Correction Of Congenital Heart Defects Research Articles

Cerebroprotective properties of nitric oxide in children in cardiac surgery (literature review)

Background. Cardiac surgery in conditions of cardiopulmonary bypass (CPB) in children with congenital heart defects is characterized by a complex of damaging factors (initial immaturity of organs and systems, the fact of non-physiology of cardiopulmonary bypass, frequent use of perfusion and non-perfusion hypothermia, comorbid infection), which dictates the validity of using a number of strategies aimed at protecting vital organs and the brain above all.The objective was to study the effectiveness of the use of nitric oxide to protect the brain in children during surgical correction of congenital heart defects in cardiopulmonary bypass conditions.Materials and methods. A literary search was performed in domestic and international bibliographic databases for keywords: nitric oxide, cerebroprotection, cardiopulmonary bypass, organoprotection, inhalation of nitric oxide, children.Results. The review provides up-to-date information on the effect of nitric oxide on the components of the neurovascular unit: angiogenesis, proliferation and myelination of nerve cells, the role in neuroinflammation and deep hypothermic circulatory arrest.Conclusion. The results of many studies confirm the effectiveness of nitric oxide for neuroprotection. However, there is a deficit of clinical researches in general and in the pediatric patient population, which does not yet allow to definitely state its effectiveness.

Impact of Intraoperative Blood Transfusion on Cerebral Injury in Pediatric Patients Undergoing Congenital Septal Heart Defect Surgery

Background: The components of donor blood themselves have the potential to initiate a systemic inflammatory response and exacerbate neuroinflammation, resulting in subsequent cerebral injury. The aim of this study was to establish the role of transfusion in the development of cerebral injury during the correction of congenital heart defects in children. Material and Methods: A total of 78 patients aged from 1 to 78 months, with body weights ranging from 3.3 to 21.5 kg, were investigated. Biomarkers of cerebral injury and systemic inflammatory response were studied at three time points. First: prior to the surgical intervention. Second: after the completion of cardiopulmonary bypass. Third: 16 h after the conclusion of the surgery. Results: The strongest correlation was found for S-100-β protein with the volume of transfusion at the second (Rho = 0.48, p = 0.00065) and third time points (Rho = 0.36, p = 0.01330). Neuron-specific enolase demonstrated a similar trend: Rho = 0.41 and p = 0.00421 after the completion of cardiopulmonary bypass. Conclusions: The use of red blood cell suspension and its dosage per kilogram of body weight correlated with the biomarkers of cerebral injury and systemic inflammatory response with moderate to significant strength.

Extracardial pathology as an additional risk factor in the correction of congenital heart defects in children

Introduction. Concomitant diseases as a risk factor for surgery remain an urgent problem in pediatric cardiac surgery. The article presents the role of comorbidity in pediatric cardiac surgery. A comparative analysis of the indicators of cardiac surgical treatment of patients with and without extracardiac pathology was carried out. Aim: to determine the significance of extracardiac causes as an additional risk factor in the correction of congenital heart lesions in children. 
 Materials and methods. Prospective analysis of five hundred patients who had undergone cardiac surgery in the departments of cardiac surgery and interventional cardiology. Patients were divided into a main group of patients with concomitant pathology 
 (n = 350) and a control group (n = 150) without concomitant pathology. A complex of modern therapeutic and diagnostic procedures and a multidisciplinary approach were used. 
 Results. A high incidence of complications was shown in the main group (70%). Hospital mortality was higher in patients with concomitant pathology and amounted to 17.4%, compared to 3.3% in the group without concomitant pathology. The average duration in the ICU for patients with concomitant pathology was 18 ± 2 bed days, for patients without concomitant pathology — 4 ± 2 bed days. 
 Conclusion. The presence of concomitant pathology has been shown to influence significantly on the development of complications and be a prognostic risk factor that must be included in modern prediction models.

