Treatment Of Congenital Heart Defects Research Articles

Stages of motor development in children with cyanotic congenital heart defects after surgical treatment

Background. The article deals with the actual problem of pediatric neurology, pediatric cardiology, and pediatric cardiac surgery, in particular, the peculiarities of neurodevelopment in children with congenital heart defects (CHD). The purpose is to conduct a study of stages of stato-motor development (SMD) in patients with cyanotic congenital heart defects after surgical treatment and to determine the influence of pathogenic factors on neurodevelopmental delay. Materials and methods. Thirty-five patients with cyanotic CHD underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine: 20 children — with transposition of the great vessels (TGV) and 15 children — with tetralogy of Fallot (TOF). The control group consisted of 35 healthy patients whose motor development corresponded to their age. Gestational age, body weight at birth, Apgar score, saturation, and duration of artificial blood circulation during surgical treatment for CHD were considered. Assessment of motor development was carried out with the help of the following scales: Munich Functional Developmental Diagnosis (G.J. Köhler, H.D. Egelkraut) and section 2 of the Hammersmith Infant Neurological Examination. Data were processed using the software Microsoft Excel version 16.0.12527.21236. Results. The gestational age of the studied group of patients with cyanotic CHD was 38 weeks, body weight — 3,500 g, which corresponded to the control group. Patients of the first subgroup with TGV were diagnosed with lower saturation indicators (р = 0.0001), a lower 1-minute Apgar score (p = 0.028) and a longer duration of artificial blood circulation — 146.00 ± 29.03 (р = 0.043) compared to the second subgroup with TOF. SMD delay was diagnosed in 29 % of cases, namely 12 % with TGV and 17 % with TOF. The average period of sitting with delayed SMD was 8.4 ± 2.2 months (p = 0.002), walking — 18.4 ± 6.3 months (p = 0.0001). Subsequently, children with TGV continue to develop without a significant delay compared to the TOF subgroup. Conclusions. 1. Patients with cyanotic CHD are born at 38 weeks of gestation, with sufficient body weight without a significant difference depending on the type of CHD and compared to the control group of healthy children. The predominance of the male gender is typical in cyanotic CHD. However, children with transposition of the great vessels are characterized by a lower 1-minute Apgar score and lower indicators of saturation at birth compared to those with tetralogy of Fallot. 2. Based on the conducted study, a delay of SMD was found in 29 % of patients with cyanotic CHD, namely 17 % with TOF and 12 % with TGV. The average duration of sitting with delay was 8.4 ± 2.2 months and walking was 18.4 ± 6.3 months. 3. Surgical treatment was carried out according to the detected indications, for transposition of the great vessels on the first day and for tetralogy of Fallot at 8 months of life. No pathogenic influence of the duration of artificial blood circulation and aortic clamping during cardiosurgical treatment on SMD in children was found. An increase in the duration of artificial blood circulation was noted during arterial switch operation in children with TGV, but no significant difference was found in children with SMD delay. 4. Timely early surgical treatment of critical CHD — TGV on the first day after birth, a developed route for pregnant women, techniques of performing operations — ensure a better SMD of this subgroup in the future. In patients with TOF, taking into account the long period of hypoxia before the start of surgical correction, neuropsychiatric disorders of varying degrees are more often noted. The development of an individual rehabilitation program is provided for this category of children.

Pulmonary hypertension in adults with congenital heart disease in light of the 2022-ESC-PAH guidelines - Part II: Supportive therapy, special situations (pregnancy, contraception, non-cardiac surgery), targeted pharmacotherapy, organ transplantation, special management (shunt lesions, left ventricular disorders, univentricular hearts), interventions, intensive care, follow-up, future perspectives

The number of adults with congenital heart defects (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary hypertension (PH), which may develop early in untreated CHD. Despite timely treatment of CHD, PH not infrequently persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart disease" is addressed only relatively superficial in these guidelines. Therefore, in the present article, this topic is commented in detail from the perspective of congenital cardiology.

