Myocardial ischaemia markers in cardiac surgery

Department of Cardiac Surgery, Republican Hospital, Chisinau, the Republic of MoldovaBackground: The variations of the recovery time, complications and survival rates among the cardiac patients who have had a heart surgery are vast. Many formulas and theories are used to predict clinical outcome and recovery time. The identification of biomarkers that provide concrete, evidence supporting clinical outcomes has greatly affected such field of medicine as cardiology, helping the clinicians to predict a clinical course in acute ischemia. Recent studies have discovered the biomarkers that may be used as predictors of cardiac patients’ state after post-cardiothoracic surgery, besides, their applications are numerous. This study represents a review of widely recognized markers of myocardial ischaemia that are already included in guidelines and clinical protocols, as well as recently emerging markers for the diagnosis of acute coronary syndrome. A comparative analysis of the strength and weaknesses of the available markers, concerning to the detection of peri-operative ischaemia in cardiac surgery, has been made. Revealing of cardiac troponin (CTN), its isoforms CTN I and CTN T, being complemented by high-sensitivity CTN, have been accepted as a gold standard for detecting cardiac ischaemia. Conclusions: Developing sensitive methods for CTN suggests taking into account the false positive cases. Troponin determination results should be interpreted in a clinical context and can not be used in isolation. Multimarker approach would be useful in case of such opportunities. BNP appears to be one of the markers suitable for this approach to cardiac surgery. But further studies are needed to implement the new markers that are emerging on the market

The oxidative stress in blood hypothermic and normothermic cardioplegia

Department of Cardiac Surgery, Republican Hospital, Institute of Cardiology, Chisinau, the Republic of MoldovaBackground: The oxidative stress is a potent tool of myocardial injury having a special significance during open-heart surgery. Obtaining of hypothermic cardioplegia is based on the decrease of myocard’s metabolic efficiency which results in the increase of its resistance to ischemia. Material and methods: This article is aimed at the evaluation of main indices belonging to oxidative stress in venous coronary sinus blood in 60 patients exposed to valvulopathy correction using hypothermic and normothermic cardioplegia. The patients were divided into 2 groups, depending on cardioplegia: group 1 comprised 30 patients that were subjected to blood hypothermic cardioplagia (t < 33ºC); group 2 also consisted of 30 patients, subjected to blood normothermic cardioplegia (t ≥ 33ºC). The groups were homogenous considering clinical and functional indices of the heart, detected with the patients before the surgical intervention. Results: The oxidative stress is found to be activated in open-heart surgery evidence proved by serum lipid hydroperoxides (LH) and malonic dialdehyde (MD) significant increase across 110 min of ischemia and at 2-3 min of reperfusion till 55.7-58.9%. This enhancement is associated with antioxidant system failure due to a significant quantitative reducing of the main antioxidant compounds at 55 and 110 min of ischemia, gluthation-peroxidase, gluthation-reductase, superoxide-dismutase (SOD), catalase (CAT) and total antioxidant activity (TAA) the most marked decline being characteristic to SOD and CAT (41.85-46.20%). However TAA and CAT have elevated in reperfusion start by 14.4 and 32.6%. Conclusions: The normothermic cardioplegia was appreciated as a more favorable condition concerning myocardial antioxidant protection ensuring because it provided a less rise of LH and MD as well as a less depletion of explored antioxidant factors

