Cyanotic Spells Research Articles

Factors Associated with the Occurrence of Cyanotic Spells in Tetralogy of Fallot Patients

A study was carried out on 114 tetralogy of Fallot patients attending the Department of Child Health, Medical School, University of Airlangga/Dr. Soetomo Hospital between 1 January 1988 to 31 December 1992. Only 81 patients fulfilled our study criteria where 52 (64.2'%) were cases with complications such as cyanotic spells, 4 (4 .93%) among them had brain abscesses. Twenty-nine individuals without complications acted as controls. Age, sex, nutritional status, hematocrit, MCHC and onset of symptoms between the two groups were analyzed using the multiple regression logistic. It has been shown that relative anemia, polycythemia and the age of 2-5 years contributed to the onset of cyanotic spells, respectively, R = 0.3171 and p = 0 .0004; R = 0.2220 and p = 0 .0073; R = 0.1363 and p = 0.00465. Therefore, in conventional treatment of tetralogy of Fallot patients it is essential to observe these risk factors in order to avoid complications and to improve the quality of life in these patients who are on the waiting list for surgery.

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2\xa0years

BackgroundJunctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age.MethodsFrom 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2 years and patients with preoperative arrhythmia. 29.8% of the patients (n = 96) had postoperative JET.ResultsJET patients were younger and had higher preoperative heart rate. Independent predictors of JET were younger age, higher preoperative heart rate, cyanotic spells, non-use of B-blockers and low Mg and Ca (p = 0.011, 0.018, 0.024, 0.001, 0.004 and 0.001; respectively). JET didn’t affect the duration of mechanical ventilation nor hospital stay (p = 0.12 and 0.2 respectively) but prolonged the ICU stay (p = 0.011). JET resolved in 39.5% (n = 38) of patients responding to conventional measures. Amiodarone was used in 31.25% (n = 30) of patients and its use was associated with longer ICU stay (p = 0.017). Ventricular pacing was required in 4 patients (5.2%). Median duration of JET was 30.5 h and 5 patients had recurrent JET episode. Timing of JET onset didn’t affect ICU (p = 0.43) or hospital stay (p = 0.14) however, long duration of JET increased ICU and hospital stay (p = 0.02 and 0.009; respectively).ConclusionJET increases ICU stay after TOF repair. Preoperative B-blockers significantly reduced JET. Patients with preoperative risk factors could benefit from preoperative arrhythmia prophylaxis and aggressive management of postoperative electrolyte disturbance is essential.

Paediatric breath‐holding spells are associated with autonomic dysfunction and iron deficiency may play a role

This study assessed cardiac performance and iron in subjects aged 12-36months with breath-holding spells (BHSs). We consecutively recruited 40 subjects (55% male) experiencing BHSs from the general paediatric outpatients department at the Children's Hospital, Ain Shams University, Egypt, from 2015 to 2016. The 20 matched comparisons were mainly healthy siblings. The workup included iron levels and electrocardiograms. The age at the onset of BHSs was 5-24months with a median monthly frequency of 13. Almost two-thirds of the patients had cyanotic spells, and one-third had pallid spells, lasting 25-90seconds. Lower serum iron levels and higher QT dispersion and T-wave dispersion were recorded in patients than the comparison group, and 4.8% had dysrhythmia and bradycardia. We observed higher durations of bradycardia during attacks and higher occurrences of dysrhythmia during cyanotic spells, which were more frequent in patients with prolonged or frequent BHSs. Our study of patients aged 12-13months supported the theory of autonomic dysfunction in BHSs. The ECG findings, especially in patients with prolonged or frequent spells, need to be studied further to evaluate the risk of life-threatening events. Iron deficiency may play a role in autonomic dysfunction in patients with BHSs.

