Surgery For Ventricular Septal Defect Research Articles

Mediastinitis caused by an NDM-1 Escherichia coli in a child with Dacron Sano shunt after pulmonary atresia with ventricular septal defect surgery treated with combination of aztreonam-avibactam

Carbapenem-resistant Enterobacterales are being reported increasingly and cause nosocomial infections, which may include postoperative mediastinitis. This paper reports a case of postoperative mediastinitis caused by an Escherichia coli NDM-1 carbapenemase producer in a 13-month-old boy with DiGeorge syndrome. The infection was managed with surgical debridement and antibiotherapy with aztreonam, ceftazidime-avibactam and IV fosfomycin for 6 weeks. The evolution was favourable, without relapse over 10 weeks of follow-up.

Evaluate the results of anesthesia and resuscitation of minimally invasive surgery for pediatric patients with ventricular septal defect at Cardiovascular Center, E hospital in 2022

Objective: Minimally invasive surgery has recently been implemented safely and effectively on children. The study aimed to evaluate the results of anesthesia and resuscitation in pediatric patients with ventricular septal defects (VSD) undergoing minimally invasive surgery. Methods: A cross-sectional study from January 1, 2021 to June 30, 2022 on 65 patients underwent minimally invasive surgery to repair ventricular septal defect, at Cardiovascular Center, E Hospital. Result: A toltal of 65 children aged from 1 month to 34 months, mean weight of 9.0 ± 6.3kg, mean height of 73.6 ± 22.1cm, with main clinical symptoms of slow weight gain (62.5%) and grade I heart failure (87.7%). The most common VSD location was perimembranous VSD (67.7%) with an mean size of 5.7±2.6 mm. The mean surgical time was 175 minutes with cardiopulmonary bypass time and aortic cross-clamp time of 77.5 and 53.0 minutes, respectively. Postoperative hemodynamic parameters changed statistically significantly compared to pre-operation: blood pressure decreased, heart rate increased, lactate level increased, P/F ratio decreased, blood potassium level decreased. The patient mainly needed to use 1 vasopressor, 1 type of sedative analgesic, continuous diuresis, and prophylactic antibiotics with a vasopressor withdrawal time of 34.2 hours, a sedation withdrawal time of 13.35 hours, and a sedative withdrawal time of 13.35 hours. Intubation time of 20.8 hours (minimum 2 hours) and length of stay ICU was 3.8 days. Postoperative complications were low, mainly pneumonia (9.2%) and residual shunt (9.2%), and no death was observed. Conclusion: Minimally invasive ventricular septal defect surgery showed that the anesthesia and surgical process did not change much, with relatively fast post-operative recovery results, short medication time, quick recovery, and no recording severe complications.

Effect of Ciprofol on Left Ventricular Myocardial Strain and Myocardial Work in Children Undergoing Cardiac Surgery: A Single-center Double-blind Randomized Noninferiority Study

ObjectiveTo compare the effect of ciprofol and propofol on left ventricular (LV) systolic function and myocardial work by noninvasive speckle-tracking echocardiography (STE) in children undergoing surgical repair of atrial septal defect (ASD) or ventricular septal defect (VSD). DesignSingle-center double-blind randomized non-inferiority study. SettingAt a tertiary care center affiliated to Shanghai Jiao Tong University, China. ParticipantsOne hundred and twelve children aged 1 month to 16 years old undergoing ASD or VSD surgery with cardiopulmonary bypass. InterventionsOne hundred and twelve children were allocated randomly into receiving ciprofol (n = 67) and propofol (n = 45) in a 1.5:1 ratio. Ciprofol or propofol were IV infused at loading doses of 0.4 mg/kg or 2.0 mg/kg respectively over 30 seconds depending on the physical condition of each patient. When the bispectral index was maintained between 45 - 55 after induction, transthoracic echocardiography including apical two-chamber, three-chamber and four-chamber views were collected at bedside. Measurements and Main ResultsOf total 112 patients enrolled, 104 completed the study. The global longitudinal strain (GLS) of ciprofol and propofol groups after anesthesia was -17.3% (95% CI, -18.0% to -16.6%) and -17.8% (-18.7 to -17.0%) in the full analysis set (FAS) and -17.5% (95% CI, -18.2% to -16.9%) and -17.8% (-18.7% to -17.0%) in the per-protocol set (PPS) respectively. The noninferiority margin was set as 2% and confirmed with a lower limit of two-sided 95% CI for the inter-group difference of 1.58% and 1.34% in the FAS and PPS. There were no significant differences between two groups in LV systolic and diastolic function and myocardial work indices. Postoperative vasoactive-inotropic score, NT-proBNP, duration of mechanical ventilation, length of stay in cardiac intensive care unit and hospital were also comparable between two groups (all p > 0.05). ConclusionsCiprofol did not show different effect from propofol on myocardial function and postoperative outcomes. Furtherly on sensitive cardiac systole marker GLS, ciprofol had noninferiority to propofol. Ciprofol might be alternative solution for cardiac anesthesia in CHD children with mild lesion.

