Authors
Khubulava G.G.1, 4, Naumov A.B.2, Marchenko S.P.1, Chupaeva О.Yu.1, 3, Kulemin E.S.3, Sazonov A.B.4
1 Pavlov First Saint Petersburg State Medical University, Saint-Petersburg
2 North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg
3 Saint-Petersburg State Pediatric Medical University, Saint-Petersburg
4 Military Medical Academy named after S.M. Kirov, Saint-Peterburg
Abstract
Objective: To identify risk factors for unfavorable outcome in newborns operated on for congenital pathology of the aortic arch.
Materials and methods of research: Data from the results of treatment of 79 patients with congenital pathology of the aortic arch were analyzed and the effectiveness of the therapy was assessed. All patients underwent an examination with the study of obstetric and gynecological history, life history and illness, with an assessment of existing complaints after birth and their changes over time. The obtained clinical, echocardiographic and laboratory parameters were analyzed and compared. The following surgical methods were used for surgical correction of congenital pathology of the aortic arch: resectionof coarctation with plastic surgery of the aortic arch with native tissues, resection of aortic coarctation with the imposition of an extended end-to-end anastomosis, hybrid version. The results of the performed operations and complications were evaluated.
Results: Factors such as the development of small ejection syndrome before surgery, the emergency nature of the intervention, and reduced left ventricular ejection fraction (less than 35%), increased heart rate, had a significant association with an unfavorable outcome. Signs of moderate significance that were associated with an unfavorable outcome of surgical treatment were the following clinical and hemodynamic preoperative parameters: increased respiratory rate, reduction of diastolic pressure in the lower extremities and reduction LV EDC. Anthropometric data and reduction of systolic pressure in the lower extremities had a weak connection with mortality.
Conclusions: The most significant factors of unfavorable outcome before surgery in newborns with congenital pathology of the aortic arch, those operated with the use of artificial blood circulation are: increased heart rate, decreased LV EF. Low anthropometric indicators of the child (weight, height, body surface area) are also have an impact on the outcome. Index of the end-diastolic size of the left ventricle as a factor reflecting his anatomically determined ability to produce a systemic blood flow it is important when choosing an option for surgical.
Keywords: newborns, congenital heart disease, coarctation of the aorta, hypoplasia of the aortic arch.
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