Abstract
Objective. To consider primary pathology as predicator for early postoperative complication development to
minimize their influence on results of surgical treatment.
Material and methods. The analysis of examination results and surgical treatment of 120 patients at the age
of 1-3 years is represented in this paper. They were operated for congenital heart disease, combined with
extracardiac pathology from 2008 to 2010. The follow-up considering 120 people without clinical and
laboratory instrumental features of combined pathology to compare the number of complications of early
postoperative period was performed. All patients were represented as uniform cohort to detect prognostic
significant predictors of complication development. Risk factors were markers of past hypoxemia and complex
perinatal affection.
Results. Complications of postoperative period, caused by extracardiac pathology, were type specific in all
cases. Risk predictors were pathologic cerebrospinal fluid circulation with asymmetry of cerebrospinal fluid
shunting structures or index of internal diameter of a skull < 200 sm/m2, verified genetical pathology or segmentation
index, ranged from 3 and more, markers of past or existing hypoxemia (arterial hypoxemia, low baseline
Apgar score <8, prolonged artificial pulmonary ventilation in the family history), persistent forms of prenatal
infection.
Conclusion. The presence of extracardiac pathology is not a contraindication to surgical correction for congenital
heart disease i.e. postoperative mortality is not increased if appropriate therapy is provided at all stages
of treatment.
References
Александрина, Н. В. Результаты катамнестического наблюдения за детьми, находившимися на ИВЛ в неонатальном периоде / Н. В. Александрина, С. В. Зайцева, О. В. Зайцева, Т. В. Празникова // Болезни новорожденных и детей раннего возраста. - 2006. - № 1. - С. 10.
Барашнев, Ю. И. Перинатальная неврология / Ю. И. Барашнев - М.: Триада-Х, 2001. - 640 с.
Бокерия, Л. А. Заболеваемость и врожденные пороки системы кровообращения у детей (распространенность и коррекция) / Л. А. Бокерия, И. Н. Ступаков, Р. Г. Гудкова // Детские болезни сердца и сосудов. - 2006. - № 1. - С. 3-10.
Левченко, Е. Г. Врожденные пороки сердца у детей - синдромальные формы и ассоциированные аномалии: диагностика и проблемы послеоперационного ведения: дис. … канд. мед. наук / Е. Г. Левченко - М., 2003. - 168 с.
Лобачева, Г. В. Факторы риска развития ранних осложнений и их коррекция у больных после операций на открытом сердце: автореф. дис. … д-ра мед. наук / Г. В. Лобачева // М., 2000. - 44 с.
Лоенко, В. Б. Принципы защиты пациентов от внекардиальных осложнений при операциях на сердце и сосудах / В. Б. Лоенко, Е. А. Сорокина, Н. А. Морова // Бюллетень сибирской медицины. - 2010. - № 1. - С. 103-111.
Сарсенбаева Г. И. Оценка состояния венозной гемодинамики головного мозга у новорожденных и детей первого года жизни с ВПС после операции на сердце и сосудах в условиях искусственного кровообращения и гипотермии: дис. … канд. мед. наук / Г. И. Сарсенбаева - М., 2007. - 119 с.
Шарыкин, А. С. Врожденные пороки сердца / А. С. Шарыкин - М.: Бином, 2009. - 392 с.
Ali, M. World health statistics 2010 / M. Ali, K. Aseel, E. Bertherat et al. // WHO Library Cataloguing-in-Publication Data. - 2010. - P. 176.
Bouma, C. G. Relationship between cardiac output and CBF in patients with intact and impaired autoregulation / C. G. Bouma, T. R. Mouzelaar // J. Neurosurgery. - 1990. - Vol. 73. - P. 368-374.
Chang, R. K. Factors associated with age at operation for children with congenital heart disease / R. K. Chang, A. Y. Chen, T. S. Klitzner // Pediatrics. - 2000. - Vol. 105. - P. 1073-1081.
Formigaria, R. Genetic syndromes and congenital heart defects: how is surgical management affected? / R. Formigaria, G. Michielonb, M. C. Digiliob // Eur. J. Cardiothorac. Surg. - 2009. - Vol. 35. - P. 606-614.
Fudge, J. C. Congenital heart surgery outcomes in down syndrome: analysis of a national clinical database / J. C. Fudge, S. Li, J. Jaggers, E. D. Peterson // Pediatrics. - 2010. - Vol. 126. - P. 315-322.
Gusev, E. Brain Ishemia / E. Gusev, V. I. Scvortsova - Plenum Publishers, 2003. - P. 207-219.
Jenkins, K. J. Consensus-based method for risk adjustment for surgery for congenital heart disease / K. J. Jenkins, K. Gauvreau, J. W. Newburger et al. / J. Thorac. Cardiovasc. Surg. - 2002. - Vol. 123. - P. 110-118
Kang, C. N. Risk stratification in pediatric open-heart surgery / C. N. Kang, V. T. Tsang, M. J. Elliott, M. R. Leval // Eur. J. Cardiothorac. Surg. - 2004. - Vol. 26. - P. 3-11.
Kang, C. N. Does the Aristotle Score predict outcome in congenital heart surgery / C. N. Kang, V. T. Tsang, M. J. Elliott, M. R. Leval // Eur. J. Cardiothorac. Surg. - 2006. - Vol. 29. - P. 986-988.
Lin, A. E. Congenital heart defects in chromosome abnormality syndromes / A. E. Lin // Heart disease in infants, children and adolescents / Ed. G. Emmanouilides et al. - 5th ed.- Baltimore, 1995. - Р. 633 - 643.
Mildh, L. H. Predictive value of pediatrics risk of mortality score and risk adjustment for congenital heart surgery score after pediatric open-heart surgery / L. Mildh, V. Pettil, H. Sairanen, P. Rautiainen // Ann. Thorac. Surg. - 2007. - Vol. 84. - P. 147-155.
Reinhard, M. Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage / M. Reinhard, F. Neunhoeffer, T. A. Gerds et al. // Intens. Care Med. - 2010. - Vol. 36. - P. 264-271.
Saffirio, C. Better surgical prognosis for patients with Down syndrome / C. Saffirio, B. Marino, R. Formigari // J. Thorac. Cardiovasc. Surgery. - 2008. - Vol. 135. - P. 230-237.