Preliminary Results of Ventricular Septal Defect Surgery in Festoc Center in Bamako

Interventricular septal defects are dehiscences of the interventricular septum connecting the systemic and pulmonary circulations. The aim of this study is to report the preliminary results of the first series of intraventricular septal defects managed at the Festoc centre in Bamako. This is a mono-centric, descriptive retrospective study taking place at the FESTOC Centre in the period from 10 September 2018 to 30 April 2023. Patients of any age and sex, operated for IVC were included. Patients operated abroad were not included. We recorded 74 cases of IVC, i.e. 23.19% out of 300 cases. 61% of the patients were male, with a sex ratio of 1.56. The average age was 11 years. Symptoms were dominated by dyspnoea and recurrent bronchitis in 67.21% and 49.18% respectively. Peri-membrane and admission topography were dominant, with rates of 84% and 10%

Post-infarction ventricular septal defect surgery in Portugal

Introduction and ObjectiveWe performed a collective analysis of a dedicated national post-myocardial infarction ventricular septal defect (VSD) registry to further elucidate controversial areas of this clinical entity's surgical treatment. MethodsA descriptive statistical analysis was carried out and cumulative survival using the Kaplan-Meier method and multivariate logistic regression of risk factors for 30-day mortality are presented. ResultsMedian survival of the cohort (n=76) was 72 months (95% CI 4–144 months). Better cumulative survival was observed in patients who underwent VSD closure more than 10 days after myocardial infarction (log-rank p=0.036). Concomitant coronary artery bypass grafting (CABG), different closure techniques, location of the VSD, extracorporeal membrane oxygenation as bridge to closure, or intra-aortic balloon pump as bridge to closure showed no statistically significant differences at Kaplan-Meier analysis. Multivariate binary logistic regression for independent factors affecting status at 30 days showed a statistically significant effect of age (OR 1.08; 95% CI 1.01–1.15) and concomitant CABG (OR 0.23; 95% CI 0.06–0.90). ConclusionsOur results are comparable with previous reports regarding mortality, risk factors and concomitant procedures. Timing of surgery remains a controversial issue. Later closure seems to be advantageous, however, there is significant observational bias.

Lifetime Burden of Morbidity in Patients With Isolated Congenital Ventricular Septal Defect.

