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1.
Sultan Qaboos Univ Med J ; 21(3): 457-464, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34522413

RESUMO

Objectives: A modified Blalock-Taussig (mBT) shunt procedure is a common palliative surgery used to treat infants and children with cyanotic congenital heart disease (CCHD). This study aimed to report the outcomes of infants and children undergoing mBT shunt procedures in Oman. In addition, risk factors associated with early mortality, inter-stage mortality and reintervention were assessed. Methods: This retrospective cohort study was conducted from January 2016 to December 2018 at the National Heart Centre, Muscat, Oman. All paediatric patients with CCHD undergoing mBT shunt procedures as a primary palliative procedure during this period were included. Data were retrieved from electronic hospital records. Kaplan-Meier survival curves were used to describe overall survival. Results: A total of 50 infants and children were included in this study. The in-hospital mortality and interstage mortality rates were 10% and 6.7%, respectively. Preoperative mechanical ventilation (odds ratio [OR] = 3.00, 95% confidence interval [CI]: 1.98-4.76; P = 0.007) and cardiopulmonary bypass (OR = 4.09, 95% CI: 2.44-6.85; P = 0.002) were significant risk factors for early mortality. In-hospital and interval surgical reintervention rates were 12% and 13.3%, respectively. Following the primary shunt procedure, the median time to second-stage surgery was 15.5 months (range: 5.0-34.0 months). Conclusion: The findings of this study support those reported in international research regarding the risks associated with mBT shunt surgeries. In particular, preoperative mechanical ventilation and cardiopulmonary bypass were significant risk factors for early mortality.


Assuntos
Procedimento de Blalock-Taussig , Cardiopatias Congênitas , Criança , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Omã/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Cardiol Young ; 31(8): 1220-1227, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34493356

RESUMO

Cardiac surgery for CHD was pioneered in Washington, DC by Charles Hufnagel and Edgar Davis working at Georgetown University and Children's Hospital of the District of Columbia. Children's Hospital, now Children's National Hospital, had been established just 5 years after the end of the Civil War. In the 1950s, Davis and Hufnagel undertook many open-heart operations using the technique of surface cooling, hypothermia, and circulatory arrest. Hufnagel and Lewis Scott, who founded the cardiology department at Children's, were trained in Boston by Gross and Nadas. Judson Randolph, also a trainee of Gross, introduced cardiac surgery using cardiopulmonary bypass and established the General Pediatric Surgery department at Children's in the 1960s. The transition of hospital staffing from community-based private physicians to full-time hospital employees was often controversial but was complete by the turn of the millennium. The 21st century has seen continuing growth of the new Children's National Heart Institute and consolidation of several congenital cardiac programmes in Washington, DC.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Cirurgia Torácica , Criança , District of Columbia , Cardiopatias Congênitas/cirurgia , Hospitais Pediátricos , Humanos
3.
J Card Surg ; 36(10): 3567-3576, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34350997

RESUMO

OBJECTIVE: The Klotho protein family plays important roles in several metabolic pathways. Soluble Klotho has been recently put forward as an antiaging protein, demonstrating renal and cardiovascular protective traits. Cardiopulmonary bypass (CPB) support during cardiac surgery has been implicated in several adverse outcomes in pediatric and adult patients. Our goal was to assess whether serum Klotho levels can be used to predict outcomes in children undergoing cardiac surgery with CPB due to congenital heart defects (CHDs). METHODS: This prospective study was conducted on pediatric patients admitted to two Pediatric Cardiac Intensive Care Units, between 2012 and 2018. All patients were born with CHD and underwent corrective surgery with CPB. Sequential blood samples were analyzed by enzyme-linked immunosorbent assay for soluble Klotho levels at baseline, 2, 6, and 24 h after surgery. The association between Klotho levels and several demographic, intraoperative, and postoperative clinical and laboratory parameters was studied. RESULTS: Twenty-nine children undergoing cardiac surgery with CPB support were included. Serum Klotho levels were shown to significantly decrease 2 h after surgery and increase to baseline levels after 6 h (p < .001 and p < .05, respectively). Patients with low Klotho levels 2 h after surgery were at a 32-fold higher risk for developing postoperative complications (p = .015, odds ratio < 0.03). Moreover, Klotho levels at each of the four time points were lower in patients who developed postoperative complications. CONCLUSIONS: Cardiac surgery with CPB results in a significant decrease of serum Klotho levels 2 h after surgery in pediatric patients with CHDs, which can be used to predict development of postoperative complications in this patient population.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Ponte Cardiopulmonar , Criança , Glucuronidase , Cardiopatias Congênitas/cirurgia , Humanos , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
4.
Dimens Crit Care Nurs ; 40(5): 295-300, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34398566

