Anticipation and management of junctional ectopic tachycardia in postoperative cardiac surgery: Single center experience with high incidence

Background : Junctional ectopic tachycardia (JET) often occurs in the early postoperative period following surgery for congenital heart diseases and may lead to hemodynamic compromise. Its exact etiology is unknown, however, longer cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, catecholamines, and hypomagnesemia are known risk factors. JET is associated with increased postoperative morbidity and mortality. Materials and Methods: A prospective cohort study of 194 consecutive children who underwent open heart surgery on CPB over 1 year period, patients was divided into three groups; JET, non-JET arrhythmia, and no arrhythmia groups. Information on patient′s demographics (sex, age, and body weight), type of surgical interventions, duration of CPB and ACC, the use of inotropic support, duration of intensive care unit (ICU) stay, and response to different therapeutic methods were collected. Results: JET was documented in 53 patients (27%) most commonly following tetralogy of Fallot (TOF) repair and was associated with longer CPB and ACC times (118 and 77 min, respectively) as compared to non-JET arrhythmia (93.9 and 55.3 min, respectively) and no arrhythmia groups (94.9 and 54.8 min, respectively). Patients with JET required more inotropic support and longer ICU stay as compared to other groups. Amiodarone was safe and effective in treatment of JET. Atrial electrocardiogram (ECG) and Lewis lead ECG were helpful tools in JET diagnosis. The mortality was 11.5% in JET patients. Conclusions: Incidence of JET was 27% possibly due to the large number of Fallot repair and Senning operation. Longer CPB and ACC times are risk factors for JET

Single patch technique versus double patch technique in repair of complete atrioventricular septal defect

Methods: This retrospective study included 145 consecutive patients who underwent complete atrioventricular (CAVSD) repair between January 2002 and January 2012. Peri-operative data were analyzed. Ninety-two patients had a two-patch technique (group A); 53 patients had a single-patch technique (group B). Results: Mean age was 13.17 ± 4.94 months (group A) versus 5.15 ± 1.52 months (group B), (p < 0.001). Mean weight was 9.87 ± 5.53 versus 5.23 ± 2.12 kg (p < 0.001). Down syndrome was present in 82 (90.2%) in group A and 48 (90.5%) in group B (p = 0.315). Aortic cross-clamp times in group A was 135.3 ± 19.6 min and group B 107.7 ± 21.4 min (p < 0.0001). Cardiopulmonary bypass times were shorter in group B (132.2 ± 24.3 min) than group A (159.42 ± 31.4 min) with p value <0.001. Chylothorax, post operative bleeding, ICU stay and hospital length were not significant. Reoperation for left atrioventricular valve insufficiency occurred in 5 patients (5.4%) in group A, one of them needed valve replacement and 3 patients (5.7%) in group B. Permanent pacemaker was required for postoperative heart block in 3 patients (3.3%) in group A and 2 patients (3.8%) in group B (p = 0.623). Hospital mortality was seen in 6 patients (6.5%) in group A and 3 patients (5.7%) in group B (p = 0.606). Conclusions: Single-patch technique can be performed with the same results like the two patch technique with a significantly shorter aortic cross clamp and bypass time

Early versus late extubation after surfactant replacement therapy for respiratory distress syndrome

AbstractPatients and methodsNinety patients treated by surfactant replacement therapy were included in the study. Patients were divided into 2 groups; group A consists of patients who were extubated early within 24h after surfactant administration and group B consists of patients who were extubated after 24h from surfactant administration.Results59 patients were extubated early (within 24h after surfactant administration) while 31 patients were extubated late (after 24h from surfactant administration). Patients in group B (late extubation group) had a longer duration of CPAP (41.53+9.74h in group B versus 17.30+4.03h in group A), a longer duration of total oxygen administration (73.41+11.24h in group B versus 45.33+5.22h in group A) and a longer duration of hospital stay (171.88+75.74h in group B versus 106.82+52.79h in group A) than patients in group A (early extubation group). 41 (69.50%) Patients who were extubated early received surfactants at or before the age of 6h while 22 (70.97%) patients who were extubated late received surfactants after the age of 6h. Regarding complications, 6 patients had transient bradycardia (6.7%), 4 patients had pneumothorax (4.4%) and 4 patients had pulmonary hemorrhage (4.4%).ConclusionEarly administration of surfactants is associated with early extubation. Patients who were extubated early (most of them had an early administration of surfactants) had a lower chance for re-intubation, less duration of total oxygen administration and less hospital stay

