Correction Of Congenital Heart Disease Research Articles

Pregnancy after heart surgery – challenges

Purpose: Advances in cardiac surgery significantly improve life expectancy and quality of life of patients with congenital or acquired heart disease. Materials and Methods: The present study included 146 pregnant women who had antenatal care and gave birth at the Institute of Gynecology and Obstetrics in an interval of ten years from 1994-2004. Patients were divided in four groups according to the type of heart surgery. Group I included four patients with surgically corrected coarctation of the aorta. Group II included 27 patients with correction of the ostial stenosis. Group III had 68 patients with correction of congenital heart diseases, and group IV had 47 patients with artificial heart valves. Results: There was 4% of heart failure after delivery. The incidence of hemorrhagic complications during pregnancy was 2.7% and 4.1% after delivery. The incidence of thromboembolic complications after delivery was 6%. Four newborns died, one of hydrocephalus and three of hypoxic ischemic encephalopathy. Two patients died. Conclusion: Patients with artificial heart valves need an enhanced level of medical care during pregnancy and labor.

Sensitivity and Specificity of Cardiac Tissue Discrimination Using Fiber-Optics Confocal Microscopy.

Disturbances of the cardiac conduction system constitute a major risk after surgical repair of complex cases of congenital heart disease. Intraoperative identification of the conduction system may reduce the incidence of these disturbances. We previously developed an approach to identify cardiac tissue types using fiber-optics confocal microscopy and extracellular fluorophores. Here, we applied this approach to investigate sensitivity and specificity of human and automated classification in discriminating images of atrial working myocardium and specialized tissue of the conduction system. Two-dimensional image sequences from atrial working myocardium and nodal tissue of isolated perfused rodent hearts were acquired using a fiber-optics confocal microscope (Leica FCM1000). We compared two methods for local application of extracellular fluorophores: topical via pipette and with a dye carrier. Eight blinded examiners evaluated 162 randomly selected images of atrial working myocardium (n = 81) and nodal tissue (n = 81). In addition, we evaluated the images using automated classification. Blinded examiners achieved a sensitivity and specificity of 99.2±0.3% and 98.0±0.7%, respectively, with the dye carrier method of dye application. Sensitivity and specificity was similar for dye application via a pipette (99.2±0.3% and 94.0±2.4%, respectively). Sensitivity and specificity for automated methods of tissue discrimination were similarly high. Human and automated classification achieved high sensitivity and specificity in discriminating atrial working myocardium and nodal tissue. We suggest that our findings facilitate clinical translation of fiber-optics confocal microscopy as an intraoperative imaging modality to reduce the incidence of conduction disturbances during surgical correction of congenital heart disease.

Ultrafiltration as a method for regulating the volume balance during correction of transposition of great vessels in newborns

Correction of congenital heart disease in newborns under extracorporeal circulation is accompanied by fluid overload. To eliminate this pathological state, the method of ultrafiltration is commonly used. The paper presents a comparative analysis of two methods of ultrafiltration in the arterial switch procedure in 20 newborns with transposition of the great vessels. In group I (n = 10) we conducted conventional ultrafiltration during cardiopulmonary bypass; and in group II (n = 10), modified ultrafiltration after completing the cardiopulmonary bypass was used. The data obtained indicate that the inotropic support, the need in blood transfusion during the immediate follow-up and the mechanical ventilation duration were significantly lower during modified ultrafiltration as compared to conventional one.

Riociguat for pulmonary arterial hypertension associated with congenital heart disease

ObjectiveThe Pulmonary Arterial hyperTENsion sGC-stimulator Trial-1 (PATENT-1) was a randomised, double-blind, placebo-controlled phase III trial evaluating riociguat in patients with pulmonary arterial hypertension (PAH). PATENT-2 was an open-label long-term extension...

Stem cell therapy and tissue engineering for correction of congenital heart disease.