Systemic inflammatory response – antiinflamatory strategies in cardiac surgery

IMSP Spitalul Clinic RepublicanOperaţiile pe inimă deseori se asociază cu dezvoltarea sindromului de răspuns inflamator sistemic. Acest fenomen este variabil clinic şi poate fi determinat în condiţii de laborator prin aprecierea indicilor principali de inflamaţie, cum sânt - complementul, citokinele şi factorii de adgezie. Luând în consideraţie că sindromul inflamator poate afecta organele majore, în ultimul timp are loc dezvoltarea vertiginoasă a strategiilor antiinflamatori având ca scop diminuarea răspunsului inflamator sistemic. Scopul acestui articol este de a sistematiza literatura mondială recentă consacrată problemei sus numite. În particular, sânt elucidate efectele antiinflamatori a by-pass-ului aortocoronarian fără circulaţie extracorporală (CEC), hemofiltrarea, filtraţia leucocitară, utilizarea corticosteroizilor, aprotininei, inhibitorilor fosfodiesterazei, dopexaminului, H2 antagonişti, şi blocatorilor enzimelor de conversie.It’s generally accepted that cardiac surgery is frequently associated with the development of systemic inflammatory response. This fhenomenon is very variable clinically, and can be detected by measuring plasma concentrations of certain inflammatory markers. Complement component, cytokines and adhesin molecules are examples of these markers. Systemic inflammation can be potentially damaging to major organs. Several anti-inflammatory strategies have been used in recent years, aiming to attenuate the development of systemic inflammatory response. This article summarizes recently published literature concerning the use of anti-inflammatory techiques and farmacological agents in cardiac surgery. In particular, the anti-inflammatory effects of off-pump surgery, leucocyte filtration, corticosteroids, aprotinin, phoshodiesterase inhibitors, dopexamine, H2 antagonists and ACE inhibitors are reviewed. The overall conclusion is that although certain strategies reduce plasma levels of inflammatory mediators, convicing evidence of sugnificant clinical benefits is yet to come

Blood saving strategy: modification of cardioplegia circuit in children operated for congenital heart malformations

Departamentul Cardiochirurgie, Spitalul Clinic Republican, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Scopul cercetării este optimizarea managementului de sânge în cardioplegie la copiii cu greutate mică, care ar putea reduce utilizarea sângelui. Material şi metode: Pentru a reduce circuitul cardioplegic a fost propusă o schemă redusă (RC), care include două şunturi 1/8 x 1/32, volumul întreg este de 14 ml. Primul este conectat la pompa seringii cu KCI, 2 Meq/ml, iar al doilea – la canula cardioplegică. Fluxul sanguin este furnizat din oxigenator. Efectul cardioplegic în grupul RC (15 pacienţi) a fost comparat cu cel al cardioplegiei administrate prin circuit standard (SC) – 16 pacienţi, care include pompa rolă, tubul 3/16, umplere volum – 80 ml. Vârsta pacienţilor a fost de 7-14 luni, greutatea corporală mai mică de 10 kg. Datele de anchetă au arătat diferenţe semnificative între grupuri. Au fost comparate timpurile de setare a stopului cardiac, „priming” volumul, cantitatea administrată de concentrat eritrocitar, hematocritul după cardioplegie. Rezultate: Volumul de amorsare utilizat în grupul SC a fost mai mare decât în grupul RC (350 vs 250 ml). Administrarea sângelui in cardioplegie prin RC a asigurat instalarea de stop cardiac în 29±13 sec, timp semnificativ mai mic decât în grupul SC, 45±11 sec. Nu a fost nici o diferenţă semnificativă dintre hematocriturile după cardioplegie, dar în grupul SC s-a administrat o cantitate mai mare de concentrate din sânge (130,5±16,3 ml vs 95,8±20,6 ml). Concentrația de K+ mai mare (>4,5 mEq/l) a fost, evident, mai frecventă în grupul SC – 31,3% faţă de 13,3%. Gestionarea cardioplegiei prin RC s-a dovedit a fi mult mai simplă. Concluzii: Reducerea schemei pentru administrare a sângelui în cardioplegie la copiii cu greutate corporală mică permite reducerea volumului de amorsare, reduce utilizarea de sânge autolog, mai puţin contact cu suprafaţa artificială şi oferă stop cardiac mai rapid. În acelaşi timp, se reduc costurile consumabilelor.The aim of study was the optimization of management of blood cardioplegia in children with low body weight, by method which could reduce blood use. Material and methods: To minimize the cardioplegic circuit was proposed reduced scheme (RC), which includes 2 shunts 1/8 x 1/32, with whole filling volume of 14 ml. The first is connected to the syringe pump with KCl, 2 Meq/ml, and the second – to the cardioplegic cannula. Blood flow was supplied from oxygenator. Cardioplegic effect in RC group (15 patients) was compared with that of cadioplegia administered by standard circuit (SC) – 16 patients, which includes the roll pump, tube 3/16, filling volume 80 ml. Patients were aged 7-14 months, body weight less than 10 kg. Investigation’s data showed no significant differences between groups. Were compared cardiac stop setting time, priming volume, administrated amount of red cells concentrate, hematocrit after cardioplegia. Results: The volume of priming used in SC group was higher than in the RC group (350 vs 250 ml). Administration of blood cardioplegia through RC assured installation of cardiac arrest in 29±13 sec, significantly shorter time than in the SC group, 45±11 sec. There was no significant difference of hematocrit value after cardioplegia, but SC group received more red blood cells concetrate (130.5±16.3 ml vs 95.8±20.6 ml). Occurrence of high potassemia (>4.5 mEq/l) was obviously more frequent in SC group – 31.3% vs 13.3%. The management of cardioplegia through RC proved to be much simpler. Conclusions: The RC for blood cardioplegia administration in children with low body weight allows reducing of priming volume, less autologous blood usage, less contact with the artificial surface and provides express cardiac arrest. At the same time, it reduces the costs of supplies