Biomarkers and predictors of postoperative necrotizing enterocolitis in neonates with duct-dependent congenital heart defects undergoing cardiac surgery: a cohort study

The development of necrotizing enterocolitis (NEC) in neonates with duct-dependent congenital heart defects (CHD) who underwent cardiac surgery is accompanied by high mortality. Analysis of predictors is necessary for understanding the pathophysiology of NEC and development of approaches for prevention to achieve favorable outcomes of cardiac surgery. The purpose of the study was to develop a prognostic model for predicting the development of NEC after cardiac surgery in neonates with duct-dependent CHD. Methods. A prognostic cohort study was performed that included full-term neonates with duct-dependent CHD who underwent cardiac surgery at the Almazov National Medical Research Center from January 2021 to September 2023. The outcome was the development/absence of stage IB-III NEC in the postoperative period. Biomarkers of NEC (intestinal fatty acid binding protein (i-FABP, ng/ml), claudin-3 (CLDN3, ng/ml), calprotectin (CALPR, ng/ml), ischemia modified albumin (IMA, ng/ml), vascular endothelial growth factor A (VEGF A, pg/ml)) were measured by ELISA in the blood serum before cardiac surgery and 12-14 hours after surgery. We also analyzed clinical characteristics of neonates, C-reactive protein levels, complete blood count, abdominal ultrasound, ejection fraction (EF, Teicholtz) in the preoperative and postoperative periods, surgical parameters, P(v-a)CO2/C(a-v)O2 upon arrival from the operating room, vasoactive inotropic score (VIS) and arterial blood lactate levels in the first 24 hours after surgery. The association between predictors and the development of NEC after cardiac surgery was assessed using univariate and multivariate logistic regression analysis. Internal validation of the model was performed using 10-fold cross-validation. Results. During the observation period, 187 neonates underwent surgical treatment of duct-dependent CHD, of which 32 children developed stage IB-III NEC in the postoperative period (17.1%), two neonates required surgical treatment of NEC (6.3%). After meeting the non-inclusion and exclusion criteria, two groups of patients were formed: a main group (30 neonates who developed stages IB-III NEC in the postoperative period, of which stage III NEC was in one neonate) and a comparison group (40 neonates without NEC). Groups were comparable by types of CHD. Predictors associated with NEC (univariate analysis): intrauterine growth retardation (IUGR), formula feeding before surgery, high levels of IMA before on the first postoperative day (POD), procedures performed before surgery (Rashkind procedure/valvuloplasty/stenting), lower EF in in the early postoperative period, a higher maximum level of VIS in the first 24 hours after surgery, as well as a higher level of IR in the superior mesenteric artery (SMA) and thickening of the intestinal wall on the first postoperative day (POD) Independent preoperative predictors of NEC (AUC of model 0.885, specificity 0.867): IUGR (OR 32.2 (1.4-730.3), p=0.029), formula feeding (OR 12.6 (2.6-60.2), p=0.002), IMA level before surgery (OR 1.03 (1.01-1.04), p=0.004), CLDN3 level before surgery (OR 0.5 (0.3-0.9), p=0.013). Independent early postoperative predictors of NEC: IMA level on 12-14 hour after surgery (OR 1.02 (1.01-1.03), p=0.030), P(v-a)CO2/C(a-v)O2 immediately after surgery (OR 2.3 (1.2-4.4), p=0.008), IR>0.93 in SMA (OR 7.2 (1.6-32.4), p=0.011) and thickness of intestinal wall by ultrasound on POD 1 (OR 4.9 (1.3-19.2), p=0.021). Adding of VEGF A level (12-14 hour after surgery, negatively associated with NEC) to the model increased the specificity, but the predictor was not significant. AUC of postoperative model 0.862, specificity 0.800. The final model included preoperative (IUGR, formula feeding) and postoperative predictors (IMA, P(v-a)CO2/C(a-v)O2, IR of SMA>0.93, intestinal wall thickness), AUC=0.921, specificity 0.83. Conclusion. The identified predictors indirectly indicate the role of hypoxia in the pathophysiology of NEC in term neonates with duct-dependent CHD. Breast milk feeding/mixed feeding in the preoperative period may help reduce the risk of NEC in the postoperative period. Low levels of CLDN3 before surgery were associated with the development of NEC, but the interpretation of the result is controversial.

