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INTRODUCTION: Ducts-dependent pulmonary circulation is spectrum of congenital heart diseases that need urgent intervention to augment pulmonary blood. Systemic to pulmonary shunt is the classical surgical management. Stenting of ductus arteriosus emerged in the last 2 decades as an alternative plausible intervention. OBJECTIVES: To evaluate and compare the short and midterm effects of PDA stenting in compared to surgically placed shunt for augmentation of pulmonary blood flow looking to pulmonary artery (PA) branches growth, oxygen saturation and suitability for second stage repair. METHODS: We conducted this prospective study in Cardiac Surgical Intensive Care Unit. Cases were divided into "stent group" and "surgical shunt" group. Results were compared between two groups regarding oxygen saturation, mechanical ventilation duration, intensive care stay, mortality and morbidity. Growth of PA branches was assessed during follow up by echocardiograph. Nakata index score was calculated by angiogram before second stage surgery and was compared between both groups. RESULTS: 43 patients were included. Forty-two cases were offered stent as initial management. 6/42 cases failed stenting (14%) and 3/42 (7%) required late BT shunt after PDA stenting. 10/43 cases ended up receiving BT shunt and were counted as "surgical shunt group". Stent group (33 cases) needed less mechanical ventilation (2.08 ± 0.65 vs.7.8 ± 4 days with p = 0.014), and less ICU stay compared with surgical shunt group (6.2 ± 1.02 vs. 14 ± 4.5 days, P = 0.009). Both groups achieved similar growth of pulmonary artery branches (p = 0.6 for Z score of left pulmonary artery and P = 0.8 for Z score for right pulmonary artery). Although "stent group" reached second stage surgery with lower O2 saturation 67.6 ± 4.6 vs. 80 ± 4.2 in "surgical shunt" group with P value = 0.0002). Majority of patients in both groups had some PA distortion and needed surgical reconstruction in main pulmonary artery or in its main branches during second stage repair. 3 cases (7.1%) died soon post stenting versus none in surgical shunt group (p = value 0.57). CONCLUSIONS: In neonates with ductus-dependent pulmonary circulation PDA stenting can be introduced as safe first possible option to augment pulmonary blood flow with good outcome and suitable preparation for second stage palliation.
RESUMO
BACKGROUND: Outcomes of cardiopulmonary resuscitation (CPR) in children with congenital heart disease have improved and many children have survived after an in-hospital cardiac arrest. AIM: The purpose of this study is to determine predictors of poor outcome after CPR in critical children undergoing cardiac surgery. METHODS: We conducted a retrospective chart review and data analysis of all CPR records and charts of all postoperative cardiac children who had a cardiac arrest and required resuscitation from 2011 until 2015. Demographic, pre-operative, and postoperative data were reviewed and analyzed. RESULTS: During the study period, 18 postoperative pediatric cardiac patients had CPR. Nine of them had return of spontaneous circulation and survived (50%). On average CPR was required on the 3(rd) postoperative day. Univariate analysis demonstrated that poor outcome was associated with higher lactic acid measured 4-6 hours prior to arrest (p = 0.045; p = 0.02) coupled with higher heart rate (p = 0.031), lower O2 saturation (p = 0.01), and lower core body temperature (p = 0.019) recorded 6 hours before arrest. Nonsurvival required longer resuscitation duration and more epinephrine doses (p < 0.05). CONCLUSION: Higher heart rate, lower core body temperature, lower O2 saturation, and higher lactic acid measured 6 hours before arrest are possible predictors of poorer outcome and mortality following CPR in postoperative cardiac children.
