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Surgical closure of the patent ductus arteriosus by anterior mini-thoracotomy in very preterm infants
Pediatrics and congenital cardiopathies ment of choice for many cardiac lesions, and serve as alternatives or adjuncts to surgical treatment. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.361 320
Surgical closure of the patent ductus arteriosus by anterior mini-thoracotomy in very preterm infants C. Wanert ∗ , C. Ovaert , F. El Louali , V. Fouilloux Cardiopédiatrie, APHM hôpital Timone Enfants, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (C. Wanert) Introduction Patent ductus arteriosus (PDA) is an important cause of morbi-mortality in preterm newborns. Purpose Our study aimed to analyze efficacy and safety of surgical closure of PDA using anterior mini-thoracotomy in very low weight preterm babies. Methods Monocentric and retrospective study including 21 preterms < 1.3 kgs, who underwent surgical closure of PDA through anterior mini-thoracotomy, between 2010 and 2016. Results Mean gestational age (GA) at birth was 25.9 ± 1.2 weeks, mean weight at birth was 734 ± 133 gr. Mean age at the time of surgery was 25.4 ± 9.6 days. Mean corrected age and weight at surgery were 29.6 ± 1.6 weeks of GA and 1058 ± 166 gr respectively. In total, 90.5% of neonates had at least one trial of ibuprofen before surgery. Eighteen patients (85.7%) were ventilated before surgery. Median follow-up was 68.5 days [11 to 273 days] after surgery. No death related to surgery occurred. Three patients died 49, 65 and 204 days after surgery, due to sepsis, not considered related to surgery. Immediate post-operative echocardiography showed non significant residual shunt in only 1 patient (4.8%), and complete closure in the 20 remaining babies. Median time to extubation was 6 [3—16] days. One patient (4.8%) had a local complication (wound infection) and 5 patients (23.8%) presented transient instability, either hemodynamic (n = 2 patients (9.5%)), respiratory (n = 1 (4.8%)) or combined (n = 2 (9.5%)). Conclusions Surgical PDA closure using anterior minithoracotomy is an effective and safe technique under experienced hands, for PDA closure in very low weight preterm babies. This technique needs to be compared with transcatheter PDA closure currently proposed for those very small babies. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.362 373
Factors determining the nature of progression of discrete fixed subaortic stenosis L. Bezdah ∗ , E. Allouche , A. Ben Salem , M. Aouina , H. Ben Ahmed , W. Ouchtati Cardiologie, hôpital Charles-Nicolle, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (L. Bezdah) Introduction In discrete fixed subaortic stenosis, surgery is indicated when the systolic gradient (Gmax) between the left ventricle (LV) and the aorta exceed 50 mmHg or in the presence of significant aortic regurgitation (AR). The aim of this study was to determine the factors that influence the progression of the obstruction and the appearance of AR.