Growth capacity of a Wharton's Jelly derived mesenchymal stromal cells tissue engineered vascular graft used for main pulmonary artery reconstruction in piglets.

Background: Surgical treatment of congenital heart defects affecting the right ventricular outflow tract (RVOT) often requires complex reconstruction and multiple reoperations due to structural degeneration and lack of growth of currently available materials. Hence, alternative approaches for RVOT reconstruction, which meet the requirements of biocompatibility and long-term durability of an ideal scaffold, are needed. Through this full scale pre-clinical study, we demonstrated the growth capacity of a Wharton's Jelly derived mesenchymal stromal cells (WJ-MSC) tissue engineered vascular graft used in reconstructing the main pulmonary artery in piglets, providing proof of biocompatibility and efficacy. Methods: Sixteen four-week-old Landrace pigs were randomized to undergo supravalvar Main Pulmonary Artery (MPA) replacement with either unseeded or WJ-MSCs-seeded Small Intestinal Submucosa-derived grafts. Animals were followed up for 6months by clinical examinations and cardiac imaging. At termination, sections of MPAs were assessed by macroscopic inspection, histology and fluorescent immunohistochemistry. Results: Data collected at 6months follow up showed no sign of graft thrombosis or calcification. The explanted main pulmonary arteries demonstrated a significantly higher degree of cellular organization and elastin content in the WJ-MSCs seeded grafts compared to the acellular counterparts. Transthoracic echocardiography and cardiovascular magnetic resonance confirmed the superior growth and remodelling of the WJ-MSCs seeded conduit compared to the unseeded. Conclusion: Our findings indicate that the addition of WJ-MSCs to the acellular scaffold can upgrade the material, converting it into a biologically active tissue, with the potential to grow, repair and remodel the RVOT.

Left atrial strain in fetal echocardiography- could it be introduced to everyday clinical practice?

Prenatal cardiology is a part of preventive cardiology based on fetal echocardiography and fetal interventional cardiology, which facilitates treatment of congenital heart defects (CHD) in pediatric patients and consequently in adults. Timely prenatal detection of CHD plays a pivotal role in facilitating the appropriate referral of pregnant women to facilities equipped to provide thorough perinatal care within the framework of a well-structured healthcare system. The aim of this paper is to highlight the role of left atrial strain (LAS) in prenatal evaluation of fetal heart and prediction of structural and functional disorders. We conducted a comprehensive literature review searching PubMed for articles published from inception up until August 2023, including the search terms "left atrial strain", "fetal echocardiography", and "prenatal cardiology" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. Our review underscores the significance of LAS parameters in fetal echocardiography as a screening tool during specific gestational windows (starting from 11 to 14 weeks of gestation, followed by better visualization between 18 and 22 weeks of gestation). The left atrial strain technique and its parameters serve as valuable indicators, not only for identifying cardiac complications but also for predicting and guiding therapeutic interventions in cases of both cardiac and noncardiac pregnancy complications in fetuses. Evidence suggests establishment of second-trimester reference strain and strain rate values by speckle-tracking echocardiography in the healthy fetal cohort is essential for the evaluation of myocardial pathologies during pregnancy. Finding of LAS of fetal heart is feasible and probably can have potential for clinical and prognostic implications.