Iron deficiency anemia in children with cyanotic congenital heart disease and effect on cyanotic spells

BackgroundIron deficiency anemia (IDA) in cyanotic congenital heart disease (CCHD) and its association with cyanotic spells has been documented in literature. However, Indian data especially in the pediatric age group is scarce. This study was conducted to find out the prevalence of IDA in this population. MethodsAn observational study was conducted in a tertiary care hospital. Children with CCHD in the age group of birth–12 years were included in the study. Hematological parameters of these patients were determined and compared. An assessment of the incidence of cyanotic spells in the iron-deficient and iron non-deficient children was also done. Data analysis was done using Fischer's exact test. ResultsThe prevalence of IDA was 47.06% in the study population. The study also showed that hemoglobin and hematocrit levels were paradoxically higher in the iron-deficient group as compared to the non-deficient, though the iron studies revealed the iron deficiency. The incidence of cyanotic spells was higher in the iron-deficient group. The mean corpuscular volume (MCV), red cell distribution width (RDW), serum ferritin, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TS) values were the parameters, which were found to be statistically significant to differentiate the study groups. ConclusionThe prevalence of IDA in children with CCHD was found to be high. Iron-deficient group had an increased frequency of cyanotic spells as compared to the non-deficient group, which was statistically significant.

Tracheal bronchogenic cyst causing cyanosis in a neonate

Abstract Bronchogenic cysts are congenital malformations of the tracheobronchial tree that are mainly located in the mediastinum or the pulmonary parenchyma. They often occur in early childhood, compressing the airway or the esophagus or by superinfection. Bronchogenic cysts located in the tracheal wall are relatively rare. They present with recurrent episodes of cyanosis, stridor and progressive respiratory distress. The diagnosis is suspected by clinical observation and endoscopic and radiologic evaluation and confirmed by anatomopathological findings. The treatment of choice is the surgical resection of the lesion. We here report the case of a newborn presenting with cyanosis and stridor due to an intramural tracheal bronchogenic cyst that was successfully treated by tracheal resection with end-to-end anastomosis. We highlight the importance of considering this rare entity in the differential diagnosis of cyanotic spells in this age group.

Profile of Congenital Heart Disease in Children: A Hospital Based Study

Objective: To study the incidence, various pattern, age and sex distribution, various presentation and complications of CHD among admitted children of age 1month to 12 yearsDesign: Hospital Based observational StudySetting: Department of Pediatrics, GMCH, Guwahati.Study Population: All children with CHD of age 1 month to 12 years admitted and first time diagnosed with CHD during above mentioned period.Method: Thorough history and clinical examination was carried out on 4569 admitted patients and clinical diagnosis was made. Final diagnosis was established by 2 D-Echocardiography and analyzed to know profile of CHD.Results: 112 patients were identified as having CHD, the incidence of CHD was 24.5 per 1000 admitted patient. VSD (43.8%), TOF (14.2%), ASD (13.4%), PDA (8%), TGA (4.5%), DORV (3.6%), AVSD (3.5%) were the common CHD. Most common age of presentation was between 1- 12 months (70.5%). Males were predominant in VSD, TOF, TGA, DORV and female were predominant in ASD, and PDA. Major clinical presentations were breathing difficulties (66%), poor weight gain (61%), easy fatigue (58%), cough (51.7%), feeding problem (50%), recurrent chest infection (40.2%), fever (33.9%), cyanotic spell & palpitation (11.6%) and convulsion (1.8%). Also, the major physical findings was tachypnoea (64.3%), tachycardia (56.3%), crepitation (49.1%), cyanosis (27.7%), wheeze (24.1%), enlarged tender liver (22.3%), and clubbing (14.3%). Most common complication was found to be growth failure, followed by recurrent chest infection and heart failure. Conclusion: VSD, ASD, PDA are the most common acyanotic and TOF was the commonest cyanotic congenital heart defects respectively. CHD needs regular monitoring so as to permit optimal growth and development and early diagnosis and timely intervention will reduce the morbidity and mortality to a large extent. This study shows the burden of CHD in North- East so it may help in policy making. Keywords: Congenital heart diseases, Incidence and profile of CHD

Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre

ObjectiveWhereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes. MethodsWe undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response. ResultsFrom 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5–124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3–88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score. Conclusiona significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment.

The Management of Cyanotic Spells in Children with Oesophageal Atresia.

Cyanotic spells, also known as blue spells, dying spells, or apparent life-threatening events, refer to a bluish tone visible in the mucosal membranes and skin caused by an oxygen decrease in the peripheral circulation. Although this decrease may be transient and benign, it may also be indicative of a severe underlying problem that requires immediate intervention. Children with oesophageal atresia (OA) are at risk for a number of coexisting conditions that may trigger cyanotic spells. This current article will focus on the management of cyanotic spells both in children with innominate artery compression and those with tracheomalacia.

