Bahaidarah Saud, Al-Ata Jameel, Abdelmohsen Gaser, Alkhushi Naif, Abdelsalam Mohamed, Mujahed Mohammed, Al-Radi Osman, Elassal Ahmed, Zaher Zaher, Azhar Ahmad, Dohain Ahmed M
Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia.
Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt.
Egypt Heart J. 2020 Nov 23;72(1):83. doi: 10.1186/s43044-020-00117-6.
Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. All patients who underwent cardiac catheterization after congenital heart surgery during the same admission of cardiac surgery from November 2015 to May 2018 were included in the study.
Thirty procedures were performed for 27 patients (20 interventional and 10 diagnostic). The median age of the patients was 15 months (15 days to 20 years), median weight was 8.2 kg (3.4 to 53 kg), and median time from surgery was 3 days (0-32 days). Eleven procedures were performed for 11 patients on extracorporeal membrane oxygenation (ECMO) support. The main indications for catheterization included the inability to wean from ECMO (10 procedures) and cyanosis (10 procedures). Interventional procedures included angioplasty using stents (10 procedures, success rate of 90%), angioplasty using only balloons (2 procedures, success rate of 50%), and occlusion for residual shunts (8 procedures, success rate of 100%). No mortality was recorded during any procedure. Vasoactive-inotropic score had significantly decreased 48 h after catheterization when compared to pre-catheterization scores (p = 0.0001). Moreover, 72% of patients connected to ECMO support were successfully weaned from ECMO after catheterization. Procedural complications were recorded in 3 interventional procedures. Survival to hospital discharge was 55.5% and overall survival was 52%. Patients on ECMO support had a higher mortality than other patients.
Cardiac catheterization can be performed safely in the early post-operative period, and it could improve the outcome of the patient (depending on the complexity of the cardiac lesions involved).
先天性心脏病手术后的心导管检查在复杂或不寻常术后病程患者的诊断和管理中可能发挥重要作用。本研究的主要目的是评估先天性心脏病手术后早期进行心导管检查的安全性、有效性和结果。2015年11月至2018年5月期间，在同一心脏手术住院期间接受先天性心脏病手术后心导管检查的所有患者均纳入本研究。
对27例患者进行了30次操作（20次介入性操作和10次诊断性操作）。患者的中位年龄为15个月（15天至20岁），中位体重为8.2千克（3.4至53千克），手术至操作的中位时间为3天（0至32天）。对11例接受体外膜肺氧合（ECMO）支持的患者进行了11次操作。导管检查的主要指征包括无法脱离ECMO（10次操作）和发绀（10次操作）。介入性操作包括使用支架的血管成形术（10次操作，成功率90%）、仅使用球囊的血管成形术（2次操作，成功率50%）以及封堵残余分流（8次操作，成功率100%）。任何操作过程中均未记录到死亡病例。与导管检查前评分相比，导管检查后48小时血管活性-正性肌力评分显著降低（p = 0.0001）。此外，接受ECMO支持的患者中有72%在导管检查后成功脱离ECMO。3次介入性操作记录到操作并发症。出院生存率为55.5%，总生存率为52%。接受ECMO支持的患者死亡率高于其他患者。
心导管检查可在术后早期安全进行，并且可以改善患者的预后（取决于所涉及心脏病变的复杂性）。