Tissue inhibitor of metalloproteinase-2 in patients aged 1 month to 1 year with and without cardiac surgery-associated acute kidney injury in congenital heart disease surgery with cardiopulmonary bypass: a single-center retrospective study

Introduction: Acute kidney injury is a common complication of cardiac surgery after management of congenital heart defects. Cardiac surgery-associated acute kidney injury (CS-AKI) results in longer stays of patients in the intensive care unit and hospital. However, using an increase in postoperative creatinine as a means of detecting AKI has some limitations, since significant changes occur after the loss of more than 50% of renal function. In children, the creatinine level is influenced by various factors such as muscle mass, cardiac output, etc. These factors vary significantly among young children and complicate the early diagnosis of AKI. Recent studies have explored biomarkers as potential predictors for the early detection of CS-AKI after cardiac surgery for management of congenital heart disease in children.Objective: To evaluate the urinary tissue inhibitor of metalloproteinase-2 (TIMP2) as a predictor of CS-AKI following management of congenital heart defects in children aged 1 month to 1 year who underwent cardiopulmonary bypass.Methods: A single-center retrospective study included patients aged 1 month to 1 year who underwent cardiopulmonary bypass for the correction of congenital heart defects. The groups were formed based on the presence of CS-AKI. The study group comprised of patients who had CS-AKI (group 1, n = 52), while those without CC-AKI constituted the control group (group 2, n = 98). To ensure minimal systematic errors and comparability between two groups, propensity score matching analysis was performed (52 patients in groups 1 and 2). Preoperative, intraoperative, and postoperative parameters and characteristics were compared.Results: The results showed no differences in baseline or demographic characteristics between the patients. In the study group, 34.6% of patients were diagnosed with CS-AKI. Among them, 67.4% (n = 35) were stage 1, 28.8% (n = 15) were stage 2, and 3.8% (n = 2) were stage 3. The results of the regression analysis show a decrease by 24% and an increase by 9 and 16% in CS-AKI respectively, with an increase in creatinine levels by 1 µmol/l, at baseline and on days 3 and 4. Additionally, male patients have a 76% lower likelihood to develop CS-AKI. It was observed that there was no significant difference in the tissue inhibitor of metalloprotease-2 levels between the groups with and without CS-AKI.Conclusion: Urinary TIMP2 levels were found to be unable to predict the early onset of CS-AKI in congenital heart defect patients ages 1 month to 1 year who underwent cardiopulmonary bypass surgery. Received 24 April 2023. Revised 27 November 2023. Accepted 28 November 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

Cost of Pacing in Pediatric Patients With Postoperative Heart Block After Congenital Heart Surgery

Surgical correction of congenital heart defects (CHDs) has improved the lifespan and quality of life of pediatric patients. The number of congenital heart surgeries (CHSs) in children has grown continuously since the 1960s. This growth has been accompanied by a rise in the incidence of postoperative heart block requiring permanent pacemaker (PPM) implantation. To assess the trends in permanent pacing after CHS and estimate the economic burden to patients and their families after PPM implantation. In this economic evaluation study, procedure- and diagnosis-specific codes within a single-institution database were used to identify patients with postoperative heart block after CHS between January 1, 1960, and December 31, 2018. Patients younger than 4 years with postoperative PPM implantation were selected, and up to 20-year follow-up data were used for cost analysis based on mean hospital event charges and length of stay (LOS) data. Data were analyzed from January 1, 2020, to November 30, 2022. Implantation of PPM after CHS in pediatric patients. Annual trends in CHS and postoperative PPM implantations were assessed. Direct and indirect costs associated with managing conduction health for the 20 years after PPM implantation were estimated using Markov model simulation and patient follow-up data. Of the 28 225 patients who underwent CHS, 968 (437 female [45.1%] and 531 male [54.9%]; 468 patients aged <4 years) received a PPM due to postoperative heart block. The rate of CHS and postoperative PPM implantations increased by 2.2% and 7.2% per year between 1960 and 2018, respectively. In pediatric patients younger than 4 years with PPM implantation, the mean (SD) 20-year estimated direct and indirect costs from Markov model simulations were $180 664 ($32 662) and $15 939 ($1916), respectively. Using follow-up data of selected patients with clinical courses involving 1 or more complication events, the mean (SD) direct and indirect costs were $472 774 ($212 095) and $36 429 ($16 706), respectively. In this economic evaluation study, the cost of PPM implantation in pediatric patients was found to accumulate over the lifespan. This cost may represent not only a substantial financial burden but also a health care burden to patient families. Reducing the incidence of PPM implantation should be a focused goal of CHS.