Background The lifetime burden of morbidity in patients with isolated congenital ventricular septal defect (VSD) is not completely described. Methods and Results In a population-based cohort study in Denmark using nationwide medical registries, we included 8006 patients diagnosed with a congenital VSD before 2018 along with 79 568 randomly selected controls from the general Danish population matched by birth year and sex. Concomitant congenital cardiac malformations and chromosomal abnormalities were excluded. Cox proportional hazard regression, Fine and Gray competing risk regression, and Kaplan-Meier survival function were used to estimate burden of morbidity, compared with matched controls. Median follow-up was 23 years (interquartile range, 11-37 years). The hazard ratio (HR) of heart failure was high in both patients with unrepaired and surgically closed VSD when compared with their corresponding matched controls (5.4 [95% CI, 4.6-6.3] and 30.5 [95% CI, 21.8-42.7], respectively). Truncated analyses with time from birth until 1 year after VSD diagnosis (unrepaired) or surgery (surgically closed) censored revealed reduced but persisting late hazard of heart failure. Similarly, the late hazard of arrhythmias and pulmonary arterial hypertension was high irrespective of defect closure. The HR of endocarditis was 28.0 (95% CI, 19.2-40.9) in patients with unrepaired defect and 82.7 (95% CI, 37.5-183.2) in patients with surgically closed defect. The increased HR diminished after VSD surgery. In general, the incidence of morbidity among patients with unrepaired VSD accelerated after the age of 40 years. Conclusions Patients with isolated congenital VSD carry a substantial burden of cardiovascular morbidity throughout life, irrespective of defect closure.

A Case of Pericardial Tamponade Induced by Protamine Neutralization and Heparin after Ventricular Septal Defect Surgery

A Case of Pericardial Tamponade Induced by Protamine Neutralization and Heparin after Ventricular Septal Defect Surgery

Vladimir Alexi‐Meskishvili (1941–2021)

Vladimir Alexi‐Meskishvili (1941–2021)

A comparison of high thoracic epidural anaesthesia versus conventional intravenous opioids in pediatric patients undergoing corrective open heart surgery for ventricular septal defect

Background: We compared high thoracic epidural anaesthesia with a combination of morphine and bupivacaine versus IV fentanyl as an alternative for perioperative pain management.Methods: Group-E: Injection Morphine 75-100 mcg/kg and Injection 0.25 % Bupivacaine 0.5 ml/kg was given via epidural catheter at insertion, Injection 0.25% Bupivacaine 0.5 ml/kg just before skin incision, and continuous infusion of Injection 0.125% Bupivacaine at 0.2 ml/kg/hr intra-operatively. Post-operative 0.1 ml/kg/hr infusion. Group F- intravenous fentanyl 2-3 mcg/Kg IV bolus given just before skin incision, followed by 1-2 mcg/Kg/hr IV fentanyl started after weaning from cardiopulmonary bypass.Results: The mean ScvO2 was comparable between the two groups during induction period but became higher in group E during bypass and post bypass period intraoperatively, and the difference in rise in ScvO2 is statistically significant with a p<0.05. The mean rSo2- C was comparable between the two groups in the first postoperative hour but group F shows higher rSo2-C postoperatively which was statistically significant. The postoperative pain was significantly lower in group E in the postoperative period (except for 4,5,6 and 40 and 48th hour).Conclusions: HTEA to paediatric patients prior to sternotomy for cardiac surgeries resulted in a much better control of haemodynamic parameters. Produces better central venous and regional tissue oxygenation during bypass and post bypass intraoperatively as compared to the patients that received only intravenous fentanyl. There was lower amount of postoperative bleeding in the HTEA group with significant reduction in requirement of post-operative ventilation and time to extubation after surgery, better post-operative pain control and overall outcome.

Outflow Ventricular Septal Defect With Aortic Regurgitation: Optimal Timing of Surgery?

BackgroundIdeal time of surgery still remains controversial in outflow ventricular septal defect (VSD) with aortic regurgitation (AR). We aimed to identify the prevalence and predictors of postoperative AR progression. MethodsA total of 154 patients with outflow VSD and AR who underwent VSD surgery between 2006 and 2012 were studied retrospectively. ResultsEighty patients with subpulmonic VSD and 74 with subaortic VSD were followed up for mean 6.32 ± 2.27 years (range, 3–12 years). Of these, 100 had trivial to mild (group A) and 54 had moderate to severe preoperative AR (group B). At follow-up, there was no significant worsening of mean residual AR grade in group A (P = .16) and subpulmonic VSD of group B (P = .083). However, AR grade worsened significantly in subaortic VSD (1.85 ± 0.87 vs 2.21 ± 1.08, P = .005) of group B. Only 2 (both had subaortic VSD) patients of group A developed moderate AR and none required aortic valve replacement (AVR), while 23 (42.60%) of group B patients developed moderate or severe AR and 7 (30.4%) of them required AVR. Moreover, all who needed AVR had subaortic VSD and had undergone valvuloplasty during VSD closure. The 10 years freedom from moderate or severe AR was significantly lower in group B than group A in both VSDs (subaortic VSD 42.5% ± 10.7% vs 89.3% ± 8.1%, P < .01; subpulmonic VSD 66.7% ± 10.3% vs 100%, P< .01). On multiple regression analysis, postoperative residual AR was the only predictor of AR progression (standardized coefficient, 0.48; P < .001) at follow-up. ConclusionsMild preoperative AR rarely progressed after VSD repair. However, worsening of AR could not be prevented effectively, even with valvuloplasty, after the development of moderate or severe AR. Mild or more postoperative residual AR requires close follow-up, especially in subaortic VSD.