Disabling the lower respiratory ways in children with foreign bodies

Introduction. Aspiration of the foreign body is the accidental penetration by pharynx and larynx of objects or pieces of objects, food in the lower airways, which produce a state of asphyxia with vital danger to the child. Material and methods. A retrospective study was performed on a group of 123 children aged 11 months -16 years, hospitalized for the period 2013-2017 at the Mother and Child Institute. Diagnosis at admission: pneumonia, bronchopneumonia or foreign body suspected in respiratory tract.In order to establish the diagnosis, paraclinical methods - radiography and bronchoscopy were used. Of the total number of patients, 81 (65.8%) and 42 (34.1%) were hospitalized in an emergency.Endoscopic diagnosis and foreign body extraction were performed with two types of bronchoscopes: Karl Sorz pediatric rigid bronchoscope and flexible BF 3C 160 and BF 1TQ 170 Olympus videobronchoscope. Clinical cases of the greatest difficulty have been resolved by a mixed approach.The origin of foreign bodies: organic - 79 (64.2%), inorganic in 44 (35.7%) children. The location of foreign bodies was the following: tracheal level -1.8%, right bronchus lumen - 64.7%, and left - 33.5%. Associated decubitus lesions were present in 11.3% of cases. Granular masses at the foreign body level were documented in 67.2% (34.2% of them were with the duration of the presence of the foreign body up to 7 days). Contact bleeding during extraction occurred in 16.7% of cases. In 4,8% cases the bronchial mucosa was not affected. In 5 cases (4.0%) the foreign body was deeply incarcerated in the bronchial wall. Results. Extraction of foreign bodies by flexible videobronchoscope was obtained in 7 patients (5.6%). By rigid bronchoscope foreign bodies were extracted from 111 patients (90.2%). In 5 children (4.0%) access to visualization to the foreign body was possible via flexible videobronchoscope, but extraction – via rigid bronchoscopy. Conclusion. In the pediatric prenatal extraction of foreign bodies in the lower respiratory tract, the main part belongs to rigid apparatus bronchoscopy with the selection of the age-appropriate insertion tube

The results of cardioplegic circuit modification in surgery of congenital heart diseases