This review article reports on the new field of stem cell therapy and tissue engineering and its potential on the management of congenital heart disease. To date, stem cell therapy has mainly focused on treatment of ischemic heart disease and heart failure, with initial indication of safety and mild-to-moderate efficacy. Preclinical studies and initial clinical trials suggest that the approach could be uniquely suited for the correction of congenital defects of the heart. The basic concept is to create living material made by cellularized grafts that, once implanted into the heart, grows and remodels in parallel with the recipient organ. This would make a substantial improvement in current clinical management, which often requires repeated surgical corrections for failure of implanted grafts. Different types of stem cells have been considered and the identification of specific cardiac stem cells within the heterogeneous population of mesenchymal and stromal cells offers opportunities for de novo cardiomyogenesis. In addition, endothelial cells and vascular progenitors, including cells with pericyte characteristics, may be necessary to generate efficiently perfused grafts. The implementation of current surgical grafts by stem cell engineering could address the unmet clinical needs of patients with congenital heart defects.

Expansion and characterization of neonatal cardiac pericytes provides a novel cellular option for tissue engineering in congenital heart disease.

BackgroundLiving grafts produced by combining autologous heart-resident stem/progenitor cells and tissue engineering could provide a new therapeutic option for definitive correction of congenital heart disease. The aim of the study was to investigate the antigenic profile, expansion/differentiation capacity, paracrine activity, and pro-angiogenic potential of cardiac pericytes and to assess their engrafting capacity in clinically certified prosthetic grafts.Methods and ResultsCD34pos cells, negative for the endothelial markers CD31 and CD146, were identified by immunohistochemistry in cardiac leftovers from infants and children undergoing palliative repair of congenital cardiac defects. Following isolation by immunomagnetic bead-sorting and culture on plastic in EGM-2 medium supplemented with growth factors and serum, CD34pos/CD31neg cells gave rise to a clonogenic, highly proliferative (>20 million at P5), spindle-shape cell population. The following populations were shown to expresses pericyte/mesenchymal and stemness markers. After exposure to differentiation media, the expanded cardiac pericytes acquired markers of vascular smooth muscle cells, but failed to differentiate into endothelial cells or cardiomyocytes. However, in Matrigel, cardiac pericytes form networks and enhance the network capacity of endothelial cells. Moreover, they produce collagen-1 and release chemo-attractants that stimulate the migration of c-Kitpos cardiac stem cells. Cardiac pericytes were then seeded onto clinically approved xenograft scaffolds and cultured in a bioreactor. After 3 weeks, fluorescent microscopy showed that cardiac pericytes had penetrated into and colonized the graft.ConclusionsThese findings open new avenues for cellular functionalization of prosthetic grafts to be applied in reconstructive surgery of congenital heart disease.

Effect of complex cardiac rehabilitation on physical activity and quality of life during long-term follow-up after surgical correction of congenital heart disease

Comprehensive cardiac rehabilitation (CCR) is an important element of the comprehensive management of grown-up congenital heart disease (GUCH) patients after surgical correction of congenital heart disease (CHD) but access to this treatment is still limited. We still lack Polish guidelines on CCR, including controlled training in young adults several years after surgical correction of CHD. To assess the effect of a CCR program on physical capacity, exercise tolerance, quality of life, and severity of depressive symptoms in GUCH patients long-term after surgical correction of CHD. We studied 57 CHD patients (30 females, 27 males, mean age 23 ± 3.4 years) at least 12 months after surgical correction of a ventricular septal defect (VSD) or ostium secundum atrial septal defect (ASD II). All patients were offered a CCR program, and 31 of them participated (rehabilitation group [Reh]) and 26 refused (non-rehabilitated group [NReh]). All patients underwent baseline cardiopulmonary exercise testing (CPET) using a cycloergometer and a ramp protocol with an initial load of 20 W followed by 10 W load increments per minute. Psychological evaluation included the Beck Depression Inventory (BDI) and the Euro QoL 5D questionnaire to evaluate quality of life. Patients were reassessed 30 days after the initial evaluation using the same investigations. During CPET, all patients reached peak exercise intensity at the level of 15-17 in the Borg scale without complications. Resting HR was lower in the Reh group (74 ± 8 bpm) compared to the NReh group (81 ± 14 bpm). During CPET, patients in the Reh group reached significantly higher peak HR and percent maximum HR. Workload increased nonsignificantly (144 W vs. 124 W, p = 0.121), while duration of exercise and peak oxygen consumption was significantly longer in the Reh group compared to the NReh group (14 min vs. 11 min, p = 0.001; and 27.5 mL/kg/min vs. 23 mL/kg/min, p = 0.003, respectively). Patients in the NReh group showed non significantly higher severity of depressive symptoms compared to the Reh group, as evaluated using BDI at 30 days (mean score 4.8 vs. 2.2, respectively, p = 0.59). In contrast, subjectively and objectively rated quality of life was significantly higher in the Reh group compared to the NReh (score 89 vs. 74.4, p < 0.01; and 94 vs. 83, p < 0.01, respectively). Implementation of a CCR program improves physical capacity, exercise tolerance, and quality of life and reduces depressive symptoms in patients late after surgical correction of CHD. Introduction of such programs seems reasonable as a supplement to the holistic care for GUCH patients.

Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE): study protocol for a prospective observational study.

BackgroundAcute kidney injury (AKI) is associated with poor outcome in critically ill children. While data extracted from retrospective study of pediatric populations demonstrate a high incidence of AKI, the literature lacks focused and comprehensive multicenter studies describing AKI risk factors, epidemiology, and outcome. Additionally, very few pediatric studies have examined novel urinary biomarkers outside of the cardiopulmonary bypass population.Methods/DesignThis is a prospective observational study. We anticipate collecting data on over 5000 critically ill children admitted to 31 pediatric intensive care units (PICUs) across the world during the calendar year of 2014. Data will be collected for seven days on all children older than 90 days and younger than 25 years without baseline stage 5 chronic kidney disease, chronic renal replacement therapy, and outside of 90 days of a kidney transplant or from surgical correction of congenital heart disease. Data to be collected includes demographic information, admission diagnoses and co-morbidities, and details on fluid and vasoactive resuscitation used. The renal angina index will be calculated integrating risk factors and early changes in serum creatinine and fluid overload. On days 2–7, all hemodynamic and pertinent laboratory values will be captured focusing on AKI pertinent values. Daily calculated values will include % fluid overload, fluid corrected creatinine, and KDIGO AKI stage. Urine will be captured twice daily for biomarker analysis on Days 0–3 of admission. Biomarkers to be measured include neutrophil gelatinase lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (l-FABP), and interleukin-18 (IL-18). The primary outcome to be quantified is incidence rate of severe AKI on Day 3 (Day 3 – AKI). Prediction of Day 3 – AKI by the RAI and after incorporation of biomarkers with RAI will be analyzed.DiscussionThe Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology (AWARE) study, creates the first prospective international pediatric all cause AKI data warehouse and biologic sample repository, providing a broad and invaluable resource for critical care nephrologists seeking to study risk factors, prediction, identification, and treatment options for a disease syndrome with high associated morbidity affecting a significant proportion of hospitalized children.Trial registrationClinicalTrials.gov: NCT01987921Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0016-6) contains supplementary material, which is available to authorized users.

Comparison of the cardioprotective effect of isoflurane versus sevoflurane during cardiopulmonary bypass in congenital heart surgery

Aims This study aimed to detect the difference in the preconditioning effect between isoflurane and sevoflurane when they are used just before aortic cross-clamp and continued throughout the bypass period by measuring cardiac troponin I (cTnI) in the postbypass period. Settings and design This individual closed-envelope randomization study was carried out in the Abou Ell-Resh Pediatric Hospital, Cairo University Unit of congenital heart surgery in collaboration with the anesthesia department. The study was approved by the local ethical committee and a written informed consent was obtained from the guardians of the patient. This study was carried out from March 2011 to September 2012 (18 months). Patients were allocated randomly to two equal groups of 30 patients each. Participants and methods Acyanotic and cyanotic patients were allocated randomly to two equal groups of 30 patients each using individual closed-envelope randomization. Patients were allocated randomly to two equal groups as follows: group I, isoflurane group (n = 30) (received isoflurane) and group S, sevoflurane group (n = 30) (received sevoflurane). cTnI, a baseline sample was obtained before cardiopulmonary bypass (T0), 8 h after bypass (T8), and 24 h after bypass (T24). Parametric data were described as mean, SD, median, and SEM. The two groups studied were compared using Student's t-test. Repeated measures of the same group were compared using two-way analysis of variance, followed by post-hoc Tukey's comparison tests. For nonparametric data, nonparametric tests were used for comparison such as the Mann-Whitney U-test, median, or quartiles. P value less than 0.05 was considered significant (size estimation with two means is 28). Results Comparison of sevoflurane and isoflurane acyanotic cases showed that the cTnI (P = 0.02 and 0.01, respectively). Comparison of isoflurane and sevoflurane cyanotic cases showed that the cTnI values 8 and 24 h after bypass were higher in cyanotic cases of the isoflurane group than those of the sevoflurane group, but the difference was statistically insignificant. In terms of the difference between cyanotic and acyanotic cTnI results in the isoflurane group, cTnI values 8 h after cardiopulmonary bypass were higher in cyanotic cases compared with acyanotic cases, but this difference was insignificant, with a P value of 0.42. At 24 h after CPB, cTnI values were significantly higher in cyanotic cases with a P value of 0.015. In terms of the difference between cyanotic and acyanotic cTnI results in the sevoflurane group, the cTnI level 8 h after CPB was significantly higher in cyanotic cases compared with acyanotic cases with a P value of 0.001; it was also significantly higher in cyanotic cases 24 h after CPB with a P value of 0.005. Conclusion The present study showed that sevoflurane is superior to isoflurane in myocardial protection in surgical correction of congenital heart diseases only in acyanotic cases, with no difference in cyanotic cases.

