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Abdominal Problems in Children with Congenital Cardiovascular Abnormalities

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Abdominal Problems in Children with Congenital Cardiovascular Abnormalities Copyright 2015 © Trakya University Faculty of Medicine Original Article | 285 Balkan Med J 2015;32:285-90 Abdominal Problems in Children with Congenital Cardiovascular Abnormalities Lütfi Hakan Güney1, Coşkun Araz2, Deniz Sarp Beyazpınar3, İrfan Serdar Arda1, Esra Elif Arslan1, Akgün Hiçsönmez1 1Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Turkey 2Department of Anesthesiology, Başkent University Faculty of Medicine, Ankara, Turkey 3Department of Cardiovasculer Surgery, Başkent University Faculty of Medicine, Ankara, Turkey Background: Congenital cardiovascular abnormal- were operated due to intra-abdominal problems, and ity is an important cause of morbidity and mortality in 62 (Group II) were followed-up clinically for intra-ab- childhood. Both the type of congenital cardiovascular dominal problems. In Group I (10 boys and 4 girls), 11 abnormality and cardiopulmonary bypass are respon- patients were aged between 0 and 12 months, and three sible for gastrointestinal system problems. patients were older than 12 months. Group II included Aims: Intra-abdominal problems, such as paralytic ile- 52 patients aged between 0 and 12 months and 10 pa- us, necrotizing enterocolitis, and intestinal perforation, tients older than 12 months. Cardiovascular surgical are common in patients who have been operated or interventions had been applied to six patients in Group who are being followed for congenital cardiovascular I and 40 patients in Group II. The most frequent intra- abnormalities. Besides the primary congenital cardio- abdominal problems were necrotizing enterocolitis and vascular abnormalities, ischemia secondary to cardiac intestinal perforation in Group I, and paralytic ileus in catheterization or surgery contributes to the incidence Group II. Seven of the Group I patients and 22 of the of these problems. Group II patients died. The patients who died in both Study Design: Cross-sectional study. groups had more than three congenital cardiovascular Methods: In this study, we aimed to screen the intra- abnormalities in the same patient, and 80% of these pa- abdominal problems seen in patients with congenital car- tients had been operated for congenital cardiovascular diovascular abnormalities who had undergone surgical or abnormalities. angiographical intervention(s). Patients with congenital Conclusion: The gastrointestinal system is involved in cardiovascular abnormalities who had been treated medi- important complications experienced by patients with cally or surgically between 2000 and 2014 were analyzed congenital cardiovascular abnormalities. The mortality retrospectively in terms of intra-abdominal problems. The rate was higher in operated patients due to gastrointes- patients’ demographic data, type of congenital cardiovas- tinal complications. Gastrointestinal complications are cular abnormalities, the intervention applied (surgical, an- more frequent in patients with cyanotic anomalies. The giographic), the incidence of intra-abdominal problem(s), presence of more than one congenital cardiovascular the interventions applied for the intra-abdominal prob- abnormality in a patient increased the mortality rate. lems, and the results were evaluated. Keywords: Abdominal surgery, cardiopulmonary, Results: Fourteen (Group I) of the 76 patients with congenital, cardiovascular abnormalities, intestinal congenital cardiovascular abnormalities diagnosis ischemia Address for Correspondence: Dr. Lütfi Hakan Güney, Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Turkey Phone: +90 533 729 81 99 e-mail: [email protected] Received: 17.11.2014 Accepted: 26.01.2015 • DOI: 10.5152/balkanmedj.2015.151045 Available at www.balkanmedicaljournal.org Cite this article as: Güney LH, Araz C, Beyazpınar DS, Arda İS, Arslan EE, Hiçsönmez A. Abdominal problems in children with congenital cardiovascular abnormalities. Balkan Med J 2015;32:285-90. 286 Güney et al. Abdominal Problems in Congenital Cardiac Disease Congenital cardiovascular abnormality is an important cause and a titrated dose of Thiopental sodium (PENTAL®Sodyum, of morbidity and mortality in childhood (1). Gastrointestinal I.E. Ulagay, İstanbul, Turkey) (5–7 mg/kg). Muscle paraly- system problems are not rare in patients with Congenital car- sis was accomplished with vecuronium (Norcurone, N V Or- diovascular abnormalities (2,3). Both the type of congenital ganon, the Netherland) (0.1 mg/kg). After the induction of cardiovascular abnormality and cardiopulmonary bypass are anesthesia, a central venous access was created. All patients responsible for gastrointestinal system complications. Heart received antibiotic prophylaxis consisting