Arrhythmias after the Fontan procedure

Objective—To study the determinants and outcome of arrhythmias after the Fontan type operation.Design—Retrospective analysis of data in patients operated on between 1972 and 1986 (follow up 5–19 years (mean 12 years)).Patients—All 60 patients undergoing a Fontan type procedure at the National Heart Hospital, London, during the study period (mean age (SD) 12·3 (6·8) years).Results—Postoperative arrhythmias occurred in 34 patients (57%), and 11 (58%) of 19 early postoperative deaths (within seven days) were related to arrhythmias. Early arrhythmias occurred in 19 (32%) patients of whom 11 (58%) died. All patients with early atrial fibrillation and His bundle tachycardia died and only preoperative atrial fibrillation recurred early. There was a higher incidence of early arrhythmias, which were less well tolerated, in double inlet single ventricle patients (9/19) than in those with tricuspid atresia (8/37). There were no other preoperative determinants of early arrhythmias or deaths from early arrhythmia. Late (after seven days) arrhythmias occurred in 15 (37% of hospital survivors). They had higher right atrial (RA) pressures both early and late after operation and had lower ventricular ejection fractions late after operation. Of those with atrial arrhythmias 86% had RA obstruction and 57% had an RA thrombus or pulmonary embolism at presentation; this was also confirmed in two patients in whom late sudden deaths occurred. Atrial fibrillation early after reoperation for RA obstruction was fatal. The actuarial arrhythmia free survival for hospital survivors was 60% at 10 years.Conclusions—Early postoperative arrhythmias were poorly tolerated, particularly atrial fibrillation and His bundle tachycardia. Previous atrial fibrillation was a relative contraindication to this procedure. Late postoperative arrhythmias were associated with higher RA pressures measured both early and late after operation and worse late ventricular function. Late arrhythmias may be the first manifestation of RA obstruction, which must be sought. RA thrombus was common in patients with atrial arrhythmias and should be treated early with anticoagulants.     

Arrhythmias after the Fontan procedure

Objective—To study the determinants and outcome of arrhythmias after the Fontan type operation.

Design—Retrospective analysis of data in patients operated on between 1972 and 1986 (follow up 5–19 years (mean 12 years)).

Patients—All 60 patients undergoing a Fontan type procedure at the National Heart Hospital, London, during the study period (mean age (SD) 12·3 (6·8) years).

Results—Postoperative arrhythmias occurred in 34 patients (57%), and 11 (58%) of 19 early postoperative deaths (within seven days) were related to arrhythmias. Early arrhythmias occurred in 19 (32%) patients of whom 11 (58%) died. All patients with early atrial fibrillation and His bundle tachycardia died and only preoperative atrial fibrillation recurred early. There was a higher incidence of early arrhythmias, which were less well tolerated, in double inlet single ventricle patients (9/19) than in those with tricuspid atresia (8/37). There were no other preoperative determinants of early arrhythmias or deaths from early arrhythmia. Late (after seven days) arrhythmias occurred in 15 (37% of hospital survivors). They had higher right atrial (RA) pressures both early and late after operation and had lower ventricular ejection fractions late after operation. Of those with atrial arrhythmias 86% had RA obstruction and 57% had an RA thrombus or pulmonary embolism at presentation; this was also confirmed in two patients in whom late sudden deaths occurred. Atrial fibrillation early after reoperation for RA obstruction was fatal. The actuarial arrhythmia free survival for hospital survivors was 60% at 10 years.

Conclusions—Early postoperative arrhythmias were poorly tolerated, particularly atrial fibrillation and His bundle tachycardia. Previous atrial fibrillation was a relative contraindication to this procedure. Late postoperative arrhythmias were associated with higher RA pressures measured both early and late after operation and worse late ventricular function. Late arrhythmias may be the first manifestation of RA obstruction, which must be sought. RA thrombus was common in patients with atrial arrhythmias and should be treated early with anticoagulants.

     

State of the colon after cholecystectomy

Study of the colon was carried out in patients with cholelithiasis after cholecystectomy. Estimated clinical symptoms, the mucous membrane status by the results of the histological, morphometric methods, computed ploidometry and immunomorphology of colon biopsy specimens. Mucosal atrophy, the buildup of sclerotic processes and proliferative activity of colonocytes was significantly more frequent in patients with cholecystectomy in history, than in patients with cholelithiasis and the control group. Most of the examined patients have disorders of the colon microbiocenosis. Use of domestic liquid synbiotic complexes Normoflorin L and B allowed to hold a successful correction of disbiosis.     

Arrhythmias after the Fontan procedure.

