Induced moderate hypothermia for low cardiac output after pediatric cardiac surgery

Postoperative low cardiac output states are a major cause of postoperative mortality in infants and children following corrective cardiac surgery or congenital heart defects. Whole body hypothermia has been used since 2001 in the management of these low output states when they are refractory to conventional modes of therapy. From December 2001 to April 2006, 25 cases were included in this study. The median [range] age of patients was 36.6 months [1 mo-19 y] with a median weight of 12.2 kg [3.5-44 kg]. Following cooling, there was a decrease in heart rate [P < 0.001], an increase in mean arterial pressure [P < 0.001] and a decrease in mean arterial pressure [P < 0.001]. Significant increases in pH and urine output were also noticed, the increase in urine output being greater in the surviving group [P = 0.02]. A decrease in platelet count was occurred [P < 0.001] but WBC count remained unchanged [P = 0.18]. Fifteen of 25 patients survived to leave hospital. Induced hypothermia does not appear to be associated with any complications and after the failure of all conventional treatments, it seems likely that the technique may have been beneficial to outcome in some patients

[Extra cardiac conduit Fontan procedure in 41 patients]

The Fontan operation is the definitive operation for palliation of complex congenital heart disease with single -ventricle physiology. The use of the extra cardiac conduit has recently been gaining popularity. The purpose of this study was to compare the outcomes of extra cardiac conduit Fontan procedure [off-pump technique] and that of traditional technique [lateral tunnel technique] in which cardiopulmonary bypass is routinely used. Forty one patients in different age groups underwent extra cardiac conduit Fontan procedure between April 2001 and December 2004. Data were collected from ICU sheets, files and during follow up visits. Under general anesthesia and through median sternotomy, using two temporary decompressing shunts, superior vena cava implanted on right pulmonary artery and a conduit interposed between transected inferior vena cava and main pulmonary artery. Fenestration was done in almost all patients and previous shunts were closed if there were any. Of our patients, 13 were female and 28 were male. Mean age of the patients was 11.1 years [SD=7.8].In 24.4% of cases Fontan procedure was done as the first palliative surgery and in 75.6% of them there was previous history of palliative procedures. In 6 patients [14.6%] we were constrained to use cardiopulmonary bypass which was predictable or necessary in 50% of cases. There was no reoperation due to post operative bleeding. Two cases suffered from prolonged plural effusion. Our in-hospital mortality was 9.8%. During 2-24 months follow up, we found two cases who were in NYHA functional class II and one case in functional class I. Extra cardiac conduit Fontan procedure could be used in a safe way. The results of this study were comparable and even in some cases better than that of the traditional technique