RESUMO

BACKGROUND: Laboratory testing is frequently used to guide postoperative management and contributes to hospital resource utilization; however, there is little evidence identifying patient or clinical factors to inform the appropriate frequency of laboratory testing in the pediatric cardiac intensive care unit. OBJECTIVES: To examine the factors associated with increased laboratory utilization following pediatric congenital heart surgery. METHODS: For each patient, the total number of tests and types of laboratory tests were recorded. Patients whose number of tests was greater than the 90th percentile were categorized as increased laboratory use. RESULTS: A sample of 250 unique patients and 909 nursing shifts were obtained for patient- and shift-level analyses. The top 10% of patients identified as the high laboratory utilization group (>128 laboratory tests). High-use group reported significantly younger patients and longer bypass time (P < .001). Patients in the highest Risk Adjustment for Congenital Heart Surgery 1 risk category were 34.7 times more likely to be in high laboratory utilization group (P = .006), independent of age at time of surgery and time on bypass (receiver operating characteristic curve = 0.855). At the shift level, time on bypass (P = .002), age younger than 30 days at surgery (P < .001), 3 to 5 years' registered nurse experience (P < .001), staff precepting (P = .03), and weekday shift status (P = .03) were all independently associated with high laboratory utilization. CONCLUSIONS: There are multiple factors associated with increased laboratory utilization. Recognition of specific patient and nursing factors can be used to impact patient management.


Assuntos
Cardiopatias Congênitas , Laboratórios , Criança , Pré-Escolar , Cardiopatias Congênitas/cirurgia , Humanos , Unidades de Terapia Intensiva Pediátrica , Fatores de Risco
5.
Cardiol Young ; 31(8): 1241-1250, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34378498

RESUMO

Fontan palliation represents one of the most remarkable surgical advances in the management of individuals born with functionally univentricular physiology. The operation secures adult survival for all but a few with unfavourable anatomy and/or physiology. Inherent to the physiology is passive transpulmonary blood flow, which produces a vulnerability to adequate filling of the systemic ventricle at rest and during exertion. Similarly, the upstream effects of passive flow in the lungs are venous congestion and venous hypertension, especially marked during physical activity. The pulmonary vascular bed has emerged as a defining character on the stage of Fontan circulatory behaviour and clinical outcomes. Its pharmacologic regulation and anatomic rehabilitation therefore seem important strategic therapeutic targets. This review seeks to delineate the important aspects of pulmonary artery development and maturation in functionally univentricular physiology patients, pulmonary artery biology, pulmonary vascular reserve with exercise, and pulmonary artery morphologic and pharmacologic rehabilitation.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Hemodinâmica , Humanos , Pulmão , Artéria Pulmonar/cirurgia , Circulação Pulmonar
6.
Eur J Radiol ; 142: 109868, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34311155

RESUMO

PURPOSE: We explored the feasibility and reproducibility of cardiac computed tomography (CCT)-derived left ventricular (LV) global strain in postoperative childrenwith congenital heart disease (CHD) and compared its correlation and agreement with transthoracic echocardiography (TTE). METHODS: Fifty-one patients (28 males, 23 females) were included who underwent clinically indicated retrospective electrocardiography-triggered CCT. and all patients underwent additional TTE on the same day. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were measured. Correlations of global strains between CCT and TTE were assessed using Pearson's correlation coefficient. Intra-class correlation coefficients (ICC) were used to assess CCT intra-observer and inter-observer reproducibility. RESULTS: GLS and GCS were not significantly different between CCT and TTE (GLS: -23.54 ± 3.24 vs. -23.85 ± 3.72, respectively, p = 0.415; GCS: -28.21 ± 3.55 vs. -28.79 ± 3.69, respectively, p = 0.155). GRS was significantly different between CCT and TTE (60.79 ± 15.11 vs. 41.73 ± 4.27, respectively, p < 0.001). There was good correlation between CCT- and TTE-derived GLS (r = 0.70, p < 0.001) and GCS (r = 0.68, p < 0.001), but GRS showed no correlation between CCT and TTE (r = 0.09, p = 0.54). CCT-derived global strain showed good intra- and inter-observer reproducibility (ICC = 0.86-0.92), except the inter-observer reproducibility for GRS (ICC = 0.77). CONCLUSIONS: CCT was feasible for postoperative evaluation of LV global strain in pediatric patients with CHD with sufficient reproducibility. CCT-derived global strain can provide additional information in selected CHD patients with poor acoustic windows and who are intolerant to or have contraindications for cardiac magnetic resonance.


