Intensive care follow-up of an infant who underwent Yasui procedure due to interrupted aortic arch and left ventricular outflow tract obstruction

Abstract

Interrupted aortic arch (IAA) is a highly complex and difficult to manage congenital heart disease (CHD) manifesting in the neonatal period. In these cases, there is an anatomical and luminal interruption between the ascending and descending aorta. Formerly, IAA was considered to be a cardiac anomaly with high mortality, but nowadays its life expectancy is getting higher. The treatment of IAA is surgical repair of the arch. The presence of left ventricular outflow tract obstruction (LVOTO) requires more complicated surgical techniques. In this article, the intensive care process of a baby who underwent Yasui procedure for type B IAA and LVOTO and followed-up in neonatal intensive care unit after postoperative day 12 was discussed within the framework of cardiac patient monitoring principles.We aim that our experiences on the management of infant patients undergoing open heart surgery will be beneficial for nurses and physicians dealing with heart care.

Keywords

• Interrupted aortic arch
• left ventricular outflow tract obstruction
• Yasui surgery
• neonatal intensive care
• management

Kesintili aortik ark: Yasui ameliyatı sonrası yenidoğan yoğun bakım ünitesi yönetimi

Abstract

Kesintili aortik ark (KAA) neonatal dönemde bulgu veren oldukça karmaşık ve yönetimi zor bir konjenital kalp hastalığıdır (KKH). Bu vakalarda, çıkan ve inen aorta arasında anatomik ve luminal kesinti vardır. KAA, geçmişte mortalitesi yüksek olan ancak günümüzde yaşam beklentisi giderek artan bir kardiyak anomalidir. KAA’nın tedavisi cerrahi olarak arkus tamiri yapılmasıdır. Sol ventrikül çıkım yolu (LVOT) darlığının eşlik etmesi daha komplike cerrahi teknikleri uygulanmasını gerektirir. Bu yazıda tip B KAA ve LVOT darlığı nedeniyle Yasui prosedürü uygulanan ve postoperatif 12. günden sonra yenidoğan yoğun bakım ünitesinde izlenen bir bebeğin yoğun bakım sürecinden yola çıkarak kardiyak hasta izlem ilkeleri tartışılmaktadır. Açık kalp cerrahisi yapılan bebek hastaların yönetimi konusundaki deneyimlerin kardiyak bakım ile ilgilenen yenidoğan hemşire ve doktor ekipleri için yararlı olması amaçlanmıştır.

Keywords

• Kesintili aortik ark
• sol ventrikül çıkım yolu darlığı
• Yasui ameliyatı
• yenidoğan yoğun bakım
• yönetim

References

1. 1-Varghese R, Saheed SB, Omoregbee B, Ninan B, Pavithran S, Kothandam S. Surgical Repair of Interrupted Aortic Arch and Interrupted Pulmonary Artery. Ann Thorac Surg. 2015 Dec;100(6):e139-40
2. 2-Van Praagh R, Bernhard W, Rosenthal A, et al: Interrupted aortic arch: surgical treatment. Am J Cardiol 1971; 27:200.
3. 3-Celoria GC, Patton RB. Congenital absence of the aortic arch. American heart journal. 1959 Sep 1;58(3):407-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/13808756
4. 4-McCrindle BW, Tchervenkov CI, Konstantinov IE, Williams WG, Neirotti RA, JacobsML, Blackstone EH, Congenital Heart Surgeons Society. Risk factors associated withmortality and interventions in 472 neonates with interrupted aortic arch: a CongenitalHeart Surgeons Society study. J Thorac Cardiovasc Surg 2005; 129:343-350.
5. 5-Rudolph AM. The changes in the circulation after birth. Their importance incongenital heart disease. Circulation 1970;41:343-359.-- Yasui H, Kado H, Nakano E, et al: Primary repair of interrupted aortic arch and severe aortic stenosis in neonates. J Thorac Cardiovasc Surg 1987; 93:539-545.
6. 6-Chamberlin M, Lozynski J. To Go Against Nature: Manipulating the Neonatal Ductus Arteriosus with Prostaglandin. Newborn and Infant Nursing Reviews. 2006; 6 (3): 158–162.
7. 7-Kanter KR. Operative Techniques in thorasic and cardiovascular surgery. Congenital Surgery. 2010: 15 83): 206-222. doi:10.1053/j.optechstcvs.2010.08.001
8. 8-Backer CL, Tweddell JS. Invited Commentary: Updating an Empirically Based Tool for Analyzing Congenital Heart Surgery Mortality: STAT 2020. World J Pediatr Congenit Heart Surg. 2021 Mar;12(2):282-283.

