ABSTRACT
<p>The patient was a 57-year-old woman. Even though she had received a diagnosis of tetralogy of Fallot as an student of elementary school, she did not consent to undertake surgical repair. Consequently, she had been observed until age 56, although she suffered from atrial fibrillation during this period. She decided to undergo surgical correction as she suffered from severe heart failure. The surgical repair included Maze procedure, a patch repair of ventricular septal defect, a repair of the right ventricular outflow tract and a pulmonary valve replacement. The right ventricular pressure reduced to around two-fifths of high left ventricular pressure postoperatively, and she was discharged without any complication.</p>
ABSTRACT
Fast‑track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post‑TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2–3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach.
Subject(s)
Airway Extubation/methods , Child , Child, Preschool , Developing Countries , Feasibility Studies , Female , Humans , India , Male , Safety , Tetralogy of Fallot/surgery , Tetralogy of Fallot/therapyABSTRACT
Objective To analyze the risk factors for perioperative mortality in children after total correction of tetralogy of Fallot (TOF),in order to provide better operation and decrease the mortality rate.Methods We enrolled 191 TOF patients including 142 males and 49 females at Chengdu Cardiovascular Hospital between Jan 2003 and Dec 2010.The age ranged from 4 months to 12 years.Preoperative,perioperative and postoperative clinical data of all patients were corrected and the risk factors for mortality after total correction of TOF were analyzed.Results Among all the 191 cases,6 cases death (3.14％) occurred in early postoperative,the main causes of death were postoperative infection with multiple organ failure (3 cases),low cardiac output syndrome (2 cases),cerebral complications (1 cases).Among them,2 children (6.67％,2/30) died in age≤6 months,1 child (1.41％,1/71)died in age ranged from 6 months to 3 years,3 children (3.33％,3/90) died in age ranged from 3 years to 12 years.The results of logistic regression and model selection indicated that age ≤ 6 months (OR =4.606,95 ％ CI 1.811 ～ 11.719,P ＜ 0.05),percutaneous oxygen saturation ＜ 70％ before operation (OR =0.982,95％ CI 0.501 ～ 1.932,P ＜ 0.01),Nakata index ＜140 mm2/m2(OR =16.960,95％ CI 1.414 ～ 150.390,P ＜ 0.01),cardiopulmonary bypass time ＞ 150 min (OR =4.398,95 ％ CI 2.091 ～ 9.216,P ＜ 0.01) and multiple organ failure (OR =4.872,95 ％ CI 2.583 ～9.192,P ＜0.05)were risk factors for early postoperative death after total correction of TOF.Conclusion Postoperative mortality in children after total correction of TOF can be predicted by risk factors of age,percutaneous oxygen saturation,Nakata index,cardiopulmonary bypass time,and multiple organ failure.
ABSTRACT
Taussig-Bing anomaly is infrequently associated with interrupted aortic arch and size discrepancy of great arteries makes it difficult to undergo arch recons- truction and arterial switch operation. A 20-day old male infant was admitted with the diagnosis of Taussig-Bing anomaly with type B interrupted aortic arch. Multi-organ failure, due to the diminution of ductal flow, was stabilized after 3 weeks of prostaglandin E1 and controlled ventilatory support. The surgical correction consisted of VSD closure, arterial swtich and extended aortic arch reconstruction. The marked disparity between the hypoplastic ascending aorta and the dilated main pulmonary artery was overcome by constructing distal neoaorta using both native ascending and descending aortic tissue. The patient was extubated on postoperative 2nd day. Postoperative catheterization showed no left ventricular outflow obstruction, no intracardiac shunt, and no incompetence of neoaortic valve.