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Predisposing Factors of Postoperative Pulmonary Complication in Children with Congenital Heart Disease.

Seung Taek YU ; Jae Hun JEONG ; Sam Yoon LEE ; Hyang Suk YOON

Journal of the Korean Pediatric Cardiology Society.2005;9(2):334-341.

PURPOSE: Postoperative care usually required 24-48 hours at intensive care unit (ICU) in children with congenital heart disease. More longer ICU stay may give more chances to produce the postoperative complications. Postoperative pulmonary complication is produced to a much higher incidence after longer immobilized state with keeping catheters and arterial and venous lines. So, we evaluated the predisposing factors those are oriented to ICU stay factors and age, hematologic abnormalities, hepatic dysfunction, infections during ICU care in children with congenital heart disease. METHODS: A retrospective review was performed of postoperative factors for children undergoing open heart surgery in intensive cardiac unit, Wonkwang medical cardiac center. A total of 193 pediatric patients who had cardiac surgery with cardiopulmonary bypass in a 10 year period from Jan. 1995 until Dec. 2004 were reviewed. After logistic regression test, predisposing factors were deemed significant if associated with a pulmonary complication with P<0.05. RESULTS: Children who fell postoperative pulmonary complication in our institution occupied 15% of 193 patients with congenital heart disease. Of all clinical factors considered, those significantly associated with postoperative pulmonary complication were as follows: high ALT level, longer duration of mechanical ventilation and arterial line maintenance. CONCLUSION: Prompt weaning of mechanical ventilation and removal of arterial line during ICU stay in children underwent open heart surgery may be necessary to decrease the risks of postoperative pulmonary complication.
Cardiopulmonary Bypass ; Catheters ; Causality* ; Child* ; Heart Defects, Congenital* ; Humans ; Incidence ; Intensive Care Units ; Logistic Models ; Postoperative Care ; Postoperative Complications ; Respiration, Artificial ; Retrospective Studies ; Thoracic Surgery ; Vascular Access Devices ; Weaning

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Decision of Surgical Treatment Strategy for Hypoplastic Left Ventricle with Coarctation of Aorta.

Han Ki PARK ; Byung Won YOO ; Young Jin KIM ; Jae Young CHOI ; Young Hwan PARK

Journal of the Korean Pediatric Cardiology Society.2005;9(2):326-333.

PURPOSE: The purpose of this study is to determine the feasibility of biventricular repair for hypoplastic left ventricle combined with coarctation of aorta and to provide strategy of surgical treatment. METHODS: The preoperative and postoperative dimension of mitral valve and left ventricle was compared for three patients with hypoplastic left ventricle combined with coarctation of aorta. Ventricular septal defect, atrial septal defect and patent ductus arteriosus were also present in all patients, and the age at the operation was 36, 15 and 11 days. The preoperative end-diastolic left ventricular volume was 13, 28, 24 mL/m2 respectively, and antegrade flow was observed in ascending aorta in all patients. RESULTS: All patients underwent repair of coarctation of aorta. In addition to coarctation repair, pulmonary arterial banding and atrial septal defect closure was performed in Case 1 and 2 respectively, leaving the ventricular septal defect unclosed. In case 3, the ventricular septal defect was closed with the coarctation repair. Case 1 had to undergo Norwood procedure due to inadequate growth of left ventricle and is waiting for univentricular repair. In Case 2 and 3, the left ventricular size increased and biventricular repair could be performed successfully. CONCLUSION: Left ventricular growth can be obtained by repair of coarctation and biventricular repair was feasible in selected cases of hypoplastic left ventricle combined with coarctation of aorta. Size and volume measurement of mitral valve and left ventricle with echocardiography or magnetic resonance image provide useful information to decide the surgical strategy for this group of patients.
Aorta ; Aortic Coarctation* ; Ductus Arteriosus, Patent ; Echocardiography ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart Ventricles* ; Humans ; Mitral Valve ; Norwood Procedures

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A Method of Preventing Perigraft Leak from a Polytetrafluoroethylene Blalock-Taussig Shunt.

Ji Hyuk YANG ; Hoseok I ; Tae Gook JUN ; Pyo Won PARK ; Kiick SUNG ; June HUH ; I Seok KANG ; Heung Jae LEE

Journal of the Korean Pediatric Cardiology Society.2005;9(2):317-325.

