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      Critical arrhythmia in postoperative cardiac children: Recognition and management

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          Abstract

          Arrhythmias after pediatric cardiac surgery are common and can be life-threatening. They occur intraoperatively or may appear shortly after surgery during postoperative care. They require early management and specific intervention. In this review, we describe important critical arrhythmias that are encountered during postoperative management of children undergoing cardiac surgery. We review the diagnosis, management, and explain the role of epicardial electrocardiogram in diagnosing certain types of postoperative rhythm abnormalities seen during early period after pediatric cardiac surgery.

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          Most cited references24

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          Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

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            Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study.

            The purpose of this study was to determine long-term outcome in adults with congenitally corrected transposition of the great arteries (CCTGA), with particular emphasis on systemic ventricular dysfunction and congestive heart failure (CHF). Patients with CCTGA have the anatomical right ventricle as their systemic pumping chamber, with ventricular dysfunction and CHF being relatively common in older adults. Retrospective analysis of records of 182 patients from 19 institutions were reviewed to determine current status and possible risk factors for systemic ventricular dysfunction and CHF. Factors considered included age, gender, associated cardiac defects, operative history, heart block, arrhythmias and tricuspid (i.e., systemic atrioventricular) regurgitation (TR). Both CHF and systemic ventricular dysfunction were common in groups with or without associated cardiac lesions. By age 45, 67% of patients with associated lesions had CHF, and 25% of patients without associated lesions had this complication. The rates of systemic ventricular dysfunction and CHF were higher with increasing age, the presence of significant associated cardiac lesions, history of arrhythmia, pacemaker implantation, prior surgery of any type, and particularly with tricuspid valvuloplasty or replacement. Aortic regurgitation (a previously unreported problem) was also relatively common in this patient population. Patients with CCTGA are increasingly subject to CHF with advancing age; this complication is extremely common by the fourth and fifth decades. Tricuspid (systemic atrioventricular) valvular regurgitation is strongly associated with RV (anatomical right ventricle connected to aorta in CCTGA patients; systemic ventricle in CCTGA) dysfunction and CHF; whether it is causative or a secondary complication remains speculative.
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              Myocardial ischemia, stunning, inflammation, and apoptosis during cardiac surgery: a review of evidence.

              Cardiac surgery (CS), in particular cardiopulmonary bypass and cardioplegia, have been reported to trigger myocardial inflammation and apoptosis. This surgery-related inflammatory reaction appears to be of extreme complexity with regard to its molecular, cellular and tissue mechanisms. Both experimental and clinical studies have ascertained the role of several hormonal mediators, mitochondria, cardioplegia and extracorporeal circulation temperature, apoptosis and even genetic modulators of damage. However, the correlations between these factors in vivo and post-surgery outcome and prognosis have not yet been systematically investigated. In animal models of myocardial cardioplegia and/or ischemia-reperfusion, experimental drugs such as antioxidants have been documented to provide amelioration of post-intervention cardiac performance and reduction of apoptosis suggesting the possibility of new therapeutic strategies. However, these findings have been only partially confirmed in humans. Moreover, markers for the differential detection of early and late phases of apoptosis are subjects of intense investigations. This review will provide an overview of the major studies about the link between ischemia, myocardial inflammation and apoptosis during and after CS, with particular regard to the markers and methods for apoptosis detection.
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                Author and article information

                Journal
                Avicenna J Med
                Avicenna J Med
                AJM
                Avicenna Journal of Medicine
                Medknow Publications & Media Pvt Ltd (India )
                2231-0770
                2249-4464
                Jul-Sep 2017
                : 7
                : 3
                : 88-95
                Affiliations
                [1 ] Department of Cardiac Science, Division of Pediatric Cardiac Critical Care Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
                [2 ] King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
                [3 ] College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
                [4 ] Department of Cardiac Science, Division of Pediatric Cardiology, King Abdul Aziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
                Author notes
                Address for correspondence: Dr. Mohamed Salim Kabbani, Department of Cardiac Science, Division of Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, P.O. Box: 22490, Riyadh 11426, Kingdom of Saudi Arabia. E-mail: kabbanim@ 123456ngha.med.sa
                Article
                AJM-7-88
                10.4103/ajm.AJM_14_17
                5525472
                98200610-02ed-45a3-8a83-c4a9d13f3127
                Copyright: © 2017 Avicenna Journal of Medicine

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Review Article

                Medicine
                bradycardia,critical arrhythmia,pediatric cardiac surgery,tachycardia
                Medicine
                bradycardia, critical arrhythmia, pediatric cardiac surgery, tachycardia

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