A Case of Duodenal Bleeding in a One-Year-Old Child in the Early Postoperative Period after the Surgical Correction of Congenital Heart Defect

Background. Gastrointestinal bleeding in children is a rather rare pathology. This especially applies to the bleeding in the postoperative period after surgical interventions that are not related to the pathology of the gastrointestinal tract. As a result, clinicians are not alert to the occurrence of such complications, which, in turn, can lead to late diagnosis and delay in the treatment of bleeding.&#x0D; Case report. We present a clinical case of duodenal bleeding in a one-year-old child in the early postoperative period after radical repair of ventricular septal defect by patching the defect. Laboratory parameters on admission: hemoglobin 120 g/L, red blood cells 4.37×1012/L. On the first postoperative day, hemoglobin was 103 g/L, hematocrit was 33%. On the 5th day after the operation, the boy had a currant jelly stool. Hemostatic therapy was provided: transfusion of fresh frozen plasma at a dose of 10 mL/kg, single administration of tranexamic acid at a dose of 10 mg/kg. The bleeding was stopped. After hemostatic therapy, hemoglobin was 105 g/L, hematocrit was 31%. Within 24 hours, fibrogastroduode-noscopy was performed which revealed an ulcer of the duodenal bulb covered with fibrin. The boy was consulted by gastroenterologist. Pathogenetic therapy was prescribed: proton pump inhibitors, antacids, enveloping drugs. The child was discharged home in a satisfactory condition on the 15th day after the operation under the supervision of a district pediatrician, cardiologist, and gastroenterologist. Laboratory parameters at discharge: hemoglobin 91 g/L, red blood cells 3.3×1012/L.&#x0D; Conclusion. The problem of gastrointestinal complications, including gastrointestinal bleeding in young children af-ter cardiac surgery, is extremely insufficiently covered in the scientific literature. Many questions remain unsolved re-garding the prevention, early diagnosis and treatment of bleeding, so research in this field remains relevant for both clinicians and scientists.

Analysis of the results of functional diagnostic studies of the cardiovascular system in children after surgical correction of congenital heart defects

Objective. To evaluate the features of the cardiovascular system in children after surgical correction of congenital heart defects revealed by functional diagnostic studies.Materials and methods. A functional diagnostic examination of the cardiovascular system (CVS) was performed in 43 children aged 5 to 17 years with the main clinical diagnosis: “Congenital heart disease” (CHD), of which 33 children of the main group (MG) had corrected CHD, in 10 children of the comparison group (CG) CHD correction was not performed due to the presence of certain contraindications. Patients were on a routine examination and treatment for CHD in the cardio-rheumatology department of the institution “Gomel Regional Children’s Clinical Hospital” in the period 2020-2022.Results. Based on the statistical processing of the results of the study, which included an assessment of clinical and anamnestic data and indicators of functional diagnostic methods for examining the CVS in children with CHD, the need for a comprehensive cardiological examination in children with this pathology was established, regardless of the method of performed surgical intervention. It was found that the majority of children with corrected CHD on the ECG had rhythm and conduction disturbances, as well as combined arrhythmias, and one third of the patients had cardiac complaints. According to the Holter monitoring (HM) and bicycle ergometry (BEM) tests, the children showed signs of electrical instability of the myocardium and a decrease in the adaptive reserves of the cardiovascular system.Conclusion. Children with corrected CHD require a comprehensive functional and diagnostic examination, which makes it possible to identify an “arrhythmogenic substrate” and establish signs of myocardial electrical instability, thereby optimizing the tactics of treatment and rehabilitation of this group of patients.