Comorbidities with Congenital Heart Disease among Hospitalized Children in a Specialized Cardiac Hospital in Bangladesh

Background: Congenital heart diseases (CHD) when associated with any comorbid condition may complicate the outcome of management. So to find out and treat comorbidities before definite treatment is essential for better outcome. Methods: This observational cross sectional study was conducted in the inpatient Department of Paediatric Cardiology at National Institute of Cardiovascular Diseases, Dhaka, during the period of January 2014 to January 2015 to identify the comorbid conditions of congenital heart disease.Results: A total of 794 children with different types of congenital heart disease were enrolled during the study period. Among them, 48.6% were simple CHD and 51.4% were complex CHD. Among simple CHD, ventricular septal defect (VSD) was commonest (27.2%), Tetralogy of Fallot (TOF) occupied the second position (20.5%). One child presented with Ectopia cardis. Among complex CHD most common anomalies were VSD with either atrial septal defect (ASD) or patent ductus arteriosus (PDA) or valvular lesion. Next common anomalies were TOF with PDA or ASD &amp;/or pulmonary valvular abnormalities. Double outlet of right ventricle (DORV) with shunt and transposition of great arteries (TGA) with shunt also occur frequently. AV canal defect with or without valvular lesion presented in significant number. Among them 616 (77.6%) had different types of comorbid conditions. Among comorbidities, respiratory and acquired cardiac comorbidities were common (37.9% &amp; 34.1% respectively). Other congenital or genetic comorbidities were in 11.2%. Multisystem involvement was in 9.8% cases.Conclusion: Pneumonia and heart failure were the most frequent comorbid condition among both simple and complex congenital heart disease. They were common among acyanotic heart disease. But cyanotic spell, acute stroke syndrome and brain abscess were common among cyanotic heart disease. Among genetic comorbidities Down’s syndrome occupied the major part.Cardiovasc. j. 2017; 9(2): 83-89

Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt.

IntroductionBreath-holding spells (BHSs) are involuntary pauses of breathing, sometimes accompanied by loss of consciousness. They usually occur in response to an upsetting or surprising situation. Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. In some children, BHSs may be related to iron deficiency anemia. The aim of the work was to study the clinical and laboratory profile of BPHs in children presented to the Neuropediatric Clinic at Sohag University Hospital.MethodsAn observational prospective study was done at Sohag University Hospital over a period of one year on children diagnosed as having BHSs by clinical history and laboratory evaluation, including complete blood count (CBC), serum iron, serum ferritin, total iron binding capacity, and Electroencephalography (EEG).ResultsDuring the period of study (one year), we reviewed data of 32 children who had been diagnosed as having BHSs. We found that cyanotic spells (71.88%) predominated over pallid spells. There were positive family histories (31.25%) and consanguinity (53.135) in the studied patients. We found a high incidence of iron deficiency anemia (62.5%) in association with BHS. Abnormal EEGs were found in (65.63%) of studied children.ConclusionBHS is a common, important problem associated with iron deficiency anemia, which is, in turn, a common nutritional problem in our country.

Tetralogy of Fallot with double aortic arch: a rare association

A 2-year-old male child presented to us with a history of a single cyanotic spell at 3 months of age and episodes of squatting for the past 6 months. There were compression symptoms in the form of dysphagia, recurrent regurgitation, and cough. A routine chest roentgenogram showed a right ventricular apex and pulmonary oligemia. On echocardiography, a large subaortic ventricular septal defect was found with aortic override. There was severe infundibular and valvular pulmonic stenosis. The branch pulmonary arteries seemed confluent and adequately sized. Cardiac computed tomography angiogram revealed a codominant double aortic arch with tetralogy of Fallot (Figs. 2 and 3). Invasive angiography was done which revealed a double aortic arch, overriding aorta, confluent and adequate sized branch pulmonary arteries (Fig. 1) and normal coronary pattern. The patient underwent total correction with ligation of the left aortic arch.