OBJECTIVE--To study the determinants and outcome of arrhythmias after the Fontan type operation. DESIGN--Retrospective analysis of data in patients operated on between 1972 and 1986 (follow up 5-19 years (mean 12 years)). PATIENTS--All 60 patients undergoing a Fontan type procedure at the National Heart Hospital, London, during the study period (mean age (SD) 12.3 (6.8) years). RESULTS--Postoperative arrhythmias occurred in 34 patients (57%), and 11 (58%) of 19 early postoperative deaths (within seven days) were related to arrhythmias. Early arrhythmias occurred in 19 (32%) patients of whom 11 (58%) died. All patients with early atrial fibrillation and His bundle tachycardia died and only preoperative atrial fibrillation recurred early. There was a higher incidence of early arrhythmias, which were less well tolerated, in double inlet single ventricle patients (9/19) than in those with tricuspid atresia (8/37). There were no other preoperative determinants of early arrhythmias or deaths from early arrhythmia. Late (after seven days) arrhythmias occurred in 15 (37% of hospital survivors). They had higher right atrial (RA) pressures both early and late after operation and had lower ventricular ejection fractions late after operation. Of those with atrial arrhythmias 86% had RA obstruction and 57% had an RA thrombus or pulmonary embolism at presentation; this was also confirmed in two patients in whom late sudden deaths occurred. Atrial fibrillation early after reoperation for RA obstruction was fatal. The actuarial arrhythmia free survival for hospital survivors was 60% at 10 years. CONCLUSIONS--Early postoperative arrhythmias were poorly tolerated, particularly atrial fibrillation and His bundle tachycardia. Previous atrial fibrillation was a relative contraindication to this procedure. Late postoperative arrhythmias were associated with higher RA pressures measured both early and late after operation and worse late ventricular function. Late arrhythmias may be the first manifestation of RA obstruction, which must be sought. RA thrombus was common in patients with atrial arrhythmias and should be treated early with anticoagulants.     

Increase in the QRS duration after amelioration of peripheral edema and after hemodialysis

Association among weights, amplitude of QRS complexes, and QRS duration in patients with peripheral edema has been described. This study explored whether increase in QRS duration occurs with amelioration of peripheral edema or after hemodialysis. Sums of the amplitudes of the 12 electrocardiographic leads and corresponding QRS duration were measured in 12 patients with peripheral edema before and after loss of weight, in 28 patients with a critical illness but without change in their weight ("controls"), and in 1 patient before and after hemodialysis. QRS duration increased from 90.1+/-25.0 milliseconds to 101.7+/-25.8 milliseconds (P=.001) in patients with peripheral edema, was unchanged in the controls, and increased from 87.8+/-5.9 milliseconds before to 92.7+/-6.7 milliseconds after hemodialysis (P=.007). It is proposed that these increases in QRS duration are only apparent (not electrophysiologically real), representing an extracardiac phenomenon mediated by alterations in the composite impedance of the passive body volume conductor, resulting in measurement of augmented QRS complexes after fluid removal. The clinical implications for patients with congestive heart failure are discussed.     

Pneumomediastinum after self-dilation of the esophagus

Pneumomediastinum following esophageal perforation is a known complication of Eder Puestow dilation for esophageal stenosis. This is the first reported case of esophageal perforation and pneumomediastinum occurring after instrumental self-dilation of a stenotic esophageal lesion. The observed 0.02 percent perforation rate in this patient (compared to the reported 0.3 percent in Eder Puestow "hetero"-dilation) makes the Eder Puestow auto-dilation procedure seem justifiable in a well-trained and well-informed patient.     

Survival after transfusion in the Netherlands

Background Cost‐effectiveness analyses of blood safety interventions require estimates of the life expectancy after blood product transfusion. These are best derived from survival after blood transfusion, per age group and blood component type. Study design and methods In the PROTON (PROfiles of TransfusiON recipients) study transfusion recipient data was collected from a hospital sample covering 28% of the total blood use between 1996 and 2006 in the Netherlands. The dataset includes date of transfusion, blood component type transfused and recipient identification details. PROTON data were individually matched to mortality data of the Netherlands. Survival after first transfusion and after any transfusion was calculated, per blood component type and age group. PROTON mortality rates were compared to mortality rates in the general population. The results were used to estimate survival beyond the study period and to estimate life expectancy after transfusion. Results Of all 2 405 012 blood product transfusions in the PROTON dataset, 92% was matched to the national Dutch Municipal Population Register, which registers all deaths. After 1 year, survival after any transfusion was 65·4%, 70·4% and 53·9% for RBC, FFP and PLT respectively. After 5 years, this was 46·6%, 58·8% and 39·3% for RBC, FFP and PLT, respectively. Ten years after transfusion, mortality rates of recipients are still elevated in comparison with the general population. Conclusion Mortality rates of transfusion recipients are higher than those of the general population, but the increase diminishes over time. The mortality rates found for the Netherlands are lower than those found in comparable studies for other countries.