RESUMEN
Transposition of great arteries (TGA) in association with total anomalous pulmonary venous connection (TAPVC) has been rarely reported. With increasing age, left ventricular (LV) regression further complicates the clinical scenario. Management strategy is not clearly defined. We describe a rare combination of TGA, TAPVC, and LV regression and outline a successful management strategy.
Asunto(s)
Ventrículos Cardíacos/patología , Venas Pulmonares/anomalías , Síndrome de Cimitarra/diagnóstico , Transposición de los Grandes Vasos/diagnóstico , Cianosis/etiología , Diagnóstico Diferencial , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Síndrome de Cimitarra/complicaciones , Síndrome de Cimitarra/diagnóstico por imagen , Síndrome de Cimitarra/cirugía , Tomografía Computarizada por Rayos X , Transposición de los Grandes Vasos/diagnóstico por imagen , Transposición de los Grandes Vasos/fisiopatología , Transposición de los Grandes Vasos/cirugíaRESUMEN
Background This study was designed to compare myocardial protection with del Nido cardioplegia and conventional blood cardioplegia in children undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery categories 1 and 2. Methods Sixty patients were randomized into 2 groups receiving del Nido cardioplegia solution or conventional blood cardioplegia. Myocardial injury was assessed using biochemical markers (troponin I and creatine kinase-MB). Vasoactive-inotropic scores were calculated to compare inotropic requirements. Results Demographic characteristics, cardiopulmonary bypass time, and aortic crossclamp time were comparable in the 2 groups. Time-related changes in troponin I and creatine kinase-MB were similar in both groups. Statistically significant differences were seen in total cardioplegia volume requirement ( p < 0.0001), number of cardioplegia doses given ( p < 0.0001), packed red cell volume usage during cardiopulmonary bypass ( p < 0.02), and time taken to restore spontaneous regular rhythm ( p < 0.0001). Vasoactive-inotropic scores on transfer to the intensive care unit ( p < 0.040) and at 24 h ( p < 0.030) were significantly lower in the del Nido group. Duration of mechanical ventilation, intensive care unit stay, and hospital stay were comparable in the 2 groups. Conclusions Our results show that del Nido cardioplegia solution is as safe as conventional blood cardioplegia. Moreover, it provides the benefits of reduced dose requirement, lower consumption of allogenic blood on cardiopulmonary bypass, quicker resumption of spontaneous regular cardiac rhythm, and less inotropic support requirement on transfer to the intensive care unit and at 24 h, compared to conventional blood cardioplegia.
