Background:Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia.Methods:A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality. We performed univariate and multivariate logistic regression using STATA 12-1 to identify predictors of postsurgical major complications.Results:A total of 257 patients (median age: 36 months) were recruited; 217 (84.1%) had complications, including low cardiac output syndrome (19.8%), arrhythmia (18.6%), sepsis (17.4%), and pleural effusion (14.8%). Forty-nine (19%) patients had major complications, including cardiac arrest (5%), need for emergency chest opening (3.9%), and multiple organ failure (7.4%). 12.8% died during hospital stay, and 30-day mortality was 13.6%. Predictors of major complications were cyanotic congenital heart disease (odds ratio [OR]: 4.6, 95% confidence interval [CI]: 1.5–14.2), longer duration of cardiopulmonary bypass (CPB, OR: 4.4, 95% CI: 1.5–13.4), high inotropes (OR: 13.1, 95% CI: 3.2–54.2), and increase in lactate >0.75 mmol/L/h or more in the first 24 h (OR: 37.1, 95% CI: 10.1–136.3).Conclusion:One-fifth of children undergoing cardiac surgery experienced major complications with around 13% mortality. Cyanotic congenital heart disease, longer duration of CPB, high inotropes on leaving operating theater, and increase in blood lactate are associated with major complications in children after cardiac surgery.
In developing countries, surgical treatment of adult congenital cardiac disease is effective and safe, with an overall survival rate of 96.3% at 60 months. Due to high mortality rate, palliative surgery of a non-atrial septal defect patient is recommended to be discontinued. The independent predictor of mortality was post-operative New York Heart Association functional class III-IV.
We describe a rare case of pulmonary artery sling occurring simultaneously with tetralogy of Fallot. This report describes the successful concomitant repair of both intracardiac anomalies.
BackgroundPrimary cardiac lymphoma (PCL) is a very rare disease and is most commonly found among immunocompromised patients. Its cardiac manifestations are non-specific, leading to delayed diagnosis and poor prognosis. However, chemotherapy could improve survival, which makes early and prompt diagnosis very crucial. This is a report of a rare case of PCL found on a 73-year-old man who benefit from early debulking surgery.Case SummaryA 73-year-old man presented with worsening dyspnoea over the last 2 months. A 7.2 × 10.2 cm intramural tumour was found extending from the right atrium to the right ventricle. It was considered that the tumour could cause sudden death due to its size and extension. Therefore, surgical debulking with biopsy and valve repair was done. Cytology examination from the resected specimen demonstrated diffuse large B-cell lymphoma non-germinal centre B-cell like type. He was discharged 2 weeks after the surgery in stable condition and referred to internal medicine department for chemotherapy. However, he chose palliative home care and died 44 days after surgery.DiscussionIn cases of PCL with concerning tumour size and symptoms due to cardiac obstruction, early surgical debulking could improve haemodynamics, prevent sudden death, and confirm immunopathological diagnosis needed in determining further chemotherapy, which is proven to improve survival.
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