Effectiveness of Peritoneal Dialysis in Management of Acute Hyperthermia after On-Pump Heart Surgery in Infants

Introduction: Acute hyperthermia is a common complication in the first 24 hours after open heart surgery with the incidence of 12% to 73%. The aim of this study was to evaluate the efficiency of postoperative peritoneal dialysis for controlling acute hyperthermia in pediatrics undergoing on-pump heart surgery. Methods: We reviewed clinical outcomes of 40 infants who underwent congenital surgery from August 2016 to August 2017. Patients were divided into two groups in terms of peritoneal dialysis requirement as group A and B. Demographic data, intraoperative and postoperative variables were compared between the patients. Results: Among the 40 high risk infants who underwent cardiac surgery, 20 patients were treated with peritoneal dialysis (group A). Mean rectal temperature and incidence of acute hyperthermia in 24h after surgery were higher in group A compared to group B (p ? 0.05). Infants in group A were younger, lighter and showed lower BSA compare to group B (p < 0.05). Also, higher concentration of serum potassium and lower urinary output were seen in group A compared to group B (p = 0.05). The incidence of neurological events was significantly higher in patients of group A (p < 0.05). Intubation time and intensive care unit stay was significantly more prolonged in the group A with peritoneal dialysis (p ? 0.05). Conclusion: Peritoneal dialysis performance was effective in treatment of induced hyperthermia in the first 24 h after operation. Indeed, younger age and lighter weight children are more prone to postoperative complication related to cardiopulmonary bypass surgery

Right Atrial Thrombus in a COVID-19 Child Treated Through Cardiac Surgery

We herein report a case of large intracardiac thrombus in a child with SARS-CoV-2 infection (COVID-19). The diagnosis of COVID-19 was confirmed through HRCT and RT-PCR. Transthoracic echocardiography revealed a large thrombus in the right atrium treated successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory condition incurred by the COVID-19 virus

Evaluation of Sternal Closure with Absorbable Polydioxanone Sutures in Children

Introduction: Sternal dehiscence, sternal wound infection and mediastinitis are troublesome complications following median sternotomy which are major causes of morbidity and mortality of patients. Synthetic polydioxanone absorbable suture seems effective in prevention of these complications in children undergoing open heart surgery.Methods: During 2 years period, 620 patients who underwent median sternotomy were studied. The efficacy of absorbable polydioxanone suture was tested on patients using figure-of-eight suture technique. The patients’ age ranged from newborn to 15 years old. All surgical interventions were performed according to a standard protocol.Results: No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Two patients experienced sternal dehiscence (0.32%). Follow-up period of patients were established between 1 to 132 months after open heart surgery.Conclusion: Sternal closure with the polydioxanone suture in combination with figure-of-eight technique is a safe and suitable method in children with good clinical results

The role of preoperative sildenafil therapy in controlling of postoperative pulmonary hypertension in children with ventricular septal defects

Introduction: Most of the ventricular septal defects (VSD) are complicated with pulmonary arterial hypertension (PAH) which is the major cause of pulmonary hypertensive crisis and right ventricular failure. Methods: We reviewed clinical outcomes of 63 infants who underwent cardiac surgery and were divided into three groups. Control group (n=20) did not received sildenafil while group A (n = 22) received drug (0.3 mg/kg) before and after surgery. Group B (n=21) received drug at the initiation of surgery. Demographic data, preoperative and postoperative variables were compared among the patients. Results: Patients in the group A had lower preoperative pulmonary arterial pressure (PAP) compared to other groups (P < 0.001). Also, patients in control group had longer cardiopulmonary bypass time (P < 0.05). Postoperative PAP in patients of group A and B decreased significantly compared to control group (P < 0.001). Also, pre- and postoperative PVR (pulmonary vascular resistance) showed a significant decrease in group A compared with control and group B (P < 0.001). The intubation time in patients of the control group was significantly more prolonged compared with patients of group A and B (P < 0.001). Moreover, the length of ICU stay was significantly longer in patients of control group compared with group A and B (P < 0.001). Conclusion: Preoperative sildenafil therapy seems to be effective and safe to prevent postoperative PAH and pulmonary hypertensive crisis in children with ventricular septal defects and has a positive impact on postoperative care

