Author Of 3 Presentations

A GIANT PSEUDO ANEURYSM AFTER THE SURGERY OF AORTICOPULMONARY WINDOW AND AORTIC ACH INTERRUPTION

Presenter
Room
Poster Area 1
Date
19.06.2019
Session Time
12:20 - 13:40
Session Name
POSTER WALK SESSION 01
Duration
5 Minutes

Abstract

Background

We present a case of aorticopulmonary window (APW) with aortic arch interruptions that developed giant pseudoaneurysm after surgery.

Objectives

Case

A 6-day-old baby was referred to hospital for surgery with the diagnosis of APW. The patient was intubated and mechanical ventilation was performed due to respiratory distress. The echocardiographic evaluation showed a wide APW, patent ductus arteriosus, transverse aortic hypoplasia, aortic arch interruption and pulmonary hypertension.

Methods

Prostaglandin infusion was started. At 12 days of age, the hypoplastic transverse arch and interrupted aortic arch were repaired with prosthetic material. APW was repaired, PDA was ligated. Candida albicans was produced in the blood culture in the preoperative period. Antifungal therapy was initiated. The echocardiogram on the 18th postoperative day revealed giant pseudo aneurysm in the aortic arch. CT angiography showed a pseudo aneurysm extending from the aortic isthmus to distal descending aorta with active bleeding and hematoma in posterior mediastinum. The patient underwent to urgent surgery on the same day. Control CT angiographic evaluation revealed no aneurysm in the transverse aorta and descending aorta.

Results

He was discharged 21th day after the second operation. Blood culture taken 1 month after the end of antifungal treatment was negative

Conclusion

Aortopulmonary window (APW) may be an isolated anomaly (simple) or associated with concomitant cardiovascular anomalies (complex). Mortality is almost always due to concomitant cardiovascular anomalies. One of the most common concomitant cardiovascular anomalies is an interrupted aortic arch. Our patient underwent re-operation because of fungal end arthritis after a successful adjustment surgery.

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WHAT ARE THE NON-CARDIAC PROGNOSTIC FACTORS AFFECTING MORTALITY IN NEONATES WITH AORTOPULMONARY SHUNT

Abstract

Background

Systemic to pulmonary shunts (SPS) have proven to be highly effective for the palliation of neonates with cyanotic congenital heart disease. Mortality after SPS surgery in neonates has multifactorial basis

Objectives

We aimed to investigate the clinical results of the SPS in relation to the underlying cardiac disease and to identify the risk factors contributing to an adverse outcome

Methods

All neonates who underwent first shunt insertion for cyanotic congenital heart disease during the study period from 1 January 2014 to 31 December 2017 were included. A retrospective review of patient records was done. Patients were grouped into 2 different categories: survived with or without any reintervention and death before or after any reintervention till discharge

Results

During the study period, 47 patients underwent SPS shunt placement. Preoperative epinephrine requirement and mechanical ventilation and postoperative erythrocyte transfusion need were statistically significant

Conclusion

Although primary cardiac pathology is the most important prognostic factor, some other preoperative and postoperative factors might also affect the prognosis. As there are very few centers in the region that specialize in pediatric cardiac surgery, a multi-center approach will be helpful in reaching reliable conclusion

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THE COMPARISON OF THE CARDIAC INDEX VALUES MEASURED BY CRITICAL CARE ECHOCARDIOGRAPHY WITH THE VALUES MEASURED BY PICCO IN THE PEDIATRIC INTENSIVE CARE UNIT

Abstract

Background

Pulse index Contour Cardiac Output (PiCCO) monitoring is an invasive, hemodynamics monitor and provides continuous cardiac output (CO) and cardiac index (CI), preload, systemic vascular resistance index measurements. Use of critical care echocardiography by the pediatric intensivists has been increased. Cardiac output and CI can be measured with echocardiography.

Objectives

In this study we aimed to compare the CO and CI values which were measured by pediatric intensivists with critical-care echocardiography and measured by PiCCO monitor in critically ill pediatric patients.

Methods

A total of 49 echocardiographic measurements were performed and recorded from 15 patients with diagnosis of septic shock, cardiogenic shock, acute respiratory distress syndrome, pulmonary edema. Echocardiographic measurements were performed by two pediatric intensive care fellows. The distance of left ventricle outflow tract (LVOT) in parasternal longer axis and LVOT-Velocity Time Integral (LVOT-VTI) measurement was performed in the apical five chamber image. Cardiac output_echocardiography (CO_echo) and CI_echocardiography (CI_echo) was calculated with these measurements. PiCCO monitoring was performed.

Results

Cardiac output (CO_picco) and CI (CI_picco) measured by PiCCO simultaneously with echocardiographic measurements were recorded another researcher who blind to echocardiographic measurements. We detected strong positive correlation between CO_echo and CO_picco measurements (p<0.001, r=0.985) and a strong positive correlation between CI_echo and CI_picco measurements (p<0.001, r=0.943).

Conclusion

According to our study results we suggested that echocardiographic CO measurements which will be performed by an experienced pediatric intensive care team with critical care echocardiography may be as valuable as PiCCO measurements in the management of the fluid and vasoactive-inotropic treatment of critically ill pediatric patients.

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Presenter Of 1 Presentation

A GIANT PSEUDO ANEURYSM AFTER THE SURGERY OF AORTICOPULMONARY WINDOW AND AORTIC ACH INTERRUPTION

Presenter
Room
Poster Area 1
Date
19.06.2019
Session Time
12:20 - 13:40
Session Name
POSTER WALK SESSION 01
Duration
5 Minutes

Abstract

Background

We present a case of aorticopulmonary window (APW) with aortic arch interruptions that developed giant pseudoaneurysm after surgery.

Objectives

Case

A 6-day-old baby was referred to hospital for surgery with the diagnosis of APW. The patient was intubated and mechanical ventilation was performed due to respiratory distress. The echocardiographic evaluation showed a wide APW, patent ductus arteriosus, transverse aortic hypoplasia, aortic arch interruption and pulmonary hypertension.

Methods

Prostaglandin infusion was started. At 12 days of age, the hypoplastic transverse arch and interrupted aortic arch were repaired with prosthetic material. APW was repaired, PDA was ligated. Candida albicans was produced in the blood culture in the preoperative period. Antifungal therapy was initiated. The echocardiogram on the 18th postoperative day revealed giant pseudo aneurysm in the aortic arch. CT angiography showed a pseudo aneurysm extending from the aortic isthmus to distal descending aorta with active bleeding and hematoma in posterior mediastinum. The patient underwent to urgent surgery on the same day. Control CT angiographic evaluation revealed no aneurysm in the transverse aorta and descending aorta.

Results

He was discharged 21th day after the second operation. Blood culture taken 1 month after the end of antifungal treatment was negative

Conclusion

Aortopulmonary window (APW) may be an isolated anomaly (simple) or associated with concomitant cardiovascular anomalies (complex). Mortality is almost always due to concomitant cardiovascular anomalies. One of the most common concomitant cardiovascular anomalies is an interrupted aortic arch. Our patient underwent re-operation because of fungal end arthritis after a successful adjustment surgery.

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