ABSTRACT
Extracorporeal membrane oxygenation (ECMO) is a life-saving rescue therapy used in acute respiratory failure refractory to invasive mechanical ventilation. Recent studies on positive outcomes of extended ECMO therapy are promising. We describe a case of a 2-year 8-month-old female child with necrotizing pneumonia secondary to Streptococcus pneumoniae, Influenza A, and Mycoplasma pneumoniae, who survived with intact neurological function and no long-term adverse outcomes after a prolonged ECMO run of 86 days. To the best of our knowledge, this is one of the longer durations of ECMO with transplant-free survival in a pediatric patient requiring respiratory support with good recovery and a good functional outcome. Allowing time for native lung recovery is pivotal for optimal recovery, despite significant lung injury due to the underlying disease process. With evolving ECMO experience, clinicians may need to re-consider the conventional maximum duration of ECMO in children with severe respiratory failure on a case-by-case basis.
ABSTRACT
INTRODUCTION: We aimed to determine the impact of diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease. MATERIALS AND METHODS: A retrospective review was conducted for 5720 consecutive patients who underwent isolated first CABG between 1982 and 1999. Outcomes were reviewed to include in-hospital mortality and long-term survival. Mean follow-up was 13.0 ± 5.8 years. To obtain comparable subgroups, 561 diabetic patients were matched with 561 non-diabetic controls based on estimated propensity scores. RESULTS: Mean age was 59.3 ± 9.1 years with 4373 (76.5%) males. Amongst 5720 patients, 1977 (34.6%) had DM. Hypertension and dyslipidaemia were the most common cardiovascular comorbidities, present in 2920 (51.0%) and 2664 patients (46.6%) respectively. Emergency surgery was performed in 563 patients (9.8%). In-patient mortality occurred in 115 patients (2.0%), 48 (2.4%) in the DM group and 67 (1.8%) in the non-DM group, (P = 0.102). In the unmatched cohort, overall 20-year survival rates were 30.9 ± 1.6% in diabetics and 49.2 ± 1.0% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 56.0 ± 2.0% in diabetics and 68.4 ± 1.0% in non-diabetics (P <0.001). In the propensity-matched group, overall 20-year survival rates were 35.4 ± 2.5% in diabetics and 48.9 ± 2.9% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 57.8 ± 3.0% in diabetics and 70.2 ± 2.9% in non-diabetics (P = 0.001). Multivariable Cox regression analysis identified age (hazard ratio (HR): 1.03/year), female gender (HR: 1.43), DM (HR: 1.51), previous myocardial infarction (HR: 1.54) and left ventricular ejection fraction (LVEF) <35% (HR: 2.60) as independent factors influencing long-term cardiac mortality. CONCLUSION: Despite low operative mortality, long-term survival and freedom from cardiac death are significantly lower in patients with DM compared to non-diabetics. Aggressive treatment of DM, cardiovascular comorbidities and smoking cessation are essential to improve long-term survival in diabetic patients.
Subject(s)
Awards and Prizes , Coronary Artery Bypass , Coronary Artery Disease/surgery , Diabetes Mellitus/epidemiology , Hospital Mortality , Age Factors , Aged , Case-Control Studies , Comorbidity , Coronary Artery Disease/epidemiology , Dyslipidemias/epidemiology , Female , Follow-Up Studies , Humans , Hypertension/epidemiology , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/epidemiology , Prognosis , Propensity Score , Proportional Hazards Models , Retrospective Studies , Sex Factors , Singapore/epidemiology , Stroke VolumeABSTRACT
We present a case of a 10-month-old male infant with thoracoabdominal ectopia cordis, as part of Cantrell pentad, repaired using a poly-L-lactic-polyglycolic acid plate, a resorbable plating system widely used in craniomaxillofacial reconstruction. This is the first reported case of sternal reconstruction using a poly-L-lactic-polyglycolic acid plate. The repair was successfully carried out without cardiopulmonary compromise and good aesthetic outcome was achieved.
Subject(s)
Absorbable Implants , Bone Plates , Ectopia Cordis/surgery , Lactic Acid , Pentalogy of Cantrell/surgery , Polyglycolic Acid , Sternum/surgery , Humans , Infant, Newborn , Male , Muscle, Skeletal/surgery , Pentalogy of Cantrell/diagnostic imaging , Pericardium/surgery , Polylactic Acid-Polyglycolic Acid Copolymer , Polytetrafluoroethylene , Surgical Flaps , Surgical Mesh , UltrasonographyABSTRACT
An 11-year-old girl with Takayasu arteritis was presented with recurrent chest pain. A transthoracic echocardiogram showed moderate to severe aortic regurgitation with impaired cardiac function. Cardiac catheterization revealed the total occlusion of the small right coronary artery and left main stenosis of 40%. An intraoperative transesophageal echocardiogram showed a redundant intimal fold partially covering the left coronary ostium and this was further confirmed from the intraoperative finding. This is a case report of recurrent angina associated with obstruction of left main coronary artery orifice by an intimal fold secondary to Takayasu arteritis.
