ABSTRACT
INTRODUCTION: The modified Blalock-Taussig shunt (MBTS) is the most commonly created systemic-pulmonary shunt in neonates with cyanotic heart disease. Morbidity and mortality after MBTS is associated with several factors including age, pulmonary artery diameter and the baseline cardiac anatomy. The objective of this research was to describe the immediate and short-term follow-up results of MBTS in Pakistani neonates. METHODS AND RESULTS: A retrospective review of patient charts was done to select 22 neonatal cases of various types of cyanotic heart diseases who had undergone MBTS creation from 1999 to 2005. Clinical and echocardiographic data were collected. Patients were followed up on their post-operative visits. Twenty-two neonates, 14 males and 8 females, mean age 11.2+/-6.9, underwent MBTS surgery during the six-year period of study. Pulmonary artery diameters were 3+/-0.2 and 2.9+/-0.2 for the right and left arteries, respectively. All patients received a 4mm Gor-Tex shunt through a postero-lateral thoracotomy approach. The mean duration of post-operative mechanical ventilation was 3.9+/-4.5 days. Three neonates (13.6%) died within one month of surgery while another three (13.6%) died after three months of surgery. Among these deaths, two were due to shunt occlusion/failure (9%) and the rest were due to non-cardiac causes. Another two patients underwent revision of surgery after shunt failure. Pulmonary atresia with intact interventricular septum was the most common cardiac anomaly in our series. CONCLUSIONS: The mortality rate in neonates is highest during the first post-operative month. Shunt thrombosis and occlusion can be sudden and fatal therefore coagulation profile should be carefully monitored especially in the peri-operative period. PA-IVS was the most common anatomical variant in our limited experience and had high morbidity and mortality rate after surgery.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Defects, Congenital/mortality , Heart Defects, Congenital/surgery , Pulmonary Artery/surgery , Subclavian Artery/surgery , Anastomosis, Surgical/methods , Cardiac Surgical Procedures/mortality , Female , Follow-Up Studies , Heart Defects, Congenital/diagnosis , Hospital Mortality/trends , Humans , Infant, Newborn , Male , Palliative Care , Retrospective Studies , Risk Assessment , Survival Analysis , Time FactorsABSTRACT
OBJECTIVES: The aim of this case series was to study the clinical presentation, treatment and outcome of pulmonary hydatid cyst disease at a tertiary care centre. METHODS: A retrospective review of case records was carried out to collect demographic, clinical and outcome data on patients with pulmonary hydatid disease, treated over a 10 year period. RESULTS: A total of 49 cases were included in the series. The most common presenting complaint was cough. Twenty-four per cent had bilateral lung involvement whereas 38% had both lung and liver involvement. Surgery was carried out in 38 cases. Surgical treatment was supplemented by pre-op and post-op chemotherapies. Muscle-preserving thoracotomy and cystectomy were most commonly carried out. Nineteen (39%) patients had post-op complications; however, there was no death. Ten patients were lost to follow up. Mean follow up was for 18 months without any recurrence. CONCLUSION: Pakistan is an endemic area for the disease. The patients in our series were relatively younger as compared with those in other reports. Surgery is the treatment of choice for hydatid disease and has good results. Pre-op and post-op chemotherapies decrease the risk of intraoperative infection and recurrence. Chest X-ray and abdominal ultrasound should be carried out in case of even minimum clinical suspicion, especially in endemic areas.