Applications of EMbedding and backscattered scanning electron microscopy for morphological and functional assessment of the thymus forcedly removed in children with congenital heart defects during the first weeks of life

Thymectomy in a number of clinical situations is an unavoidable step of cardiac surgical treatment of congenital heart defects, but the issue of its effects on development of immunity in early ontogenesis remains open. There is still debates among scientists about the risk of immune deficiency states in children who underwent thymectomy at an early age. One may see completely different opinions, both in domestic and foreign publications. A tool for resolving this issue may be provided by morpho-functional studies of the removed thymic tissue by means of modern scanning electron microscopy techniques. The objective of our study was to assess the possibilities of EMbedding and backscattered scanning electron microscopy for morphological and functional evaluation of the thymus, which was forcedly removed in the infant patients with congenital heart defects over the first weeks of life. The thymus of a newborn infant (postnatal day 27) with congenital heart disease: ventricular septal defect was examined using EMbedding and backscattered scanning electron microscopy imaging after embedding in epoxy resin. The mass of thymus gland was 15.7 g, the dimensions of thymus were: transverse, 3.4 cm; longitudinal, 4.1 cm; thickness, 1.7 cm; volume, 12.4 cm3. The study showed ability of EMbedding and backscattered scanning electron microscopy in morphological and functional assessment of thymus gland considered the central organ of the immune system. Step-bystep visualization from low to high magnifications, from tissues to cells and intracellular structures, as well as layer-by-layer examination of thymic cortex, medulla, interlobular septa and vessels, allows you to effectively assess the functionality of the thymus. This research method is sufficient for scientific research of the forcedly removed thymus since it enables us to visualize its microanatomy, allowing cell phenotyping at different layers of the thymus, studying intercellular interactions of thymocytes with reticulo-epithelial cells, subtle features of Hassall’s bodies and, finally, the process of T lymphocytes’ release from thymus gland.

Editorial: Congenital Heart Defects in Pakistan: Addressing Challenges and Enhancing Care

Introduction:
 Congenital heart defects (CHDs) are a significant health concern worldwide, affecting millions of infants each year. In Pakistan, the prevalence of CHDs is alarmingly high, posing a considerable burden on the healthcare system and placing numerous families in distress. This editorial aims to shed light on the challenges associated with CHDs in Pakistan and highlight the need for improved strategies and resources to enhance the care and outcomes for affected individuals.
 
 High Prevalence:
 Pakistan witnesses a high incidence of CHDs, with estimates suggesting that around 50,000 children are born with these defects every year [1]. The exact causes for this high prevalence are not yet fully understood, but factors such as consanguineous marriages, maternal malnutrition, exposure to environmental toxins, and limited access to prenatal care may contribute to the increased occurrence [2].
 
 Challenges Faced:
 Several challenges impede the effective management of CHDs in Pakistan. Limited awareness among the general population, particularly in rural areas, hampers early detection and timely intervention. Late diagnosis often leads to complications and reduced chances of successful treatment. Moreover, the shortage of specialized pediatric cardiac centers and trained healthcare professionals further exacerbates the problem [3].
 
 Inadequate Infrastructure:
 Pakistan faces a scarcity of dedicated pediatric cardiac centers equipped with the necessary technology and facilities to diagnose and treat CHDs effectively. The existing infrastructure is insufficient to cater to the overwhelming demand, resulting in long waiting times and delayed interventions. Investment in establishing more centers with state-of-the-art equipment and skilled medical staff is essential to ensure timely and accessible care for affected children throughout the country.
 Financial Barriers:
 The cost of treating CHDs can be exorbitant, making it unaffordable for many families in Pakistan. Surgical interventions and long-term medical management impose a significant financial burden, further compounded by the lack of health insurance coverage for congenital conditions. Public and private collaborations, along with governmental initiatives, are needed to develop financial assistance programs and insurance schemes that provide necessary support to families affected by CHDs [4].
 
 Improving Awareness and Education:
 Raising awareness about CHDs is crucial in order to promote early diagnosis, timely intervention, and prevention strategies. Public health campaigns, educational programs in schools and colleges, and community outreach initiatives should be implemented to disseminate information about CHDs, their signs and symptoms, and the importance of seeking medical attention. Empowering healthcare professionals with specialized training and knowledge in pediatric cardiology is also essential to enhance the capacity for accurate diagnosis and appropriate management[5].
 
