The Effect of Oral Triiodothyronine in Outcome of Pediatric Congenital Cardiac Surgery

Background: Cardiac surgery especially in small children is associated with a marked decrease in thyroid hormone levels consistent with the phenomenon referred to as Sick Euthyroid Syndrome (SES). The purpose of the present study was to determine if oral triiodothyronine could reduce the length of ICU stay, vasoactive inotropic score (VIS), and promote ejection fraction in infants and children undergoing cardiac surgery with CPB. Materials and Methods: In a double-blind clinical trial, one hundred and twenty children aged 6 to 60 months and scheduled for different types of cardiac surgery with CPB, were randomized into two groups to receive either 2 mcg/Kg triiodothyronine (trial group) or 5% dextrose water (placebo group), immediately after anesthesia and 24 hours after surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The intubation time, ICU stay length, ICU inotropic use, and cardiac ejection fraction was recorded. Results: The basic demographic data were comparable in two groups. No significant side effects or adverse reactions were seen due to hormone therapy. Intubation time, ICU stay, and VIS values were significantly shorter between the two groups. Conclusion: In children undergoing cardiac surgery with CPB, perioperative oral small-dose triiodothyronine therapy could improve clinical indices of perioperative care

Red Cell Distribution Width as a Predictor of Outcome in Cyanotic Congenital Cardiac Surgery

Background: Red blood cell distribution width (RDW) is a vital marker associated with various clinical states. In the present study, we aimed to determine the associations between RDW changes and adverse effects caused by pediatric cardiac surgery. Materials and Methods: In the present research, we retrospectively analyzed 100 pediatric patients enrolled in this study who were candidates for cardiac surgery. RDW was determined pre-and postoperatively and at the time of discharge from the hospital. Intubation time, duration of intensive care unit (ICU) stay and hospital stay, cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, vasoactive inotropic score (VIS), and mortality rate were determined as well. Results: Intubation time, duration of hospital stay, CPB time, ACC time, VIS, and mortality rate were significantly higher in the patients with higher RDW rates. Conclusion: This study demonstrated that RDW could be used as an essential indicator in predicting both morbidity and mortality caused by pediatric congenital heart surgery

Effect of combined Conventional Ultrafiltration and Modified Ultrafiltration on Serum Interleukin-6 and TNF-α Levels in Pediatric Cardiac Surgery Patients

AbstractBackground: Water retention occurs in most of the congenital heart surgery patients, especially in pediatrics. Ultrafiltration excretes water, electrolytes, many free radicals and inflammatory mediators. The aim of this study was to investigate the effect of modified ultrafiltration (MUF) on the serum levels of TNF-α and IL-6 in pediatrics patients undergoing congenital heart surgeries.Methods and Materials: A total of 91 pediatric congenital heart disease patients candidate for total correction were selected and divided randomly in two groups: CUF (Conventional Ultrafiltration) and CUF+MUF; 40 patients were allocated to CUF group and 51 patients to CUF+MUF group. Serum levels of TNF-α and IL-6 were assessed before CPB and 6 hours after the end of the operation in ICU. Postoperative levels of TNF-α and IL-6 were compared between the two groups.Results: In the MUF+CUF group, the preoperative and postoperative TNF-α levels were 2.5±5.6 and 1.4±3.0 respectively. However, IL-6 serum levels before and after operation were 4.8±8.9 and 41±56. In the CUF only group, the TNF-α level before and after surgery was 3.1±6.2 and 1.0±0.44; respectively; similarly, IL-6 serum levels were 3.3±8.2 and 34.8±37.7.Conclusion: MUF in congenital heart surgery could filtrate excess water and elevate hematocrit but does not have a definitive role in reducing TNF-α and IL-6 serum levels.Keywords: MUF, TNF-α, IL-6, CUF, cardiopulmonary bypas

Left Pulmonary Artery Stenting with Glenn Shunt: In- troducing a Hybrid Procedure

Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months’ follow-up of the patient exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry

