Background: The radical change in techniques in paediatric cardiac surgery has dramatically reduced the morbidity and mortality. The different varieties of arrhythmia that are frequently observed in postoperative period in our country are still not well documented.Objectives: To determine the incidence and risk factors of arrhythmia immediately after cardiac surgery in paediatric age group.Materials and method: It was a prospective study. A total of 100 paediatric patients (age <18 years) who underwent cardiac surgery at Dhaka Shishu Hospital between 2013 and 2016 were selected purposivelyResults: Out of 100 patients maximum 41% were from 13-72 months age group. The mean age was 49.73±37.17 months with range of 0.5-231 months, 58% patients were male and rest were female. Postoperatively 31% subjects were arrhythmic and of these the highest number of patients suffered from junctional ectopic tachycardia. Out of these 100 patients, 39% were diagnosed as VSD followed by TOF (35%). Among 31 arrhythmic patients 59.83%, 41.93% and 3.22% manifested onset of arrhythmia at 1st, 1st to 2nd and 2nd to 7th postoperative period respectively. In this study age, body weight, cyanosis, CPB time, postoperative acidosis, ventilation support days, hypertension on arrival in ICU as well as ICU stay days were recognized as significant risk factors (p <0.05).Conclusion: Proper and careful monitoring of younger patient with lower body weight undergoing corrective cardiac surgery with long cardiopulmonary bypass (CPB) time may reduce the episodes of post operative arrhythmia. These patients may require high inotropic support post operatively. So, medical prevention and early diagnosis as well as proper management may improve the operative outcome.Delta Med Col J. Jan 2018 6(1): 22-28
Background & Objective: Patent ductus arteriosus (PDA) is a common condition in preterm infants and is associated with profound morbidity and mortality. Pharmacotherapy (indomethacin or ibuprofen) is the first choice to close the PDA, but if pharmacological closure is contraindicated or failed, surgical ligation is usually performed. But following surgical ligation of PDA, preterm infants may develop severe hypotension and respiratory failure. Prophylactic stress hydrocortisone (HC) has emerged as a therapy to prevent complications, although its efficacy in reducing postoperative hypotension and oxygenation difficulties has not been rigorously tested. The purpose of this study was to compare the outcomes in preterm infants who received stress HC before their PDA ligation to those who did not (standard treatment group or control). Materials & Methods: This comparative clinical trial was conducted in Dhaka Shishu Hospital (DSH), Dhaka over a period of 15 months between April 2014 to June 2015. A total of 40 infants with a significant PDA and a history of failed medical treatment were included in the study and were divided into two groups (each group having 20 infants) – one receiving stress HC before PDA ligation (Case) and the other did not (Control). Respiratory support, expressed as highest FiO2, highest mean airway pressure and mode of ventilation, was noted as was cardiovascular support including inotropic medication, its dose throughout the preoperative and the postoperative periods. Post-operative cardiovascular and respiratory supports were the main outcome measures which were measured within 72 hours following PDA ligation. Result: At baseline both the study groups were almost similar with respect to their sex, gestational age, birth weight, and age at surgery and prenatal steroid exposure. However, there was more incidence of preoperative steroid exposure in standard treatment group. Urine output was somewhat higher in the standard treatment group compared to the HC group but it was not statistically significant (1.33 vs. 1.21 ml/kg/min, p = 0.205). The mean arterial pressure was higher in the HC group than that in the standard treatment group (92.5 vs. 86.7 mmHg, p = 0.018), but it was clinically insignificant. The study observed that infants who received stress dose HC rarely needed vasopressor support post ligation and their average and highest doses of dopamine were also significantly lower compared to their standard treatment group. The postoperative high-frequency ventilation was more often needed in the standard treatment group, although none in either group needed this support preoperatively. The mean airway pressure was although similar in both groups the highest FiO2 was much less in the HC group. Conclusion: The study concluded that stress dose HC given to preterm infants before surgical ligation of PDA may improve the postoperative cardiorespiratory outcomes. But as the sample size was too small, this finding requires validation by large-scale study. Ibrahim Card Med J 2015; 5 (1&2): 9-14
Submission of an original paper with copyright agreement and authorship responsibility.I (corresponding author) certify that I have participated sufficiently in the conception and design of this work and the analysis of the data (wherever applicable), as well as the writing of the manuscript, to take public responsibility for it. I believe the manuscript represents valid work. I have reviewed the final version of the manuscript and approve it for publication. Neither has the manuscript nor one with substantially similar content under my authorship been published nor is being considered for publication elsewhere, except as described in an attachment. Furthermore I attest that I shall produce the data upon which the manuscript is based for examination by the editors or their assignees, if requested.Thanking you.
not availableBangladesh J Child Health 2016; VOL 40 (2) :124-128
Background: Ventricular Septal Defect (VSD) is the commonest congenital cardiac anomaly in Bangladesh. For this reason, patch repair of VSD is commonly performed cardiac surgery here. Aim: To observe the short term outcome of patch repair of VSD. Methods: 50 consecutive patients were enrolled in the study by purposive sampling who received treatment for isolated VSD in Department of Paediatric Cardiac Surgery of Dhaka Shishu Hospital, Dhaka, Bangladesh. They underwent ventricular patch repair from January, 2017 to December, 2017. A prospective observational cross-sectional study was conducted for this 12 months period. A pre-structured, interview and observation based, peer reviewed data collection sheet was prepared. Data regarding Sociodemographic, clinical, surgical and outcome profile were recorded. Data were compiled, edited and analyzed with SPSS version 23. Data were presented as mean and standard deviation, frequency percentage and median with range. Results: The mean birth weight of 50 patients was 2.8 kg (range: 2.1-3.5 kg) whereas the median of gestational age was 38 weeks. Among these 50 patients, 22 (44%) and 28 (56%) were boys and girls respectively. The indication of surgery was volume load, failure to thrive and repeated respiratory tract infection. Out of 50 patients, 46 (92%) had perimembranous variety. On the contrary, 4 (8%) experienced Double committed type of VSD. The mean Bypass time and Aortic cross-clamp time were recorded as 70 ± 13.7 minutes and 35 ± 6.85 minutes respectively. Out of 50 patients who underwent ventricular patch repair, 2 (4%) experienced pneumothorax, 1 (2%) got chylothorax and 1 (2%) had transient heart block. Total 45 (90%) patients showed uneventful outcome. Conclusion: Contemporary results of ventricular patch repair in case of VSD showed unparallel outcome with extremely low morbidity in our perspective.
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