LINGUISTIC AND COGNITIVE DISORDERS IN 4-6 YEARS OLD PATIENTS WITH CONGENITAL HEART DEFECTS BEFORE AND AFTER SURGICAL CORRECTION

Highlights There are data about speech disorders in children with congenital heart defects. The results of the speech research in 4–6 years old children before and after surgery are described according to the surgical tactics. Aim. To compare linguistic and cognitive disorders in in 4–6 years old children with congenital heart defects before and after surgery.Methods. A prospective investigation of group of children (n = 92) with septal heart defects was done before and after surgery and within decreed terms: in 1 and 2 years after the surgical correction of congenital heart defects in cardiopulmonary bypass or in cath-lab in Research Institute for Complex Issues of Cardiovascular Diseases. The anamnesis, clinical and hemodynamic aspects were studied before and after surgery, as well as early postoperative period, residual hemodynamic disorders and speech diagnostic was also done.Results. 57% children had different speech disorders (general or delayed speech development) in preoperative period. It was made worse by cardiosurgery: the number of children with speech disorders increased to 63% in a year after surgery and was 59.8% in 2 years, while there was a positive dynamic in clinical and hemodynamic aspects. Conclusion. There are speech disorders in children with septal heart defects after surgery in long-term postoperative period despite of clinical and hemodynamic normalization. That can lead to the real risks and quality of life worsening in general in the absence of timely correction.

Influence of Congenital Heart Defect Types over Cardiopulmonary Bypass, Aortic Cross-Clamping, and Intensive Care Unit Length of Stay and Their Association with Genetic Factors

Aim: Surgical correction of congenital heart defects (CHD) often requires interruption of blood flow through cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC), for which duration(s) are considered to be prognostic factors, along with intensive care unit (ICU) length of stay (ICULOS). The aim of this study was to evaluate these surgical prognostic factors in pediatric patients with different types of CHD regarding their type of lesion and associated genetic factors.&#x0D; Study Design: Cross-sectional cohort study with 307 pediatric patients.&#x0D; Place and Duration of Study: Pediatric Intensive Care Unit (ICU) of Hospital da Criança Santo Antônio, in Porto Alegre/RS, Brazil, from 2006-2009 (3 years)&#x0D; Methodology: After inclusion criteria, we studied 266 pediatric patients admitted for the first time in a reference cardiac pediatric ICU from Southern Brazil following cardiac surgery. Intraoperative prognostic factors such as duration of CPB, ACC and ICULOS, in addition to dysmorphological and cytogenetic examinations were compiled and analyzed. P-values of &lt;0.05 were considered significant.&#x0D; Results: CPB time was associated to four outflow tract defects (Tetralogy of Fallot [ToF], transposition of the great arteries [TGA], double outlet right ventricle, and truncus arteriosus [TA]), atrioventricular septal defect, and hypoplastic left heart syndrome (HLHS) (P &lt; 0.001). ACC duration was associated with three outflow tract defects (ToF, TGA, and TA) and HLHS (P &lt; 0.001). Moreover, CPB and ACC times showed an association with cyanotic and complex heart defects, as well as prolonged ICULOS (P &lt; 0.001). There was no relationship between these prognostic factors and syndromic aspects or cytogenetic findings.&#x0D; Conclusions: CHD type has an impact over CPB and ACC duration and ICULOS, whereas genetic factors are not associated with those prognostic factors.