Assuntos
Cardiopatias Congênitas , Disfunção Ventricular Esquerda , Criança , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda
7.
Int J Pediatr Otorhinolaryngol ; 148: 110825, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34252699

RESUMO

INTRODUCTION: Vocal fold motion impairment (VFMI) is a known potential complication of congenital heart surgery (CHS). Flexible nasolaryngoscopy (FNL) is the gold standard for evaluation of vocal fold movement but has risks, including epistaxis, desaturation, and changes in heart rate. Laryngeal ultrasound (LUS) has begun to emerge as a diagnostic tool and has been shown to have high accuracy in the evaluation of VFMI. We sought to assess the utility of hand-held LUS as a point-of-care screening tool to assess VFMI in pediatric patients following congenital heart surgery. METHODS: Using a prospective cohort design, children under 18 years who were undergoing congenital heart surgery at a tertiary care pediatric hospital were enrolled. All patients underwent postoperative LUS and FNL. All studies were reviewed by two otolaryngology reviewers blinded to the clinical diagnosis. Higher quality studies were reviewed by two cardiology reviewers also blinded to the clinical diagnosis. Accuracy and inter-rater reliability were calculated. RESULTS: Sixty-two children were screened. Fourteen children with VFMI were identified via FNL. When comparing LUS and FNL, both individual accuracy (90.3% and 75.8%) and interrater agreement (79% overall, 96% for high quality videos) were high for the otolaryngology reviewers. The cardiology reviewers were able to obtain 100% accuracy for high quality videos. CONCLUSION: Handheld LUS has utility as a point-of-care screening tool to assess VFMI. This may have benefit in low-resource settings, for universal screening in cardiac intensive care units, or in settings where otolaryngology consultation may be difficult to obtain.


Assuntos
Cardiopatias Congênitas , Paralisia das Pregas Vocais , Adolescente , Criança , Cardiopatias Congênitas/cirurgia , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Reprodutibilidade dos Testes , Prega Vocal/diagnóstico por imagem
8.
Diagn Interv Radiol ; 27(4): 488-496, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34313233

RESUMO

PURPOSE: This study was planned to assess the application of three-dimensional (3D) cardiac modeling in preoperative evaluation for complex congenital heart surgeries. METHODS: From July 2015 to September 2019, 18 children diagnosed with complex congenital heart diseases (CHDs) were enrolled in this study (double outlet right ventricle in nine patients, complex types of transposition of the great arteries in six patients, congenitally corrected transposition of the great arteries in two patients, and univentricular heart in one patient). The patients' age ranged from 7 months to 19 years (median age, 14 months). Before the operation, 3D patient-specific cardiac models were created based on computed tomography (CT) data. Using each patient's data, a virtual computer model (3D mesh) and stereolithographic (SLA) file that would be printed as a 3D model were generated. These 3D cardiac models were used to gather additional data about cardiac anatomy for presurgical decision-making. RESULTS: All 18 patients successfully underwent surgeries, and there were no mortalities. The 3D patient-specific cardiac models led to a change from the initial surgical plans in 6 of 18 cases (33%), and biventricular repair was considered feasible. Moreover, the models helped to modify the planned biventricular repair in five cases, for left ventricular outflow tract obstruction removal and ventricular septal defect enlargement. 3D cardiac models enable pediatric cardiologists to better understand the spatial relationships between the ventricular septal defect and great vessels, and they help surgeons identify risk structures more clearly for detailed planning of surgery. There was a strong correlation between the models of the patients and the anatomy encountered during the operation. CONCLUSION: 3D cardiac models accurately reveal the patient's anatomy in detail and are therefore beneficial for planning surgery in patients with complex intracardiac anatomy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Dupla Via de Saída do Ventrículo Direito , Cardiopatias Congênitas , Comunicação Interventricular , Transposição dos Grandes Vasos , Criança , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/cirurgia
9.
Am J Cardiol ; 155: 128-134, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34315570

