Objective: To investigate the risk factors associated with prolonged ventilation after Fontan surgery. Design: Retrospective case series. Setting: Tertiary childrens hospital. Patients: We included 123 children who underwent Fontan surgery without delayed sternal closure or extracorporeal membrane oxygenation between 2011 and 2017. Intervention: Fontan surgery. Measurements and main results: Prolonged ventilation was defined as intubation for more than 24 hours after surgery. Preoperative, intraoperative, and perioperative data were collected retrospectively from medical records. Multivariate logistic regression analysis was used to identify risk factors for prolonged ventilation. The median age and weight of patients were 2.2 years and 10.0 kg, respectively. Seventeen per cent of the patients (n = 21) received prolonged mechanical ventilation, and the median intubation period was 2.9 days. There were no 90-day or in-hospital deaths. The independent predictors of prolonged ventilation identified were fenestration (p < 0.01), low pulmonary artery index (p = 0.02), and advanced atrioventricular regurgitation (p < 0.01). The duration of ICU stay was significantly longer in the prolonged ventilation group than in the early extubation group (10 days versus 6 days, p < 0.01). Conclusion: Fenestration, low pulmonary artery index, and significant atrioventricular regurgitation are risk factors for prolonged ventilation after Fontan surgery. Careful preoperative and perioperative management that considers the risk factors for prolonged ventilation in each individual is important.
Introduction: Coronary artery disease is a well-known cause of cardiac arrest in adults; however, this condition can also cause cardiac arrest in children. In this study, we report cases of out-of-hospital cardiac arrest caused by congenital coronary artery disease. Data were retrospectively obtained from the medical records of patients treated at our hospital for out-of-hospital cardiac arrest (April 2007-March 2017). Cases: Among the 74 cases of out-of-hospital cardiac arrest that occurred during the 10-year study period, 3 were caused by congenital coronary artery disease. Cases of coronary artery disease included 1 patient each with an anomalous left coronary artery from the pulmonary artery, an anomalous aortic origin of right coronary artery, and an anomalous aortic origin of left coronary artery. Cardiac arrest was triggered in all 3 patients by exercise or crying. One patient with cardiac arrest who was rapidly resuscitated at school survived without sequelae; however, one infant died and the other suffered severe hypoxic encephalopathy. All 3 patients were diagnosed with transthoracic echocardiography. Conclusions: When investigating causes of pediatric cardiogenic cardiac arrest, congenital coronary artery diseases need to be considered.
Background: Atrioventricular valve regurgitation (AVVR) has a notable impact on the prognosis of patients with hypoplastic left heart syndrome (HLHS) and right atrial isomerism (RAI). Methods: The study population comprised two groups: (1) HLHS and RAI group: n 32 (HLHS 15, RAI 17), and (2) normal control group: n 53. X-plane images of apical four-chamber view and orthogonal plane cutting through the center of annulus were acquired using transthoracic matrix array probe. Speckle-tracking of the two opposing points on the annulus in four-chamber plane and orthogonal plane was performed, and the distances of respective opposing points were consecutively measured along the cardiac cycle. Atrioventricular valve (AVV) area dynamics were classified into three categories according to the areal change pattern during systole in the normal group: Type-1: area decreases during systole; Type-2: area increases during systole; and Type-3: no significant areal change. The HLHS and RAI groups were subdivided into two subgroups according to the grade of AVVR: low-grade AVVR and high-grade AVVR, and the annular dynamics were compared between
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