AMIODARONE VERSUS PROPANOLOL ATRIAL FIBRILLATION PRE-VENTION AFTER CABG IN PATIENTS WITH LOW EJECTION FRACTION

Abstract &nbsp;&nbsp; BACKGROUND: Atrial fibrillation (AF) occurs often in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality. The purpose of this study is to compare the prophylactic effect of Amiodarone versus Propranolol in patients with various levels of ejection fraction. &nbsp;&nbsp; METHODS: In a randomized double-blinded clinical trial, 110 patients received either Amiodarone (n=65) or propanolol (n=65). Adult patients of either sex and age of 40-75 years were considered for participation when listed for nonemergent CABG surgery and bypass without other concomitant procedures. Amiodarone was given as 150&nbsp;mg single dose 30 min after procedure through 48 hours. In addition, Amiodarone was also administered intravenously during surgery in a 300-mg bolus for 1&nbsp;h and as a total maintenance dose of 20&nbsp;mg/kg weight over 24&nbsp;h on the first day following surgery. Propanolol was given as 10&nbsp;mg oral single dose immediately after surgery and continued for long term operation. &nbsp;&nbsp; RESULTS: The primary endpoint was the occurrence of AF after CABG. The secondary endpoint was the hospitalization length of stay after CABG. The baseline characteristics were similar in both treatment groups. The incidence of post-operative AF was significantly higher in the Propranolol group compared with the Amiodarone group (4 vs 12.2 % of patients with low EF, P&lt;0.0001). The durations of postoperative intensive care unit stays were the same in the Amiodarone and Propranolol groups (2&plusmn;0.7 vs. 3.5&plusmn;0. 5 days, P&lt;0.001).&nbsp; &nbsp;&nbsp; CONCLUSION: This study demonstrates that postoperative course of Amiodarone administration is an effective, possibly safe, well-tolerated, and widely applicable therapy for the prevention of postoperative atrial tachyarrhythmia after cardiac surgery. This benefit was associated with a reduction in the probability of preoperative sustained ventricular tachyarrhythmia and a trend toward a reduction in postoperative hospital stay. &nbsp; &nbsp;&nbsp; Keywords: Atrial Fibrillation, Coronary Artery Bypass Grafting, Amiodarone, Propranolol. &nbsp;</p

Prophylaxis of dexamethasone protects patients from further post-operative delirium after cardiac surgery: A randomized trial

Background: Coronary artery bypass graft is one of common cardiac surgeries which unfortunately accompany with some adverse events such as delirium. Proinflammatory processes play an important role in pathogenesis of post-operative delirium. Therefore, the effect of dexamethasone (DEX) on post-operative delirium after cardiac surgery was evaluated. Materials and Methods: This randomized clinical trial study was conducted with objective of evaluation of DEX effects on post-operative deliriums and complications after cardiac surgery. Ninety three eligible patients who undergone coronary arteries bypass graft was divided into two groups of DEX with 43 patients and placebo (PCB) with 50 patients. DEX group taken 8 mg DEX intra-venous before induction of anesthesia followed by 8 mg every 8 h for 3 day and other group received PCB in same way. Results: All patients assessed by Mini-mental status questionnaire and psychiatric interviewing with aim of diagnosing delirium. Extubation time of DEX group was significantly reduced. The first post-operative day deliriums, extubation time, hospital, and intensive-care unit length of stay significantly reduced in DEX group without increasing serious complications such as infectious disease. After administration of DEX only hyperglycemia as an adverse event was increased in DEX group. Other complications of renal, cardiac, cerebrovascular and respiratory system did not show any significant differences between groups. Conclusion: Pre-operative administration of DEX might safely protect brain of the patients who undergone cardiac surgery against post-operative delirium

Repair of Tetralogy of Fallot in Infancy via the Atrioventricular Approach

Background: Tetralogy of Fallot (TOF) is a well-recognized congenital heart disease. Despite improvements in the outcomes of surgical repair, the optimal timing of surgery and type of surgical management of patients with TOF remains controversial. The purpose of this study was to assess outcomes following the repair of TOF in infants depending on the surgical procedure used. Methods: This study involved the retrospective review of 120 patients who underwent TOF repair between 2010 and 2013. Patients were divided into three groups depending on the surgical procedure that they underwent. Corrective surgery was done via the transventricular approach (n=40), the transatrial approach (n=40), or a combined atrioventricular approach (n=40). Demographic data and the outcomes of the surgical procedures were compared among the groups. Results: In the atrioventricular group, the incidence of the following complications was found to be significantly lower than in the other groups: complete heart block (p=0.034), right ventricular failure (p=0.027) and mediastinal bleeding (p=0.007). Patients in the atrioventricular group had a better postoperative right ventricular ejection fraction (p=0.001). No statistically significant differences were observed among the three surgical groups in the occurrence of tachycardia, renal failure, and tricuspid incompetence. The one-year survival rates in the three groups were 95%, 90%, and 97.5%, respectively (p=0.395). Conclusion: Combined atrioventricular repair of TOF in infancy can be safely performed, with acceptable surgical risk, a low incidence of reoperation, good ventricular function outcomes, and an excellent survival rate

COMPARISON OF RETROGRADE VERSUS ANTROGRADE-RETROGRADE COLD BLOOD CARDIOPLEGIA: A RANDOMIZED CLINICAL TRIAL IN PATIENTS WITH CORONARY ARTERY BYPASS GRAFTING