Реабилитационный потенциал детей, перенесших в разные возрастные периоды хирургическую коррекцию врождённых пороков сердца

Comparative evaluation of rehabilitation potential in 20 girls at the sanatorium stage of rehabilitation after surgical correction of congenital heart disease in different age periods was carried out. Structural and functional diagnoses were specified to determine the level of rehabilitation potential. Identified violations were assessed as the loss or absence, reduction, addition or excess. Research methods included: clinical examination with determination of the level of physical development on the body mass index, functional orthostatic test, as-sessment of the estimated impact of blood volume and &amp;#34;double work&amp;#34;, Doppler echocardiography, spectral analysis of heart rhythm, some indicators of emotional state on the differentiated self-assessment of functional status test and “quality of life” according to test SF-36. In children of the first group with early surgical correction regarding (under 2 years) significant changes in functionality were noted: higher initial rehabilitation potential and positive changes in central and peripheral hemodynamics, positive changes in the emotional sphere traced by the level of comfort, improved exercise tolerance under the influence of sanatorium rehabilitation. Preliminary observations suggest the possibility of compensation of impaired functions in children of the specified contingent during the sanatorium stage of rehabilitation is to improve their sano-genetic and psycho-physiological potential.

Dexmedetomidine; an adjuvant drug for fast track technique in pediatric cardiac surgery

BackgroundSimple surgical procedures in pediatric open cardiac surgery can be planned for early extubation by using dexmedetomidine alpha2 agonist. Early extubation is associated with shortening of postoperative ventilation and intensive care unit length of stay. The aim of this study was to examine the effects of dexmedetomidine on recovery profile, ICU length of stay, analgesic needs, and hospital stay in pediatric patients undergoing elective correction of congenital heart diseases using CPB.MethodsForty patients with age ranging from 2–10 years of either sex submitted for elective correction of simple congenital heart diseases undergoing CPB. All patients were premedicated in preoperative area with intramuscular 0.1 mg/kg midazolam and 0.015 mg/kg atropine sulfate. Patients were randomly classified into one of two equal groups (n = 20). In the Dex group, patients received an initial bolus dose of dexmedetomidine (0.4 μg/kg) over 10 min, followed by continuous infusion of 0.5 μg/kg/hr. In the control group, patients received an initial bolus dose of saline over 10 min, followed by continuous infusion of 0.5 μg/kg/hr.ResultsMAP, HR, the total dose of intra-operative fentanyl, vasodilator needs, time of extubation, pain score, ICU length of stay and hospital stay were significantly higher in the control group when compared with DEX group. Also in control group these were significant decrease in HR and MAP relative to baseline. There was significant increase in duration of inotropic support in control group than DEX group.ConclusionDexmedetomidine is a short-acting alpha2-adrenoceptor agonist with many desirable clinical benefits that encourage its use in the perioperative period. Dexmedetomidine has anesthesia-sparing effects, it decreases MAP, HR and with reasonable analgesic effect.