Anaesthetic management for drainage of frontoparietal abscess in a patient of uncorrected Tetralogy of Fallot.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, characterised by aortic overriding, right ventricular hypertrophy, pulmonary stenosis (PS) and ventricular septal defect (VSD). When left untreated, survival to adulthood is rare.[1] Brain abscesses can occur in them because of paradoxical embolism and absence of pulmonary phagocytic clearance of pathogens. There are few case reports of uncorrected TOF surviving to adulthood and then presenting for non-cardiac surgeries.[1,2,3] We present a case of drainage of a large left fronto-parietal abscess under general anaesthesia, in a patient of uncorrected TOF.

Bath-induced paroxysmal events - Notes on a case report.

To the Editor I was interested to read the case report of bathing epilepsy published by Stutchfield and Loh [1] and wish to comment on several misleading statements and factual errors. As the authors would know, we have published a comprehensive review of bath-induced events [2]. Since then, three further papers on bathing epilepsy have been published [3], [4], [5], [6] together with a letter [6] confirming that what was originally reported as neonatal-onset bathing epilepsy is in fact alternating hemiplegia of childhood. Stutchfield and Loh [1] begin their Abstract by writing that “Bath-induced events in infants and children can be triggered by various etiologies, including cardiological, neurological, and metabolic causes.” This statement reflects the general message of the paper and its conclusion that “There is a wide differential diagnosis for reduced conscious level triggered by bathing” [1]. This contradicts the findings of our very careful review [2], which found only four conditions triggered by bathing in infants, these being bathing epilepsy — by far the commonest [2], [3], [4], [5], alternating hemiplegia of childhood [6], hyperekplexia, and paroxysmal extreme pain disorder [2]. Stutchfield and Loh [1] stated that reflex anoxic seizures (reflex asystolic syncope), cyanotic breath-holding spells (prolonged expiratory apnea), and cardiac syncope from long QT syndrome might be triggered by bathing in infancy, but to my knowledge, no such reports have been published. With regard to the authors' EEG findings, readers should note that the unit of measurement for the amplitudes of the interictal background activity as well as the “slow build-up of irregular high amplitude (530 mV) delta activity” should be microvolts and not millivolts: indeed, the calibration at the top of Fig. 1. confirms this. Finally, the authors' list of references deserves comment as well. Their reference [1] – De Keyzer et al. – describes a case of bathing epilepsy (bath water was at 37 °C) and not hot water epilepsy, despite its title. Their reference [3] – Fertleman et al. – was not published in JAMA Neurol (the new name for Archives of Neurology) but rather in the journal Neurology. Lastly, their reference [4] – Mikati et al. – was published in Pediatr Neurol and not J Pediatr Neurol. Conflict of interest None.

Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker.

Objectives:To validate the physical and psychological effectiveness of cardiac pacing in pediatric patients with breath-holding spells (BHS) and prolonged asystole.Materials and Methods:The records and clinical data of all the patients with BHS who presented to our center in the period of 2001–2013 were reviewed. All patients who received cardiac pacemaker implantation for prolonged asystole during BHS were included. In addition, the parents were asked to fill out a standardized quality of life (QOL) questionnaire.Results:Seven patients were identified. The mean onset of symptoms was 7 month (1–12 months) of age, documented asystole was 12–21 seconds, and a permanent cardiac pacemaker device was implanted at a mean age of 23 months (8 months–3.9 years). No pacemaker related adverse events were recorded. Follow up showed immediate resolution from spells in four cases (4/7). Two patients (2/7) showed significant reduction of frequency and severity of spells, with complete elimination of loss of consciousness (LOC). One patient (1/7) with an additional neurologic disorder continued to have minor pallid BHS and eventually switched from pallid to cyanotic spells without further detection of bradycardia or asystole in holter examination. QOL questionnaire revealed significant reduction in subjective stress levels of patients (P = 0.012) and parents (P = 0.007) after pacemaker implantation.Conclusion:Cardiac pacing using appropriate pacemaker settings seems effective in the prevention of LOC and reduction of the frequency of BHS. Our results imply a reduction of subjective stress levels of patients and parents as well as an increased quality of everyday life. After all, randomized controlled trials of the influence of cardiac pacemaker implantation on subjective stress levels in patients with BHS are needed.