Intraoperative transfusion is a risk factor for cerebral injury after cardiac surgery in children: a prospective observational study

INTRODUCTION: Donor blood components are able to initiate a systemic inflammatory response syndrome (SIRS) and potentiate neuroinflammation with subsequent cerebral damage. OBJECTIVE: To study the effect of transfusion on the development of cerebral damage during the surgical correction of congenital heart defects in children. MATERIALS AND METHODS: 78 patients aged from 1 to 78 months, weighing from 3.3 to 21.5 kg, were studied. All patients underwent correction of a septal defect under cardiopulmonary bypass. All patients were divided to group 1 — without the use of transfusion and group 2 — with the use of red blood cell transfusion. Cerebral damage markers (S-100-β protein, neuron-specific enolase (NSE) and glial fibrillar acidic protein (GFAP)) and SIRS (interleukins 1 (ILb-1), 6 (IL-6), 10 (IL-10) and tumor necrosis factor alpha (TNF-α) were studied. Markers ware studied at three control points: 1 — before the start of surgery, 2 — immediately after end of cardiopulmonary bypass, 3 — 16 hours after the end of the operation. RESULTS: The peak concentration of most markers in the blood in both groups of patients was noted at the 2nd control point. The concentration of all markers of cerebral damage was significantly higher in the transfusion group at the 2nd control point: S-100-β protein (ng/ml) — 509.90 [379.30–871.70] and 717.10 [517.90–1195.33] (р = 0.024); NSE (ng/ml) — 17.55 [11.19–26.41] and 34.05 [17.06–44.90] (р = 0,023); GFAP (ng/ml) — 0.1190 [0.1135–0.1245] and 0.1231 [0.1138–0.1493]. Correlations were found between markers of cerebral damage and SIRS, the strongest of which was the relationship between NSE and TNF-α at the 3rd control point — Rho = 0.43 (p = 0.0001). A correlation of S-100-β protein with transfusion volume was observed at the 2nd (Rho = 0.48, p = 0.00065) and 3rd control points (Rho = 0.36, p = 0.01330). CONCLUSIONS: The influence of the fact of transfusion and the dose of red blood cell on the development of cerebral damage during cardiac surgery in children has been proven.

Unravelling early sinus node dysfunction after pediatric cardiac surgery: a pre-existing arrhythmogenic substrate.

Early post-operative sinus node dysfunction (SND) is common in paediatric patients undergoing surgical correction of congenital heart defects (CHD). At present, the pathophysiology of these arrhythmias is incompletely understood. In this case series, we present three paediatric patients in whom we performed intraoperative epicardial mapping and who developed early post-operative SND. All patients had either an inferior or multiple sinoatrial node (SAN) exit sites, in addition to extensive conduction disorders at superior and inferior right atrium. Our findings contribute to the hypothesis that pre-existing alterations in SAN exit sites in combination with atrial conduction disorders may predispose paediatric patients with CHD for early post-operative SND. Such insights in the development of arrhythmias are crucial as it may be the first step in identifying high-risk patients.

Early Outcome of Simplified Standardized Trileaflet Polytetrafluoroethylene Valved Conduit Placement.

Use of the expanded polytetrafluoroethylene (ePTFE) valved conduit in the pulmonary position during the correction of congenital heart defects has significantly increased in popularity over the last decade due to its promising conduit longevity. We describe the standardized process to create and implant a trileaflet ePTFE pulmonary conduit along with the early outcomes of such procedures at our institute. Records of 100 consecutive patients who underwent ePTFE valved conduit placement using our technique from April 2018 through February 2022 were retrospectively analyzed. The function of the conduit was evaluated by transthoracic echocardiography. The mean age of the patients was 28 ± 13.2 years old at the time of the operation. The conduit diameters ranged from 16 to 24 mm (mean 23.0 ± 1.9 mm). Conduit placement was utilized for pulmonary valve replacement in 68 patients, conduit change in 25 patients, and as a part of total repair in 7 patients. There were 2 in-hospital conduit-unrelated deaths from multi-organ dysfunction and pulmonary hypertensive crisis. From the postoperative echocardiography, the average peak pressure gradient across the conduit was 18.6 ± 9.0 mm Hg, and the conduit regurgitation was graded as none or trace in 81 patients, mild in 17 patients, and moderate in 2 patients. At 589 days of median follow-up, there was no conduit reoperation. Follow-up imaging of 60 available patients at a median time of 511 days did not show a significant change in conduit function. Our standardized ePTFE valved conduit creation and placement demonstrated satisfactory clinical and echocardiographic outcomes.

