Reduced brain mammillary body volumes and memory deficits in adolescents who have undergone the Fontan procedure.

BackgroundAdolescents with single ventricle heart disease (SVHD) who have undergone the Fontan procedure show cognitive/memory deficits. Mammillary bodies are key brain sites that regulate memory; however, their integrity in SVHD is unclear. We evaluated mammillary body (MB) volumes and their associations with cognitive/memory scores in SVHD and controls.MethodsBrain MRI data were collected from 63 adolescents (25 SVHD; 38 controls) using a 3.0-Tesla MRI scanner. Cognition and memory were assessed using Montreal Cognitive Assessment (MoCA) and Wide Range Assessment of Memory and Learning 2. MB volumes were calculated and compared between groups (ANCOVA, covariates: age, sex, and total brain volume [TBV]). Partial correlations and linear regression were performed to examine associations between volumes and cognitive scores (covariates: age, sex, and TBV).ResultsSVHD group showed significantly lower MoCA and WRAML2 scores over controls. MB volumes were significantly reduced in SVHD over controls. After controlling for age, sex, and TBV, MB volumes correlated with MoCA and delayed memory recall scores in SVHD and controls.ConclusionAdolescents with SVHD show reduced MB volumes associated with cognitive/memory deficits. Potential mechanisms of volume losses may include developmental and/or hypoxic/ischemic-induced processes. Providers should screen for cognitive deficits and explore possible interventions to improve memory

Iterative Segmentation from Limited Training Data: Applications to Congenital Heart Disease

We propose a new iterative segmentation model which can be accurately learned from a small dataset. A common approach is to train a model to directly segment an image, requiring a large collection of manually annotated images to capture the anatomical variability in a cohort. In contrast, we develop a segmentation model that recursively evolves a segmentation in several steps, and implement it as a recurrent neural network. We learn model parameters by optimizing the interme- diate steps of the evolution in addition to the final segmentation. To this end, we train our segmentation propagation model by presenting incom- plete and/or inaccurate input segmentations paired with a recommended next step. Our work aims to alleviate challenges in segmenting heart structures from cardiac MRI for patients with congenital heart disease (CHD), which encompasses a range of morphological deformations and topological changes. We demonstrate the advantages of this approach on a dataset of 20 images from CHD patients, learning a model that accurately segments individual heart chambers and great vessels. Com- pared to direct segmentation, the iterative method yields more accurate segmentation for patients with the most severe CHD malformations.Comment: Presented at the Deep Learning in Medical Image Analysis Workshop, MICCAI 201

Orthognathic Surgical Outcomes in Patients With and Without Craniofacial Anomalies

Purpose The objective of this study is to examine hospitalization outcomes after orthognathic surgery. This study tests the hypothesis that patients with craniofacial anomalies have higher billed hospital charges, longer lengths of stay, and increased odds of development of infectious complications when compared with patients without craniofacial anomalies. Materials and Methods The Nationwide Inpatient Sample for the years 2012 and 2013 was used. All patients who underwent an orthognathic surgical procedure were selected. The primary independent variable of interest was presence of a congenital cleft and/or craniofacial anomaly. The outcome variables were the occurrence of complications, billed hospital charges, and length of stay. Multivariable logistic and linear regression models were used to examine the effect of the presence of craniofacial anomalies on outcomes. Results During the study period, a total of 16,515 patients underwent an orthognathic surgical procedure in the United States. Of these patients, 2,760 had a cleft and/or craniofacial anomaly. An infectious complication occurred in 7.4% of those with a craniofacial anomaly (compared with 0.6% of those without a craniofacial anomaly). The mean billed hospital charges in those with a craniofacial anomaly was $139,317 (compared with$56,189 in those without a craniofacial anomaly). The mean length of stay in the hospital in patients with a craniofacial anomaly was 8.8 days (compared with 1.8 days in those without a craniofacial anomaly). These differences in outcomes between patients with and patients without craniofacial anomalies were significant after we adjusted for patient- and hospital-level confounders. Conclusions Patients with a craniofacial anomaly are at higher risk of development of infectious complications, have higher hospital charges, and stay in the hospital for a longer duration after orthognathic surgery when compared with those without a craniofacial anomaly

Grown up congenital heart disease patient presenting for non cardiac surgery: anaesthetic implications

Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies

Health-related quality of life and everyday life for children with right ventricular outflow tract anomalies. Perspectives from children and parents.

Background: Children with right ventricular outflow tract (RVOT) anomaliestypically undergo surgical repair during their first months of life and thereafter they will need one or more reoperations through their life.Aims: The overall aim was to describe health-related quality of life (HRQoL) forchildren with congenital heart disease (CHD) with a special focus on children withRVOT anomalies and to explore children’s and their parents’ experiences ofeveryday life during assessment that could result in a new heart surgery.Methods: Two quantitative studies with HRQoL assessment for 337 children withCHD and 97 children with RVOT anomalies were performed. Another twoqualitative interview studies were conducted, in which nine children with RVOTanomalies and their parents were interviewed at three time points (at start of thepreoperative assessment, at the assessment decision and around 11 months after the decision).Results: Children with three or more surgeries had lower HRQoL than children with fewer heart surgeries. Children with RVOT anomalies rated their lowest HRQoL for cognitive function, as did their parents. The agreement for HRQoL between children with RVOT anomalies and their parents was strong for 13 of 22 items. The thematic analysis of the interviews with children resulted in three themes and eight subthemes: Me and my heart disease explores the children’s experiences of their heart disease; Being me explores their sense of self; Being placed in someone else’s hands describes how the assessment was a safety net for the child, at least until the decision for heart surgery. The interviews with parents resulted in five themes: The heart surgery keeps my child alive illuminates’ parents’ experiences related to the assessment: Everyday struggles illuminates the struggles parents had to face on behalf of their child in everyday life; Unconditional love, Trust in life and Togetherness illuminates the ways in which the parents gained inner strength in their everyday lives.Conclusion: By inviting both the child and their parents to participate in the child’s care, individually tailored support can be identified and given

Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization

Background:Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively, among Patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan. Methods: A prevalence based cost of illness Study Design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children Results:The mean age at the time of surgery in group A (1-12 mo age) was 6.08 +/- 2.80 months and in group B (1-5 yrs) was 37.10 +/- 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outPatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures. Conclusion: This study concluded that significant expenditure is incurred by people with CHD, with the implication that resources could be saved by earlier detection and awareness campaigns

Advanced ablation strategies for management of post-surgical atrial arrhythmias.

Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects

Comparing Two Surgical Outcomes: Minithoracotomy or Full Sternotomy in Coronary Artery Bypass Grafting Surgery

Cardiovascular diseases and heart-related conditions can be life-threatening; however, some cardiovascular conditions can be managed with open heart surgery. Coronary artery bypass grafting (CABG) is the most common type of heart surgery performed on adults. There are two different surgical procedures to correct cardiac defects: mini-thoracotomy and full sternotomy. Mini thoracotomy approach has been shown to reduce complications, such as pneumonia, excessive blood loss, and infection in mitral valve repair surgeries. However, little research has been done to compare these two surgical approaches performed for patients undergoing coronary artery bypass grafting (CABG). Specifically, there is inadequate data to compare these two surgical approaches in relation to length of stay and duration of ventilator use. The purpose of this study was to compare the surgical outcomes of mini-thoracotomy and full sternotomy in patients undergoing CABG surgeries. A retrospective chart review was conducted from an archival data (2010 to 2016) in patients undergoing CABG surgeries with either a mini-thoracotomy or full sternotomy approach. Included were patients with coronary artery blockages who required CABG surgeries. A one-way ANOVA and independent sample t-test were used for statistical analysis. Results showed that, there was no significant difference in days of hospitalization in those receiving mini-thoracotomy (M= 10.75, SD=10.25) as compared to those who receiving full- sternotomy (M=11.91, SD= 10.03), F (1,537) = 1.17, p = .23.There was no significant difference in number of hours of ventilation time for mini thoracotomy (M= 13.62, SD= 17.58) and full sternotomy (M= 22.33, SD= 95.96), F (1,537) = .90, p=.34. As the length of hospitalization and duration of ventilation did not differ in both surgical approaches, we can conclude that mini-thoracotomy was very comparable to full-sternotomy in these two areas for patients undergoing coronary artery bypass grafting

Assessment of intraoperative events and complications in non-cardiac surgeries and procedures in patients with congenital heart disease

INTRODUCTION: Currently, patients diagnosed with Congenital Heart Disease (CHD) are living longer lifespans, leading to an increased number of these patients presenting for non-cardiac procedures/surgeries. Little research has been recently done analyzing intraoperative complications/risks for CHD patients undergoing non-cardiac surgeries. This study aims to identify common intraoperative events experienced by CHD patients undergoing non-cardiac surgeries using more recent data, while at the same time analyzing to see if there is any difference in frequency of intraoperative events experienced between different types of CHD diagnoses. METHODS: After receiving IRB approval, patients with CHD presenting for non-cardiac procedures/surgeries between the years 2008 and 2012 were pulled from Boston Children’s Hospital’s Electronic Medical records. 1,024 non-cardiac surgical encounters from 362 patients were analyzed to determine average age, average weight, patient gender, average ASA class, frequency of CHD diagnoses, ventricular function, type of non-cardiac procedure, premedication administration, type of induction and type and frequency of intraoperative events experienced. The 1,024 encounters were divided into two groups: those done in patients diagnosed with single ventricle physiology (n=79) and those done in patients diagnosed with non-single ventricle physiology (n=945). Unpaired Mann-Whitney tests were performed to determine if there was a significant difference in overall and specific intraoperative event occurrence between the single ventricle and non-single ventricle groups. RESULTS: Average age and weight at the time of these surgical encounters was 4.86 years and 20.57 Kg. A majority of the surgical encounters were done in males (59.2%). Atrial septal defect was the most common type of CHD, and most of the patients in these surgical encounters received an ASA class of 3. Intraoperative events occurred in 24.4% of the surgical encounters with cardiovascular events being the most common (44.82% of total events). Other events made up 30.49% of events experienced intraoperatively, with respiratory events making up the remaining 24.70%. There was a significant difference in the occurrence of overall events between the single ventricle and non-single ventricle group (P<0.0001). Additionally, there was a significant difference in the occurrence of cardiovascular events (P<0.0001) and Other events (P=0.0001) between the single ventricle and non-single ventricle groups. There was no significant difference in the occurrence of respiratory events between the two groups (P=0.648). DISCUSSION: The most common type of intraoperative event experienced by CHD patients during a non-cardiac surgery was cardiovascular events. Significantly more overall intraoperative events, including cardiovascular and other events, occurred in surgical encounters performed on CHD patients exhibiting single ventricle physiology than those encounters done on CHD patients with a non-single ventricle physiology. Results of this study suggest that it would be likely for CHD patients to have a cardiovascular event occur during non-cardiac surgery and that this may be more likely in patients with a single ventricle physiology. This study was subjected to the limitations of retrospective chart review, as well as missing and infrequent documentation. Future analysis will look to find correlations between the occurrence of intraoperative events, and demographic and procedure variables analyzed in this study.2017-06-16T00:00:00