RESUMO
The aim of this study was to analyze patients diagnosed with chylothorax after congenital heart disease surgery among a cohort of neonatal patients, comparing the evolution, complications, and prognosis after surgery of patients who were and were not diagnosed with chylothorax, and to analyze possible risk factors that may predict the appearance of chylothorax in this population. Retrospective and observational study included all neonates (less than 30 days since birth) who underwent congenital heart disease surgery in a level III neonatal intensive care department. We included infants born between January 2014 and December 2019. We excluded those infants who were born before 34 weeks of gestational age or whose birth weight was less than 1800 g. We also excluded catheter lab procedures and patent ductus arteriosus closure surgeries. Included patients were divided into two groups depending on whether they were diagnosed with chylothorax or not after surgery, and both groups were compared in terms of perinatal-obstetrical information, surgical data, and NICU course after surgery. We included 149 neonates with congenital heart disease surgery. Thirty-one patients (20.8%) developed chylothorax, and in ten patients (32.3%), it was considered large volume chylothorax. Regarding the evolution of these patients, 22 infants responded to general dietetic measures, a catheter procedure was performed in 9, and 5 of them finally required pleurodesis. Cardiopulmonary bypass, median sternotomy, and delayed sternal closure were the surgical variables associated with higher risks of chylothorax. Patients with chylothorax had a longer duration of inotropic support and mechanical ventilation and took longer to reach full enteral feeds. As complications, they had higher rates of cholestasis, catheter-related sepsis, and venous thrombosis. Although there were no differences in neonatal mortality, patients with chylothorax had a higher rate of mortality after the neonatal period. In a multiple linear regression model, thrombosis and cardiopulmonary bypass multiplied by 10.0 and 5.1, respectively, the risk of chylothorax and have an umbilical vein catheter decreases risk. CONCLUSION: We have found a high incidence of chylothorax after neonatal cardiac surgery, which prolongs the average stay and causes significant morbidity and mortality. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during the neonatal period. WHAT IS KNOWN: ⢠Acquired chylothorax in the neonatal period usually appears as a complication of congenital heart disease surgery, being the incidence quite variable among the different patient series (2.5-16.8%). The appearance of chylothorax as a complication of a cardiac surgery increases both mortality and morbidity in these patients, which makes it a quality improvement target in the postsurgical management of this population. WHAT IS NEW: â¢Most of the published studies include pediatric patients of all ages, from newborns to teenagers, and there is a lack of studies focusing on neonatal populations. The main strength of our study is that it reports, to the best of our knowledge, one of the largest series of neonatal patients receiving surgery for congenital heart disease in the first 30 days after birth. We have found a high incidence of chylothorax after cardiac surgery during the neonatal period compared to other studies. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during this period of life.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Quilotórax , Cardiopatias Congênitas , Lactente , Adolescente , Humanos , Criança , Recém-Nascido , Estudos Retrospectivos , Quilotórax/epidemiologia , Quilotórax/etiologia , Quilotórax/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/diagnóstico , Fatores de RiscoRESUMO
INTRODUCTION AND OBJECTIVES: The NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy. METHODS: National multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019. RESULTS: A total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n=73; trivial shunt, n=23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications. CONCLUSIONS: The NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.
Assuntos
Cateterismo Cardíaco , Comunicação Interventricular , Comunicação Interventricular/cirurgia , Humanos , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Masculino , Recém-Nascido , Dispositivos de Oclusão Vascular , Permeabilidade do Canal Arterial/cirurgia , Doenças do Prematuro/cirurgia , Toracotomia , Cateterismo Periférico , Angiografia/métodosRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Implantes Absorvíveis , Enxerto Vascular , Cardiopatias Congênitas/cirurgia , Stents , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Cateterismo Cardíaco/efeitos adversos , Comunicação Interventricular/cirurgia , Hemólise , Complicações Pós-Operatórias/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Angiografia , Ecocardiografia Doppler em Cores , Feminino , Comunicação Interventricular/sangue , Comunicação Interventricular/diagnóstico , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , ReoperaçãoRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dispneia/complicações , Hipertensão Pulmonar/complicações , Ecocardiografia/métodos , Endocardite/diagnóstico por imagem , Coração Auxiliar , Espirometria/métodos , Ecocardiografia Doppler em Cores , Ventriculografia com Radionuclídeos/instrumentação , Ventriculografia com Radionuclídeos/métodosAssuntos
Aorta/lesões , Cateterismo Cardíaco/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemodinâmica , Insuficiência da Valva Pulmonar/terapia , Valva Pulmonar/fisiopatologia , Transposição dos Grandes Vasos/cirurgia , Lesões do Sistema Vascular/etiologia , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Cateterismo Cardíaco/instrumentação , Criança , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Procedimentos de Cirurgia Plástica , Dispositivo para Oclusão Septal , Transposição dos Grandes Vasos/diagnóstico , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/terapiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Cardiopatias Congênitas/cirurgia , Intervenção Coronária Percutânea , Resultado do TratamentoAssuntos
Permeabilidade do Canal Arterial/patologia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/patologia , Alprostadil/administração & dosagem , Alprostadil/uso terapêutico , Angiografia , Malformações Arteriovenosas/patologia , Permeabilidade do Canal Arterial/tratamento farmacológico , Permeabilidade do Canal Arterial/cirurgia , Atresia Esofágica/complicações , Atresia Esofágica/patologia , Humanos , Recém-Nascido , Masculino , Artéria Pulmonar/cirurgia , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêuticoRESUMO
No disponible
No disponible