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Background and aims: The incidence of congenital stenosis of the main bronchus (MBS) appears in 0.1–5% cases. In patients with congenital heart disease (CHD), the postoperative period is often accompanied by respiratory problems that may be intensified by concomitant bronchial stenosis. Aims: The study aims to determine managing tactics for the children with congenital MBS. Methods: The study included 10 children aged from 10 days to 1 year who underwent surgical correction of complex CHD in 2012–2013. Before the operation all patients breathed spontaneously, and MBS was not pre-operatively diagnosed only in 1 patient. Results: Four patients underwent balloon dilatation of the stenotic bronchus (in one - simultaneously with the correction of CHD) and the others were being managed conservatively. Postoperative respiratory disorders were observed in all patients: 6 cases of atelectasis on the affected side, 4 cases of subsequent air trapping emphysema syndrome and 5 cases of pneumonia. The average duration of mechanical ventilation was 56 days, and it was significantly increased in 50% of the ICU patients due to the MBS effects. There were 3 cases of tracheal reintubation. The ICU period was 2 - 200 days. One patient with critical respiratory insufficiency died. There were four cases of the full restoration of bronchial patency. Conclusions: Children with CHD and MBS always have respiratory problems in postoperative period that intensify the severity of their condition and significantly increase the ICU-time. It is needed to determine tactics for these patients at all stages of treatment.

ABSTRACT 538

Background and aims: In pediatric cardiac surgery, early sepsis diagnosis and assessment of severity of sepsis is extremely difficult, due to the nature of postoperative period of these special group of patients. The use of routine sepsis biomarkers such a procalcitonin and C-reactive protein levels has several limitations in infants after cardiac surgery with CPB. Aims: The goal was to study the sensitivity and specificity, positive and negative prognostic value of neutrophil?D64-index as an early diagnostic marker of sepsis in infants and neonates after cardiac surgery with cardiopulmonary bypass (CPB). Methods: This study enrolled 36 neonates and infants with suspected sepsis after surgical correction of congenital heart diseases with CPB. CD-64 index had been measured simultaneously with other parameters (procalcitonin, C-reactive protein (CRP), complete blood count, bacterial blood culture). All patients were divided into 2 groups: group with sepsis (suspected or confirmed; n = 16), and group without sepsis (n = 20).FigureResults: All patients were divided into 2 groups: group with sepsis (suspected or confirmed; n = 16), and group without sepsis (n = 20). CD64 - index was significantly higher in the group with sepsis episodes (2.29 (1.96: 3.32)) compared with no sepsis group (1.23 (1.05: 1.88), p = 0.001), its cutoff-value more than 2.00 (AUC = 0.895),increased the risk of sepsis in 9.4 times with sensitivity 80 % and specificity 90 %, with a negative predictive value -74% and positive predictive value - 77%. Conclusions: CD64-index is a new highly sensitive and specific early diagnostic marker of sepsis in infants after cardiac surgery with CPB.

Iloprost for children with pulmonary hypertension after surgery to correct congenital heart disease

Congenital heart disease (CHD) can cause pulmonary hypertension (PH) in children, and surgery to correct CHD may be complicated by postoperative pulmonary hypertensive crises (PHC). Clinical data regarding the use of inhaled iloprost to treat children with PH are scarce. Our aim was to determine the efficacy and safety of iloprost in children with PH following surgery to correct CHD. This was a randomized, placebo-controlled study of 22 children (median age 7 months) undergoing surgery to achieve biventricular repair. The combined clinical endpoint was a decrease of more than 20% in the ratio of systolic pulmonary arterial pressure to systolic arterial pressure or pulmonary resistance to systemic resistance, with no PHC or death. Patients were randomized to receive low-dose iloprost (30 ng/kg/min), high-dose iloprost (50 ng/kg/min), or placebo, for 10 min every 2 hr in the first 48 hr after surgery. PHC were experienced by two patients who received placebo and one patient treated with high-dose iloprost. The combined clinical endpoint was reached by six patients administered low-dose iloprost (P = 0.005) and four administered high-dose iloprost (P = 0.077), compared with none in the placebo group. Patients treated with iloprost showed a significant reduction from baseline in mean pulmonary vascular resistance index (-2.2 Wood units, P < 0.05), whereas patients who received placebo showed no significant change. This study supports the use of iloprost to treat children with PH following surgery to correct CHD.