Abstract&nbsp;&nbsp; INTRODUCTION: The quality of myocardial protection during Coronary Artery Bypass Grafting (CABG) has a direct effect on post-operative cardiac function, recovery and complications. This study aimed to reveal the benefits of retrograde cardioplegia alone or with antrograde in CABG for myocardial function.&nbsp;&nbsp; METHODS: A total number of 90 patients that underwent CABG between 2005 and 2006 were assigned randomly into two groups according to myocardial protection technique; Antrograde cold blood cardioplegia (ACBC) and retrograde cold blood cardioplegia (RCBC). The results were assessed considering clinical outcome, assessment of early systolic function by means of cardiac output (CO), stroke, left ventricular and atrial fibrillation and transient atrioventricular block after coming off bypass.&nbsp;&nbsp; RESULTS: The mean of age, gender, diabetes, hypertension, euro score, anatomical pattern of coronary disease, indexed left ventricular mass and ejection fraction (EF) were similar in the two groups. Complete LAD occlusion (95% in cross-sectional area of proximal LAD) of grafts was 95.55% in the RCBC group and 97.77% in the A/RCBC group. There were no patients suffering from severe impairment of left ventricle function and EF less than 35%. The cross-clamp time was same in both groups.&nbsp;&nbsp;&nbsp; CONCLUSION: The main findings of this study showed no significant difference between RCBC and A/RCBC procedure on myocardial function and EF also in patient with normal condition.&nbsp;Keywords: Retrograde, Antrograde, Cardioplegia.</p

Predictors and clinical outcomes of postoperative delirium after administration of dexamethasone in patients undergoing coronary artery bypass surgery

Background: Postoperative delirium (POD) is one of the important complications of cardiac surgery and it is assumed to provoke inflammatory responses. Theoretically, anti-inflammatory effects of dexamethasone can have an influence on the incidence and outcomes of POD. The aim of our study was to assess POD predictors and outcomes of dexamethasone administration after cardiac surgery. Methods: Patients′ mental status was examined by mini-mental status examination and psychiatric interviewing to diagnose delirium. Subsequently, authors analyzed the patient variables for identification of predictors and outcomes of POD. Results: Between 196 patients who met the inclusion criteria, 34 (17.34%) patients were delirious. History of chronic renal failure, obstructive pulmonary disease, smoking, and addiction strongly predicted development of POD. Other predictors were intra-aortic balloon pump insertion, transfusion of packed cells, and atrial fibrillation rhythm. In our study, the administration of dexamethasone significantly reduced the risk for POD. Furthermore, delirium was associated with longer intensive care unit (ICU) stay. Conclusion: Our study reports the predictors of POD, which patients commonly facing them in cardiac surgery ICU. Appropriate management and prevention of these predictors, especially modifiable ones, can decrease the incident of POD and improves cognitive outcomes of cardiac surgeries

Right ventricular Hemodynamic Alteration after Pulmonary Valve Replacement in Children with Congenital Heart Disease

Introduction:  In patients who underwent surgery to repair Tetralogy of Fallot, right ventricular dilation from pulmonary regurgitation may be result in right ventricular failure, arrhythmias and cardiac arrest. Hence, pulmonary valve replacement may be necessary to reduce right ventricular volume overload. The aim of present study was to assess the effects of pulmonary valve replacement on right ventricular function after repair of Tetralogy of Fallot.   Materials and  Method:  This retrospective study was carried out between July 2011 and October 2013 on 21 consecutive patients in Chamran Heart Center (Esfahan). The study included 13 male (61.9%) and 8 female (38.1%). Cardiac magnetic resonance was performed before, 6 and 12 months after pulmonary valve replacement in all patients (Babak Imaging Center, Tehran) with the 1.5 Tesla system. The main reason for surgery at Tetralogy of Fallot repaired time was Tetralogy of Fallot + Pulmonary insufficiency (17 cases) and Tetralogy of Fallot + Pulmonary atresia (4 cases). Right ventricular function was assessed before and after pulmonary valve replacement with Two-dimensional echocardiography and ttest was used to evaluate follow-up data.   Results:  Right ventricular end-diastolic volume, right ventricular end- systolic volume significantly decreased (P value ˂ 0.05).Right ventricular ejection fraction had a significant increase (P value ˂ 0.05). Right ventricular mass substantially shrank after pulmonary valve replacement. Moreover, pulmonary regurgitation noticeably decreased in patients. The other hemodynamic parameter such as left ventricular ejection fraction improved but was not significant (P value= 0.79). Conclusion:  Pulmonary valve replacement can successfully restores the impaired hemodynamic function of right ventricle which is caused by direct consequence of volume unloading in patient. Pulmonary valve surgery in children with Tetralogy of Fallot who have moderate to severe pulmonary regurgitation leads to an improvement of right ventricular function.