Factors influencing the intermediate outcome in patients with single-ventricle physiology after Fontan operation.

OBJECTIVE: This study was conducted to analyze the factors affecting the intermediate outcome following the Fontan procedure in the current era. METHODS: Between January 1992 and December 2008, 189 patients underwent Fontan procedure at a median age of 3.4 years (0.4-37 years). Single left ventricle was present in 77 (40%) patients, right ventricle in 70 (37%), in 7 (3.7%) patients, the ventricular morphology was indetermined and in 35 (18.5%) a dominant systemic ventricle with smaller second ventricle was present. The Fontan procedure was performed using an atriopulmonary connection (n=5, 5.6%), lateral atrial tunnel (n=99, 52%) or extracardiac conduit (n=85, 45%). 97.4% of patients recieved fenestration. RESULTS: The hospital survival was 95% and five patients required a takedown of Fontan circulation. The survival at 1.5 and 10 years was 94%, 93% and 92%, respectively. Multivariate analysis identified that the outcome was influenced by the diagnosis of a complete common AV canal (p = 0.015), duration of ventilation (p < 0.0001) and duration of pleural effusions (p = 0.003). Failure-free survival at 1.5 and 10 years was 95%, 92% and 89%, respectively. The overall freedom from reoperation was 73%. Risk factors for reoperation were preoperative pulmonary artery pressure and duration of ventilation. CONCLUSIONS: The Fontan procedure is associated with excellent operative and intermediate survival. Common atrioventricular canal, duration of pleural effusions and ventilation have an adverse influence on the intermediate outcome. Reintervention is associated with pulmonary artery pressure and duration of ventilation (Tab. 7, Fig. 3, Ref. 16).

Long-term results of surgical treatment of total anomalous pulmonary venous drainage in children.

AIM OF STUDY: Retrospective analysis of surgical correction of TAPVD performed between January 1992 and March 2008. METHODS: Review of patients' medical records. Patients' preoperative, operative as well as postoperative data were collated and analyzed using JMP statistical program version 5. RESULTS: A total of 51 patients with total anomalous pulmonary venous drainage underwent surgery at our center during a period of over seventeen years. Actuarial survival was 90.2%. Early postoperative death was recorded in 4 patients (7.8%) as against one late postoperative death. The only statistically significant risk factor for death was the time of surgical repair. Patients undergoing the repair before 1997 were more likely to die than those operated on after this period, p=0.006. Patients' survival following the surgical correction prior to the year 1997 was 63.63% as opposed to 97.5% for the period between 1997 and 2008. Freedom from surgical re-intervention over the period of follow-up was 92%. The obstructive type of TAPVD was associated with longer ICU stay and higher postoperative complications, p=0.003. CONCLUSION: We have recorded a significant improvement in patients' survival following surgery for total anomalous pulmonary venous drainage in the last decade. This can be attributed to a number of new measures both surgical and medical employed in the treatment of our patients (Tab. 3, Fig. 7, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

Arrhythmias in congenital heart defects.

AIM OF THE STUDY: Evaluation of the incidence and severity of late arrhythmias in patients with predisposing congenital heart defects--either due to the anatomy of the defect itself or as a result of a particular type of surgical intervention. PATIENTS AND METHODS: In a retrospective long-term study authors analyzed 158 patients (divided into 5 groups) with congenital heart defects after surgical correction. Evaluated were: the incidence of rhythm disturbances, the type of arrhythmia and the need for medication or intervention. RESULTS: The most rhythm disturbances occurred in patients after physiological correction of D-transposition of the great arteries (68.5%) and these patients also mostly needed medication or pacemaker implantation; followed were by patients with hypoplastic left heart syndrome after Fontan procedure (40%), then were patients after long-term correction of tetralogy of Fallot (31.1%), atrial septal defect sinus venosus type with partial anomalous pulmonary venous return after Warden correction (25.7%) and congenitally corrected L-transposition of the great arteries (25 %). Most of these arrhythmias were asymptomatic and there was no need to treat them. There was an increased incidence of arrhythmias with time (p < 0.05). DISCUSSION: During childhood in patients after surgical correction late arrhythmias mostly do not represent a severe problem, but with time, when reaching adulthood, this may be an issue. It is therefore very important to understand the anatomy, physiology and the arrhythmogenic substrate of every high risk congenital heart defect (Tab. 2, Fig. 6, Ref. 10).

Surgical closure of patent ductus arteriosus in pre-term babies.

OBJECTIVES: To present by illustration the surgical options in neonatal PDA closure with emphasis on clip application. METHODS: Photo/video-documentation of surgical closure of PDA in a neonate by clip application coupled with free-hand drawings showing PDA closure by ligation and division. Review of 38 neonates undergoing surgical PDA closure in our institution between 1998 and 2006. RESULTS: Overall survival following surgery was 100%. There was one case of residual PDA and three postoperative complications - 2 cases of pneumothorax and one chylothorax. CONCLUSION: The outcome of surgical closure of PDA in neonates is very good with zero mortality in our series and only few postoperative complications.