Determinants of Physical Fitness in Children with Repaired Congenital Heart Disease.

The aim of this study was to determine factors associated with physical fitness (PF) in children who underwent surgery for congenital heart disease (CHD). Sixty-six children (7-14years) who underwent surgery for ventricular septal defect (n = 19), transposition of great arteries (n = 22), coarctation of aorta (n = 10), and tetralogy of Fallot (n = 15) were included. All children performed PF tests: cardiorespiratory fitness, upper- and lower-limb muscle strength, speed, balance, and flexibility. Cardiac evaluation was done via echocardiography and cardiopulmonary exercise test. Factors related to child's characteristics, child's lifestyle, physical activity motivators/barriers, and parental factors were assessed. Linear regression analyses were conducted. The results showed no significant differences in physical activity (PA) level by CHD type. Boys had better cardiorespiratory fitness (difference = 1.86ml/kg/min [0.51;3.22]) and were more physically active (difference = 19.40min/day [8.14;30.66]), while girls had better flexibility (difference = -3.60cm [-7.07;-0.14]). Physical activity motivators showed an association with four out of six PF components: cardiorespiratory fitness, coefficient = 0.063 [0.01;0.11]; upper-limb muscle strength, coefficient = 0.076 [0.01;0.14]; lower-limb muscle strength, coefficient = 0.598 [0.07;1.13]; and speed, coefficient = 0.03 [0.01;0.05]. Age, sex, and motivators together reached a maximum adjusted R2 = 0.707 for upper-limb strength. Adding other possible determinants did not significantly increase the explained variance. Apart from age and sex as non-modifiable determinants, the main target which might improve fitness would be the introduction of an intervention which increases the motivation to be active.

探讨影响室间隔缺损术后恢复的危险因素

探讨影响室间隔缺损术后恢复的危险因素

Outcome of Preoperative Administration of Oral Ambrisentan on Pulmonary Hypertension After Cardiac Surgery for VSD

Background: There is significant difference between the survival of patient with and without post-operative pulmonary arterial hypertension (PAH). This study was designed to see the early post-operative outcomes of PAH after preoperative oral administration of ambrisentan.&#x0D; Objective: Evaluation of role of preoperative oral ambrisentan for the management of PAH following cardiac surgery for ventricular septal defect (VSD) with moderate to severe PAH.&#x0D; Materials and Methods: A total of 54 patients were stratified into two equal groups (n=27) depeding upon receiving of orala mbisentan. Ambrisentan group received dose of 2.5mg and 5mg in two divided doses for weight &lt;20kg and &gt; 20 kg respectively at least two weeks before surgery.&#x0D; Results: PASP was measured peroperatively before establishment of CPB, immediately after VSD closure and after weaning from CPB which were 59.55±11.16 mm of Hg, 45.49±9.46 mm of Hg and 40.49 ±10.33 mm of Hg respectively in the ambrisentan group (Group-A) and was 71.92 ±10.62 mm of Hg, 66.34±10.22 mm of Hg and 62.14 ±9.46 mm of Hg respectively in the control group (Group-B) with a p value of 0.002, 0.001 and 0.001 respectively. Considering PASP on echocardiogram at 7th post-operative day was 33.55 ± 1.23 in ambrisentan group and 41.70 ± 5.60 in control group. At one month PASP on echocardiogram was 30.55±2.26 in ambrisentan group and 39.11 ±3.28 in control group.&#x0D; Conclusion: Preoperative oral administration of ambrisentan is more effective in control of postoperative PAH and may be advised in every patients with VSD with moderate to severe PAH.&#x0D; KYAMC Journal Vol. 11, No.-1, April 2020, Page 36-41