Intravenous infusion of lidocaine as a component of multimodal analgesia in children under one year of age after cardiac surgery

BACKGROUND: The use of lidocaine in the scheme of multimodal anesthesia in order to reduce doses of opioids in comparison with traditional anesthesia and the possibility of influencing various links in the pathogenesis of pain is a promising direction in modern cardioanesthesiology.&#x0D; AIM: This study evaluates the effectiveness of intravenous infusion of lidocaine as a component of multimodal analgesia and its effect on the postoperative period in children under one year of age after surgical correction of congenital heart defects.&#x0D; MATERIALS AND METHODS: The prospective comparative study included 81 cardiac surgery patients aged 0 to 1 year. All patients underwent open cardiac surgery by a cardiopulmonary bypass from January 2019 to April 2021. The patients were divided into two groups: the first (n = 40) included patients receiving intravenous lidocaine as a component of multimodal analgesia in the postoperative period, and the second, control (n = 41) patients who were not prescribed lidocaine.&#x0D; RESULTS: : In patients receiving lidocaine infusion, the need for opioids was significantly lower (p 0.001), which is also associated with a shorter mechanical ventilation time (p = 0.03). The cortisol levels and most laboratory parameters (the concentration of glucose, lactate, albumin, C-reactive protein, and the level of leukocytes and lymphocytes) in the two patient groups did not differ. Clinical indicators reflecting intestinal paresis development (the appearance of peristalsis, the onset of enteral nutrition, the rate of its increase, and the time when the patient receives the total amount of food only enterally) also did not differ between the groups. No side effects of lidocaine infusion were reported. There were no deceased patients in any of the study groups.&#x0D; CONCLUSIONS: Intravenous infusion of lidocaine as a component of multimodal analgesia after heart surgery in children has an additional opioid-saving effect and shortens the mechanical ventilation time. It is not accompanied by the development of side effects and does not affect the restoration of gastrointestinal functions.

Review of long-term results and possible mechanisms of their improvement in patients after surgical treatment of congenital heart defects

Highlights. Congenital heart disease (CHD) is estimated to occur nearly in one per 100 newborns and a third of these babies are in need of corrective procedures. There is a downward trend in mortality associated with advances in surgical treatment and perioperative care. An increasing number of patients with corrected CHD are accumulating in the population. This article provides a literary review of the current state of long-term outcomes of CHD corrections and possible mechanisms for improving late outcomes.Abstract The article analyzes the literature on long-term results of surgical treatment of congenital heart defects and possible mechanisms for their improvement. The bibliographic method was used. The analysis of domestic and foreign literary sources with a search depth of 20 years is carried out. The criteria for including publications were: access to full-text publications, original research, scientific and review articles. Exclusion criteria: abstracts and summaries of publications. The following search queries were formulated for the review: in English: late outcomes of corrections of congenital heart defects, in Russian: long-term results of corrections of congenital heart defects, long-term results after corrections of congenital heart defects. The used search engines are Science Direct, PubMed, Cyberleninka, E-library. The analysis of the literary data showed that the volume and duration of patients’ observation that underwent surgical correction of congenital heart defects remain controversial. In world and domestic practice modern digital technologies are used for the purpose of patients remote monitoring. Remote monitoring programs in the Russian Federation are used for such socially significant diseases as diabetes mellitus, bronchial asthma, as well as cardiac rehabilitation of adult patients. There are no similar programs for patients with congenital heart defects. There is a problem of patients remote monitoring after congenital heart defects surgical treatment. In Russia today there is no any comprehensive program for remote monitoring of children after congenital heart disease surgical correction. We believe that a universal remote monitoring system for managing this group of patients must be created.

