Cardiac Catheterisation Interventions in Neonates and Infants Less Than Three Months.

INTRODUCTION: Pediatric cardiac catheterization interventions become an established way of care for selected patients with congenital heart diseases. Cardiac catheterization for neonates and small infants can be challenging. The indications for diagnostic cardiac catheterization have decreased with the advent of advanced non-invasive imaging modalities. PATIENTS AND METHOD: Between June 2012 and July 2017 patients less than three months who had cardiac catheterization in two centers were reviewed. RESULTS: During the study period, 174 patients underwent interventional cardiac catheterization,83.3% of them had CHD with two-ventricle circulation and 29 patients (16.7%) had single ventricle pathophysiology. Procedures include diagnostic cath, BAS, balloon pulmonary and aortic valvuloplasty, coarctation angioplasty, and stenting procedures. The vascular access depends upon the type of procedure. All except one had general anesthesia. ICU admission was required on 106 patients (62%). Patients were divided according to the type of cardiac lesion (single versus biventricular pathology) as well as according to the type of intervention (stenting and non-stenting procedures). Comparing these groups revealed that: stent procedures and procedures for patients with single ventricle pathologies were performed at an earlier age, with more contrast, fluoro and procedure time than for non-stent procedures and procedures for patients with biventricular pathologies. Complications include transient arrhythmias in most patients, perforation of the RVOT in one and lower limb hypoperfusion in 12 patients. ICU complications include low cardiac output symptoms (LCOS) in 10 (7%), and sepsis in 8. No intra-procedure mortality. The overall survival was 94%. Ten patients died, with one early and 9 late mortality. 60% of the dead patients had PDA stenting. Reintervention varies according to the patient's diagnosis. CONCLUSION: Cardiac catheterization intervention an important modality in the management of neonates and infants with critical CHD. Well planned procedures and team expertise are essential. Stenting procedures and procedures for patients with single ventricles carries higher morbidity and mortality.

Anomalous Drainage of Persistent Left Superior Vena Cava to the Left Atrium: Case Series and Literature Review.

Persistent left superior vena cava (PLSVC) draining into the coronary sinus is not uncommon, but to the left atrium is a rare condition. Such anomaly may be a cause of unexplained hypoxia in all age groups. It is often diagnosed accidentally during cardiovascular diagnostic work-up or in a contest of other cardiac investigations. We report two cases of these rare PLSVC associations with subsequent medical and surgical management.

Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Experience from a single cardiac center.

OBJECTIVES: We studied these predictors at a single cardiac center. Methods: A retrospective cohort study was carried out after obtaining approval from the institutional review board. All patients (age, 0-14 years) who underwent  congenital heart disease (CHD)  surgery from January 2014 to June 2016 were included. Prolonged mechanical ventilation (PMV)  was defined as greater than 72 hours of ventilation. Results: A total of 257 patients were included, among whom 219 (85.2%) were intubated for greater than 72 hours and 38 (14.8%) were intubated for ≥72 hours. Age (29.9 versus 11.95 years), weight (9.6 versus 5.9 kg), cross-clamp time (CCT) (53.6 versus 71.8 min), cardiopulmonary bypass time (CBP) (80.98 versus 124.36 min), length of stay in the pediatric intensive care unit (PICU) (10.4 versus 27.2 days), infection (12.8% versus 42.1%), open sternum (0.9% versus 13.2%), re-intubation (19.2% versus 39.5%), pulmonary hypertension (10.9% versus 31.6%), and impaired heart function (10.1% versus 23.7%) were associated with PMV. In terms of Risk Adjustment in Congenital Heart Surgery (RACHS) classification, only patients with RACHS 4 (18.4%) were associated with the risk for PMV. Conclusions: Age, weight, CBP, CCT, pulmonary hypertension, impaired cardiac function, and sepsis are risk factors for PMV. These factors should be considered when deciding surgery and in providing PICU care.

Palliative emergency stenting of the vertical vein in obstructive supracardiac pulmonary venous drainage prior to surgical repair.

Obstructed "total anomalous pulmonary venous connection" mostly presents with respiratory distress secondary to pulmonary congestion. We report two very sick patients who were referred to our cardiac center for intervention to relieve vertical vein (VV) obstruction. Due to hemodynamic instability and associated morbidity, the decision in our combined meeting was to go for interventional cardiac catheterization.

Methemoglobinemia due to nitric oxide therapy in a child after cardiac surgery.

A 5-month-old boy with trisomy 21 had repair of ventricular septal defect, atrial septal defect, and ligation of a patent ductus arteriosus. Due to severe pulmonary hypertension, NO inhalation was instituted postoperatively. Over the course of next few hours, he developed life-threatening methemoglobinemia. The condition once recognized was corrected with exchange blood transfusion. The management strategy is described with a brief review of the literature.

A study of infant deaths in a Regional Hospital in Saudi Arabia.

Full text is available as a scanned copy of the original print version.