ABSTRACT
OBJECTIVE: Transfontanelle ultrasound is a noninvasive method for assessing cerebral blood flow in neonates and infants. The authors applied this technique as a point-of-care tool, before and after modified Blalock-Taussig shunt procedure, to evaluate cerebral perfusion. DESIGN: Retrospective, observational study. SETTING: Tertiary care children's hospital. PARTICIPANTS: Ten infants undergoing modified Blalock-Taussig shunt procedure. OBSERVATION: Transfontanelle ultrasound examinations with modified resistive index were analyzed before and after the modified Blalock-Taussig shunt procedure. MEASUREMENTS AND MAIN RESULTS: Two infants died and 2 patients required a revision procedure due to shunt thrombosis. Baseline-modified resistive index and regional cerebral oxygenation were comparable between the right and left hemisphere. However, after the procedure, the modified resistive index decreased at both sides of the internal carotid arteries compared with baseline values (p value right side = 0.012, left side = 0.036) and was greater at the ipsilateral internal carotid arteries with the shunt (p = 0.012, mean difference = 0.07, 95% confidence interval [CI] 0.02-0.12). Four infants with the large patent ductus arteriosus presented diastolic reverse flows at both internal carotid arteries at baseline. However, the diastolic reverse flow disappeared after the procedure. An infant who developed diastolic reverse flow after the procedure, died. CONCLUSIONS: Transfontanelle ultrasound is a feasible tool for assessing the pattern of shunt flow and cerebral perfusion before and after the modified Blalock-Taussig shunt procedure. The transfontanelle ultrasound examinations may have potential role in assessing "over-shunting," but it needs more studies.
Subject(s)
Blalock-Taussig Procedure/methods , Cerebrovascular Circulation/physiology , Cranial Fontanelles/diagnostic imaging , Ultrasonography, Interventional/methods , Female , Humans , Infant , Infant, Newborn , Male , Monitoring, Intraoperative/methods , Point-of-Care Systems , Retrospective StudiesABSTRACT
Aortopexy is a surgical procedure in which the aortic arch is fixed at other structures, thus widening the interaortic space. This study aimed to evaluate the outcome of aortopexy by means of chest computed tomography for patients with congenital heart disease. The study retrospectively reviewed the medical records of 16 patients with congenital heart disease who had undergone aortopexy by compressed airway. The severity of compressed bronchus before aortopexy, immediately after aortopexy (≤ 1 month), and after the patient had grown up were compared. To estimate the efficacy of the aortopexy, the interaortic distance index was calculated. Of the 16 patients, aortopexy was performed at the ascending aorta in 7, at the descending aorta in 7, and at the transverse arch in 2. The diameter ratio between the narrowest bronchus and the trachea was improved after aortopexy, as was the diameter ratio before aortopexy versus immediately after aortopexy (n = 9; p = 0.018) and the diameter ratio before aortopexy versus after the patient had grown up (n = 11; p = 0.006). Also, the interaortic distance index was increased after aortopexy, as was the diameter before aortopexy versus immediately after aortopexy (n = 9; p = 0.039) and the diameter before aortopexy versus after the patient had grown up (n = 11; p = 0.014). The study had one case of mortality due to sepsis. As shown by the results, aortopexy in patients with a compressed airway between arches is a useful surgical option. Such a compressed airway between arches should be considered for patients with an unusual clinical course before and after open heart surgery.
Subject(s)
Airway Obstruction/surgery , Aorta, Thoracic/surgery , Cardiac Surgical Procedures/methods , Heart Defects, Congenital/surgery , Adolescent , Airway Obstruction/diagnostic imaging , Airway Obstruction/etiology , Aorta, Thoracic/abnormalities , Aorta, Thoracic/diagnostic imaging , Child , Child, Preschool , Female , Follow-Up Studies , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnostic imaging , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Young AdultABSTRACT
The purpose of this study was to compare the outcomes of lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution. From April 1995 to December 2006, 165 Fontan procedures were performed (67 LT, 98 ECC). Pre-, intra- and postoperative variable values were compared between two different techniques. Operative mortality was 5 (3 LT, 2 ECC). Immediate postoperative transpulmonary gradient (LT 8.5+/-ECC 2.5 vs. 6.6+/-2.4 mmHg) and central venous pressure (LT 18.3+/-3.8 vs. ECC 15.6+/-2.4 mmHg) showed significant difference (P<0.001). The LT patients had a higher incidence of sinus node dysfunction in the postoperative period (22.4% vs. ECC 11.2%; P=0.05). Mean follow-up was 74.1+/-31.5 months in LT, and 31.7+/-28.1 months in ECC patients. There was one late death. Actuarial survival at 10 years is 92% for LT, and 89% for ECC patients (P=0.796). The LT and ECC, both, showed comparable early and mid-term outcomes in operative morbidity and mortality, postoperative hemodynamics, survival. Use of ECC for modified Fontan operation reduces the risk of sinus node dysfunction and shows better outcome of immediate postoperative hemodynamics.