The Effect of Erythrocyte-Containing Donor Blood Components in the Priming of the Cardiopulmonary Bypass Circuit on the Development of Systemic Inflammation During Correction of Congenital Heart Defects in Children

Various pathological factors accompanying any cardiac surgery can cause intraoperative systemic inflammatory responses (SIR). As the number of cardiac surgical interventions grows worldwide, the issue of SIR prevention appears highly relevant.Aim of the study. To determine the effect of not using donor blood components in the priming of the cardiopulmonary bypass circuit in children with septal congenital heart defects, operated under cardiopulmonary bypass, on the severity of SIR.Material and methods. A prospective, randomized study included 40 children with a median age of 14 [12–22.5] months and weight of 8.8 [7.25–11] kg. All patients underwent radical correction of septal defect under cardiopulmonary bypass. The patients were divided into two groups depending on the use of donor blood components for priming the CPB. The severity of SIR was assessed using four specific serum biomarkers such as interleukin 1b (IL-1b), interleukin 6 (IL-6), interleukin 10 (IL-10), and tumor necrosis factor alpha (TNF-α), measured before the operation, after the CPB and 16 hours after the surgery. In addition, the intra- and postoperative periods were evaluated.Results. The safety of the proposed strategy of skipping the donor blood was confirmed by lack of any organ dysfunction in all patients, as well as a significant difference in the balance of oxygen delivery and consumption. In addition, the levels of systemic inflammation markers after CPB were significantly higher in patients who had transfusion: IL-1b was 3.3 [3.2–3.48] pg/mL vs 2.86 [2.7–3.11] pg/mL (P=0.003) and TNF-α reached 1.81 [1.37–3.3] pg/mL vs 1.33 [1.26–1.76] pg/mL (P=0.034). Meanwhile, 16 hours post surgery, IL-6 and IL-10 levels were significantly higher in the group using donor blood components with IL-6 being 48.91 [33.89–57.6] pg/mL vs 31.56 [26.83–48.89] pg/mL (P=0.087) and IL-10 reaching 0.8 [0.76–1.43] pg/mL vs 0.69 [0.6–0.83] pg/mL (P=0.005).Conclusion. The study demonstrates and confirms the safety and efficacy of cardiopulmonary bypass without using donor blood components to reduce the severity of the systemic inflammatory response in children undergoing correction of septal congenital heart defects.

Eisenmenger Syndrome Among Children with Unrepaired Congenital Heart Defects in Yunnan, China.

Eisenmenger syndrome is a life-threatening complication of congenital heart defects (CHD). Since Eisenmenger syndrome among children of repaired CHD is rare, very few studies have had the necessary data to investigate its distribution in children. The current study used data collected in rural China to investigate the prevalence of Eisenmenger syndrome in children with unrepaired CHD. Data were from the 2006 to 2016 patient medical records of China California Heart Watch, which is a traveling cardiology clinic in Yunnan Province, China. Patients were included if they (1) aged 18 or below, (2) had CHD(s), and (3) the defect was not repaired by the time of the clinic visit. The prevalence of Eisenmenger syndrome was calculated in each age and defect group. Using logistic regression models, we tested whether oxygen saturation, Down syndrome, sex, and age were significantly associated with Eisenmenger syndrome. Of the 1301 study participants, ventricular septum defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA) were the most common CHD. About one-sixth of the patients had pulmonary hypertension and 1.5% had Eisenmenger syndrome. The percentages of Eisenmenger syndrome were 1.8% in VSD patients, 0 in ASD patients, and 0.9% in PDA patients. Patients in the age group between 15 and 18years had the highest percentages of Eisenmenger syndrome (11.5%). Age and presence of Down syndrome were significantly associated with the presence of Eisenmenger syndrome. Our finding highlights the importance of early detection and correction of CHD.