Acute Change in Ventricular Contractility-Load Coupling After Corrective Surgery for Congenital Heart Defect: A Retrospective Cohort Study

Ventricular performance and its loading condition change drastically after surgical correction of congenital heart defect. Pressure–volume loops analysis can provide quantitative information about ventriculo-arterial coupling (VAC) indicating the interaction between ventricular contractility and loading condition. Therefore, we investigated changes in VAC after corrective surgery for ventricular septal defect (VSD)/tetralogy of Fallot (TOF), and implication of ventriculo-arterial decoupling as a prognostic factor of post-operative outcomes. In children with VSD/TOF, pre- and post-operative arterial elastance (Ea), end-systolic ventricular elastance (Ees) and VAC (Ea/Ees) were non-invasively estimated using echocardiographic parameters. Post-operative outcomes included maximum vasoactive-inotropic score, the duration of mechanical ventilation and hospital stay. Preoperatively, patients with VSD had significantly lower Ea and Ees than patients with TOF; however, VAC were preserved in both. In patients with VSD, post-operative Ea increased disproportionately to change in Ees, resulting in increased VAC. Post-operative higher VAC in patients with VSD was independently associated with maximum vasoactive-inotropic score (odds ratio [OR] 63.9; 95% Confidence Interval [CI] 4.0–553.0; P = 0.003), prolonged mechanical ventilation (OR 6.3; 95% CI 1.1–37.8; P = 0.044) and longer hospitalization (OR 17.6; 95% CI 1.6–187.0; P = 0.018). In patients with TOF, Ea and Ees reduced post-operatively; however, VAC remained unchanged and was not associated with post-operative outcomes. Despite of different loading condition, preoperative VAC maintained in both of VSD and TOF. However, particularly in VSD patients, abrupt increase in post-operative loading state induces contractility-load decoupling, which leads to worse post-operative outcomes.

Physical Fitness and Metabolic Syndrome in Children with Repaired Congenital Heart Disease Compared with Healthy Children

To determine whether children who underwent surgery for congenital heart disease (CHD) are as fit as their peers. We studied 66 children (6-14 years) who underwent surgery for ventricular septal defect (n = 19), coarctation of aorta (n = 10), tetralogy of Fallot (n = 15), and transposition of great arteries (n = 22); and 520 healthy children (6-12 years). All children performed physical fitness tests: cardiorespiratory fitness, muscular strength, balance, flexibility, and speed. Metabolic score was assessed through z-score standardization using 4 components: waist circumference, blood pressure, blood lipids, and insulin resistance. Assessment also included self-reported and accelerometer-measured physical activity. Linear regression analyses with group (CHD vs control) as a predictor were adjusted for age, body mass index, physical activity, and parental education. Measured physical activity level, body mass index, cardiorespiratory fitness, flexibility, and total metabolic score did not differ between children with CHD and controls, whereas reported physical activity was greater in the CHD group than control group. Boys with CHD were less strong in upper muscular strength, speed, and balance, whereas girls with CHD were better in lower muscular strength and worse in balance. High-density lipoprotein was greater in boys and girls with CHD, whereas boys with CHD showed unhealthier glucose homeostasis. Appropriate physical fitness was achieved in children after surgery for CHD, especially in girls. Consequently, children with CHD were not at increased total metabolic risk. Lifestyle counseling should be part of every patient interaction.

Impaired cardiac output during exercise in adults operated for ventricular septal defect in childhood: a hitherto unrecognised pathophysiological response.

