Single center experience on dosing and adverse events of recombinant factor seven use for bleeding after congenital heart surgery

There are limited data on the relationship between the administered dose of recombinant factor seven (rFVIIa) and the development of adverse clinical outcomes after congenital heart surgery. This single institution case series reports on dosing, adverse events, and blood product usage after the administration of rFVIIa in the congenital heart surgery patient population. A retrospective review identified 16 consecutive pediatric patients at an academic, free-standing, children’s hospital who received rFVIIa to curtail bleeding following congenital heart surgery between April 2004 and June 2012. Patients were assessed for survival to hospital discharge versus in-hospital mortality and the presence or absence of a major neurological event during inpatient hospitalization. The median age at surgery was 6.8 months (range: 3 days–42 years). Seven patients (44%) survived to hospital discharge and nine patients (56%) died. The cause of mortality included major neurological events (44%), uncontrolled bleeding (33%), and sepsis (23%). Eight patients (50%) required extracorporeal membrane oxygenation support following congenital heart surgery. The median cumulative rFVIIa dose administered was 97 mcg/kg, and the median cumulative amount of blood products administered was 452 ml/kg. In conclusion, this case series underscores the need to prospectively evaluate the effect that rFVIIa has on patient survival and the incidence of adverse events, including thrombotic and major neurological events, in congenital heart surgery patients. Ideally, a randomized, multicenter study would provide the sufficient numbers of patients and events to test these relationships

Sternal abscess overlying giant aortic pseudoaneurysm developed after Bentall procedure Bentall prosedürü sonrası gelişmiş dev aortik pseudoanevrizma üzerine oturmuş sternal apse Olgu Sunumu

Abstract Aortic pseudoaneurysms are one of the most important complications to be encountered in cardiac surgery. Recently, the aortic pseudoaneurysms have been diagnosed by contrast enhanced computerized tomography. It has high specificity and sensitivity rates. Late postoperative sternal abscesses are rarely seen after open heart surgery. Thorax computerized tomography scan revealed abscess extending from subcutaneous tissue to the medullar component of sternum, overlying retrosternal giant aortic pseudoaneurysms. This article presents the case of a patient, who had undergone Bentall procedure three years ago due to type I aortic dissection and later presented in our cardiovascular surgery department with a sternal mass. Pam Med J 2013;6(1):33-36 Key words: Abscess; sternal wound infection; aortic pseudoaneurysm Özet Aortic pseudoanevrizmalar kalp cerrahisinde karşılaşılabilecek en önemli komplikasyonlardan biridir. Son zamanlarda aortic pseudoanevrizmalara kontrastlı bilgisayarlı tomografi ile tanı konmaktadır. Bu test oldukça yüksek özgüllük ve hassasiyet değerlerine sahiptir. Geç dönem sternal apseler açık kalp cerrahisinden sonra nadiren gözlenmektedirler. Bilgisayarlı toraks tomografisinde subkutanöz dokudan başlayıp sternum medullasına kadar uzanan absenin aortik retrosternal dev bir pseudoanevrizma üzerine oturduğu saptandı. Bu makalede; üç yıl önce tip I aortic diseksiyon nedeni ile Bentall ameliyatı olan ve daha sonra sternal kitle yakınmasıyla kalp damar cerrahisi kliniğimize müracaat eden hasta sunulmaktadır. Tıp Derg 2013;6(1):33-36 Pa

Bilateral branch pulmonary artery banding as a bridge to decision/preoperative optimization of high-risk neonates with hypoplastic left heart syndrome

We present our experience with bilateral branch pulmonary artery banding as a bridge to decision/optimization of hemodynamics, followed by standard Norwood stage I palliation in very high-risk infants with hypoplastic left heart syndrome

Intracardiac Fungal Mass in a Term Neonate

Systemic fungal infections pose insidious challenges in neonatal intensive care settings. We present the case of a 9-day-old male term neonate admitted for polymicrobial sepsis and hepatic dysfunction who later developed candidemia superinfection. Despite broad antifungal therapy, the fungemia was complicated by progressive growth of a fungus ball in the right ventricular outflow tract that threatened cardiac function. Surgical excision of the mass was undertaken by right atriotomy and histologic examination confirmed Candida albicans