are believed to represent numerous HITS that could not be separated from each other in the spectrogram. HITS were manually detected in an in-house MatLab application. Results The study group consisted of 28 infants (17 males) with different CHD who underwent CATH or surgery. The median age and weight was 96 days (range 3-240 days) and 5650 g (range 2400-8085 g). HITS were detected in 13/15 patients during CATH with a total of 392 HITS (Median 12, Range 0-149) and in all patients during surgery with a total of 772 HITS (Median 45, Range 11-150). The picture shows examples of single HITS (panel A) and HITS with curtain effect (panel B). One can appreciate the embolic trajectory pattern in depth over time in the color M-mode Display. Conclusion In this study we found that NeoDoppler enables detection of frequent HITS in patients with CHD undergoing surgery or CATH. NeoDoppler could become a useful tool to guide modifications of procedures, with aim to reduce the risk of silent stroke. However, further studies are needed to validate the technique. Abstract Figure.

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The role of EEG recordings in children undergoing cardiac surgery for congenital heart disease

Wiener Medizinische Wochenschrift ◽

10.1007/s10354-017-0576-0 ◽

2017 ◽

Vol 167 (11-12) ◽

pp. 251-255

Author(s):

Sascha Meyer ◽

Martin Poryo ◽

Mohammed Shatat ◽

Ludwig Gortner ◽

Hashim Abdul-Khaliq

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Eeg Recordings

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CONGENITAL HEART DISEASE PATIENTS ARE AT HIGHEST RISK OF RIGHT-SIDED COMPLICATIONS AFTER CARDIAC SURGERY, REGARDLESS THE SIDE OF SURGERY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60446-5 ◽

2013 ◽

Vol 61 (10) ◽

pp. E446

Author(s):

Mark J. Schuuring ◽

David Koolbergen ◽

Mark Hazekamp ◽

Petr Symersky ◽

Wim Lagrand ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart

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Nineteen Years of Adult Congenital Heart Surgery in a Single Center

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116682454 ◽

2017 ◽

Vol 8 (2) ◽

pp. 182-188

Author(s):

Madurra Perinpanayagam ◽

Signe H. Larsen ◽

Kristian Emmertsen ◽

Marianne B. Møller ◽

Vibeke E. Hjortdal

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Postoperative Complications ◽

Adverse Events ◽

Congenital Heart ◽

Postoperative Bleeding ◽

Registration System ◽

Growing Population

Background: Adults with congenital heart disease are a growing population. We describe surgical interventions, short- and long-term mortality and morbidity, and risk factors for adverse events in a population-based cohort. Methods: Patients over or equal to 18 years with congenital heart disease who underwent cardiac surgery at Aarhus University Hospital, Denmark, from 1994 to 2012 were included in the study. Diagnoses, surgical procedures, postoperative complications, and survival were identified in hospital databases, medical records, and the Danish Civil Registration System. Results: Four hundred seventy-four surgeries were performed in 445 adults (50% men). The median age was 39 years (range 18-83). Thirty-nine percent had previous surgical or catheter-based interventions. Thirty-day and in-hospital mortality were 1.1%. Postoperative complications occurred in 50% of cases, most were minor such as temporary arrhythmias and pneumonia. Major complications included postoperative bleeding necessitating intervention (6%), stroke (2%), and acute temporary renal failure (1%). Multivariate analysis identified RACHS-1 categories over or equal to 3 compared to category 1 (odds ratio (OR) = 2.3; 95% confidence interval (CI): 1.5-3.7), New York Heart Association functional class III and IV compared to class I (OR = 2.2; 95% CI: 1.3-3.7) and age at surgery (OR = 1.03, 95% CI: 1.01-1.04), as risk factors for adverse events. Survival during a median follow-up of 7.8 years (range 0 days-21.4 years) was 85% (95% CI: 80%-89%). Conclusion: Adults with congenital heart disease constitute a growing population with the need for cardiac surgery. Postoperative complications are frequent but early and late mortality are low.

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