Departamentul Chirurgie Cardiacă, IMSP Spitalul Clinic Republican, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Obiectivul. Optimizarea cardioplegiei sangvine la copiii cu greutate corporală mică. Material și metode. Pentru minimalizarea circuitului cardioplegic a fost propus un circuit redus (CR), care include doua șunturi 1/8x1/32 cu volum total de umplere de 14ml. Primul șunt este conectat la pompa-seringă cu KCl 2 mEc/ml si al doilea – la canula cardioplegică. Fluxul sanguin pentru alimentarea sistemului era deviat de la oxigenator. Efectul cardioplegiei prin CR (15 pacienți) a fost comparat cu cel al cadioplegiei administrate prin circuit standard (CS, 16 pacienți): pompa cu rotile, tub de 3/16 cu volum de umplere 80ml. Pacienții aveau vârsta 7- 14 luni, greutatea corporala sub 10 kg. Datele investigațiilor nu prezentau diferente semnificative intre grupuri. Au fost comparate timpul stabilirii asistoliei, volumul de priming, cantitatea de concentrat eritrocitar administrat, hematocritul după cardioplegie. Rezultate. Volumul de priming folosit in grupul CS era mai mare fata de cel din grupul CR (350:250). Administrarea cardioplegiei sangvine prin CR a asigurat instalarea stopului cardiac în 29+13 sec., rezultat semnificativ mai mic fata de cel din grupul CS, 45+11 sec. Hematocritul după cardioplegie era fără diferențe semnificative, dar in grupul CS s-a administrat mai mult concentrat eritrocitar (130,5+16,3ml vs 95,8+20,6ml). Menajarea cardioplegiei prin CR s-a dovedit a fi mult mai simplă. Concluzii. Circuitul redus pentru administrarea cardioplegiei sangvine la copii cu greutatea corporala mica permite micșorarea volumului de priming, de concentrat eritrocitar, reducerea suprafețelor artificiale de contact şi asigură stopul cardiac expres. Reducerea circuitului salvează costurile consumabilelor.Objectives. Optimizing management of blood cardioplegia in children with low body weight. Material and methods. To minimize the cardioplegic circuit was proposed reduced scheme (RC), which includes two shunts 1/8x1/32, whole filling volume of 14ml. The first is connected to the syringe pump with KCl, 2Meq/ ml, and the second - to cardioplegic cannula. Blood flow was supplied from oxygenator. Cardioplegic effect in RC group (15 patients) was compared with that of cadioplegia administered by standard circuit (SC, 16 patients), which includes the roll pump, tube 3/16, filling volume 80ml. Patients were aged 7-14 months, body weight less than 10 kg. Investigation’s data showed no significant differences between groups. Were compared cardiac stop setting time, priming volume, administrated amount of red cells concentrate, hematocrit after cardioplegia. Results. The volume of priming used in SC group was higher than in the RC group (350:250). Administration of blood cardioplegia through RC assured t installation of cardiac arrest in 29+13 sec., significantly lower time than in the SC group, 45+11 sec. There was no significant difference of hematocrit after cardioplegia, but SC group received more red blood cells concentrate (130,5+16,3ml vs 95,8+20,6ml). The management of cardioplegia through RC proved to be much simpler. Conclusions. The RC for blood cardioplegia administration in children with low body weight allows reducing of priming volume, less autologous blood usage, less contact with the artificial surface and provides express cardiac arrest. At the same time, reduces costs of supplies

Surgical treatment of ventricular septal defect associated with tricuspid valve insufficiency