9. 9-Gaies MG, Jeffries HE, Niebler RA, Pasquali SK, Donohue JE, Yu S, Gall C, Rice TB, Thiagarajan RR. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med. 2014 Jul;15(6):529-37.
10. 10-Çelebioğlu A, Polat S (2004) Yenidoğanda ağrı değerlendirmesi, Sendrom Tıp Dergisi, 16(4):99-101
11. 11-Cavalcante AM, Brunori EH, Lopes CT, Silva AB, Herdman TH. Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit. Rev Bras Enferm. 2015 Jan-Feb;68(1):155-60.
12. 12-Ailes EC, Gilboa SM, Honein MA, Oster ME. Estimated number of infants detectedand missed by critical congenital heart defect screening. Pediatrics. 2015 Jun;135(6):1000-8.
13. 13-Dilli D, Köse MR, Gündüz RC, Özbaş S, Tezel B, Okumuş N. Recent declines in infant and neonatal mortalıty in turkey from 2007 to 2012: impact of improvements in health policies. Cent Eur j Public Health 2016; 24 (1): 52–57
14. 14-Dilli D, Doğan V, Özyurt BM, Özyurt A, Hakan N, Bozabalı S, Caner İ, Olgun H, Koç M, Taşoğlu İ, Karademir S, Zenciroğlu A. Should we start a nationwide screening program for critical congenital heart disease in Turkey? A pilot study on four centres with different altitudes.Predictive Value of Vasoactive-inotropic Score for Mortality in Newborns Undergoing Cardiac Surgery.Cardiol Young. 2019 Apr;29(4):475-480.
15. 15-Varal İG, Köksal N, Özkan H, Bostan Ö, Sığınak IŞ, Bağcı O ve ark. Yenidoğan yoğun bakım ünitemizde izlenen konjenital kalp hastalıkları: sıklığı, risk faktörleri ve prognozu. J Curr Pediatr 2015; (13):159-64.
16. 16-Cheng HH, Ferradal SL, Vyas R, Wigmore D, McDavitt E, Soul JS, Franceschini MA, Newburger JW, Grant PE. Abnormalities in cerebral hemodynamics and changes with surgical intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg. 2020 May;159(5):2012-2021.
17. 17-McNamara PJ, Barker P, Jain A, Lai WW. Towards use of POCUS to evaluatehemodynamics in critically ill neonates: caution before adoption in this population. Crit Care. 2021 Mar 3;25(1):92. doi: 10.1186/s13054-020-03394-4.
18. 18-Jang WS, Kim WH, Choi K, Nam J, Jung JC, Kwon BS, Kim GB, Kang HG, LeeJR, Kim YJ. Incidence, risk factors and clinical outcomes for acute kidney injury afteraortic arch repair in paediatric patients Eur J Cardiothorac Surg 2014;45:e208-14.
19. 19-Dilli D, Aydin B, Zenciroğlu A, Özyazici E, Beken S, Okumuş N. Treatment outcomes of infants with cyanotic congenital heart disease treated with synbiotics. Pediatrics. 2013 Oct;132(4):e932-8. doi: 10.1542/peds.2013-1262.
20. 20-Akdag A, Dilmen U, Haque K, Dilli D, Erdeve O, Goekmen T. Role of pentoxifylline and/or IgM-enriched intravenous immunoglobulin in the management of neonatal sepsis. Am J Perinatol. 2014 Nov;31(10):905-12.