ABSTRACT
Background and Aim: Aortic valve [AV] prolapse and subsequent aortic regurgitation [AR] are two complications of ventricular septal defects [VSD] that are located close to or in direct contact with the AV. This finding is one of the indications for surgical VSD closure even in the absence of symptoms to protect the AV integrity. The goal of our study was to assess the outcome and to identify the predictors for improvement or progression of AR after surgical repair
Materials and Methods: A retrospective study of all children with VSD and AV prolapse who underwent cardiac surgery at King Abdulaziz Cardiac Centre in Riyadh between July 1999 and August 2013
Results: A total of 41 consecutive patients, operated for VSD with prolapsed AV, with or without AR, were reviewed. The incidence of AV prolapse in the study population was 6.8% out of 655 patients with VSD. Thirty six [88%] patients had a perimembranous VSD, and four had doubly committed VSD. Only one patient had an outlet muscular VSD. Right coronary cusp prolapse was found in 38 [92.7%] patients. Preoperative AR was absent in five patients, mild or less in 25 patients, moderate in seven, and severe in four patients. Twenty six patients showed improvement in the degree of AR after surgery [Group A], 14 patients showed no change in the degree of AR [Group B] while only one patient showed the progression of his AR after surgery. Those with absent AR before surgery remained with no AR after surgery. Improvement was found more in those with mild degree of AR preoperatively compared to those with moderate and severe AR. Female gender also showed a tendency to improve more as compared to male
Conclusion: Early surgical closure is advisable for patients with VSD and associated AV prolapse to achieve a better outcome after repair and to prevent progression of AR in future
ABSTRACT
Background: Intraoperative transesophageal echocardiography [TEE] has a major role in detecting residual lesions during and/or after pediatric cardiac surgery
Methods: All pediatric patients who underwent cardiac surgery between July 2001 and December 2008 were reviewed. The records of surgical procedure, intraoperative TEE, and predischarge transthoracic echocardiograms were reviewed to determine minor and major residual cardiac lesions after surgical repair
Results: During the study period, a total of 2268 pediatric cardiac patients were operated in our center. Mean age was 21 months [from 1 day to 14 years]. Of these patients, 1016 [48%] had preoperative TEE and 1036 [46%] were evaluated by intraoperative echocardiography [TEE or epicardial study]. We identified variations between TEE and preoperative transthoracic echocardiography in 14 patients [1.3%]. Only one surgical procedure was cancelled after atrial septal defect exclusion. The other 13 patients had minor variation from their surgical plan. Major residual lesions requiring surgical revision were detected in 41 patients [3.9%], with the following primary diagnoses: tetralogy of Fallot in 12 patients [29%], atrioventricular septal defect in seven patients [17%], ventricular septal defect in seven patients [17%], double outlet right ventricle in two patients [5%], Shone complex in two patients [5%], subaortic stenosis in two patients [5%], mitral regurgitation in two patients [5%], pulmonary atresia in two patients [5%], and five patients [12%] with other diagnoses
Conclusion: Intraoperative TEE has a major impact in pediatric cardiac surgery to detect significant residual lesions. Preoperative TEE has a limited role in case of a high quality preoperative transthoracic echocardiography. We recommend routine use of intraoperative TEE during and/or after intracardiac repair in children
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Thoracic Surgery , Pediatrics , Intraoperative Care , Heart Defects, CongenitalABSTRACT
To review the experience with Norwood and Damus-Kaye-Stansel [DKS] staged repair in the management of hypoplastic left heart syndrome [HLHS], or functional single ventricle [FSV] with systemic outflow tract obstruction [SOTO]. A retrospective study was conducted from a single center from January 2001 to September 2007 at the Cardiac Sciences Department, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. The cardiac departmental database was reviewed, together with the echocardiographic findings. Demographic data representing age and weight at operation, gender, cardiac anatomy, non-cardiac abnormalities, and operative details were collected. Twenty-eight patients with a diagnosis of HLHS were included in the study. The mean +/- SD for weight was 3.4 +/- 0.85kg and 32 +/- 37 days for age. All infants at our institution who underwent a Norwood or DKS surgery for HLHS, or other forms of FSV with SOTO were included. All included patients underwent first stage palliation consisting of either a classical Norwood procedure in 6/23 [21%] patients, or a modified Norwood with right ventricle to pulmonary artery [RV-PA] conduit in 22/28 [79%] patients. After first stage palliation, 23 patients [82%] survived, and all but one underwent second stage palliation with bidirectional cavopulmonary anastomosis [BCPA]. The survival rate after second stage repair was 91%. Subsequently, 4 patients completed a third stage Fontan with 100% survival. All deceased patients had HLHS. The Norwood procedure is applied to a heterogeneous group of patients with variable outcomes in certain subgroups. Patients with HLHS palliated with the Norwood procedure are at a greater risk for morbidity and mortality compared to those with other forms of FSV with SOTO