175 Methods Retrospective serial echocardiographic review of 19 patients, mean age 16 years (2 years—38 years), with fixed discrete subaortic stenosis that did not require surgery (initial Gmax at inclusion < 50 mmHg and without any symptom). The mean follow up was 5.42 years. The progression of gradient is defined by the formula (Gmax at follow up—initial Gmax). Results The mean velocity of increasing of Gmax was 2 mmHg/year. This progression was correlated to the patient’s age (cut off = 15 years, r = −0.5 P = 0.02), and the initial value of the Gmax (cut off = 40 mmHg, r = 0.43, P = 0.04). The appearance or the aggravation of aortic regurgitation was determined by: the initial grade of AR (r = 0.64; P = 0.003), initial Gmax (r = 0.65; P = 0.002), progression’s velocity of G max (r = 0.47; P = 0.04), and distance between the membrane and the aortic cusps (cut off = 5 mm, r = 0.49; P = 0.03). LV hypertrophy was influenced by the velocity of progression of obstruction (> 2 mmHg/year). Conclusion The identification of factors determining the evolution of discrete subaortic stenosis (age < 15 years, initial Gmax > 40 mmHg, distance membrane- cusps > 5 mm) allow an adequate screening of patients that will require early operation. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.363 307
Management of myocardial infarctus in children H. Thabet ∗ , N. Ben Halima , A. Sghaier , G. Hamila , M. Abdalah , B. Ezzine Cardiologie, hôpital Ibn-El-Jazzar-Kairouan, Kairouan, Tunisia ∗ Corresponding author. E-mail address: [email protected] (H. Thabet) Background Myocardial infarction is usually the preserve of the elderly but is not exceptional in children. Different and numerous are its etiologies in the child. This clinical entity is little explored around the world. Purpose The objective of our study is to describe the clinical, paraclinical, etiologies and management of children presenting for STEMI. Methods It was a monocentric, retrospective, and descriptive study of children, registered from our cardiology department who were hospitalised for the management of an STEMI between 2010 and 2017. For each patient, medical record, transthoracic echography (TTE) report, biological reports and the coronarography report were analysed. Results We counted 7 cases; the average age was 12.87 years (from 4 to 17 years). All the kids in our study were boys. Two children were followed in paediatrics the first for KAWASAKI disease, the other for familial hypercholesterolemia. The common reason for consultation was anginal chest pain. Positive diagnosis was focused on the ECG. The most affected territory was the anterior in 57.14%. Infarction was complicated in two patients. The etiology of STEMI was variable from child to others; there was no etiology more common than others. TTE was performed before coronarography in all children; it identified the etiology in three children (the myxoma of the left atrium(LA), coronary birth anomaly, and KAWASAKI disease’s by visualizing dilatation of coronaries and thrombus of the LAD). Coronarography was performed in all except for the child who had a myxoma of the LA. Only two children had tenecteplase thrombolysis. Two children were treated by angioplasty. Evolution: Only one child was dead after one year. Conclusion Although the STEMI in children is rare, but it must be evoked and perform an ECG in any child who consults for chest pain. TTE is essential in children. Management is broadly in line with that
Surgical closure of the patent ductus arteriosus by anterior mini-thoracotomy in very preterm infants C. Wanert ∗ , C. Ovaert , F. El Louali , V. Fouilloux Cardiopédiatrie, APHM hôpital Timone Enfants, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (C. Wanert) Introduction Patent ductus arteriosus (PDA) is an important cause of morbi-mortality in preterm newborns. Purpose Our study aimed to analyze efficacy and safety of surgical closure of PDA using anterior mini-thoracotomy in very low weight preterm babies. Methods Monocentric and retrospective study including 21 preterms < 1.3 kgs, who underwent surgical closure of PDA through anterior mini-thoracotomy, between 2010 and 2016. Results Mean gestational age (GA) at birth was 25.9 ± 1.2 weeks, mean weight at birth was 734 ± 133 gr. Mean age at the time of surgery was 25.4 ± 9.6 days. Mean corrected age and weight at surgery were 29.6 ± 1.6 weeks of GA and 1058 ± 166 gr respectively. In total, 90.5% of neonates had at least one trial of ibuprofen before surgery. Eighteen patients (85.7%) were ventilated before surgery. Median follow-up was 68.5 days [11 to 273 days] after surgery. No death related to surgery occurred. Three patients died 49, 65 and 204 days after surgery, due to sepsis, not considered related to surgery. Immediate post-operative echocardiography showed non significant residual shunt in only 1 patient (4.8%), and complete closure in the 20 remaining babies. Median time to extubation was 6 [3—16] days. One patient (4.8%) had a local complication (wound infection) and 5 patients (23.8%) presented transient instability, either hemodynamic (n = 2 patients (9.5%)), respiratory (n = 1 (4.8%)) or combined (n = 2 (9.5%)). Conclusions Surgical PDA closure using anterior minithoracotomy is an effective and safe technique under experienced hands, for PDA closure in very low weight preterm babies. This technique needs to be compared with transcatheter PDA closure currently proposed for those very small babies. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.362 373
Factors determining the nature of progression of discrete fixed subaortic stenosis L. Bezdah ∗ , E. Allouche , A. Ben Salem , M. Aouina , H. Ben Ahmed , W. Ouchtati Cardiologie, hôpital Charles-Nicolle, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (L. Bezdah) Introduction In discrete fixed subaortic stenosis, surgery is indicated when the systolic gradient (Gmax) between the left ventricle (LV) and the aorta exceed 50 mmHg or in the presence of significant aortic regurgitation (AR). The aim of this study was to determine the factors that influence the progression of the obstruction and the appearance of AR.
