Complication of surgery for scoliosis in children with surgically corrected congenital cardiac malformations (original) (raw)
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Mid-term results following surgical treatment of congenital cardiac malformations in adults
Cardiology in the Young, 2008
The long term consequences of untreated of residual or recurrent lesions pose unique challenges in the growing population of adults with congenitally malformed hearts. In our unit, 335 patients aged from 18 to 72 years, with a mean age of 35 plus or minus14 years, presented for correction of congenital cardiac disease from September, 1997, through December, 2006. Of the group, 42 (12.5%) had undergone one or more prior surgical procedures, 3 were admitted as emergencies, and a further 10 (3%) had suffered prior cardiac related complications. Symptoms had been noted by 181 patients (54%), and 42 (12.5%) had an established arrhythmia. Chromosomal anomalies were identified in 13 (3.8%), and diagnostic catheterisation was required in 201 (60%) patients. Of the overall group, 2 patients died early (0.6%). Complications occurred in 61 patients (18%), including atrial fibrillation, pneumothorax, postoperative haemorrhage, pericardial or pleural effusions requiring drainage, stroke, complete heart block, endocarditis, wound dehiscence, and peripheral neuropathy. The median length of stay in the intensive care unit and hospital were 2 and 7 days, respectively. Death occurred later in 2 further patients (0.6%), due to atrial fibrillation and pulmonary hypertension. At mean follow-up of 63 plus or minus 30 months, the majority of the remaining patients are well with resolution or significant improvement in their symptoms. Despite the long term deleterious effects of untreated, residual or recurrent congenital cardiac lesions in adults, therefore, we conclude that surgical correction can be achieved with low mortality and acceptable morbidity. Most significant complications are related to arrhythmias.
Ten-year experience with surgical treatment of adults with congenital cardiac disease
Cardiology in The Young, 2010
The number of adults with congenital cardiac disease continues to increase, and adult patients are now more numerous than paediatric patients. We sought to identify risk factors for perioperative death and report our results with surgical management of adult patients with congenital cardiac disease. We retrospectively analysed in-hospital data for 244 consecutive adult patients who underwent surgical treatment of congenital cardiac disease in our centre between January, 1998 and December, 2007. The mean patient age was 27.2 plus or minus 11.9 years, 29% were in functional class III or IV, and 25% were cyanosed. Of the patients, half were operated on for the first time. A total of 61% of patients underwent curative operations, 36% a reoperation after curative treatment, and 3% a palliative operation. Overall mortality was 4.9%. Predictive factors for hospital death were functional class, cyanosis, non-sinus rhythm, a history of only palliative previous operation(s), and an indication for palliative treatment. Functional class, cyanosis, type of initial congenital cardiac disease (single ventricle and double-outlet right ventricle), and only palliative previous operation were risk factors for prolonged intensive care stay (more than 48 hours). The surgical management of adult patients with congenital cardiac disease has improved during recent decades. These generally young patients, with a complex pathology, today present a low post-operative morbidity and mortality. Patients having undergone palliative surgery and reaching adulthood without curative treatment present with an increased risk of morbidity and mortality. Univentricular hearts and double-outlet right ventricles were associated with the highest morbidity.
Electronic Journal of General Medicine
Background: Congenital heart defects are represented by numerous nosological forms. Today is known to be more than 90 variants of congenital heart defects (СHD) and their combinations. In the structure of the CHD 1st place occupies the defect of the interstitial septum, which according to various authors is 30-50% of all congenital defects of the heart, 2nd place-open arterial duct (10%), defect of the interstitial artery, interstitial defect, tetrad Fallo, transposition of main vessels, atrioventricular communication do not exceed 5-7% of each defect. The share of the remaining congenital malformations of the heart is less than 1-2%. Aim: To study the factors of the condition and organization of cardiac surgery to children with congenital heart defects Center for Perinatology and Pediatric Cardiac Surgery. Methods: From November 20, 2011 to December 29, 2018, the Center for Perinatology and Pediatric Cardiac Surgery treated 1,098 children aged 1 year, 175 of whom were newborns (15.9%). Of the last 27 were restricted to conservative treatment. Eight (29.6%) of these patients died from hypoxia and / or cardiac insufficiency, which were incompatible with life, as well as from congenital pathology of other organs and systems. In the remaining 148 (81.7%) cases, various surgical interventions were performed. Results: The comparison of the risk group shows that there was no difference between them in the structure of the main critical CHD. He drew attention to the fact that the increase in the number of risk factors (RF) was associated with an increase in the number of obstructive lesions of the left ventricle and aortic arch. The difference between the groups RF (0)-RF (3), RF (0)-RF (4), RF (2)-RF (3) and RF (2)-RF (4) according to the number of these patients was reliable (r) <0.05). Thus, this pathology was the most dangerous in relation to the accompanying problem. As the number of risk factors increased naturally, the number of patients in the corresponding groups decreased, and the level of mortality increased. Considering all the variants of the outcome (recurrence of postoperative complications, lethality), the most weighted isolated risk factors were "artificial ventilation", " intrauterine infection" and "Inconsistency", with the exception of the 2nd, 2nd and 3rd versions, respectively. 5-9.9 times. The most dangerous in this aspect are "Syndromes", "GIEP". Conclusion: Risk factors are predictors of specific postoperative complications: outbreaks of encephalopathy occur in cerebral complications in 5.4% of newborns, intrauterine infection, 30%, and 30% of coronary heart disease. Assessment of the significance of the origin of non-surgical factors determines the most "weak link", and proves the necessity of the mandatory use of algorithms and protocols of individual congenital anomalies of congenital heart disease and congenital heart disease.