Tips and Tricks in Cardiac Surgical Anesthesia

For operations including coronary artery by-pass grafting (CABG), heart valve repair or replacement, ascending aorta surgeries, heart transplantation, and surgical correction of congenital heart defects, anesthesia management shares many similar concepts

Long-Term Follow-Up of Pediatric Patients with Severe Postoperative Pulmonary Hypertension After Correction of Congenital Heart Defects

The surgical repair of congenital heart defects in children with preoperative pulmonary hypertension (PH) is to varying degree associated with the occurrence of postoperative PH. The objective of this study was to follow up children with severe postoperative PH (pulmonary arterial/aortic pressure ratio ≥ 1.0) to evaluate if pulmonary arterial pressure spontaneously normalized or needed PH-targeting therapy and to identify potential high-risk diagnoses for bad outcome. Twenty-five children who developed clinically significant severe PH on at least three occasions postoperatively were included in the follow-up (20–24 years). Data from chart reviews, echocardiographic investigations, and questionnaires were obtained. Three children died within the first year after surgery. Three children were lost to follow-up. The remaining 17 children normalized their pulmonary arterial pressure without the use of PH-targeting drugs at any time during the follow-up. Two children had a remaining mild PH with moderate mitral valve insufficiency. All three children with bad outcome had combined cardiac lesions causing post-capillary pulmonary hypertension. Normalization of the pulmonary arterial pressure occurred in almost all children with severe postoperative PH, without any need of supplemental PH-targeting therapies. All children with bad outcome had diagnoses conformable with post-capillary PH making the use of PH-targeting therapies relatively contraindicated. These data emphasize the need to perform randomized, blinded trials on the use of PH-targeting drugs in children with postoperative PH before accepting it as an indication for routine treatment.

Management of post-operative Junctional Ectopic Tachycardia in symptomatic neonates and infants at a tertiary care center in a developing country: Lessons learned!

Purpose: Junctional ectopic tachycardia (JET) is an uncommon form of arrhythmia that occurs after surgical correction of congenital heart defects. Data on neonates and infants are rare. This study highlights the epidemiology, incidence, and management of neonates and infants with JET at a tertiary care center in Lebanon.&#x0D; Methods: We conducted a retrospective chart review between January 1, 2013, and December 31, 2017. All Patients with documented symptomatic junctional ectopic tachycardia on electrocardiogram who required medical treatment post-surgery were included.&#x0D; Results: A total of 9 patients were included. The median age was 18 days, and six were males. Six out of nine (66.67%) were successfully treated with cooling and amiodarone on the initial attempt. The other three cases failed initial treatment with adenosine. However, they were successfully treated with cooling and amiodarone as second-line therapy. All cases of junctional ectopic tachycardia occurred post-surgery at an average of 1.67 ± 1.11 days.&#x0D; Conclusion: Junctional ectopic tachycardia mostly occurs after corrective cardiac surgery and can be successfully treated with cooling and amiodarone. Timely diagnosis significantly affects the outcome.

The Inverse Relationship Between Endothelium-Dependent Vasodilation and Blood Pressure is Lost After Cardiopulmonary Bypass.

Cardiopulmonary bypass (CPB) is required for the surgical correction of congenital heart defects and incites an acute inflammatory response that impairs endothelial function post-operatively. Therefore, we hypothesized that the pre-operative relationship between endothelial function and blood pressure would be impaired after CPB-mediated inflammation. Using laser Doppler perfusion monitoring coupled with iontophoresis, we found that while there was a significant inverse correlation between endothelium-dependent vascular reactivity to acetylcholine (ACh) stimulation and systolic blood pressure (SBP), this relationship was lost after CPB. No relationship was observed between endothelium-independent vascular reactivity using sodium nitroprusside (SNP) and SBP either pre-CPB or any point thereafter. Additionally, neither CPB time nor inflammatory cytokines correlated with the degree of responsiveness to ACh. These data suggest that the measurement of endothelium impairment after CPB may be more reflective of cardiovascular health than SBP alone.