Results of surgical treatment for 79 patients with aortic coarctation combined with complex anomalies: A retrospective analysis in a single center / 中国胸心血管外科临床杂志

@#Objective    To summarize the results of surgical treatment for 79 patients with coarctation of the aorta (CoA) combined with complex anomalies (CA) in recent years. Methods    The data from 79 patients with CoA combined with CA admitted to Guangzhou Women and Children's Medical Center between January 19, 2010 and September 7, 2017 were collected and analyzed. There were 52 males and 27 females. The median age was 71 days, and the median weight was 4.3 kg. There were 26 patients combined with tracheostenosis and 7 patients with preoperative tracheal intubation. Extended end-to-side anastomosis was used to correct the CoA, and the associated cardiac abnormalities were treated simultaneously by an incision through median sternotomy. All operations were performed by the same group of surgeons. Results    The median deep hypothermic circulatory arrest was 18 (13-28) minutes, the median aorta cross-clamp time was 62 (15-199) minutes, the median cardiopulmonary bypass time was 145 (71-674) minutes, the median ventilation time was 72 (9-960) hours, the median length of ICU stay was 144 (12-1 944) hours, and the median length of hospital stay was 24 (2-93) days. Early death occurred in 9 patients and late death occurred in 5 patients. Reoperation occurred in 28 patients and recoarctation developed in 10 patients. After operation, transcoarctation gradient was reduced, and the transcutaneous oxygen saturation, C-reactive protein (CRP), lactate and creatinine were increased. Compared to the survival group, both preoperative and postoperative transcutaneous oxygen saturation were worse and the postoperative levels of plasma brain natriuretic peptide (BNP) and CRP were higher in the death group. Conclusion    Correcting the CoA and the associated CA simultaneously with extended end-to-side anastomosis by an incision through median sternotomy is effective and safe, and the outcomes of immediate and medial-term are satisfactory. Improving oxygenation and limiting elevation of BNP and CRP levels may reduce the death rate.

Cardiovascular malformations in infants of diabetic mothers: a retrospective study

Background: Despite improvements in medical care provided during pregnancy to diabetic mothers, the cardiac complications in their infants are still more frequent than in infants of general population.Methods: A retrospective case-control study was performed between the years 2017-2018 on two groups of newborns, recording details of outcome of live born babies born to diabetic and non-diabetic mothers.Results: Data were extracted from medical records, and the descriptive and analytical statistics of this information was duly applied. in a total of 50 studied infants, 40 cases (80%) of cardiovascular anomalies have been diagnosed. Most of the cardiac anomaly was hypertrophic cardiomyopathy. The incidence of cardiovascular anomalies in infants of diabetic mothers is significantly higher than the infants of non-diabetic mothers (P=0.002). The type of maternal diabetes (diabetes mellitus, overt or gestational diabetes) did not bring about any significant difference in the incidence of cardiac malformations in infants (P=0.406).Conclusions: The incidence of cardiovascular anomalies in infants of diabetic mothers is significantly higher than the infants of non-diabetic mothers. Many of the infants were asymptomatic and therefore clinical examination and follow up in infants of diabetic mothers is important.

A retrospective study of atrial septal defect

Background: An Atrial Septal defect is an abnormal hole of variable size in the atrial septum, which generally permits left to right shunting of blood at the atrial level. ASD is one of the most common congenital cardiac anomalies, present in 10-15 percent of patients with congenital heart disease. Aim: To study the clinical profile, diagnostic modalities used, post operative morbidity and mortality of patients operated for atrial septal defect in a major teaching hospital in Telangana. Materials and Methods: This study was based on a patient population of 50, admitted to undergo surgical correction for atrial septal defect. Results: The incidence of ASD is more in females. The male to female ratio was 1:2.1 in this study. The majority of the patients were symptomatic (96%). The commonest symptom was dyspnoea on exertion (76%). Most of the patients were in NYHA class II (62%). Consanguineous marriage of parents was present in 28% of patients. Most of the patients were in sinus rhythm (94%). ASD were of fossa ovalis type (96%). In 74% of the patients, the size of ASD was between 2-4 cm in diameter. 78% of the patients were repaired by direct closure of ASD. Most of the patients (96%) were supported by ventilation, out of which 62% (31/50) of patients were ventilated for 1-6 hours. Patients (70%) were discharged by 9th –12th post operative day. Mortality was 2% in this study. Conclusion: Surgical repair of atrial septal defects is a safe procedure which is associated with excellent results and low morbidity.

Lineamientos en soporte nutricional en posoperatorios de cirugía cardíaca neonatal / Introduction on postoperative nutritional support in neonatal cardiac surgery

La malnutrición es una complicación habitual de los neonatos con patología cardiovascular en el período posquirúrgico. Esto sucede por la escasa reserva metabólica, el aumento del gasto energético provocado por la lesión, el aporte de nutrientes insuficiente o tardío que reciben y por su incapacidad de metabolizarlos dada su condición crítica. Una intervención nutricional adecuada, que alcanza los objetivos, logra mejor respuesta metabólica del neonato operado y tiene consecuencias significativas en el tiempo de internación, cicatrización de heridas, susceptibilidad a las infecciones y evolución posquirúrgica. Estos lineamientos pretenden establecer fundamentos prácticos para el soporte nutricional tanto enteral como parenteral del paciente cardiovascular neonatal, teniendo en cuenta la restricción hídrica y la optimización de macro y micronutrientes requeridos en el posoperatorio.

Malnutrition is common in newborn patients after cardiac surgery, because of the low metabolic reserves, increased energy expenditure caused by the injury, and reduced or delayed nutritional support they receive, as well as their inability to metabolize the nutrients administered. It is important to achieve appropriate nutrition; a better metabolic response after surgery has a significant impact on length of stay, wound healing, susceptibility to infections and surgical outcome. This guideline intended to establish the practical foundation for parenteral and enteral nutritional support in the newborn with cardiac surgery, considering water restriction, optimizing macro and micronutrients required in the postoperative time.

Tracheal agenesis with broncho-esophageal fistula in VACTERL / TACRD association.

Tracheal agenesis (TA) is an extremely rare malformation. We report here autopsy findings in a case of TA with bronchoesophageal fistula of Floyd type III. The other malformations present included laryngeal atresia, Right lung hypolobulation, ventricular septal defect in membranous portion, bilateral cystic renal dysplasia, spleninculus, Meckel's diverticulum, and imperforate anus. The constellations of malformations present in our case have overlapping features with Vertebral anomalies, Anal atresia, Cardiovascular anomalies, Tracheo-esophageal fistula, Esophageal atresia, Renal anomalies, Limb anomalies and Tracheal atresia or laryngo tracheal atresia, Cardiac anomalies, Renal anomalies, Duodenal atresia association described previously in the literature.

A Case of Right Intrathoracic Kidney with Complex Cardiac Anomalies / 대한주산의학회잡지

Intrathoracic kidneys are rare developmental anomalies and represent less than 5% of all congenital kidney ectopia. Ectopic intrathoracic kidneys are usually asymptomatic and have normal renal function. This disease occurs more frequently in males and on the left side. We report a case of right intrathoracic kidney with congenital complex cardiac anomalies such as single atrium, patent ductus arteriosus and tricuspid regurgitation.