Postmitral Valve Replacement Biatrial, Septal Macroreentrant Atrial Tachycardia Developing After Perimitral Flutter Ablation

Atypical macroreentrant atrial tachycardias are frequently encountered in patients after cardiac surgery, correction of congenital heart disease, or atrial fibrillation ablation. Ablation of one circuit can produce an abrupt change in atrial activation sequence giving rise to another macroreentrant circuit. In this report, we present a unique case of a biatrial septal macroreentrant atrial tachycardia, which developed after perimitral flutter ablation in a patient with mitral valve replacement. Editor’s Perspective see p 175 A 59-year-old man with a mitral valve replacement (bioprosthesis) in 1983 for a rheumatic mitral stenosis and a rereplacement in 1999 (right-sided approach with a vertical incision of the interatrial septum) with a mechanical prosthesis attributable to the degeneration of the former prosthesis was referred for the ablation of a sustained atrial tachycardia with a stable cycle length of 260 ms. The echocardiogram demonstrated a left ventricular ejection fraction of 45% to 50%, a moderately dilated right atrium (RA) as well as left atrium (LA) without signs of a prosthetic malfunction. The baseline surface 12-lead ECG showed an atypical atrial flutter with a regular, monomorphic atrial activity and an irregular atrioventricular conduction (Figure 1A). With broad positive flutter waves in unipolar lead V1 and inferior limb leads II, III and avF but negative flutter waves in limb leads I and avL, the ECG morphology suggested LA localization. Any significant 12-lead isoelectric interval was absent. Endocardial activation mapping with a quadripolar catheter in the RA and a steerable octapolar catheter in the coronary sinus (CS; Bard Medical, Covington, GA) demonstrated a distal to proximal activation sequence in the CS with a baseline cycle length of 260 ms, suggestive of a lateral to septal activation of the LA posterior wall (Figure 1B). An irrigated tip ablation catheter (Navistar Thermocool, Biosense Webster, Diamond Bar) was advanced into the LA via …

Monitoring the effects of propofol and sevoflurane on cerebral oxygen supply-demand balance using transcranial Doppler sonography and jugular bulb saturation in pediatric open heart surgery

Background Increasing awareness of neurologic abnormalities associated with congenital heart surgical intervention has heightened investigations for prevention of neurologic injury during the perioperative period. This study investigated the effects of propofol and sevoflurane on cerebral oxygen supply demand balance using transcranial Doppler sonography and jugular bulb saturation in pediatric open heart surgery. Methods After obtaining institutional approval and a written consent from parents, 60 children who were admitted for elective open cardiac surgery for correction of congenital heart disease using CPB were included in this study. Children were randomized into two groups; group (P) and group (S). Induction of Anesthesia was achieved by 5 μg/Kg I.V. fentanyl, propofol 2- 2.5 mg/Kg (in propofol or P group) or sevoflurane 2-3 MAC (in sevoflurane or S group). Anesthesia was maintained by propofol infusion between 75-100 μg/kg/min in P group or sevoflurane 2 MAC in S group. Calculated parameters from the blood gas variables included cerebral metabolic rate of oxygen (CMRO 2 ), cerebral extraction of oxygen (CeO 2 ) and cerebral blood flow equivalent (CBF). Arterial blood gases (ABG) and velocities of flow were monitored by Trancranial Doppler at 5 time points : before the surgery, before CPB, during CPB (after establishment of full flow), after CPB and after recovery. Neurological examination and CT scan were done before surgery and 2 days after that. Results There is no significant difference between the two groups in demographic data. Children in propofol group showed lower heart rate values after induction and after CPB than those in sevoflurane group. Mean arterial pressure was statistically higher in sevoflurane group compared with propofol group after induction. Children in sevoflurane group showed significantly higher; velocity maximum, velocity mean and pulsatile index, in the after induction and after bypass periods than those in propofol group. Velocity minimum showed no difference between the two groups. SjvO 2 , CMRO 2 , CeO 2 and CBF was significantly different after induction in sevoflurane group compared with propofol group. Perioperative blood gases showed no difference between the studied groups. Conclusion Compared with propofol anesthesia, sevoflurane anesthesia provides a wider margin of safety against impaired cerebral oxygenation and better preservation of systemic hemodynamics. Moreover, cerebral oxygen saturation may not reflect changes in cerebral oxygenation as monitored by jugular venous oxygen tension measurement in children undergoing CPB.

Isolated left bundle branch block in a toddler.