PURPOSE: Perigraft seroma and excessive fluid leaks are well known complications after the use of expanded polytetrafluoroethylene(ePTFE, Gore-Tex(R)) graft. The purpose of this study is to evaluate the effectiveness of precoating the grafts with fibrin glue in the patients underwent a modified Blalock-Taussig shunt. METHODS: Among 51 consecutive infants underwent modified Blalock-Taussig shunt between June 2000 and August 2003, 49 patients underwent 53 shunt procedures through thoracotomy were included for analysis. Their median age was 0.9 months(2 days-5.9 months), median body weight was 3.5(2.2-7.9) kg. The ePTFE grafts precoated with fibrin glue were used in 20 procedures. Perioperative variables of the precoated group were compared with those of a control group(n=33) using t-test and Fisher's exact test. RESULTS: There was no operative mortality in the both groups. No significant difference between the groups could be found in the preoperative variables, postoperative morbidity, and the incidence of perigraft seroma, which developed only in 1 case in the control group. The size of the grafts was significantly smaller in the precoated group(P<0.01). The total amount of pleural drainage per body weight of the precoated group was significantly less than that of the control group(19.7+/-25.2 versus 5.5+/-4.9 mL/kg; P<0.01). CONCLUSION: Precoating an ePTFE graft with fibrin glue may reduce perigraft leak after a modified Blalock-Taussig shunt, although the impact of the size of the graft used and the native pulmonary artery requires further investigation.
Blalock-Taussig Procedure ; Blood Vessel Prosthesis ; Body Weight ; Drainage ; Endoleak* ; Fibrin Tissue Adhesive ; Humans ; Incidence ; Infant ; Mortality ; Polytetrafluoroethylene* ; Postoperative Complications ; Pulmonary Artery ; Seroma ; Thoracotomy ; Tissue Adhesives ; Transplants

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Initial and Intermediate-term Result of Transcatheter Closure of Patent Foramen Ovale Associated with Paradoxical Embolism Using the Amplatzer(R) PFO Occluder.

So Ick JANG ; Yoon Jin CHOI ; Do Jun CHO ; Ki Yang YOO

Journal of the Korean Pediatric Cardiology Society.2005;9(2):308-316.

PURPOSE: Paradoxical embolism due to the presence of patent foramen ovale(PFO) is a well-established possible mechanism of ischemic stroke of unknown origin, and the closure of PFO seems to be a kind of most effective method of the prevention of stroke recurrence. We report the initial and intermediate-term result of transcatheter closure of PFO associated with paradoxical embolism leading to cryptogenic transient ischemic attack or cerebrovascular accident using the Amplatzer(R) PFO Occluder. METHODS: From January 2003 through May 2005, 10 patients with PFO(4 male, 6 female) with history of at least 1 cryptogenic transient ischemic attack or cerebrovascular accident underwent percutaneous transcatheter closure of PFO using Amplatzer(R) occluder assisted by transesophageal echocardiography(TEE). All procedure were performed under general anesthesia and assisted by TEE. RESULTS: In all patients, the implantation procedure was successful and no significant complication was observed(in one case, peri-interventional ST-segment elevation observed). During the follow-up period of mean 13.1 months(range, 1-28 months), no recurrence of neurologic episode were observed and there was no residual shunt through PFO. CONCLUSION: We were able to implant the device without significant complication in all our patients and close PFO effectively. No recurrence of neurologic episode were observed. We conclude that in this initial and intermediate-term follow up, the transcatheter closure of PFO associated with paradoxical embolism using the Amplatzer(R) PFO Occluder is a safe and effective method in prevention of stroke recurrence and there is no significant adverse effect until now. And this procedure may be the treatment choice in patients with the high risk of recurrence ischemic attack. However, in this study, the number of patients included[5 patients(50%) had multiple thromboembolic events] is small and follow-up period is not long. So, we need more clinical cases and long-term clinical follow-up.
Anesthesia, General ; Embolism, Paradoxical* ; Follow-Up Studies ; Foramen Ovale, Patent* ; Humans ; Ischemic Attack, Transient ; Male ; Recurrence ; Stroke