Increased myocardial methionine‐enkephalin with reduced arterial oxygenation in congenital heart disease

Cardiac opioid peptides have been identified to exert important adaptive metabolic signalling for cardioprotection against ischaemia or hypoxia-related injury. To determine myocardial methionine-enkephalin content in children with hypoxemic congenital heart defects and to correlate myocardial content of methionine-enkephalin with the extent of arterial oxygen desaturation. Children (n= 20, median age of 16 months), undergoing cardiac surgical repair (tetralogy of Fallot, 17/20), were included in this study. Arterial oxygen saturation was measured on admission. Myocardial samples obtained during surgery were assayed via radioimmunochemistry for methionine-enkephalin content. Greater methionine-enkephalin content was measured in the right ventricles of the patients suffering from recent cyanotic spells compared with those with no recent spells (cyanotic spells: 2418 ± 844 pg/g wet weight tissue, n= 6; no spells: 1175 ± 189 pg/g wet weight tissue, n= 14, P= 0.04). An inverse correlation was evident between the arterial oxygen saturation and myocardial methionine-enkephalin content. Myocardial methionine-enkephalin levels increase with the severity of hypoxic stress in congenital cardiac disease and may play an important adaptive role in countering adrenergic over-activity and related excess demand on myocardial metabolic capacity.

ELECTIVE BALLOON PULMONARY VALVULOPLASTY DURING THE NEONATAL PERIOD IN TETRALOGY OF FALLOT

In tetralogy of Fallot (TOF), the risk of cyanotic spells can lead to emergency surgery like palliative systemic-pulmonary shunt before the ideal time to do complete repair. During corrective surgery in case of insufficient development of the pulmonary valve, the use of a trans-annular patch is required which, in the long-term, causes excessive dilatation of the right ventricle, arrhythmia and sudden death. The development of the pulmonary branch and the onset of cyanotic spells are conditioned by the volume of the trans-valvular flow. We conducted a retrospective study to determine whether elective primary pulmonary valvuloplasty (EPPV) in the neonatal period 1) allows a better development of the pulmonary valve and artery; 2) reduces the risk of cyanotic spells and the use of emergency surgery; 3) increase the possibilities of conservative surgery of the pulmonary valve. Patients with simple TOF who received an EPPV within the first month of live between 2000 and 2010 were compared to an observational group (OBS). Main parameters included progress of O2-saturation, pulmonary valve and artery growth, need for urgent aorto-pulmonary shunt, need for trans-annular patch reconstruction. Of a total of 203 patients identified, 42 were analyzed (23 EPPV and 19 OBS). At birth O2-saturation was 91.52±7.12 respectively vs 94.16 %±3.5 %; p= 0.043; The Z score of the pulmonary valve was -3.01±2.12 vs 0.508±1.71 (p=0.66) and Nakata index 115.12±39.67 vs 156.3±43.06 mm2/m2 (p=0.001). At the time surgery the growth of pulmonary annulus was z-score: -3.47±2.09 (p=0.73) vs -3.11±2.43 (p=0.214). Nakata index increased to 174.51±93.74 (p= 0.57) in EPPV and to 151.19±74.14 (p=0.14) in OBS, this increase was not significant between the 2 groups however (39.59±91.39 vs 4.85±78.34, p=0.214). The need for pulmonary re-intervention after corrective surgery was lower in EPPV 4/22(18%) vs. OBS 6/20(30 %); p=0.04. Neonatal EPPV in simple TOF allows appropriate growth of the pulmonary arteries and reduces the rate of re-intervention on the pulmonary arteries after corrective surgery. In this small series, there was no significant difference in the use of a transannular patch or on cyanotic spells.