The Dilemma in Treatment of hemodialysis patients with catheter-induced right atrial thrombi (CRAT): A case report

Catheter-induced right atrial thrombi (CRAT) is a serious complication of central venous catheterization. Herein we report a case of large hypermobile right atrial thrombi in a 57-year-old man with hemodialysis catheter in the right internal jugular vein

Enzyme polymorphism in warfarin dose management after pediatric cardiac surgery

Background: Warfarin is an anticoagulant and is widely used for the prevention of thromboembolic events. Genetic variants of the enzymes that metabolize warfarin, i.e. cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1), contribute to differences in patients’ responses to various warfarin doses. There is, however, a dearth of data on the role of these variants during initial anticoagulation in pediatric patients. Objectives: We aimed to evaluate the role of genetic variants of warfarin metabolizing enzymes in anticoagulation in a pediatric population. Patients and Methods: In this prospective cohort study, 200 pediatric patients, who required warfarin therapy after cardiac surgery, were enrolled and divided into two groups. For 50 cases, warfarin was prescribed based on their genotyping (group 1) and for the remaining 150 cases, warfarin was prescribed based on our institute routine warfarin dosing (group 2). The study endpoints were comprised of time to reach the first therapeutic international normalization ratio (INR), time to reach a stable warfarin maintenance dose, time with over- anticoagulation, bleeding episodes, hospital stay days and stable warfarin maintenance dose. Results: There was no significant difference concerning the demographic data between the two groups. The time to stable warfarin maintenance dose and hospital stay days were significantly lower in group 1 (P <0.001). However, there was no statistically significant difference in time to reach the first therapeutic INR, time with over-anticoagulation and bleeding episodes, between the two groups. Conclusions: The determination of warfarin dose, based on genotyping, might reduce the time to achieve stable anticoagulation of warfarin dose and length of hospital stay

Device-Induced Perforation of Right Atrium Following Interventional Closure of Atrial Septal Defect (ASD)

This is a case presentation of a 26-year-old woman with a moderate-sized atrial septal secundum defect (17mm) who underwent catheterism, during which an Amplatzer Septal Occluder number 26 was inserted successfully. On the second postoperative day, she deteriorated and a clinical examination showed a typical tamponade. After a percutaneous aspiration of the pericardial cavity and transient improvement in vital signs, a pig-tail catheter was inserted percutaneously emergently, and the patient was transferred to the operating room in a preshock state. During the operation, an active bleeding point in the superoanterior aspect of the right atrium near the aortic root was detected, which was repaired by direct suture and pericardial patch reinforcement. The Amplatzer device was removed and the atrial septal defect was repaired with a pericardial patch. A lethal complication of the interventional closure of atrial septal defect, properly treated by an emergent intervention and operation, is presented and discussed herein

Early and mid-term outcome of pediatric congenital mitral valve surgery

Background: Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge. Objectives: The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death. Patients and Methods: In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 ± 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 ± 38.18 months and 11.92 ± 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two- dimensional echocardiography and then every six months after surgery Results: Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P < 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P < 0.001), weight (P < 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in 85.7% of patients with MS and in 76.6% of patients with MR. Age (P = 0.002) and weight (P = 0.003) of patients are strong predictors for surgical success in multivariate analysis. Conclusions: Surgical repair of the congenital MV disease yields acceptable early and intermediate-term satisfactory valve function and good survival at intermediate-term follow-up. Strong predictors for poor surgical outcome and death were age smaller than 1 year, weight smaller or equal than 6 kg, and associated cardiac anomalies such as pulmonary stenosis

Inflammatory myofibroblastic tumor of the pericardium in an 11‐month‐old infant: A case report

Abstract Primary cardiac tumors are very rare in infants. Here we present an 11‐month‐old infant with a pericardial inflammatory myofibroblastic tumor who presented with symptoms of respiratory distress and cardiac tamponade. The tumor was surgically removed, and the patient received medical treatment; the patient had no problem with follow‐up