EXPERIENCE OF APPLICATION OF THE PROCEDURE OF RASHKIND IN THE STATE INSTITUTION
About the author:
Imanov E., Truba Y. P., Plyska O. I., Dzyurii I. V., Sloboda A. O., Lazoryshynets V. V.
METHODS AND METHODOLOGIES
Type of article:
Congenital heart defects (СHD) occur in 8% of cases. At the same time, up to 25% of newborns with critical CHD are discharged from maternity wards without diagnosis, and half of them die. The life preservation of a newborn with a critical CHD in some cases depends on maintaining adequate blood circulation in the large circulatory system by maintaining the atrial junction. The procedure involves the removal of the atrial septum, and the creation of a connection between the right and left atria. There are two types of intervention – atrial atrioseptostomy (PA): open PA – it is performed with the help of the device of artificial circulation (efficiency is almost 100%) and – balloon PA – is performed with the help of an intravenous catheter, which contains a balloon that breaks the atrial septum (effective in 90% of cases and is performed under X-ray control). The purpose of the work is to analyze the results of the Rashkind procedure, depending on its type and diagnosis. Object and methods. For the period from 2007 to 2019 at the State Institution «National Institute cardiovascular surgery them. M.M. Amosov National Academy of Medical Sciences of Ukraine» 180 atrioseptostomies were per-formed. Of these, 57 (32%) are female and 123 (68%) are male. Atrioseptostomy was performed in patients with critical congenital heart defects with a small diameter of an open oval window and an open arterial duct. On the day of surgery, the average age of the patients was 5.7 days (from 1 to 60 days) Me = 3, respectively, the weight on average 3.5±2 kg. In 35% of patients, the defect was diagnosed prenatal and confirmed by echocardiographic (Echocardiogram) immediately after birth, in 90% of cases – at birth, which allowed to immediately deliver patients to NSSH for the delivery of highly qualified medical care. Results. Vessel catheterization and balloon dilation were performed according to the Rashkind standard procedure in X-ray surgery using X-ray angiographic complexes. In each case, the efficacy of the procedure was verified with the help of Echo-KG, which confirmed that it went without difficulty. In all cases, stage 2 was available: 80% of patients after the procedure were operated on the second day, 20% – stage 2 was delayed. The largest number of patients undergoing Rashkind was diagnosed with transposition of the main vessels, the number of boys was 2.27 times exceeded that of girls. In all cases, these are critical shortcomings of the CHD that require immediate surgery to preserve these patients and prepare them for the next stage of surgery. The Rashkind procedure is widely used in other cardiac surgery centres. In particular, in Ukraine. Conclusions. 1. Atrial atrioseptostomy is an effective and safe operation in cases of saving the life of the patient to prepare him for the second stage of surgery in critical congenital heart defects of different nature and etiology. 2. To determine the effectiveness of the procedure, it is advisable to use Echocardiography, which reduces the radiation burden on the patient and the medical staff.
Rashkind procedure, atrial atriosepostomy, open atrial atriosepstomy, balloon atrial atriosepostomy.
- Miller-Hance WC, Tacy TA. Gender differences in pediatric cardiac surgery: the cardiologist’s perspective. The Journal of Thoracic and Cardiovascular Surgery. 2004;36(1):11-6.
- Watson H, Rashkind WJ. Creation of atrial septal defects by balloon catheter in babies with transposition of the great arteries. Lancet. 1967;25.1(7487):403-5.
- Mavrodis C, Backer L. Pediatric cardiac surgery. 2nd edition. St. Louis: Mosby; 1994. 645 р.
- Rashkind WJ, Miller WW. Creation of an atrial septal defect without thoracotomy: palliative approach to complete transposition of the great arteries. JAMA. 1966;196:991.
- Emec ІМ. Nevidkladna dopomoga pri kritichniкh vrodgenich vadach serca. Sovr. pediatria. 2008;1(18):125-7. [in Ukrainian].
- Feltes TF, Bacha E, Beekman RH. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation. 2011;123(22):2607-52.
- Symalc АА, Nyshonov NА. Atryoseptostomya u bolnych s legochnoy gypertenzyey. Grudnayi i serdechno-sosudistaya chyrurgyya. 2015;57(5):18-25. [in Russiаn].
- Maksimenko AV, Dovgaluyk АА, Kuzmenko YuL. Endovaskukarna balonna atrioseptostomia u novonarodgenich z transpozicieyu magistralnich sudin. Praktichna angiologia. 2007;5(10):37-41. [in Ukrainian].
- Kuzmenko YuL, Maksymenko AV, Dovhalyuk AA. Dosvid endovaskulyarnykh vtruchan pry krytychnykh vrodzhenykh vadakh sertsya. Sovremennaya pedyatryya. 2013;55(7):155-60. [in Ukrainian].
- Lazoryshynets VV, Truba YaP, Dordyay IS. Dosvid khirurhichnoho likuvannya syndromu hipoplaziyi livykh viddiliv sertsya. Visnyk sertsevosudynnoi khirurhiyi. 2015;23:89-92. [in Ukrainian].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 244-247 pages, index UDK 616.12-089-028.46(477)