László Király

Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery

Background:  Early extubation after cardiac surgery in children is feasible; however, predictors of prolonged mechanical ventilation (MV) should be recognized as soon as possible.

Late endocarditis of Amplatzer atrial septal occluder device in a child.

Bacterial endocarditis following atrial septal defect closure using Amplatzer device in a child is extremely rare. We report a 10-year-old girl who developed late bacterial endocarditis, 6 years after placement of an Amplatzer atrial septal occluder device. Successful explantation of the device and repair of the resultant septal defect was carried out using a homograft patch. The rare occurrence of this entity prompted us to highlight the importance of long-term follow up, review the management and explore preventive strategies for similar patients who have multiple co-morbidities and a cardiac device. A high index of suspicion is warranted particularly in pediatric patients.

Újszülöttkorban és később végzett primer artériás switchműtétek eredményei egy újonnan létrehozott, átfogó congenitalis szívközpontban

Absztrakt Bevezetes: Az ujszulottkori komplett nagyer-transzpozicio anatomiai korrekciojanak (arterias switchműtet) eredmenyei egy adott ellatas sebeszi minősegenek indikatorai. Celkitűzes: A betegcsoportok elemzese, az arterias switchműtetek parametereinek es eredmenyeinek vizsgalata es elhelyezese az ellatasban. Modszer: A szerzők uj, teljes korű congenitalis szivellatast hoztak letre, amelyben az ujszulottkori primer korrekciora helyeztek a hangsulyt. A nagyer-transzpozicios betegeket ket csoportba soroltak a kamrai sovenyhiany meglete alapjan. A tarsulo anomaliakat (peldaul aortaiv-hypoplasia) az anatomiai korrekcioval egy ulesben kezeltek. Az ujszulottkor utan jelentkező betegseget mechanikus keringestamogatassal kezeltek a posztoperativ szakban. Eredmenyek: 2007–2014 kozott 118 arterias switchműtetet vegeztek, 96,62%-os tulelessel. Kamrai sovenyhiany tarsulasa nem rontotta a morbiditast-mortalitast. A bal kamra ujraedzeset segitő mechanikus keringestamogatas sikeres, es atlagosan 4,5±1,5 nap volt. K...

The application of a simplified system of criterions for audit to improve paediatric cardiologic and paediatric cardiac surgical care: Evidence from a regional approach in Hungary

AIMS To evaluate the quality of cardiac and surgical care provided for children with congenital cardiac malformations in the eastern county of Hungary. METHODS We used the method of clinical audit based in selection of criterions, developing five such criterions concerning timely diagnosis, access to treatment, and outcome. To examine compliance with these criterions, we analysed retrospectively the routine data relating to children living in Hajdu-Bihar County. The period of observation lasted from January, 1994, until December, 2001, and was divided into two epochs in order to evaluate any changes over time. RESULTS In the first epoch, 28 infants, representing 0.1% of all newborns, died of congenital cardiac disease, with one of the malformations being recognised post mortem. In the second epoch, 21 infants died, representing 0.09% of newborns. In this group, each malformation was diagnosed before death. In each period, 6 infants died without having undergone cardiac surgery, and having no other non-cardiac disease. The overall postoperative mortality was 9.2% for the first period, and 4.6% for the second. The number of patients waiting for non-urgent repair had reduced significantly by the end of the second epoch. CONCLUSIONS The results show that the timely diagnosis of congenital cardiac malformations is in line with accepted international standards. Conversely, the access to invasive treatment was limited over the period of observation, albeit that the waiting list was reduced significantly by the end of the second epoch. The postoperative mortality for those suffering congenital cardiac malformations is also comparable with international standards, except for mortality during infancy for treatment of complex anomalies. Our audit highlights the need for surgical repair of the more complex malformations during infancy.

Left-sided hepatic vein connected to the coronary sinus

A left-sided hepatic vein connected to the coronary sinus is reported in a case of a 22-month-old boy with isomerism of the left atrial appendages, complete atrioventricular septal defect and azygous continuation of the inferior caval vein. The diagnosis of the anomalous hepatic vein was made intraoperatively and successful biventricular repair has been accomplished. To the best of our knowledge, this is the first communication on this peculiar entity diagnosed during life, notwithstanding Nabarros description of a similar autopsy finding in 1903. Aspects of the development of this rare entity are discussed.