A Retrospective Study of Congenital Cardiac Abnormality Associated with Scoliosis
Asian Spine Journal, 2016
To identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatment for scoliosis. Overview of Literature: Congenital and idiopathic scoliosis (IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwent surgical treatment for scoliosis. Methods: Ninety consecutive scoliosis patients, who underwent surgical correction of scoliosis, were classified as CS (55 patients, 28 female [51%]) and IS (35 patients, 21 female [60%]). The complete data of the patients, including medical records, plain radiograph and transthoracic echocardiography were retrospectively assessed. Results: We found that mitral valve prolapse was the most common cardiac abnormality in both patients with IS (nine patients, 26%) and CS (13 patients, 24%). Other congenital cardiac abnormalities were atrial septal aneurysm (23% of IS patients, 18% of CS patients), pulmonary insufficiency (20% of IS patients, 4% of CS patients), aortic insufficiency (17% of IS patients), atrial septal defect (11% of IS patients, 13% of CS patients), patent foramen ovale (15% of CS patients), dextrocardia (4% of CS patients), bicuspid aortic valve (3% of IS patients), aortic stenosis (2% of CS patients), ventricular septal defect (2% of CS patients), and cardiomyopathy (2% of CS patients). Conclusions: We determined the increased incidence of congenital cardiac abnormalities among patients with congenital and IS. Mitral valve prolapse appeared to be the most prevalent congenital cardiac abnormality in both groups.
Cardiology in the young, 2008
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the cardiac system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has prepared and defined a near-exhaustive list of cardiac complications, including intraoperative complications and cardiopulmonary bypass-related complications. These cardiac complications are presented in the following subgroups:1) Cardiac (general)2) Cardiac – Metabolic3) Cardiac – Residual and Recurrent cardiac lesions4) Arrhythmia5) Cardiopulmonary bypass and Mechanical circulatory support, and6) Operative/Procedural.Within each subgroup, complications are presented in alphabetical order. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, quality improvement initiatives, reporting of complications, and comparing strategies for treatment.
The World Society for Pediatric and Congenital Heart Surgery: Its Mission and History
Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual, 2009
The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) was established in 2006 to assemble pediatric and congenital heart surgeons from all continents and regions of the world and their colleagues from related specialties dealing with pediatric and congenital heart disease. Since its birth, it has held a highly successful inaugural scientific meeting in 2007 in Washington, DC, and a World Summit on Pediatric and Congenital Heart Surgery Services, Education, and Cardiac Care for Children and Adults with Congenital Heart Disease in 2008 in Montreal. It currently has 549 members from 71 countries and in a short period of time has become the largest organization in the world of pediatric and congenital heart surgeons. Its brief history already seems to be a guarantee of a promising future. Projects in the areas of research, training and education, patient care, and community service will allow the Society to reach its goals. By bringing together professionals from every region of the world, the WSPCHS should play a significant role in the improvement of care for children and adults with congenital heart disease around the world.
Current outcomes and future trends in paediatric and congenital cardiac surgery: a narrative review
Pediatric Medicine
Objective: To provide a narrative review of the current outcomes and future trends in paediatric and congenital cardiac surgery in a historical and multidisciplinary context. To present the paradigm shift in treating congenital heart disease that translate into improved outcomes. To identify current problems with directions of research. Background: Congenital heart disease (CHD) is the most common birth defect affecting approximately 1 neonate in every 120-166 births. More than half of CHD-patients need cardiac surgery in their lifetime; and half of the surgeries are required within the first six months of life. Methods: Narrative overview of the literature combining with current outcome data available from international databases is presented in comparison to the programme development of a newly-established tertiary-care centre. Conclusion: Congenital cardiac surgery is reconstructive surgery that aims for restoring biventricular circulation, when possible. Single-stage primary complete repair has become the central philosophy since the 1980s. In about thirty percent, physiologic and anatomical reasons do not permit repair by a single operation; these patients endure staged-repairs. Another 15% of CHD patients will require subsequent reoperationsmostly re-replacements of non-growing and/or deranged prostheses. Owing to advances of multidisciplinary treatment, CHD survival to adulthood now reaches 90-95% in high-income countries from less than 20% in the presurgical era. Treating CHD patients is a commitment for life. Research for viable and growing prostheses may solve the significant public health aspects currently associated with reoperations.
Congenital Heart Surgery: What we do to your patient
Continuing Medical Education, 2011
Cardiothoracic surgeon, Red Cross War Memorial Children's Hospital, Cape Town John Hewitson has been in charge of the Red Cross Cardiothoracic Unit since 1994, and has a special interest in developing paediatric cardiac services in Africa. He believes time is an illusion.