Eraso-Díaz Del Castillo Ana María, Escobar-Díaz María Clara, Lince Varela Rafael, Díaz Medina Luis Horacio, Cañas Arenas Eliana Mabel
Pediatric Cardiology Department, Clínica Cardio VID, Calle 78B No. 75-21, Medellín, Colombia.
Universidad Pontificia Bolivariana, Medellín, Colombia.
Pediatr Cardiol. 2019 Apr;40(4):827-833. doi: 10.1007/s00246-019-02078-3. Epub 2019 Mar 4.
The aim of this study was to describe pediatric patients who underwent early postoperative cardiac catheterization after congenital heart surgery, their clinical indications, findings, interventions, and complications in a cardiovascular center. A descriptive retrospective study was performed. All catheterizations performed within 6 weeks after congenital heart surgery between January 2004 and December 2014 were reviewed. We analyzed 101 early postoperative catheterizations. They were performed on median postoperative day five (IQR: 0-39); the median age was 64 days (IQR: 22-240). The most common diagnoses were single ventricle (53%), left heart obstruction (12%), and tetralogy of fallot or pulmonary atresia with ventricular septal defect (11%). Most common indications were persistent cyanosis (53%), low cardiac output (24%), and residual defect on echocardiogram (20%). Most frequent findings during the catheterization were pulmonary artery stenosis (29%), surgical conduit obstruction (12%), and coarctation or hypoplasia of the aorta (11%). Forty-six (45%) procedures involved intervention. Most frequent interventions were pulmonary artery, aorta, and Blalock-Taussig fistula angioplasty with or without stent implantation. There were adverse effects in 11 cases (11%), and 30-day mortality was 28% (28 patients) with the majority unrelated to the catheterization directly. Although early postoperative catheterizations are high-risk procedures, they are currently a very good option to solve acute problems in critically ill patients. This study provides relevant information for a better understanding and approach to this complex group of patients.
本研究的目的是描述在心血管中心接受先天性心脏手术后早期进行心脏导管插入术的儿科患者、他们的临床指征、检查结果、干预措施及并发症。进行了一项描述性回顾性研究。回顾了2004年1月至2014年12月期间在先天性心脏手术后6周内进行的所有导管插入术。我们分析了101例术后早期导管插入术。这些手术在术后中位第5天进行（四分位间距：0 - 39）；中位年龄为64天（四分位间距：22 - 240）。最常见的诊断是单心室（53%）、左心梗阻（12%）以及法洛四联症或肺动脉闭锁合并室间隔缺损（11%）。最常见的指征是持续青紫（53%）、低心输出量（24%）以及超声心动图显示的残余缺损（20%）。导管插入术中最常见的检查结果是肺动脉狭窄（29%）、手术管道梗阻（12%）以及主动脉缩窄或发育不全（11%）。46例（45%）手术涉及干预。最常见的干预措施是肺动脉、主动脉以及Blalock - Taussig瘘管血管成形术，伴或不伴支架植入。11例（11%）出现不良反应，30天死亡率为28%（28例患者），其中大多数与导管插入术无直接关联。尽管术后早期导管插入术是高风险操作，但目前它是解决危重症患者急性问题的一个很好的选择。本研究提供了相关信息，有助于更好地了解和处理这一复杂的患者群体。