 Collaboration and Research:
 Strengthening collaboration between healthcare institutions, researchers, and policymakers is vital to tackle the challenges associated with CHDs effectively. Increased investment in research on the causes, prevention, and treatment of CHDs in the Pakistani context can lead to significant advancements in understanding the disease and developing targeted interventions. Furthermore, fostering international collaborations can facilitate knowledge exchange and promote best practices in CHD management.
 
 Conclusion:
 Congenital heart defects present a significant healthcare challenge in Pakistan, affecting a large number of children and placing a strain on families and the healthcare system. Addressing the challenges associated with CHDs requires a comprehensive approach that includes improved infrastructure, enhanced awareness, financial support, and collaborative research efforts. By investing in these areas, Pakistan can pave the way for better outcomes and improved quality of life for individuals with CHDs.

The Outcome of Congenital Cardiac Surgery in Patients with Down Syndrome: Single-Center Experience.

This study aimed to describe the outcomes of Down syndrome patients who underwent cardiac surgery for congenital heart defects and to develop risk prediction models for in-hospital mortality, recurrent hospital admission, and the need for catheter intervention among a cohort of patients. This single-centre retrospective cohort study included consecutive Down syndrome patients who underwent cardiac surgery for congenital heart defects between January 2018 and December 2021. We reviewed the electronic medical records. Two hundred patients fulfilled the eligibility criteria with complete data reporting. The patients' perioperative data and outcomes were recorded. Females constituted 56.5%. Most (78.5%) patients showed accepted recovery. The incidence of all-cause in-hospital mortality was 3.0%. The rates of the need for a second operation, heart failure management, and permanent pacemaker insertion were 3.0%, 2.0%, and 2.5%, respectively. Only 8 (4.0%) patients stayed in the hospital for a long duration after chylothorax or tracheostomy (if intubated more than 2 weeks). The model had an accuracy of 99% and included the intraoperative transesophageal echocardiography (TEE) abnormalities (residual heart lesions) (adjusted odds ratio [AOR]: 26.541, p = 0.033), the duration of mechanical ventilation following the operation (AOR: 1.152, p = 0.009), and the occurrence of postoperative heart block (AOR: 76.447, p = 0.005). Surgical treatment of congenital heart defects in Down syndrome patients had good outcomes with accepted recovery (without intra-hospital or during follow-up mortality or morbidity) of 78.5% and a 3% incidence of in-hospital mortality. Though, the occurrence of chylothorax was considerably high, and resulted in a long hospital stay (more than 10 days). Repair of tetralogy of Fallot and coarctation of the aorta were associated with an increased likelihood of catheter intervention following the operation.

#4339 CARDIORENAL SYNDROME TYPE 1 IN CHILDREN AFTER SURGICAL TREATMENT OF CONGENITAL HEART DISEASE USING CARDIOPULMONARY BYPASS

Abstract Background and Aims According to recent data, acute kidney injury (AKI) after pediatric cardiac surgery is a significant postoperative complication that occurs in 35-64% of children (1,2) and is associated with increased hospital mortality and unfavorable short-term outcomes. The problem of acute kidney injury in children after cardiac surgery remains relevant, despite the development of modern technologies and methods. Complications after pediatric cardiac surgery have serious negative consequences, prolonging the days of stay in the pediatric intensive care unit (PICU) and increasing mortality (3). The aim of the study is to analyze the frequency of AKI in children after open-heart surgery for congenital heart defects (CHD) using cardiopulmonary bypass (CBP). Method We conducted a retrospective analysis of 402 medical records of patients hospitalized in the ICU of JSC NRCSC Astana, Kazakhstan, from January 2018 to December 2022. Inclusion criteria: Children under 18 with CHD who underwent open-heart surgery with the following diagnosis - transposition of the great vessels, total anomalous pulmonary venous connection, interrupted aortic arch, coarctation of the aorta, ventricular septal defect. Exclusion criteria: The presence of AKI and terminal chronic kidney failure. Results The analysis included the total number of patients - 402 patients. The frequency of AKI was 15.6% (63 out of 402). Among the patients who developed AKI: boys - 45 (71.4%), girls - 18 (28.5%). The age distribution is as follows: children under 1 month among AKI - 50 (79.3%), under 6 months among AKI – 13 (20.6%), under 1 year among AKI – 5 (7.9%). According to the statistical analysis results, the complication depends on the type of operation, as there is a statistical significance of the differences in the groups (p = 0.046). However, the type of operation (p = 0.35) does not matter for the outcome. Also, the children's weight (p = 0.082) has no statistical significance on the number of complications and the outcome. The sex of children has a statistical significance for complications; in boys, it is significantly higher (p = 0.05). In addition, the lethal outcome in male children is higher than in girls (p = 0.000). The total number of patients with peritoneal dialysis is 63 (15.6%). The total mortality was 80 patients (19.9%). Mortality in the intensive care unit in patients with AKI after open-heart surgery for CHD was 43 (68.2%). Conclusion According to our data, the frequency of AKI developed in 15.6% of patients after surgical treatment of CHD using CBP. The overall mortality rate is 19.9%, with boys having a higher risk. Thus, the frequency of AKI is influenced by many factors before, during and after surgery. Therefore, developing preventive measures is a priority for improving the cardiac surgery results in children.

