ABSTRACT
OBJECTIVE: To assess outcomes and factors influencing outcomes in neonates requiring cardiac surgery in India. METHODS: This study reports on review of hospital data from a tertiary care cardiac surgical institute from January-2009 to December-2015. RESULTS: A total of 200 neonates were included; of them, 5% of the cases were antenatally diagnosed and most of them had unmonitored transport (111, 55.5%). The overall mortality rate was 13.5%, (n=27) and 178 (89%) underwent complete defect repair. There was a significant association of mortality with shock, the number of inotropes, intra-operative procedure, residual lesion, aortic cross-clamp and deep hypothermic circulatory arrest time (all P<0.05). Logistic regression analysis showed ventilation duration, cardiac-bypass time, shock, and residual cardiac lesion as independent predictors of mortality. CONCLUSIONS: Cardiac defects were found to have late detection and most transports were unmonitored. Complete surgical repair and shorter cardiac bypass time can potentially improve neonatal cardiac surgical outcomes.
Subject(s)
Cardiac Surgical Procedures , Heart Defects, Congenital , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/mortality , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/mortality , Heart Defects, Congenital/surgery , Humans , India , Infant, Newborn , Male , Operative Time , Postoperative Complications , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Isolation of the subclavian artery is a rare aortic arch anomaly with fewer than 100 cases reported in the literature. Left subclavian artery isolation is seen in 0.8% of right aortic arches, and right subclavian artery isolation is seen four times less frequently. Other intracardiac or arch malformations are usually associated, among which tetralogy of Fallot is commonly described. We describe the presentation, preoperative imaging, surgical strategies, and outcomes of four patients with this rare condition and review the published literature. The embryological basis and interesting pathophysiology are also discussed. Surgical division and reimplantation of the isolated subclavian artery onto the aortic arch or common carotid artery is the treatment of choice, with good immediate and midterm outcomes.
Subject(s)
Abnormalities, Multiple , Aorta, Thoracic/abnormalities , Subclavian Artery/abnormalities , Vascular Malformations/diagnosis , Vascular Surgical Procedures/methods , Adolescent , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Echocardiography , Female , Humans , Infant , Infant, Newborn , Male , Multidetector Computed Tomography/methods , Rare Diseases , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Vascular Malformations/surgeryABSTRACT
INTRODUCTION: Incidence of junctional ectopic tachycardia (JET) after repair of tetralogy of Fallot (TOF) is 5.6-14%. Dexmeditomidine is a a-2 adrenoceptor agonist modulates the release of catecholamine, resulting in bradycardia and hypotension. These effects are being explored as a therapeutic option for the prevention of perioperative tachyarrhythmia. We undertook this study to examine possible preventive effects of dexmedetomidine on postoperative JET and its impact on the duration of ventilation time and length of Intensive Care Unit stay. METHODS: After obtaining approval from the hospitals ethics committee and written informed consent from parents, this quasi-randomized trial was initiated. Of 94 patients, 47 patients received dexmedetomidine (dexmedetomidine group) and 47 patients did not receive the drug (control group). RESULTS: Dexmedetomidine group had more number of complex variants like TOF with an absent pulmonary valve or pulmonary atresia (P = 0.041). Hematocrit on cardiopulmonary bypass (CPB), heart rate while coming off from CPB and inotrope score was significantly low in the dexmedetomidine group compared to control group. The incidence of JET was significantly low in dexmedetomidine group (P = 0.040) compared to control group. CONCLUSIONS: Dexmedetomidine may have a potential benefit of preventing perioperative JET.