Departamentul Chirurgie Cardiacă, IMSP Spitalul Clinic Republican, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Insuficienţa tricuspidiană (IT) congenitală izolată se întâlnește foarte rar şi constituie 0,3 -0,6 % din toate malformaţiile cardiace congenitale (MCC). Mult mai frecvent IT are caracter secundar ca consecinţă şi complicaţie a altor MCC. După datele literaturii de la 10 până la 30% din pacienţii cu defect septal ventricular (DSV) localizat în regiunea perimembranoasă pot dezvolta IT. Scopul studiului. constă în evaluarea comparativă a diverselor tactici şi metode de corecţie chirurgicală a DSV asociat cu IT şi elaborarea algoritmului optimal de tratament al acestor bolnavi. Material şi metode. În lotul de bolnavi cu DSV asociat cu IT, operaţi în Centrul de Chirurgie a Inimii pe parcursul anilor 2005-2015, au fost incluşi 40 de pacienţi cu vârsta medie de 80,9±20,5 luni. Greutatea medie a pacienţilor din acest grup a fost 19,3±3,2 kg şi varia în limitele 4-68 kg. În 25 (57,0%) cazuri s-a diagnosticat IT de gradul II, în 8 (23,0%) cazuri - IT de gradul III şi în 7 (20,0%) cazuri - IT de gradul IV. Concomitent cu plastia DSV, la toţi pacienţii s-a efectuat şi repararea VT: la 4 (11,0%) pacienţi s-a efectuat plastia VT De Vega, la 19 (40,0%) pacienţi – comisuroplastia, la 6 (17,0%) pacient – suturare de cleft, la 1 (4,0%) pacient – plastia VT De Vega şi comisuroplastie, la 10 (29,0%) pacienţi – comisuroplastie şi suturare de cleft. La etapa postoperatorie s-a ameliorat semnificativ tabloul clinic: s-au redus dispneea (de la 91,7% cazuri la 8,3% cazuri), palpitaţiile (de la 91,7% cazuri la 33,3% cazuri) şi edemele periferice (de la 10,8% cazuri la 4,2% cazuri). Numărul de pacienţi cu insuficienţă cardiacă NYHA 1, care la etapa preoperatorie nu s-a determinat nici la un pacient cu DSV asociat cu IT, a crescut postoperator de la 0 la 54,2% pacienţi, NYHA 2 s-a redus de la 60,0% la 41,7% pacienţi, NYHA 3 - de la 36,0% la 4,2% pacienţi. Concluzii. În marea majoritate de cazuri s-a utilizat metoda prin sutură la comisura antero-septală. Această procedura chirurgicală este simplă, necostisitoare, poate fi efectuată cu aorta declampată, practic lipsită de complicaţii şi diminuează semnificativ regurgitarea tricuspidiană.Tricuspid valve regurgitation occurs up to 10% of cases in association with ventricular septal defect (VSD) especially its perimembranos localization. Methods and results. Between 2010 and 2015, 40 patients whose ages averaged 80,9±20,5 months underwent tricuspide annuloplasty within correction of VSD in Center of Cardiac Surgery of Republic of Moldova. The patients weight were 19,3±3,2 kg and in limits of 4-68 kg. There were regurgitation of II grade of tricuspide valve in 25 (57,0%) of cases, regurgitation of III grade in 8 (23,0%) of cases and regurgitation of IV grade in 7 (20,0%) of cases. Within correction of VSD there was plastia of tricuspide valve performed: in 4 cases (11, 0%) of patients plastia of tricuspide valve De Vega, in 19 cases (40,0%) of patients comisuroplastia, in 6 case (17,0%) of patients comisuroplastia and suture of cleft, in 1 case (4,0%) of patients plastia of tricuspide valve De Vega şi comisuroplastia, in 10 cases (29,0%) of patients comisuroplastia and suture of cleft. After operation the clinic state of patients improved significantly: asthma reduced from 91,7% of cases till 8,3% of cases, cases of tachycardia reduced from 91,7% till 33,3% of cases and other cardiac failure symptoms from 10,8 % till 4,2% of cases. The number of patients with cardiac failure after NYHA classification class I was present after operation in 54,2% of cases comparative with its absence before operation, class 2 diminished from 60,0% to 41,7% of cases, class 3 from 36,0% to 4,2% of cases. Conclusion. In most commonly cases additional sutures were applied to approximate the septal and anterior leaflet close to the commisure. It is simple, reliable, inexpensive, time not more than 5-10 min. and in our experience free of complications in correction of tricuspide valve insufficiency

Junctional ectopic tahicardia in early postoperative period after correction of conjenital heart deseases (CHD)

