Introduction:The neutrophil-lymphocyte ratio (NLR) has been associated with worse outcomes in patients undergoing coronary artery bypass graft surgery. Little is known about this association in the pediatric population who require surgery for congenital heart defects, especially in patients with a single ventricle (SV).Objective: To analyze the association of the preoperative NLR with outcomes in patients undergoing the bidirectional Glenn procedure.Methods: This study involved a retrospective cohort analysis of 141 consecutive patients with SV undergoing the bidirectional Glenn procedure between January 2011 and December 2017 in two centers. The preoperative NLR was included in the last hemogram test before surgery. According to the NLR level, the patients were divided into group I (NLR < 1), group II (NLR between 1 and 2), and group III (NLR > 2).The primary endpoint was total hospital length of stay (LOS), and secondary endpoints were mechanical ventilation (MV) time, intensive care unit (ICU) LOS, ventricular dysfunction, complications, and middle-term mortality.Results: The average follow-up duration was 48 months. There were 61, 47, and 33 patients in groups I, II, and III, respectively. Patients in group III exhibited an increased risk of prolonged total hospital LOS (P = .00). An increase in MV time (P = .03) and ICU LOS (P = .02) was also observed in this group, and these patients experienced greater mortality in 24 months following the surgery (P = .03). There was no association between the NLR and ventricular dysfunction (P = .26) and complications (P = .46).
Conclusion:A high preoperative NLR was associated with worse outcomes in patients with SV physiology undergoing the bidirectional Glenn procedure.
K E Y W O R D Sbidirectional Glenn procedure, congenital heart disease, neutrophil-lymphocyte ratio, single-ventricle physiology
Brief communicationCongenital anomalies of the coronary arteries, occurring in 1-2% of the population 1 , are classified as anomalies at the origin (abnormal exit from the pulmonary trunk of the left coronary artery), terminal (coronary fistulae) and distributive (one coronary artery only) 2 . Congenital atresia of the ostium of the left coronary artery is a rather rare occurrence that is not even mentioned in the above-cited literature. Classically, it consists of total ostial atresia of the left coronary artery, possibly in association with atresia of the trunk of this vessel. Clinically, during the first months of life such patients may present with cardiac insufficiency (infantile form) or a delayed (including adults) picture of coronary insufficiency (adult form). We report below two patients of different ages and clinical presentations, having congenital atresia of the ostium of the left coronary artery of difficult diagnosis, who underwent successful surgical myocardial revascularization.
Case reportsCase 1 -A nine-month-old boy from Divinolândia, SP, with a clinical history of tiredness on sucking, accompanied by discrete diaphoresis from the first month of life on. At six months of age, after a case of pneumonia, a sudden worsening of his condition occurred accompanied by cardiac insufficiency. A noninvasive investigation diagnosed dilated myocardiopathy. The patient showed significant improvement following medication, receiving a discharge from the hospital with a prescription of digoxin, furosemide and captopril. At nine months of age, he was referred to clinical examination at the Heart Hospital of Ribeirão Preto and he was found to be in excellent general condition (weight: 10 kg). On physical examination, he had a normal pulse and upon cardiac auscultation a ++/6 systolic murmur on the 2 nd -3 rd left intercostal space with normal heart sounds. Thoracic antero-posterior radiography showed significant cardiomegaly ( fig.1 upper side). The electrocardiogram showed unequivocal signs of anterolateral infarction ( fig. 2 A). In view of this consistent clinical evidence, an initial diagnosis of anomalous origin of the left coronary artery from the pulmonary atretik was made. Due to lack of evidence of an anomalous coronary artery on a previously performed echocardiogram, a diagnostic hemodynamic study was indicated. Depressed left ventricular function was observed during this procedure. The right coronary artery was dilated, and collateral circulation nourished the left coronary, which was atretic in its ostium. No shunting to the pulmonary artery was detected ( fig. 3). Once the diagnosis of congenital atresia of the ostium of the left coronary artery had been established, the infant immediately underwent surgical treatment by revascularization of the left coronary artery with a graft from the internal thoracic artery. The postoperative period was uneventfull, and 11 months following surgery the patient remains asymptomatic, in good general condition and under the use of digoxin. Thoracic radiography sh...
The use of multiple patches for biventricular correction of this anomaly simplifies and renders feasible the intraventricular repair in cases in which the 1-patch technique was deemed impossible.
IntroductionPost-cardiotomy myocardial dysfunction requiring mechanical circulatory
support occurs in about 0.5% of cases. In our environment, the use of
extracorporeal membrane oxygenation has been increasing in recent years.ObjectiveTo evaluate the impact of investment in professional training and improvement
of equipment in the rate of weaning from extracorporeal membrane oxygenation
and survival.MethodsA retrospective study. Fifty-six pediatric and/or congenital heart patients
underwent post-cardiotomy extracorporeal membrane oxygenation at our
institution between November 1999 and July 2014. We divided this period into
two phases: phase I, 36 cases (before the structuring of the extracorporeal
membrane oxygenation program) and phase II, 20 cases (after the
extracorporeal membrane oxygenation program implementation) with investment
in training and equipment). Were considered as primary outcomes:
extracorporeal membrane oxygenation weaning and survival to hospital
discharge. The results in both phases were compared using Chi-square test.
To identify the impact of the different variables we used binary logistic
regression analysis.ResultsGroups were comparable. In phase I, 9 patients (25%) were weaned from
extracorporeal membrane oxygenation, but only 2 (5.5%) were discharged. In
phase II, extracorporeal membrane oxygenation was used in 20 patients,
weaning was possible in 17 (85%), with 9 (45%) hospital discharges
(P<0.01). When the impact of several variables on
discharge and weaning of extracorporeal membrane oxygenation was analyzed,
we observe that phase II was an independent predictor of better results
(P<0.001) and need for left cavities drainage was
associated with worse survival (P=0.045).ConclusionThe investment in professional training and improvement of equipment
significantly increased extracorporeal membrane oxygenation results.
In this study, imaging diagnosis was basically attained through echocardiography, with good correlation with intraoperative findings. Histopathological findings were consistent with the literature, with rhabdomyoma being the most common neoplasm in children. The evolution after surgical treatment was favorable in most cases.
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