RESUMO

Fontan palliation has improved survival for single ventricle patients, but long-term complications persist including cardiovascular dysfunction, neurohormonal abnormalities, and protein-losing enteropathy (PLE). Although chronic inflammation contributes to morbidity, an association between inflammation and vascular dysfunction has not been studied. We assessed inflammation and vascular function in 31 Fontan-palliated patients (52% male, median age 14.3 years), including 10 PLE+. Fontan circulation was associated with altered inflammatory cytokines (TNF-α: mean 2.5 ± 1.4 vs. 0.7 ± 0.2 pg/ml, p < 0.0001; sTNFR2: 371 ± 108 vs. 2694 ± 884 pg/ml, p < 0.0001) and vascular dysfunction [log-transformed reactive hyperemia index (lnRHI) 0.28 ± 0.19 vs. 0.47 ± 0.26, p < 0.01; augmentation index (AI) -2.9 ± 13.8 vs. -16.3 ± 12.0, p = 0.001; circulating endothelial progenitor cells (cEPCs) 5.0 ± 8.1 vs. 22.8 ± 15.9, p = 0.0002)]. Furthermore, PLE+ patients showed greater inflammation (IFN-γ 6.3 ± 2.2 vs. 11.5 ± 7.9 pg/ml, p = 0.01; sTNFR1: 1181 ± 420 vs. 771 ± 350 pg/ml, p = 0.01) and decreased arterial compliance (AI: 5.4 ± 17.1 vs. -6.8 ± 10.2, p = 0.02) than PLE- patients. Circulating EPCs, but not inflammatory cytokines, were inversely associated with arterial stiffness in Fontan patients. In conclusion, chronic inflammation and vascular dysfunction are observed after Fontan operation, with greater inflammation and arterial stiffness in Fontan patients with active PLE. However, there is no clear association between inflammatory cytokines and vascular dysfunction, suggesting these pathophysiologic processes are not mechanistically linked.


Assuntos
Biomarcadores/sangue , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/sangue , Enteropatias Perdedoras de Proteínas/sangue , Doenças Vasculares/sangue , Resistência Vascular/fisiologia , Adolescente , Adulto , Criança , Feminino , Seguimentos , Cardiopatias Congênitas/sangue , Humanos , Inflamação/sangue , Inflamação/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Enteropatias Perdedoras de Proteínas/etiologia , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia , Adulto Jovem
10.
Thorac Cardiovasc Surg ; 69(S 03): e41-e47, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34327689

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates. MATERIALS AND METHODS: Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. RESULTS: Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500 g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24 hours (p = 0.008 and 0.001, respectively), longer time to lactate normalization (p = 0.001), lactate > 10 mmol/L before ECMO (p = 0.01), lower weight (p = 0.01), longer ECMO duration (p = 0.005), lower platelet count (p = 0.001), more surgical site bleeding (p = 0.001), and surgical residual malformation (p = 0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24 hours (p = 0.003), longer ECMO duration (p = 0.015), and surgical site bleeding (p = 0.025) were independent risk factors. CONCLUSION: ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Oxigenação por Membrana Extracorpórea , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/terapia , Procedimentos Cirúrgicos Cardíacos/mortalidade , China , Oxigenação por Membrana Extracorpórea/efeitos adversos , Cardiopatias Congênitas/mortalidade , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Humanos , Recém-Nascido , Tempo de Internação , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Emerg Med Clin North Am ; 39(3): 605-625, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215405

RESUMO

Encountering a child with congenital heart disease after surgical palliation in the emergency department, specifically the single-ventricle or ventricular assist device, without a basic familiarity of these surgeries can be extremely anxiety provoking. Knowing what common conditions or complications may cause these children to visit the emergency department and how to stabilize will improve the chance for survival and is the premise for this article, regardless of practice setting.


Assuntos
Parada Cardíaca/terapia , Cardiopatias Congênitas/cirurgia , Medicina de Emergência Pediátrica , Choque Cardiogênico/terapia , Manuseio das Vias Aéreas , Algoritmos , Reanimação Cardiopulmonar , Procedimentos Cirúrgicos Cardiovasculares , Criança , Técnicas de Laboratório Clínico , Contraindicações de Medicamentos , Diagnóstico por Imagem , Serviço Hospitalar de Emergência , Coração Auxiliar , Humanos , Cuidados Paliativos
13.
Angiol Sosud Khir ; 27(2): 135-145, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166354