Departamentul Chirurgie Cardiacă, IMSP Spitalul Clinic Republican, Chişinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Aritmiile după chirurgia pe “cord deschis”contribuie la complicațiile postoperatorii si mortalitate, inclusiv după corecția MCC. Mecanismul precis și importanța factorilor declanșatori ai TJE nu sunt încă elucidați, tratamentul rămânând dificil. Scopul. Determinarea factorilor etiologici şi eficacității tratamentului TJI apărute în perioada postoperatorie precoce la pacienţii cu MCC. Materiale si metode. Au fost analizate cazurile de TJE (a.2014- 2015),confirmată ECG, apărută la 24 - 48 ore după corecţia DSV, CAVC şi a tetralogiei Fallot, la 6 copii cu vârsta 3 luni - 2 ani. Au fost studiate durata perioadei de circulație extracorporală(CEC), clampării aortei,dozele de cardiotonice administrate,concentrația ionilor de K+,Mg++, parametrii sindromului de răspuns inflamator sistemic (SIRS). Rezultate. Factorii principali declanşatori ai TJE pot fi: CEC mai lung de 100 minute,dezvoltarea SIRS, traumatismul chirurgical în regiunea nodului AV, infuzia excesivă de cardiotonice, scăderea concentraţiei K+, Mg++. Pentru restabilirea ritmului sinusal a fost efectuată corecţia deficitului ionic, aplicată infuzia de Amiocordinâ5 -10mcg/kg/min şi MgSO4 25% -100 mcg/kg/h. In caz de dezvoltarea șocului circulator pacienții au fost ventilați artificial mecanic, cu inducerea hipotermiei de 32°C. Cardioversia nu a fost eficientă. Un caz de aritmie refractar tratamentului s-a soldat cu deces. Concluzii. TJE este o complicaţie severă,cu înalt risc de mortalitate în perioada precoce postoperatorie a MCC. Dereglările de ritm pot fi cauzate de deficitul ionilor de potasiu și magneziu,infuzii excesive de cardiotonice,ischemia indusă și SIRS în CEC. Tratamentul farmacologic în majoritatea cazurilor este eficient. In cazurile dificile este indicat ECMO.Introduction. The arrhythmias after congenital cardiac surgery contributes to high incidents of postoperative complications and mortality. The importance of trigger factors have not been elucidated, treatment remains difficult. The goal. Determination of etiologic factors and efficacy of pharmacologic management of JET occurred in the early postoperative period in patients with CHD. Materials and methods. Were analyzed cases of ECG confirmed JET, appeared in 24-48 hours after correction of VSD, AV channel, Tetralogy of Fallot. The period of extracorporeal circulation (CEC), length of aortic cross-clamping period, doses of administered inotrope drugs, magnesium and potassium ions concentration, parameters of systemic inflammatory response syndrome (SIRS) were studied. Results. the main factors which induce JEC can be: extended bypass period (more than 100 min.),SIRS occurrence, surgical trauma of the AV node region, excessive infusions of inotropic drugs, and decreased concentration of magnesium and potassium ions. To restore sinus rhythm was performed ionic deficit correction, applied infusion of Amiocordin 5 -10mcg / kg/min; MgSO4 25% to 100 mcg /kg/h. In the case of circulatory shock development patients were mechanically ventilated, induced in hypothermia (32 ° C). Cardioversion was not efficient. Conclusions. JET is a severe complication with high mortality risk during early postoperative period. Rhythm disorders can be caused by deficiency of potassium and magnesium electrolytes, excessive infusion of inotropic drugs, cardiac ischemia and SIRS. Pharmacologic treatment in most of cases is efficient. In difficult cases ECMO could be a solution

Endoscopic dilation in the treatment and profilaxy of esofagien strictures in newborns operated for esophagus atrezia