Left bundle branch block (LBBB) usually occurs as a postoperative complication from surgical correction of congenital heart disease and can be associated with hypertensive heart disease, coronary artery disease, myocarditis, and aortic valvular disease. Although isolated LBBB is a conduction abnormality found in some healthy adults, it has not been reported in pediatric population. We report a 2-year-old, healthy African American female who was incidentally discovered to have isolated LBBB that has persisted in a follow-up of 3 years.

Peritoneal Dialysis does not Adversely Affect Kidney Function Recovery after Congenital Heart Surgery

Acute kidney injury (AKI) after cardiopulmonary bypass surgery to correct congenital heart disease is common. We prevent fluid overload and further cardiac compromise in oliguric infants with continuous peritoneal dialysis (CPD). The effect of CPD on kidney recovery is unknown, thus indications to discontinue CPD are unclear. We aimed to determine if CPD affects kidney recovery, measured by urine output and novel urinary AKI biomarker concentrations. Twenty infants <90 days old with congenital heart disease who underwent bypass surgery and were post-operatively treated with CPD were randomized at the time of clinical readiness for CPD discontinuation to 1) discontinue CPD (control) or 2) continue 24 h more CPD (experimental). Urine output (ml/kg per h), total output (ml/kg per h) and urinary neutrophil gelatinase-associated lipocalin, interleukin-18, liver-type fatty acid binding protein, and kidney injury molecule-1 were assessed post-surgery until CPD catheter removal. 24 hours preceding randomization, there were no differences in mean urine output or total output; 24 hours post-randomization, the control group had higher mean urine output (4.2 ± 2.6 ml/kg per h vs. 2.8 ± 2.0 ml/kg per h, p = 0.02) but lower total output (6.3 ± 2.1 ml/kg per h vs. 4.7 ± 2.7 ml/kg per h, p = 0.01). Median biomarker concentrations did not differ significantly between groups at any time point. Our results suggest renal replacement therapy does not change the time course of kidney function recovery.

Profile of cardiac disease in Cameroon and impact on health care services.

Cardiovascular diseases (CVD) have emerged as a major public health problem and impose an escalating burden on the health care system in Cameroon. The aim of the study was to investigate the preparedness of health care services for patients presenting with CVD in general and specifically, in St. Elizabeth catholic general hospital Shisong, cardiac centre. Between November 2009 and November 2011, a population of 8,389 adults and 706 children consulted the referral cardiac centre of St. Elizabeth Catholic General Hospital. The patients' age ranges between 5 days and 103 years old, with a mean of 48.7±18 years. Female represented 54.2% of the total population. Hypertension was diagnosed in 41.5% of patients. Isolated systolic hypertension was rarely found (4.2%) and 45.2% of patients were classified as class II according to the JNC7. Congestive heart failure was diagnosed in 29.6%. Forty-four percent of patients were in class III and 7% in class IV heart failure (NYHA). Arrhythmia was seen in 12.2% cases, with atrial fibrillation in 35.2%, followed by ventricular ectopic beats in 20.3%. Stable angina was diagnosed in 1.5%, and acute myocardial infarction 0.9%. In children, the prevalence of congenital heart disease was (4.3%). The disease the most detected was isolated ventricular septal defect, followed by tetralogy of Fallot. Post rheumatic valvulopathies were the main cause of heart failure in teenagers and young adults. Valve replacement with a mechanical valve was performed in 110 patients, valvuloplasty in eight patients, and surgical correction of congenital heart diseases in 105 cases. Our data, collected in a rural area, shows the high prevalence of hypertension in rural sub-Saharan Africa. Congestive heart failure mainly due to post rheumatic valvulopathies is common amongst children and young adults.

Effects of corticosteroids after total reapair of congenital heart desease with extracorporeal circulation

Background Nowadays, the use of cardiopulmonary bypass (CPB) followed by systemic hypothermia is common in cardiac surgery procedures. CPB causes a systemic inflammatory response syndrome (SIRS) that is markedly expressed in congenital caridiosurgical surgery programe resulting with deleterious consequences. Those effects are mediated through cytokines and others mediators of acute inflammatory response in circulation, which may lead to low cardiac output syndrome, multiorgan failure and lethal outcome after surgical total correction of congenital heart disease. The best method for SIRS prevention remains unclear, although some authors suggest perioperative use of corticosteroids. The study sough to evaluate the impact of perioperative corticosteroids on SIRS extent as well as clinical outcomes following total correction of congenital heart disease.