Common Congenital Heart Problems in Acute and Intensive Care.

Over the past five decades, there have been multiple advances in the treatment of congenital heart defects, resulting in an increasing population of adults living with congenital heart disease (CHD). Despite improved survival, CHD patients often have residual hemodynamic sequelae, limited physiologic reserve and are at increased risk for acute decompensation with occurrence of arrhythmias, heart failure and other medical conditions. Comorbidities occur more frequently and at an earlier age in CHD patients than in the general population. The management of the critically ill CHD patient requires an understanding of the unique aspects of congenital cardiac physiology as well as the recognition of other organ systems that may be involved. Certain patients may be candidates for mechanical circulatory support, and goals of care should be established with advanced care planning.

Evolution and interdisciplinary interaction of early childhood cardiac surgery in the Republic of Tatarstan

Surgical treatment of congenital heart defects is one of the most difficult tasks. The article shows the way of development of this direction in Kazan and in the Republic of Tatarstan. The benefits of using the ways and methods adopted in cardiac surgery for the treatment of patients in difficult clinical situations are described. The positive influence of the scientific study of medical activity on the development of the general situation is reflected.

Diagnosis and principles of treatment of congenital heart defects

Diagnosis and principles of treatment of congenital heart defects

Clinical case of successful correction of aortic coarctation with hypoplasia of the distal aortic arch in a premature infant with very low birth weight

Congenital heart disease is considered to be one of the most common diseases among congenital defects. Aortic coarctation belongs to the groupof common congenital heart defects. In the overwhelming majority of cases, it is combined with hypoplasia of the aortic arch and requires urgent surgical intervention. The absence of timely diagnosis of pathology and necessary therapy may lead to congestive heart failure, cardiogenic shock and death. Although the results of treatment of congenital heart defects in newborns have improved significantly in recent years, children with low weight are remainedto be difficult category of patients. Prematurity and low birth weight are risk factors for increased mortality and development of recoarctation in infants who have undergone surgical correction. We represent the case of successful correction of aortic coarctation with hypoplasia of the distal aortic arch in a prematured baby with very low birth weight. The diagnosis was made prenatally. The mother was recommended to be monitored at Рerinatal Сenter, Penza, where at the 35th week, an early delivery was performed because of lack of water and intrauterine fetal development delay. The body weight at birth was 1330 grams. On the same day, the child was admitted to the Federal Center of Cardiovascular Surgery, Penza, where he received the necessary surgical care. The results of dynamic observation of the patient showed the absence of recoarctation and arterial hypertension. Despite the fact that low body weight and prematurity are significant risk factors for complication and an unfavourable outcome, modern medical technologies and accumulated experience have allowed to carry out surgical correction timely and then to do successful postoperative treatment and nursing of the child with coarctation and hypoplasia of the aortic arch.