Endoscopie, Clinica Chirurgie, IMSP Institutul Mamei și Copilului, Chișinău, Republica Moldova, S. C. Donica & Donica, Mangalia, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Restabilirea tranzitului esofagian după plastia chirurgicală esofagiană este subiect recunoscut. Material și metode: Studiul a cuprins 16 copii cu vârsta: două zile de la naștere și șase ani, spitalizați si operați de atrezie de esofag în clinica chirurgie pediatrică IMșiC în perioada 2012-2018. Dilatatoarele folosite: balonașe și bujii Savary-Gilliard. Rezultate: În perioada preoperatorie endoscopic a fost constatată discontinuitatea esofagului cu, sau fără, prezența fistulei esolaringo-traheală. Postoperator s-a remarcat: restrângerea segmentelor individuale ale esofagului și imposibilitatea consecutivă a depașirii stricturii cu endoscopul corespunzător dimensiunilor esofagului; bride mucosale; fire restante; corpi străini. Localizarea și extensia stricturii de la gingii, datorită tehnologiei operațiilor a fost unică la toți pacienții. Stricturile au avut următoarele dimensiuni de apertură: până la 9 mm– 3 copii, 6-7 mm – 8, 4-5 mm - 4 si 2 mm – un copil. La o sesiune pacienții au suportat 3-5 dilatări. Dinamică pozitivă s-a înregistrat la toți copiii. Concluzii: Endoscopia evaluează diferențiat rezultatele plastiei chirurgicale esofagiene, determină tratamentul endoluminal al stricturii anastomozei. Pacienții cu atrezie de esofag operați, necesită dispanserizare în primul an de viața, pentru depistarea posibililor complicații – stenoza anastomozei, incompetență joncțională, refluxul gastro-esofagian. Strictura anastomozei trebuie dilatată sub control vizual, urmată de dilatări de susținere, după necesitate.Introduction: Restoring esophageal transit after esophageal surgery is a recognized issue. Material and Methods: Study includes 16 children aged from two days to six years, operated for esophagus atresia during 2012-2018 years. Used dilators: balloons and Savary-Gillard bougies. Results: Endoscopy revealed discontinuity of the esophagus, the presence or not of eso-laryngo-tracheal fistula. It was noted: the restriction of the individual segments of the esophagus and the consequent impossibility to overpass stricture with the corresponding endoscope; mucous membranes; residual threads; foreign bodies. The location and extension of stinging from the gums due to the operation technology was unique in all patients. The stricture had the following aperture dimensions: up to 9 mm - 3 children, 6-7 mm - 8, 4-5 mm - 4 and 2 mm - one. At one session the patients underwent 3-5 dilations. Positive dynamics was recorded in all children. Conclusions: Endoscopy evaluates the results of surgical esophageal plasty, makes available the endoluminal treatment of anastomosis strictures. Patients with operated esophagus atresia require first-year dispanserization for detection of possible complications - anastomosis stenosis, junctional incompetence, gastro-esophageal reflux. Anastomotic strictures should be dilated under visual control, followed by maintaining dilations

Endoscopic methods to reset the esofagian transit in children with esofagian stenosis

Introduction. Since the 15th century various methods of treatment of oesophageal stenosis have been proposed. Endoscopic stricturoplasty is one of the current methods of endoluminal expansion. Material and methods. A study was conducted on a group of 30 children aged one month -17 years, hospitalized at the Pediatric Surgery Clinic, diagnosed with esophageal stenosis.The barium transit reveals dilation in the suprastenotic region; Superior digestive endoscopy finds lumen narrowing.Of the total patients undergoing dilation (30 patients), 8 (26.6%) were patients with esophageal atresia subjected to surgical esophagoplasty,two (6.6%) - with ahalasia of the heart,one (3.3%) - with axial transhyathal hernia complicated with esophageal stenosis. 19 (63.3%) patients had strictures developed as a result of ingestion of foreign substances and bodies with different degrees of chemical aggression.Prior to endoscopic treatment of children, anti-inflammatory, spasmolytic, oily preparations were indicated. During the endoluminal treatment, patients received spasmolytic, reparative and anthibiotic indications.Dilatations were performed under general anesthesia combined with spontaneous breathing and full monitoring. Dilation procedures were performed under visual control via the videoendoscope. Two types of dilators were used: balloon dilator and Savory-Gilliard dilator. The endoluminal treatment cure consists of sessions. Interruption between sessions was 1-3 days. Results. A positive result was considered when the strictures were dilated to the size corresponding to the patient’s age, consistent with the published classifications. The total duration of a treatment course was at most one and a half years. The end of the treatment showed that the evolution was favorable at 66.6%.In 20% of cases, patients are still in treatment. At 3 (10%) the dilation procedure was complicated by perforation. Two out of patients with complications over 3 months restored the sessions of dilation. Surgical esophagoplasty was performed in one patient. Conclusion. Endoscopic stricturoplasty has been shown to be effective, less aggressive, is the only method of endoluminal resolution of esophageal stenosis