175 Methods Retrospective serial echocardiographic review of 19 patients, mean age 16 years (2 years—38 years), with fixed discrete subaortic stenosis that did not require surgery (initial Gmax at inclusion < 50 mmHg and without any symptom). The mean follow up was 5.42 years. The progression of gradient is defined by the formula (Gmax at follow up—initial Gmax). Results The mean velocity of increasing of Gmax was 2 mmHg/year. This progression was correlated to the patient’s age (cut off = 15 years, r = −0.5 P = 0.02), and the initial value of the Gmax (cut off = 40 mmHg, r = 0.43, P = 0.04). The appearance or the aggravation of aortic regurgitation was determined by: the initial grade of AR (r = 0.64; P = 0.003), initial Gmax (r = 0.65; P = 0.002), progression’s velocity of G max (r = 0.47; P = 0.04), and distance between the membrane and the aortic cusps (cut off = 5 mm, r = 0.49; P = 0.03). LV hypertrophy was influenced by the velocity of progression of obstruction (> 2 mmHg/year). Conclusion The identification of factors determining the evolution of discrete subaortic stenosis (age < 15 years, initial Gmax > 40 mmHg, distance membrane- cusps > 5 mm) allow an adequate screening of patients that will require early operation. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.363 307
Management of myocardial infarctus in children H. Thabet ∗ , N. Ben Halima , A. Sghaier , G. Hamila , M. Abdalah , B. Ezzine Cardiologie, hôpital Ibn-El-Jazzar-Kairouan, Kairouan, Tunisia ∗ Corresponding author. E-mail address: [email protected] (H. Thabet) Background Myocardial infarction is usually the preserve of the elderly but is not exceptional in children. Different and numerous are its etiologies in the child. This clinical entity is little explored around the world. Purpose The objective of our study is to describe the clinical, paraclinical, etiologies and management of children presenting for STEMI. Methods It was a monocentric, retrospective, and descriptive study of children, registered from our cardiology department who were hospitalised for the management of an STEMI between 2010 and 2017. For each patient, medical record, transthoracic echography (TTE) report, biological reports and the coronarography report were analysed. Results We counted 7 cases; the average age was 12.87 years (from 4 to 17 years). All the kids in our study were boys. Two children were followed in paediatrics the first for KAWASAKI disease, the other for familial hypercholesterolemia. The common reason for consultation was anginal chest pain. Positive diagnosis was focused on the ECG. The most affected territory was the anterior in 57.14%. Infarction was complicated in two patients. The etiology of STEMI was variable from child to others; there was no etiology more common than others. TTE was performed before coronarography in all children; it identified the etiology in three children (the myxoma of the left atrium(LA), coronary birth anomaly, and KAWASAKI disease’s by visualizing dilatation of coronaries and thrombus of the LAD). Coronarography was performed in all except for the child who had a myxoma of the LA. Only two children had tenecteplase thrombolysis. Two children were treated by angioplasty. Evolution: Only one child was dead after one year. Conclusion Although the STEMI in children is rare, but it must be evoked and perform an ECG in any child who consults for chest pain. TTE is essential in children. Management is broadly in line with that