of cefuroxime so- failure, hypotension, and cardiopulmonary bypass-related dium (Zinnat, Glaxo Smith Kline Medical, London, England) hypoperfusion may cause a short- or long-term ischemia in (30 mg/kg every 8 hours for 24 hours) together with prophy- the gastrointestinal system. The tissue injury caused by isch- lactic H2-receptor blockade using ranitidine (Ulcuran, Abfar emia may lead to complications ranging from a decrease in Medical, İstanbul, Turkey), with a dose of 50 mg that was in- intestinal motility to necrosis. In this study, gastrointestinal travenously administered at the time of anesthesia induction. system problems of patients with congenital cardiovascular We administered positive pressure ventilation with air and abnormalities were investigated regarding predetermined pa- oxygen (60:40) with a variable inspiratory concentration of rameters. sevoflurane (Sevorane®, Queenborough, England) (0.5–1%). Statistical analysis MATERIALS AND METHODS Descriptive statistics are showed as mean ± standard de- viation or median (75%) for continuous variables. The t test In this study, gastrointestinal system problems of children was performed for normally distributed variables, and the with congenital cardiovascular abnormalities who underwent Mann–Whitney U test was performed for variables that did surgical intervention and/or cardiac catheterization at a ter- not distribute normally. The continuity correction Chi-square tiary health care institution between 2000 and 2014 were ret- test was used for categoric variables, and results are shown as rospectively reviewed. All procedures were performed by the the frequency and percentage (%). A p-value below 0.05 was same team. All patients received a detailed explanation of the accepted as significant. procedure before surgery, and the study was approved by the Logistic regression analysis was performed to find risk fac- hospital review board. tors. IBM SPSS Statistics for Windows, Version 20.0 (Ar- After our project had been approved by Başkent Universty monk, NY, USA) was used for statistical analysis. Ethical committee. Medical records of the children who had been treated by the Department of Pediatric Surgery were studied. The parameters considered were: age, gender, type RESULTS of congenital cardiovascular abnormality, interventions per- formed for congenital cardiovascular abnormality, gastroin- A total of 3373 patients with congenital cardiovascular ab- testinal complications, and follow-up findings. The results normality had undergone surgical intervention and/or cardiac obtained were compared with the findings in the literature. catheterization. Gastrointestinal complications were recorded After the patients with congenital cardiovascular abnormali- in 76 (2.3%) of the total number, 14 (18.5%) of whom were ties were diagnosed to have surgical gastrointestinal system operated (Group I), while 62 patients (81.5%) were treated problems, a proper informed consent was taken from their non-surgically (Group II). parents and they were transferred to the anesthesia room, and The demographic data of the patients are presented in Table continuous arterial pressure and electrocardiographic moni- 1. In Group I (10 boys and 4 girls), 11 patients were aged be- toring were established before induction of anesthesia by the tween 0 and 12 months, and three patients were older than 12 administration of 1–2 µgr/kg of fentanyl citrate (Fentanyl, months. Group II included 52 patients aged between 0 and 12 Meditera Medical Istanbul, Turkey) delivered intravenously months, and 10 patients older than 12 months. TABLE 1. Distribution of patients according to age and gender Group I Group II Age 0–12 months >12 months TOTAL 0–12 months >12 months TOTAL Gender Male Female Male Female Male Female Male Female Male Female Male Female 8 3 2 1 10 4 35 17 6 4 41 21 TOTAL 11 3 14 52 10 62 Group I: operated patients; Group II: medically managed patients Balkan Med J, Vol. 32, No. 3, 2015 Güney et al. Abdominal Problems in Congenital Cardiac Disease 287 Congenital cardiovascular abnormalities of the patients (Table 4). Visualization of free air in abdominal plain radio- include: ventricular septal defect, atrial septal defect, ductus graph, intestinal content detection in parasynthesis following arteriosus defect, pulmonar stenosis, double outlet right ven- extensive dense-liquid detection in abdominal ultrasonogra- tricle, transposition of the great arteries, aortic coarctation, phy, and edema and color change in the abdominal wall were fallot tetralogy, and tricuspid atresia. accepted as laparotomy indications. In these patients, local- Eleven (78.5%) of the 14 patients in Group I had cyanotic ized or wide necrosis and single or multiple foci of perforation congenital cardiovascular abnormalities, and 3 (21.5%) had were detected. In two cases abdominal exploration
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