Outcome

Objective: To evaluate our experience in the Fontan procedure comparing those below and above 6 years of age. Methods: A review of our clinical database was conducted to identify the patients who received extracardiac Fontan between 2002 and 2010. All demographic, echocardiographic, surgical, haemodynamic and follow-up data were collected. The overall mortality was defined as death occurring from the time of surgery to the most recent follow-up. Early postoperative death was defined as death occurring during admission or within 30 days from the operation. Seventy-six patients with functionally univentricular hearts were included in the study. Patients were divided into two groups. Group A included patients who had received extracardiac Fontan at the age of 6 years or less, whereas group B included patients who had received extracardiac Fontan at an age of more than 6 years. Results: The overall hospital mortality was 7.9% (10.2% in group A and 5.9% in group B). No statistically significant difference was seen between the two groups regarding the postoperative mortality including thrombosis, stroke, chylothorax, bleeding, pericardial effusion, wound infection, serious postoperative arrhythmias and protein losing enteropathy. On the other hand the mechanical ventilation duration, duration of hospital and ICU stay, duration of the chest tubes and the postoperative saturation was not significant between the two groups. Conclusions: The age of the patient at the time of Fontan surgery does not affect the results, in terms of both morbidity and mortality

Galectin-3 as an early marker of diastolic dysfunction in children with end-stage renal disease on regular hemodialysis

Introduction and Aim : Diastolic dysfunction is a common finding in end-stage renal disease (ESRD) on regular hemodialysis (HD). Galectin-3 (Gal-3) has emerged as an early biomarker with diagnostic and prognostic values in cardiac dysfunction with reduced or preserved ejection fraction. We aimed to assess the correlation between Gal-3 levels and diastolic dysfunction in children with ESRD on regular HD. Materials and Methods : Gal-3 levels were assessed in 67 patients on regular HD and 67 healthy controls. Conventional echo-Doppler imaging and tissue-Doppler imaging were done to all patients and control groups. Patients were split into two categories: with or without diastolic dysfunction, based on the early diastolic transmitral velocity to early diastolic mitral annular velocity (E/E') whether more or less than 15, respectively Results : Plasma Gal-3 levels in ng/ml were 16.7 (12.0–22.0) in healthy controls, 15.7 (10.5–22.0) in patients on HD without diastolic dysfunction, and 23.4 (13.4–25.0) in patients on HD with diastolic dysfunction. Gal-3 levels were significantly higher in HD patients with left ventricular diastolic dysfunction (LVDD). Both uni- and multivariate logistic regression analyses revealed that low left ventricular Tei index, low early diastolic mitral annular velocity of lateral wall wave, low early diastolic mitral annular velocity of septal wall wave, high septal early diastolic transmitral velocity to early diastolic mitral annular velocity of lateral wall (E/E') ratio, and high Gal-3 are significant predictors for LVDD in the whole study group. Furthermore, there was a significant positive correlation between the Gal-3 and the grade of diastolic dysfunction. The cut of point of diagnostic accuracy of serum Gal-3 in diastolic dysfunction in HD children was 20.12 with a sensitivity of 93.3 and a specificity 78.4. Conclusions : Gal-3 is a potential early biomarker that can be used in early diagnosis and grading of diastolic dysfunction in ESRD children on regular HD

Mid-term outcome of extracardiac Fontan operation using Contegra conduit

BackgroundLimited surgical experience of constructing Fontan circulation using Contegra conduit has raised concerns of high risk of thrombotic occlusion of Fontan circuit.In this study we intended to retrospectively evaluate thrombotic complication and survival of patients undergone extra-cardiac Fontan procedure.MethodsMedical records of all patients who underwent Fontan completion from January 2002 to December 2010 were reviewed. Echocardiographic, catheterization, and peri-operative data were recorded. Outcome of Fontan procedure using Contegra conduit was compared with those constructed with Dacron tube. All patients received anticoagulation using heparin in the immediate postoperative period and later on Coumadin to maintain therapeutic level of INR. The primary outcome was the prevalence of thrombotic complication and the survival in the two groups. Chi-square was used to compare the categorical variables. Independent 2 sample t-test was used to compare the pre-operative and postoperative numerical variables in the two groups and Kaplan meier curve and Log Rank test were generated to compare the time interval of the two primary outcomes of the two groups.ResultsSeventy-six patients underwent Fontan procedure, using Contegra (n=47) and Dacron tube (n=29). The two groups matched with regard to demographic variables, preoperative hemodynamic data, intra-operative and post-operative outcome. Thrombotic complications occurred within the first 30 days in 6/47 (13%) in Contegra and 3/29 (10%) in Dacron group and the difference was not significant (p=0.983). Relative risk of thrombosis in Contegra group was 0.949 (95% CI=0.8–1.3). The mean follow up for the whole group was 87 months. The mean follow up for Contegra group was 70 months and 95 months for the Dacron group but this difference was not significant (p=0.304). Nine patients died: Contegra 7/47, Dacron, 2/28 (p=0.486). Relative risk of dying in Contegra group was 0.909 (95% CI=0.8–1.1).ConclusionThis is the largest series evaluating the outcome of extra-cardiac Fontan procedure using Contegra conduit. Our results suggest that using Contegra conduit does not increase the risk of thrombotic complication or death compared to Fontan completion using Dacron tube