RESUMO

BACKGROUND: Surgical treatment of 'blue' congenital heart defects frequently implies various interventions on the outlet portion of the right ventricle or pulmonary artery trunk. Most often used are various conduits, reconstructing the outlet portion of the right ventricle and pulmonary artery. Most patients having previously endured the mentioned interventions, would in the remote terms require repeat operative procedures for stenosis or insufficiency on the pulmonary valve or the implanted conduit. Taking into account complexity and the risk of open interventions, the current trends are towards more frequent use of transcatheter implantation of the pulmonary valve. AIM: The purpose of this work is to present the first serial experience with hybrid transventricular implantation of an original Russian-made valve into the position of the pulmonary artery. PATIENTS AND METHODS: We retrospectively studied a series of 5 clinical cases who from July 2019 to May 2020 at the Federal Centre of Cardiovascular Surgery (Penza) had underwent hybrid transventricular implantation of the first Russian-made valve-containing stent (MedLab-KT) into the position of the pulmonary valve, with the stent's closing component consisting of leaflets made of polytetrafluoroethylene. RESULTS: 3 patients underwent implantation of valve # 25 and 2 subjects received valve # 23, with all cases yielding good immediate results. The haemodynamic parameters of the implanted prosthesis were optimal. In all cases, the significant gradient was absent and regurgitation did not exceed grade I. There was no in-hospital mortality. The method of hybrid prosthetic repair of the pulmonary valve via the transapical right-ventricular access from the left lateral mini-thoracotomy was aimed at reducing potential risks of artificial circulation, also contributing to a significant decrease in the traumatic nature of surgical treatment of patients requiring a repeat intervention for pulmonary valve pathology.


Assuntos
Cardiopatias Congênitas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Pulmonar , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia , Estudos Retrospectivos , Federação Russa , Resultado do Tratamento
14.
Braz J Med Biol Res ; 54(9): e10220, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34076139

RESUMO

Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.


Assuntos
Enterocolite Necrosante , Cardiopatias Congênitas , Brasil/epidemiologia , Enterocolite Necrosante/complicações , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Estudos Retrospectivos
19.
J Card Surg ; 36(9): 3207-3214, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34091970

RESUMO

OBJECTIVE: Bidirectional Glenn procedure is a staged palliative procedure for patients with the univentricular hearts or complex congenital heart disease. We in our study, attempted to evaluate the preoperative characteristics, operative data and the early postoperative outcomes in the patients who underwent Bidirectional Glenn procedure at our center. METHODS: In our single center retrospective experience, 115 patients underwent Bidirectional Glenn procedure from January 2015 to December 2019. RESULTS: The mean age of the patients was 6.55 ± 6.5 years (range from 9 months to 48 years) and a median of 5 years. The most common anatomic diagnosis was double outlet right ventricle (n = 49, 42.6%). The primary diagnosis and the additional cardiac anamolies were not associated with the adverse outcomes. The increased cardiopulmonary bypass and operative time affect the postoperative outcomes. The median oxygen saturation in the patients postoperatively was 82%. The median postoperative stay was 8 days. The early postoperative complications were seen in 29 patients (25.2%). There were 12 early deaths (10.4%) in our study. The late age of presentation and poor preoperative nutrition, increased the risk of the postoperative morbidity and mortality. CONCLUSION: Bidirectional Glenn procedure is an effective procedure to improve efficacy of the gas exchange and reduce volume overload on the single ventricle at early as well as late stages. However, the late age of presentation increases the risk of the postoperative outcomes.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Ponte Cardiopulmonar , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Lactente , Estudos Retrospectivos , Resultado do Tratamento
20.
BMC Psychiatry ; 21(1): 316, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167512

RESUMO

BACKGROUND: The aim of the present study was to investigate the differences in ADHD symptomatology between healthy controls and children who underwent cardiac surgery at different ages. METHODS: Altogether, 133 children (54 patients with congenital heart disease undergoing first cardiac surgery under 3 years of age, 26 operated at the age of 3 or later, and 53 healthy controls) were examined. Patients completed the Youth Self Report (YSR), while their parents completed the Child Behaviour Checklist (CBCL) and the ADHD Rating Scale-IV. RESULTS: Children receiving surgery for the first time under the age of 3 years were more likely diagnosed with cyanotic type malformation and have undergone to a greater number of operations. However, ADHD symptoms of those treated surgically at or above 3 years of age were more severe than that of the control group or those who were treated surgically at a younger age. The control group and those treated surgically below the age of three did not differ across any of the ADHD symptom severity indicators. CONCLUSIONS: The age at the time of cardiac surgery might be associated with later ADHD symptom severity - with lower age at operation associated with better outcomes. Further, adequately powered studies are needed to confirm these exploratory findings and investigate the moderators of this relationship.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Adolescente , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Humanos , Pais
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