Background:Junctional ectopic tachycardia (JET) often occurs in the early postoperative period following surgery for congenital heart diseases and may lead to hemodynamic compromise. Its exact etiology is unknown, however, longer cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, catecholamines, and hypomagnesemia are known risk factors. JET is associated with increased postoperative morbidity and mortality.Materials and Methods:A prospective cohort study of 194 consecutive children who underwent open heart surgery on CPB over 1 year period, patients was divided into three groups; JET, non-JET arrhythmia, and no arrhythmia groups. Information on patient's demographics (sex, age, and body weight), type of surgical interventions, duration of CPB and ACC, the use of inotropic support, duration of intensive care unit (ICU) stay, and response to different therapeutic methods were collected.Results:JET was documented in 53 patients (27%) most commonly following tetralogy of Fallot (TOF) repair and was associated with longer CPB and ACC times (118 and 77 min, respectively) as compared to non-JET arrhythmia (93.9 and 55.3 min, respectively) and no arrhythmia groups (94.9 and 54.8 min, respectively). Patients with JET required more inotropic support and longer ICU stay as compared to other groups. Amiodarone was safe and effective in treatment of JET. Atrial electrocardiogram (ECG) and Lewis lead ECG were helpful tools in JET diagnosis. The mortality was 11.5% in JET patients.Conclusions:Incidence of JET was 27% possibly due to the large number of Fallot repair and Senning operation. Longer CPB and ACC times are risk factors for JET.
Patients and methods: Ninety patients treated by surfactant replacement therapy were included in the study. Patients were divided into 2 groups; group A consists of patients who were extubated early within 24 h after surfactant administration and group B consists of patients who were extubated after 24 h from surfactant administration. Results: 59 patients were extubated early (within 24 h after surfactant administration) while 31 patients were extubated late (after 24 h from surfactant administration). Patients in group B (late extubation group) had a longer duration of CPAP (41.53 + 9.74 h in group B versus 17.30 + 4.03 h in group A), a longer duration of total oxygen administration (73.41 + 11.24 h in group B versus 45.33 + 5.22 h in group A) and a longer duration of hospital stay (171.88 + 75.74 h in group B versus 106.82 + 52.79 h in group A) than patients in group A (early extubation group). 41 (69.50%) Patients who were extubated early received surfactants at or before the age of 6 h while 22 (70.97%) patients who were extubated late received surfactants after the age of 6 h. Regarding complications, 6 patients had transient bradycardia (6.7%), 4 patients had pneumothorax (4.4%) and 4 patients had pulmonary hemorrhage (4.4%). Conclusion: Early administration of surfactants is associated with early extubation. Patients who were extubated early (most of them had an early administration of surfactants) had a lower chance for re-intubation, less duration of total oxygen administration and less hospital stay. ª 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of The Egyptian Pediatric Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
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