Catheter intervention for branch and crossed pulmonary arteries

IntroductionOver the last decade, stent implantation has become a widely accepted, effective therapy for the treatment of pulmonary arterial (PA) stenoses. Stent implantation has proved to be a safe procedure with minimal complications.ObjectivesTo review our experience with branch PA stenting. We reviewed also catheter based interventions for patients with right aortic arch and crossed pulmonary arteries associated with branch PA stenosis.MethodRetrospective data analysis of all patients who had branch PA stenting at KACC, NGHA, Riyadh KSA, during the period from January 2006 till October 2009. Patients with pulmonary atresia VSD and MAPCAS were excluded.ResultsTwenty-one patients were identified to have PA stenting during the study period. 14 were females (66.7%). Six patients (29%) were syndromic (Alagile syndrome, DiGeorge syndrome, Down syndrome, Goldenhar Syndrome, and Noonan Syndrome). Five patients (24%) had crossed Pas. Seven patients (33%) had PA, VSD, PDA, Two had TOF, one had AVSD with TOF, one DORV, one TGA, one truncus arteriosus with IAA type B, and one had Bicuspid AV with aortic stenosis as a primary diagnosis. All of them had branch PA stenting as a secondary procedure (post surgical intervention). Six patients (29%) had PA stenting as a primary intervention with no prior surgical intervention. Six patients (29%) had Bilateral branch PAs stenting, 11 (52%) had LPA stenting and 4 (19%) had RPA stenting. The median age at branch PA stenting was 35months (range 2months to 45years). The median weight was 10.5kg (2.8–100kg). The median F/U period was 32months (40days to 61months). Ten patients (48%) required stent dilatation after a median period of 28months (12–38months). One patient had failed LPA stenting (stent embolized and parked into RPA) who later underwent another intervention with successful LPA stenting.ConclusionStent implantation has proved to be a safe procedure with minimal complications.Even in those with crossed Pas. Restenoses is long term concerns which are amenable to redilatation with excellent results

Outcome of tracheostomy after pediatric cardiac surgery

AbstractObjectiveTo investigate the incidence, timing indications and outcome of tracheotomy in children who underwent cardiac surgeries.MethodsAll pediatric cardiac patients (under 14years of age) who underwent cardiac surgeries and required tracheotomy from November 2000 to November 2010 were reviewed. The data were collected and reviewed retrospectively.ResultsSixteen children underwent tracheotomy after cardiac surgery. Fifteen of these cases had surgery for congenital heart disease, and one had surgery for an acquired rheumatic mitral valve disease. The mean±SEMs of the durations of ventilation before and after tracheotomy were 60.4±9.8 and 14.5±4.79days respectively (P value 0.0002). The means±SEM of the lengths of ICU stay before and after tracheotomy were 63.31±10.15 and 22±5.4days respectively (P value 0.0012). After the tracheotomy 12/16 patients (75%) were weaned from their ventilators and 10/16 were discharged from the PCICU. Six patients were discharged from the hospital and 3 were successfully decannulated. The overall survival rate was 9/16 (56%).ConclusionTracheostomy shortens the duration of mechanical ventilation and facilitates discharge from the ICU. The mortality of tracheotomy patients is still significant but is mainly related to the primary cardiac disease

Safety and usefulness of outreach clinic conducted by pediatric echosonographers

Background: Outreach echocardiographic services led by cardiac sonographers may help district level hospitals in the management of patients suspected to have cardiac anomalies. However, the safety and utility of such an approach is not tested. Methods: We retrospectively reviewed our experience of patients seen in the outreach visits by the echocardiographers alone and subsequently reviewed in the pediatric cardiology clinic. Comparison between the diagnosis made by the echocardiographer and the consultant pediatric cardiologist were done. We defined safety as no change in patient management plan between the outreach evaluation and the pediatric cardiology clinic evaluation, and we defined usefulness as being beneficial, serviceable and of practical use. Results: Two senior echocardiographic technicians did 41 clinic visits and over a period of 17 months, 623 patients were seen. Patients less than 3 months of age constitute 63% of the total patients seen. Normal echocardiographic examinations were found in 342 (55%) of patients. These patients were not seen in our cardiology clinic. Abnormal echocardiographic examinations were found in 281 (45%) of patients. Among the 281 patients with abnormal echos in the outreach visits, 251 patients (89.3%) were seen in the pediatric cardiology clinic. Comparing the results of the outreach clinic evaluation to that of the pediatric cardiology clinic, 73 patients (29%) diagnosed to have a minor CHD turned to have normal echocardiographic examinations. In all patients seen in both the outreach clinics and the pediatric tertiary cardiac clinics there was no change in patient′s management plan. Conclusions: Outreach clinic conducted by pediatric echo sonographers could be useful and safe. It may help in reducing unnecessary visits to pediatric cardiology clinics, provide parental reassurance, and help in narrowing the differential diagnosis in critically ill patient unable to be transferred to tertiary cardiac centers provided it is done by experienced echosonographers

