Background: Regional low-flow perfusion of the brain is a bypass technique commonly used during stage 1 reconstruction in neonates with hypoplastic left heart syndrome and related variants. The neurodevelopmental outcome of these children is unknown.
Methods: Twenty-nine infants (22 boys, 7 girls) with hypoplastic left heart syndrome or variant requiring single ventricle palliation and aortic arch reconstruction were studied between 1999 and 2004. Mental Developmental Index (MDI) and Psychomotor Developmental Index were assessed using Bayley Scales of Infant Development and correlated with intraoperative and perioperative variables. Results are reported as mean +/- standard deviation.
Results: Average age at stage 1 operation and at bidirectional Glenn was 7 +/- 8 days and 6.0 +/- 2 months, respectively. The MDI was in the low average range (87.7 +/- 13.2). The Psychomotor Developmental Index was in the mildly delayed range (75.2 +/- 14.5). Regional low-flow perfusion was used in 31% (9 of 29 patients), with an average circulatory arrest time of 23.5 +/- 13.4 minutes. Deep hypothermia and circulatory arrest was used as the primary operative strategy in 69% of patients (20 of 29 patients), with an average circulatory arrest time of 44.3 +/- 15.3 minutes (p = 0.003). No differences in MDI or Psychomotor Developmental Index scores were observed between the regional low-flow perfusion and non-regional low-flow perfusion groups (MDI, 88.0 +/- 12.1 versus 87.6 +/- 14.0; p = 0.93, respectively; Psychomotor Developmental Index, 75.5 +/- 15.1 versus 75.0 +/- 14.6; p = 0.93, respectively). Lowest operative temperature (<16 degrees C) and birth order (<2 versus >3) significantly related to MDI (89.6 versus 72.8; p = 0.047).
Conclusions: At 1 year of age, neurodevelopmental outcomes of patients undergoing stage 1 using regional low-flow perfusion were similar to outcomes observed in children exposed to circulatory arrest. The association of birth order and MDI suggests that early intervention may benefit these patients.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.athoracsur.2006.06.069 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Extracorporeal Cardiopulmonary Resuscitation: Life-saving or Resource Wasting?
US Cardiol
August 2024
Division of Cardiology, New York University Grossman School of Medicine New York, NY.
Article Synopsis
- - The rates of illness and death are high for patients experiencing cardiac arrest, as traditional CPR methods don't effectively maintain blood flow.
- - Extracorporeal cardiopulmonary resuscitation (eCPR) using venoarterial extracorporeal membrane oxygenation is suggested as a better way to improve blood circulation during cardiac arrest.
- - This article presents a debate on the benefits and drawbacks of current eCPR research, highlighting uncertainties and proposing ideas for future studies.
Compact Arterial Monitoring Device Use in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): A Simple Validation Study in Swine.
Cureus
October 2024
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, USA.
Article Synopsis
- - Hemorrhage is the main cause of preventable death in trauma situations, leading to military and civilian advancements in medical practices, particularly through the use of tourniquets to manage extremity bleeding and save lives.
- - While tourniquets have significantly decreased deaths from bleeding in military settings, noncompressible hemorrhage still poses a major risk, especially before patients receive definitive medical care.
- - The study explores using a small, disposable pressure monitor during resuscitative endovascular balloon occlusion of the aorta (REBOA) to enhance blood pressure monitoring, facilitate better resuscitation practices, and reduce the need for blood products in extreme environments.
Survival Without Neurological Sequelae Following Massive Pulmonary Embolism and Prolonged Cardiac Arrest.
Cureus
October 2024
Emergency Department, Epicura Hospital, Hornu, BEL.
We present the case of a 17-year-old female who survived cardiac arrest caused by a massive pulmonary embolism leading to obstructive shock. Despite a prolonged low-flow period of 193 minutes, she fully recovered without apparent neurological damage, thanks to immediate cardiopulmonary resuscitation (CPR) initiated by her father, timely intervention by paramedics and medical teams, and the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Key factors in her recovery included the absence of a no-flow period, maintenance of end-tidal CO (ETCO) levels above 25-30 mmHg during resuscitation, and the vital role of VA-ECMO in supporting organ perfusion.
View Article and Find Full Text PDFSegmental Aqueous Humor Outflow.
Methods Mol Biol
October 2024
Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.
Of the known risk factors for glaucoma, elevated intraocular pressure (IOP), is the primary one. The conventional aqueous humor outflow pathway contains the key source of IOP regulation, which is predominantly the trabecular meshwork (TM). Studies of outflow have demonstrated that the outflow pathway is not uniform around the circumference of the eye but highly segmental with regions of relative high flow (HF) and intermediate or medium flow (IF) and regions of low or no flow (LF).
View Article and Find Full Text PDFEvaluation of Preoperative Low-flow Areas in STA-MCA Bypass Surgery Using Vascular Fusion Map Image.
Neurol India
September 2024
Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan.
Background: The superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery requires an anastomosis of the STA to an MCA with diminished blood flow. However, identifying the precise location of the MCA with reduced flow preoperatively is challenging as it often remains nonvisualized. To address this issue, we developed a novel technique, the area target bypass (ATB) method, to infer the location of the responsible vessel for low-flow areas.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!