Yuliya Domnina

82: MORTALITY AND INCIDENCE OF ACUTE ADVERSE NEUROLOGIC EVENTS IN THE CARDIAC INTENSIVE CARE UNIT

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) models were used to assess which predictors significantly and independently predicted a significant thrombotic event and significant bleeding. Results: All four measures showed good discrimination – RCK (AUC=0.81, p<0.01), Anti factor Xa (AUC=0.79, p<0.01), aPTT (AUC=0.68, p=0.02) and ACT (AUC=0.64, p=0.03) for a thrombotic event. However, Anti-Xa (OR=0.62, 95% CI 0.53– 0.72, p<0.001) and RCK (OR=1.19, 95% CI 1.07–1.34, p=0.003) were the only independent predictors of a significant thrombotic event (ACT and aPTT fell out of the model). However, none of the measures showed good discrimination for significant bleeding or independently predicted significant bleeding. Conclusions: Anti factor Xa and RCK appear to be stronger indicators than ACT or aPTT for predicting risk of a significant thrombotic event during ECMO support. Further studies need to be conducted in ECMO patients to determine indicators for bleeding.

Tetralogy of Fallot with Pulmonary Atresia

Tetralogy of Fallot with Pulmonary Atresia (TOF-PA) accounts for 1.5–3.4% of all forms of congenital heart disease and for 20% of all forms of TOF [1]. The Baltimore Washington Infant study reported an incidence of 0.07 per 1,000 live births for TOF-PA. TOF-PA is slightly more prevalent in males than in females. The intra-cardiac anatomy of TOF-PA has all the features of classic Tetralogy of Fallot: ventricular septal defect, overriding of the aorta, right ventricular outflow obstruction, and right ventricular hypertrophy. The difference is in the membranous or complete atresia of the pulmonary valve, and extreme variability of the architecture of the main and distal pulmonary arteries [Fig. 21.1]. The central pulmonary arteries can be of good size, variably hypoplastic, discontinuous, or even absent. Blood flow to the pulmonary vasculature may be provided by a persistent ductus arteriosus (PDA), major aorto-pulmonary collaterals (MAPCAs), or both.

Tetralogy of Fallot

Tetralogy of Fallot (TOF) is a relatively common congenital heart defect occurring in approximately 15% of patients with congenital heart disease. The four main anatomic features of TOF include right ventricular outflow tract (RVOT) obstruction [1, 2], ventricular septal defect (VSD), aortic dextroposition overridding the VSD, and right ventricular hypertrophy (Fig. 19.1). Current teaching postulates that the basic pathology of TOF results from underdevelopment of the right ventricular infundibulum. This underdevelopment causes an anterior malalignment of the infundibular septum which subsequently determines the degree of RVOT obstruction. The VSD that results from this malalignment is almost always large, and thus unrestrictive, permitting similar pressures between the right and left ventricles to occur. In addition to these features the pulmonary valve is frequently hypoplastic and thickened and the level of obstruction may extend to the main pulmonary artery and right and left pulmonary arteries.

Hypoplastic Left Heart Syndrome

Hypoplastic left heart syndrome (HLHS) is the most common severe congenital heart defect which constitutes 1–2% of all congenital heart anomalies and 7–9% of total anatomic abnormalities diagnosed within the 1 year of life. It is also the most common congenital cardiac malformation involving a single ventricle. It is more frequent in males, with a 67% male predominance. Without surgical intervention HLHS is a uniformly fatal condition with a 95% mortality rate within the 1 month of life. A multifactorial mode of inheritance is likely present for most cases [1].