Recent studies have demonstrated that surgical ventricular septal defect closure in childhood is associated with reduced functional capacity and disruption of the right ventricular force-frequency relationship during exercise. To further describe long-term cardiac function, we performed a non-invasive assessment of cardiac index during exercise in adults having undergone surgery for ventricular septal defect in early childhood. A total of 20 patients (surgical age 2.1±1.4 years, age at examination 22.1±2.2 years) and 20 healthy, matched controls (23.4±2.1 years at examination) underwent continuous supine bicycle ergometry during MRI. Their blood flow was recorded in the ascending aorta and the pulmonary trunk at increasing exercise levels. Cardiac index, retrograde flow, and vessel diameters were determined by blinded, post hoc analyses. The patient group had normal cardiac index at rest (2.9±0.7 L/minute/m2), which was comparable with that of the controls (3.0±0.6 L/minute/m2); however, they had a lower increase in cardiac index during exercise (reaching 7.3±1.3 L/minute/m2 at submaximal exercise) compared with controls (8.2±1.2 L/minute/m2), p<0.05. Patients had a significantly higher ascending aorta retrograde flow than controls at rest and throughout exercise. In the pulmonary artery, the retrograde flow was minimal at rest in both groups, but increased significantly in patients during exercise compared with controls. Young adults with a surgically closed ventricular septal defect have a reduced cardiac index during exercise compared with healthy, young adults. The impaired cardiac index appears to be related to an increasing retrograde flow in the pulmonary artery with progressive exertion.

Hemolysis During Open-Heart Surgery With Vacuum-Assisted Venous Drainage at Different Negative Pressures in Pediatric Patients Weighing Less Than 10 kilograms.

This study examined the degree of hemolysis during vacuum-assisted venous drainage at different negative pressures to identify an adequate negative pressure that provides effective venous drainage without significant hemolysis in open-heart surgery in children weighing less than 10 kg. Patients weighing less than 10 kg who underwent surgery for ventricular septal defect or atrial septal defect from 2011 to 2014 were enrolled. We used one of four negative pressures (20, 30, 40, or 60 mm Hg) for each patient. We measured haptoglobin, plasma hemoglobin, aspartate aminotransferase, and lactate dehydrogenase levels in the patients' blood three times perioperatively and determined the potential correlation between the change in each parameter with the level of negative pressure. Forty-six patients were enrolled in this study (mean age: 7.1 ± 7.0 months, mean body weight: 6.1 ± 1.8 kg). There were no significant differences according to the degree of negative pressure with respect to patient age, body weight, cardiopulmonary bypass (CPB) time, aorta cross-clamping time, blood flow during CPB, or lowest body temperature. All parameters that we measured reflected progression of hemolysis during CPB; however, the degree of change in the parameters did not correlate with negative pressure. In pediatric patients weighing less than 10 kg, the change in the degree of hemolysis did not differ with the amount of negative pressure. We may apply negative pressures up to 60 mm Hg without increasing the risk of hemolysis, with almost same the level of hemolysis using negative pressures of 20, 30, and 40 mm Hg for effective venous drainage and an ideal operative field during open-heart surgery.

Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery.

Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α) playing an active role in this process. This research was to investigate the effects of pre-operative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery. Controlled clinical study. This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL) level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF); at the 5(th) minute of cross-clamping (Per TNF); 2 hours after termination of cardiopulmonary bypass (Post TNF); and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF). The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05). The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05). There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect patients operated in cardiac surgery with cardiopulmonary bypass. (ClinicalTrials.gov Identifier: TCTR20150930001).

Investigating the Impacts of Preoperative Steroid Treatment on TNF-α and Duration of Extubation Time Underwent Ventricular Septal Defect Surgery

Investigating the Impacts of Preoperative Steroid Treatment on TNF-α and Duration of Extubation Time Underwent Ventricular Septal Defect Surgery

Effect of age difference of cerebral oxygen saturation to predict early outcome in pediatric cardiac surgery for ventricular septal defect

Effect of age difference of cerebral oxygen saturation to predict early outcome in pediatric cardiac surgery for ventricular septal defect