Systemic to pulmonary shunting in 93 cyanotic neonates

Background: Systemic to pulmonary shunting is still the main palliation option in many neonates with cyanotic heart disease

Design: A Retrospective Study

Setting: The Mohammed bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain Defence Force Hospital, Bahrain

Method: All infants from January 1995 to December 2008 who had undergone systemic to pulmonary shunting procedures were included in the study

Result: Ninety-three infants underwent 108 shunt type procedures, 39 females and 54 males. One hundred five Modified Blalock-Taussig Shunts [MBTS] and three classic Blalock-Taussig shunts were performed. Tetralogy of Fallot/Double Outlet Right Ventricle [DORV] with right ventricular outflow tract obstruction was the most common diagnosis, 51 [55%]. Early postoperative mortality was 1 [1%]. Late postoperative mortality was 4 [4%]; sepsis was the major cause. Early [<1 month postoperatively] shunt failure/occlusion occurred in 6 [6%] patients. Under 14 days of age at the time of shunting and shunt size of 5mm [18% versus 4.6%] were risk factors for early shunt occlusion/failure. Eight [8%] patients required late shunt revision at two months to 5 years post initial shunting. Fifty-one patients had undergone final corrective surgery

Conclusion: MBTS shunting provides effective and safe palliation in small infants with complex cyanotic heart disease. Early shunting [<14 days of age], and 5mm shunt size are additional risk factors for early shunt failure

Large atrial septal defects in adolescents and adults: a high incidence of sinus venosus type defects presenting late

Background: Isolated Atrial Septal Defect [ASD] is a common congenital heart disease that could present at any age. It is the most common form of heart disease presenting in adolescents and adults

Objective: To evaluate adolescents and adults presenting late with significant ASD's and their presentation, management and short-term outcomes

Design: A Retrospective Study

Setting: Mohammed Bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain

Method: A retrospective study was performed. Adolescents/adults more than 14 years of age with significant ASD referred to a tertiary cardiology unit over a three-year period were reviewed from 1 March 2012 to 31 March 2015. The data was obtained from a computerized database

Result: Thirty-two patients presented with large ASD. Twenty-five [78.1%] were females. The mean age was 29.4 years. The majority were diagnosed as an incidental finding of murmur during routine examination. A high number of Sinus Venosus Defects in the adolescent/adult group [22% compared to 7% in the pediatric group: P=0.01] was found, which were more common in males [42% compared to 17%: P=0.128]. Nine [28.1%] underwent successful device closure. Twenty three [71%] patients were referred for surgical correction. There was no mortality

Conclusion: Significant ASD is often undiagnosed until adolescence or adulthood. If not promptly diagnosed and managed, it is likely to present with symptoms and signs of pulmonary overload later in life. Sinus Venosus ASD's should be suspected in male adolescents and adults with significant ASD's in Bahrain and surgical closure is often required

Potential risk factors for surgical site infection after isolated coronary artery bypass grafting in a Bahrain cardiac centre: a retrospective, case-controlled study

Objective: The purposes of this study were to determine the incidence of surgical site infections [SSI] and associated risk factors in patients undergoing isolated coronary artery bypass grafting [CABG] in our cardiac center during a 2?year period

Materials and Methods: Retrospective case-control analysis for 80 patients who underwent isolated cardiac surgery CABG. These patients were divided into the SSI study group [n = 40] and the noninfected control group [n = 40]. Eight potential perioperative risk variables were compared between the two groups using univariate logistic regression analysis

Results: Univariate analysis was carried out for eight potential risk factors. The risk factors found to be significant were: Impaired estimated glomerular filtration rate [P = 0.011] and impaired left ventricular ejection fraction [P = 0.015]. However, Factors found to have no significant influence on the incidence of SSIs were: Perioperative length of hospital stay [days], urgency of surgery, use of bilateral internal mammary artery [BIMA] grafting, prolonged cardiopulmonary bypass duration, elevated body mass index

Conclusion: Patients with comorbidities of impaired renal function and/or impaired left ventricular systolic function are at high risk of developing SSI. There appears to be a relationship between SSIs in CABG patients and impaired renal or LV function [low ejection fraction]. CABG with BIMA grafting could be performed safely even in diabetics. Future studies should consider further scrutiny of these and other factors in relation to SSIs in a larger surgical population