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

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

Wharton’s Jelly–Mesenchymal Stem Cell–Engineered Conduit for Pulmonary Artery Reconstruction in Growing Piglets

Surgical treatment of congenital heart defects affecting the right ventricular outflow tract often requires complex reconstruction and multiple reoperations. With a randomized controlled trial, we compared a novel tissue-engineered small intestine submucosa-based graft for pulmonary artery reconstruction (seeded with mesenchymal stem cells derived from Wharton's Jelly) with conventional small intestine submucosa in growing piglets. Six months after implantation, seeded grafts showed integration with host tissues at cellular level and exhibited growth potential on transthoracic echocardiography and cardiovascular magnetic resonance. Our seeded graft is a promising biomaterial for pulmonary artery reconstruction in pediatric patients with right ventricular outflow tract abnormalities.

ТРАНСКАТЕТЕРНАЯ ИМПЛАНТАЦИЯ КЛАПАНА ЛЕГОЧНОЙ АРТЕРИИ ПОСЛЕ ХИРУРГИЧЕСКОЙ КОРРЕКЦИИ ПУТЕЙ ОТТОКА ПРАВОГО ЖЕЛУДОЧКА: ОПЫТ ОДНОГО ЦЕНТРА

Transcatheter pulmonary valve implantation (TPVI) is a relatively new method of treating patients with right ventricular outflow tract (RVOT) dysfunction after surgical treatment of congenital heart defects. Since its introduction in 2000 by Bonhoeffer, more than ten thousand of such procedures have been performed worldwide. Currently two types of valves are available in the Republic of Belarus: Melody TPVMedtronic and Edwards Sapien. TPVI is safe and effective in the majority of patients with RVOT dysfunction and in some selected patients with patched RVOT. The low complication rate and the reduced number of open-chest re-interventions over a patient’s lifetime are among the main advantages of the procedure. The article presents a literature review, and summarizes the experience and results of TPVI performed on 24 patients in the Republican Centre of Pediatric Surgery.

Carriage of antibiotic-resistant bacteria and etiology of postoperative infectious complications in infants with congenital heart defects

Objective. To determine resistant microorganisms carriage, the frequency and etiology of postoperative infectious complications in high-risk infants with congenital heart defects (CHD). Materials and Methods. The retrospective analysis included 489 patients admitted for surgical treatment for CHD. The median age was 0.23 (0–12) months. Swabs were taken from the oropharynx and rectum for microbiological examination no later than 72 hours after admission (a total of 978 samples). The growth of resistant microorganisms (ESBL and/or carbapenemase-producing Enterobacterales, resistant non-fermentative Gram-negative bacteria, MRSA and VRE) was recorded. Results. Of 489 patients, 128 (26.2%) were colonized with resistant bacteria. The majority of patients were carriers of ESBL-producers (81.3%), in some cases (24%) with concomitant production of several carbapenemases. The rate of VRE carriage was 21.1%, in 8 cases – in combination with other resistant microorganisms. MRSA was detected in 1.6% of carriers, other multidrug-resistant microorganisms – in 3.9% of carriers. In early postoperative period, 145⁄489 (29.7%) patients developed infectious complications. The ventilator-associated respiratory tract infections were the most common. In most cases (73.8%) infectious complications were caused by ESBL producers, in 43.9% of cases those microorganisms also produced carbapenemases. Resistant non-fermentative Gram-negative bacteria caused postoperative infections in 4.8% of cases. The rates of MRSA and VRE in infants with infectious complications were 3.4% and 1.4%, respectively. There were no differences in the incidence of infectious complications in colonized and non-colonized patients – 42⁄128 (32.8%) versus 103⁄361 (28.5%), respectively (p = 0.6). Postoperative infectious complications were caused by resistant microorganisms in colonized patients significantly more often than in non-colonized patients – 41⁄42 (97.6%) and 82⁄103 (79.6%) cases, respectively (p = 0.008). Conclusions. It is confirmed the active process of the introduction of resistant microorganisms into the hospital with the possible development of complications of the corresponding etiology. Gram-negative bacteria with different mechanisms of antibiotic resistance present the greatest problem. In order to manage this process, it is advisable to screen hospitalizing patients with the implementation of the infection control measures.

