Abstract
Objective. To analyze the immediate results of diagnosis and surgical interventions in emergency conditions caused by congenital heart defects (CHD).
Material and methods. The study analyzed the clinical cases of 106 patients with emergency conditions in CHD, Department of Pediatric cardiac surgery of the multidisciplinary clinic «AKFA Medline» for the period from August 2018 to September 2022. Instrumental methods of echocardiography, multispiral computed tomography (MSCT), and angiocardiography (ACG) with intraoperative data were used for comparative analysis.
Results. In the early postoperative period, the functional state was studied in 97 (91.5%) of 106 operated patients. At the same time, the patients were divided into good, satisfactory and unsatisfactory groups. Observations of fatal outcomes were analyzed in a separate group. To interpret the results, the duration of artificial blood circulation, the duration of postoperative stay of patients on artificial ventilation and the availability of cardiotonic support, as well as the total duration of stay of patients in the intensive care unit were taken into account.
Conclusion. A comparative analysis of the diagnostic effectiveness of echocardiography compared with the results of intraoperative revision in relation to FGM, DMPP and SLA found that sensitivity, specificity, and overall accuracy give very good results. As well as for all forms of TAD, sensitivity, specificity, and overall accuracy range from 93.8% to 100%. It was found that ACG, along with MSCT, is characterized by outstanding indicators of diagnostic effectiveness, however, taking into account the advantages of MSCT (less invasiveness, speed, quality of medical imaging and cost-effectiveness) in order to optimize the diagnostic program, it is possible to painlessly exclude ACG from the diagnostic protocol for CHD with urgent conditions.
References
- Anderson R.H., Becker A.E., Freedom R.M., Macartney F.J, Quero-Jimenez M., Shinebourne E.A. et al. Sequential segmental analysis of congenital heart disease. Pediatr. Cardiol. 1984; 5: 281–287. DOI: 10.1007/BF02424973
- Gorbatykh Yu.N., Volkov A.M., Khapaev T.S., Naberukhin Yu.L., Grekhov E.V., Tokarev A.V. et al. The dynamics of structural changes in lung vessels in patients with congenital heart defects of cyanotic type, depending on age, type of systemic pulmonary anastomoses and the timing of their functioning. Pathology of Blood Circulation and Cardiac Surgery. 2008; 2: 3–7 (in Russ.).
- Doronina T.N., Cherkasov N.S. Features of epidemiology of congenital heart defects in young children. Medical Almanac. 2012; 3: 175–176 (in Russ.).
- Kawashima Y., Kitamura S., Matsuda H., Shimazaki Y., Nakano S., Hirose H. Total cavopulmonary shunt operation in complex cardiac anomalies. A new operation. J. Thorac. Cardiovasc. Surg. 1984; 87: 74–81. PMID: 6690861
- Gorbatykh Yu.N., Khapaev T.S., Naberukhin Yu.L., Zhalnina E.V. Stepwise approach in surgical treatment of congenital heart defects with univentricular hemodynamics. Siberian Medical Journal. 2007; 22 (2): 93–97 (in Russ.).
- Mirolyubov L.M., Petrushenko D.Yu., Kalinicheva Yu.B., Sabirova D.R. Diagnosis and treatment of congenital heart defects in newborns. Kazan Medical Journal. 2015; 96 (4): 628–632 (in Russ.). DOI: 10.17750/KMJ2015-628
- McElhinney D.B., Marianeschi S.M., Reddy V.M. Additional pulmonary blood flow with the bidirectional Glenn anastomosis: does it make a difference? Ann. Thorac. Surg. 1998; 66: 668–672.
- Kondratev V.A. Congenital heart defects before and after surgery. Tauride Medical and Biological Bulletin. 2005; 8 (2): 76–82 (in Russ.).
- Chowdhury U.K., Subramaniam K.G., Joshi K., Varshney S., Kumar G., Singh R., Venugopal P. Rechanneling of total anomalous pulmonary venous connection with or without vertical vein ligation: results and guidelines for candidate selection. J. Thorac. Cardiovasc. Surg. 2007; 133: 1286–1294. DOI: 10.1016/j.jtcvs.2006.08.010
About the authors
- Khabibulla A. Akilov, Dr. Med. Sci., Professor, Director
- hamshidzhon T. Pirnazarov, Head of Department of Pediatric Cardiac Surgery
- Amonzhon B. Alimov, Cand. Med. Sci., Cardiac Surgeon