Different types of isolation of arch branches using cardiac imaging tools

Introduction: The goal of this study is to describe (1) different types of isolation of arch branches and (2) to show the importance of careful evaluation of arch morphology using imaging tools such as echocardiography, cardiac computerized tomography (CT) and cardiac catheterization. Methodology: Following IRB approval from KAIMRC with number RC17/298/R, we reviewed retrospectively a consecutive case series of pediatric patients who were diagnosed to have isolated innominate or subclavian arteries at King Abdul-Aziz and Prince Sultan Cardiac Centers by use of imaging techniques mentioned above. Data was collected, including demographic information, cardiac diagnosis, diagnostic modalities, and surgical interventions. Results: There were a total of 11 patients who were diagnosed to have isolated arch branches. 9 of these patients (82%) had a right aortic arch (RAA) while 3 patients (27%) were found to have a left-sided aortic arch (LAA). Three patients from those with documented RAA had isolated left innominate artery with retrograde blood supply from the circle of Willis through the left vertebral artery and the isolated artery was connected to the pulmonary artery by patent ductus arteriousus or its remnant ligament; the remaining six patients with RAA presented with an isolated left subclavian artery. 3 patients were found to have LAA arch with an isolated left subclavian artery. Of the 11 patients included in this study, one patient had normal intracardiac anatomy, 3 patients a VSD, 2 patients an interrupted aortic arch type B, 2 patients had tetralogy of Fallot, one patient left isomerism, another one hypoplastic left heart syndrome, and the last patient presented with crossed PAs and LPA stenosis. Conclusion: Isolation of arch branches is a rare condition, but if it is present a careful initial assessment of arch morphology during echocardiography examination is mandatory; however, the utilization of cardiac CT with expert people reading the results will improve the detecting rate of such a lesion significantly

Healthcare productivity, and its sociodemographic determinants, of Saudi female nurses: A cross-sectional survey, Al-Qassim, Saudi Arabia, 2017

Background: In Saudi Arabia, cultural and language differences between expatriate nurses and patients affect the quality of nursing care. Hence, the Kingdom is eying Saudization in this field. The productivity of nurses can affect the productivity of the whole health system. The aim of this study was to investigate the health-care productivity of Saudi female nurses and socio-demographic determinants of their productivity. Methods: We conducted a cross-sectional survey of 256 randomly selected Saudi female nurses in the Qassim region. The nurses who were not working in public hospitals" not giving direct patient care or had Results: The mean age of the nurses was 30.2 ± 5.6 years. Among the nurses, 62.6% were currently married, 33% were never married, and 4.4% were divorced/widowed. Most of the nurses were not willing to serve male patients (70.3%)" they wanted to work only in female units (66.1%) and did not prefer night shifts (50.8%). Over the past 1 year, most of them demonstrated tendency of taking emergency leave (64.2%) and sick leave (56.4%), while 27.3% had unexcused absences and 19.5% had unplanned but excused absences. In addition, 20.3% demonstrated a tendency of taking frequent breaks during duty hours and 18.9% demonstrated tendency of being late on duty. Multivariable linear regression analysis revealed that being married was associated with 1.66 points decrease in the productivity index score when compared to never married nurses. Having one more child under 5 years of age was associated with 0.75 points increase in the productivity index score. In addition, nurses who employed household workers at home scored 1.04 points less than those who did not. Conclusions: Healthcare productivity index score was lower among married Saudi female nurses than never married nurses. However, aspects of married life commonly believed to cause home work-life conflicts, such as number of children, living with or without family, having disabled children in household and personal factors such as age did not have statistically significant influence on the productivity index score. It is possible that unexplained cultural issues associated with being married may be responsible for a lower productivity index score among married female nurses in Saudi Arabia