Abstract 13314: Development of a Computational Fluid Dynamics Model for Assessing Hemodynamics in Aortic Arches in Human Fetuses

Background and Objective: The hemodynamics of fetal circulation and its alterations, as in cases of congenital heart defects (CHD), have been investigated in instrumented animal models or in human fetuses by noninvasive fetal echocardiography and Doppler (FED). There is little data in computational modeling of fetal circulation due to challenges in fetal cardiac imaging and the availability of validation methodologies. This study aims to develop and validate a computational model for assessing hemodynamics in aortic and ductal arches in human fetuses. Methods: Figure 1 shows our computational workflow. The process started by preparing a reconstructed 3D aortic and ductal arch anatomy derived from 3D FED. Then, the computational model was built and validated using clinical data from five human fetuses. The primary output was the velocity waveform at the aortic isthmus (AoI), validated using tracings from spectral Doppler. Results: Upon superimposing the reconstructed fetal aortic arch anatomies onto the original 3D FED stack, our results demonstrated a precise rendering of each subject’s unique vessel structure. Simulations were run for ten cardiac cycles, with each velocity waveform at the AoI showing a discrepancy of less than 15% when compared with the Doppler echocardiography tracings. These findings indicate a good agreement between our computational model and the FED data. Conclusion: This study presents the development and validation of a computational model for assessing patient-specific hemodynamics in the aortic arches of human fetuses. Continued investigation is warranted to further validate and apply this approach to improve the diagnosis, prognosis, and treatment of CHD in human fetuses.

The use of Amplatzer devices in the percutaneous treatment of congenital heart defects in children and adults based on own experience

The use of Amplatzer devices in the percutaneous treatment of congenital heart defects in children and adults based on own experience

Role of toll-like receptors in complications of cardiac surgery for congenital heart defects in children

Background. Cardiac surgery in combination with hypothermia, ischaemia and reperfusion leads to an inflammatory response causing postoperative complications. Toll-like receptors are signalling molecules through which some functions of innate immunity can be activated, and polymorphic variants in the TLR-family genes can be predictors of complications after cardiac surgery.Aim. To study the associations of TLR-family genes with infectious and non-infectious complications of cardiac surgery for congenital heart defects.Methods. The study included 89 children (44 girls and 45 boys) with congenital heart defects who underwent cardiac surgery. Complications occurred in 47 children 47 days after cardiac surgery. There were no complications in 42 children. Genotyping was performed by real-time PCR using TaqMan probes.Results. A two-locus model of gene-gene interaction between TLR1 rs5743551 and TLR2 rs3804099 was the best fit, accounting for 4.01% of phenotypic entropy. The TLR2 gene polymorphic variant rs5743708 had the highest predictive potential (2.59%).Conclusion. The development of postoperative complications of cardiac surgical treatment for congenital heart defects can be due to the synergistic effect of the polymorphic variants rs5743551 in the TLR1 gene and rs3804099 in the TLR2 gene. This effect occurs through the features of TLR1 and TLR2 transcription, the subsequent expression of receptors on cells and signalling which activates the synthesis of proinflammatory cytokines and chemokines.Received 25 February 2021. Revised 11 May 2021. Accepted 12 May 2021.Funding: The work is supported by the complex program of fundamental research of the Siberian Branch of the Russian Academy of Sciences (No. 0554-2019-0002).Conflict of interest: The authors declare no conflicts of interests.Contribution of the authorsConception and study design: A.V. Shabaldin, A.V. Ponasenko, A.V. TsepokinaData collection and analysis: A.A. Anikeenko, A.V. Tsepokina, S.A. ShmulevichStatistical analysis: A.V. Shabaldin, A.V. TsepokinaDrafting the article: A.V. Shabaldin, A.V. Tsepokina, A.V. PonasenkoCritical revision of the article: A.V. TsepokinaFinal approval of the version to be published: A.V. Tsepokina, A.A. Anikeenko, S.A. Shmulevich, A.V. Ponasenko, A.V. Shabaldin