Author: Denisa Pop1 Second Authors : Dominic Pasca l Ke l ler 1

Roxana Costache 1

Tamas Szabo 1

Coordinators : Medica l Doctor Va lent in Stroe 2

Pro fessor Horat iu Suc iu 2

The Neonatal Cardiac Surgical Emergencies at IuBCVT Tîrgu-Mureş

1 2Marisiensis

2015

The congenital heart defects are present in the neonatal period

Critical congenital heart diseases dependent on a PDA

Require intervention within the first month

Neonatal arrhythmias

EMERGENCY

Pediatric Cardiovascular Center

Pediatric Cardiology

Pediatric Cardiovascular

Surgery

Pediatric Surgical ICU

Operating Unit

Angio-Cath Lab

Neonatology Department

SMURD

DischargeAdmission

IuBCVT

The activity of IuBCVT Tîrgu-Mureş

2010 2011 2012 2013 2014

2724

18

3532

the single-center in Romania for the surgical treatment of neonatal emergencies

IuBCVT Tîrgu-Mureş

5.01.2010

29.12.2014

136 patients

54 female 82 male

The inclusion criteria: Urgency of surgery

Diagnostics Age

0-7 days 8-14 days 15-21 days 22-30 days0

10

20

30

40

50

60

8

4449

35

Distribution of patients

54%

12%

15%

1%

4%

3%

4%4%

3%Transposition of the Great Arteries

Pulmonary Atresia/ Stenosis

Coarctation of the Aorta

Ebstein Anomaly.

Total Anomalous Pulmonary Venous Connection

PDA. Severe Cardiac Failure.

Tetralogy of Fallot

Congenital 3rd degree atrioventricular block.

Others

AGE

DIAGNOSTICS

The mean age at the time of surgery- 17.80 days

Transposition of Great Arteries (TGA)

TGA is a congenital cyanotic heart defect

The Aorta and the Pulmonary Artery reversed

TGA - 2 parallel circulations

RARV

Aorta

Systemic

circulation

Pulmonary

Circulation

Pulmonary Arter

y

LALV

ASD

VSD

PDA

Management and treatment of TGA

prostaglandin E1 IV

PDA open

↑pulmonary

flow

atrial balloon septostomy

↑ASD

improve the mixing

•stabilization of the patient

1. Immediate

2. Definitivearterial switch operation

•pericardial harvest• evaluation•dissection

1

• cannulation• cardio-pulmonary bypass

2

• neo-pulmonary artery reconstruction

5

Mortality

Sur-vival98%

Death2%

Transposition of the Great Arteries associated with:• Interrupted Aortic Arch• Subpulmonary VSD and ASD• Severe Hypoxia and Acidosis

136 patients

3 intraoperative deaths

CAUSE OF DEATH

intraoperative irreversible

cardiac failure DIAGNOSTIC

Conclusion

High survival rate (97.80% for our patients)

Early diagnostic-within hours-

Adequate surgical approach

-first month of life-

Experienced teams• Obstetrician• Neonatologist

• Pediatric cardiologist• Cardiac surgeon

In all these cases, the surgical treatment must be rushed in order to prevent major morbidity and mortality and minimize

the need of future surgeries.

Discussions

IuBCVT Tîrgu-Mureș

the single-center for the surgical treatment of neonatal emergencies

high difficulty of creating national interdisciplinary teams to deal with this

emergencies

Bibliography

Illustrations provided by Joe Lara III for www. pediatricheartspecialists.com

Constantine Mavroudis and Carl L. Backer. Pediatric Cardiac Surgery Fourth Edition, John Wiley & Sons Ltd. Publication 2013. 26-492 Transposition of the Great Arteries.

www.nlm.nih.gov/medlineplus, Bethesda (MD): National Library of Medicine (US), updated 2013 May 11 by Kurt R. Schumacher, MD, Pediatric Cardiology, University of Michigan Congenital Heart Center, Ann Arbor, MI.

Thank you for your attention!