Sternotomy After Classic Blalock-Taussig Shunt: A Unique Challenge

atients who have undergone the classic BlalockPTaussig (BT) shunt are rare in the present day. They are a special subset, with extensive arterial collaterals between both the internal mammary arteries. We encountered a 24-year-old man who had had tetralogy of Fallot andhadundergone a right classic BT shunt at 3 years of age for a cyanotic spell. Preoperative computed tomography (CT) showed extensive collaterals between the left and right internal mammary arteries in themidline across the sternum anteriorly (Fig 1A) and posteriorly

Treatment of Cyanotic Breath-Holding Spells With Oral Theophylline in a 10-Year-Old Boy

Cyanotic breath-holding spells are generally benign and resolve spontaneously by 4 to 5 years of age. Treatment with iron and other drugs has been employed in selected cases with very frequent and severe episodes. We describe a 10-year-old boy with recent-onset cyanotic breath-holding spells that were activity limiting. He was unable to participate in physical activities with his peers as any argument or emotional upset provoked these spells. Treatment with oral iron and piracetam was ineffective. However, treatment with oral theophylline produced dramatic amelioration of symptoms, and he was once again able to participate in play activities with his peers. We believe that general central nervous system stimulant and respirogenic effects of theophylline were instrumental in control of symptoms in our child.

Near Infrared Spectroscopy Monitoring in the Pediatric Cardiac Catheterization Laboratory

Near-infrared spectroscopy (NIRS) is a noninvasive method used to evaluate tissue oxygenation. We evaluated the relationship between cerebral and renal NIRS parameters during transcatheter intervention and adverse events in the catheterization room. Between January 1 and May 31, 2012, 123 of 163 pediatric patients undergoing cardiac catheterization were followed by NIRS. All were monitored by electrocardiography, noninvasive blood pressure measurement, pulse oxymetry, initial and final blood lactate level measurement. The number of interventional procedures was 73 (59%). During the procedures, 39 patients experienced a total of 41 adverse events: 18 (19.5%) had desaturation, 10 (8.1%) arrhythmia, three (2.4%) had respiratory difficulty, six (4.8%) had a situation calling for cardiopulmonary resuscitation, three (2.4%) had anemia necessitating transfusion, and one (0.8%) had a cyanotic spell. Cranial NIRS values worsened in 12 (9.8%) and renal measurements worsened in 13 (12.5%) patients. The sensitivity and specificity of a 9% impairment of cranial values were 90 and 61%, respectively, while the corresponding calculations for a 21% fall in renal measurements were 54% sensitivity and 90% specificity. When arrhythmia developed, NIRS values fell simultaneously, while the development of a desaturation problem was heralded by NIRS falling 10-15 s earlier than changes in pulse oxymetry; on improving saturation, NIRS returned to earlier values 10-15 s before pulse oxymetry readings. NIRS monitoring may provide an early warning with regard to complications likely to develop during a procedure. A fall of 9% in cranial NIRS values, or of 21% in renal measurements, should raise clinician awareness.

Assessment of Right Ventricular Function in Post Operative Patients of Tetralogy of Fallots and Its Predictive Factors

Introduction: Right ventricular (RV) dysfunction can occur early and late in patients after intracardiac repair (ICR) for Tetralogy of Fallots (TOF). This study focuses on early RV dysfunction as there is limited data on it. Aims & Objective: RV function was studied with respect to its incidence, course over 3 months, co-relation with peri operative factors and serum iron levels. Material & Method: All patients of TOF undergoing ICR during July 2007-October 2008, done by single surgeon at a single centre, were prospectively studied. Patients were divided into group A (with RV dysfunction) and group B (without RV dysfunction). All patients underwent pre operative & post operative clinical assessment, biochemical evaluation (serum iron profile & CK MB) and 2D echocardiography (pulse Doppler & tissue Doppler). Echocardiography was done at 24 hours, 4 weeks & 12 weeks of ICR. Patients were also assessed for intra operative parameters including cross clamp time, by pass time, acidosis, RV and PA pressures. Results: 24 patients underwent ICR (transannular patch repair) with mean age of 7.31 ± 4.74 years. RV dysfunction was present in 13 patients (54.2%) but was persistent only in 15.3% (2/13) at 12 weeks. Presence of cyanotic spell (p = 0.006), recurrent chest infection (p = 0.002), raised heamatocrit (p = 0.02), and rise in serum iron level (p = 0.002) were significantly associated with post operative RV dysfunction. It resulted in prolong ICU stay and slower recovery. Pre operative RV dysfunction was associated with difficult weaning from bypass and poor post operative outcome (p < 0.001). Conclusion: RV dysfunction is commonly present even after satisfactory ICR. Its aetiology remains unclear in such setting. In our study, pre operative clinical profile and serum iron fluctuations were important determinants of post operative outcome.