Cardiac catheterisation in the postoperative period emerges as a primary tool, providing effectiveness and safety in diagnosis, treatment guidance, and resolution of major residual lesions.

This is a retrospective case-control study. We collected the clinical records of patients who underwent cardiac catheterisation between January 2003 and December 2022 within the initial 72 hours after surgery in the pediatric cardiac ICU of a national referral hospital in Mexico City. Descriptive, univariate, and multivariate analyses were performed.

A total of 6,243 surgeries were performed, of which 264 were cardiac catheterizations carried out within the first 72 hours of the postoperative period;these included 73 diagnostic procedures and 191 interventional procedures. One hundred and thirty-five (135) catheterisations targeted recent suture intervention sites. The primary indications for cardiac catheterisation included low cardiac output and the suspicion of major residual lesions. Approximately 65% of interventions occurred within the first 24 hours and solved 426 residual lesions. No significant associations were found between mortality, complications, and the need for surgical reintervention in patients who underwent interventional catheterisation at recent suture sites (OR 1.93;95% CI:0.94–4.07:p = 0.076). Seventeen patients (17) were extubated in the initial 24 hours post-catheterisation. Two major complications were identified: rupture of the systemic-to-pulmonary shunt in the anastomosis, and a pulmonary artery laceration requiring emergency surgery. One patient died.

Cardiac catheterisation has evolved into a vital instrument to diagnose and resolve abnormalities and significant residual lesions without increasing the morbidity and mortality risks.

This study aimed to compare the graft success rate, hearing outcomes, operation time and complications between myringoplasty with raising of a mucosal flap (RMF) and raising of a tympanomeatal flap (RTF) for the repair of subtotal perforations.

Subtotal perforations were recruited and randomly allocated to either the RMF group or the RTF group. The graft success rate, hearing outcomes and complications were evaluated at 6 months post-operatively.

The mean operation time was 31.4 ± 2.8 minutes (range: 26–47) in the RMF group and 57.6 ± 0.9 minutes in the RTF group (p < 0.01). The graft success rate was 96.0 per cent in the RMF group and 88.9 per cent in the RTF group (p = 0.659).

Endoscopic myringoplasty with the RMF achieved similar graft success and hearing gain compared to the tympanomeatal flap technique for repairing subtotal perforations, but with significantly shorter operation time and minimal temporary hypogeusia.

This case report discusses a successful emergency Lichtenberger lateralisation procedure after immediate bilateral laryngeal immobility, occurring after total thyroidectomy.

A 63-year-old female with right-sided vocal fold paralysis due to compression by a multinodular thyroid goitre underwent total thyroidectomy, which resulted in immediate post-operative bilateral vocal fold immobility. The patient had acute-onset post-operative dyspnoea, was promptly re-intubated, and an emergency lateralisation Lichtenberger suture was placed over the right vocal fold and fixated on the outer surface of the neck.

After two weeks, her right vocal fold recovered first, with the suture still in place. At four weeks, both vocal folds regained function and the suture was extracted.

The take-away message is that an emergency lateralisation suture may be a viable option in maintaining airway patency, while allowing for normal deglutition, in patients who would otherwise be candidates for prolonged intubation, posterior cordotomy, medial arytenoidectomy or tracheostomy.

Long hospital stays for neonates following cardiac surgery can be detrimental to short- and long-term outcomes. Furthermore, it can impact resource allocation within heart centres' daily operations. We aimed to explore multiple clinical variables and complications that can influence and predict the post-operative hospital length of stay.

We conducted a retrospective observational review of the full-term neonates (<30 days old) who had cardiac surgery in a tertiary paediatric cardiac surgery centre – assessment of multiple clinical variables and their association with post-operative hospital length of stay.

A total of 273 neonates were screened with a mortality rate of 8%. The survivors (number = 251) were analysed; 83% had at least one complication. The median post-operative hospital length of stay was 19.5 days (interquartile range 10.5, 31.6 days). The median post-operative hospital length of stay was significantly different among patients with complications (21.5 days, 10.5, 34.6 days) versus the no-complication group (14 days, 9.6, 19.5 days), p < 0.01. Among the non-modifiable variables, gastrostomy, tracheostomy, syndromes, and single ventricle physiology are significantly associated with longer post-operative hospital length of stay. Among the modifiable variables, deep vein thrombosis and cardiac arrest were associated with extended post-operative hospital length of stay.

Complications following cardiac surgery can be associated with longer hospital stay. Some complications are modifiable. Deep vein thrombosis and cardiac arrest are among the complications that were associated with longer hospital stay and offer a direct opportunity for prevention which may be reflected in better outcomes and shorter hospital stay.

Antidepressants and antipsychotics have a wide range of cardiac side effects. Although the absolute risk is considered low, some are potentially life-threatening.

We aim to review the main cardiological complications of antidepressants and antipsychotics and their management. We will consider 1) QTc prolongation and arrhythmia 2) heart rate 3) blood pressure 4) myocarditis.

Review of cardiological complications of antidepressants and antipsychotics.

Qtc prolongation is correlated with arrhythmia risk. QTc is obtained with Bazett’s formula, which has limitations. All inpatients and some outpatients starting antipsychotic should undergo ECG. Increased QTc can result in different approaches, depending on severity. Most antidepressants do not significantly affect QTc, except for escitalopram and tricyclics, mostly in overdose. Sinus tachycardia can occur with most antipsychotics. Tricyclics can also produce this effect. Other causes should be excluded, and management can be achieved with bisoprolol. Other antidepressants most commonly produce a slight decrease in heart rate or have a minimal to no effect. Antipsychotics can cause hypertension or hypotension depending on the degree of affinity to specific adrenergic receptors. Tricyclics can lead to postural hypotension. Antidepressants interfering with noradrenaline can cause hypertension. Myocarditis is mostly associated with clozapine. Patients should be screened for clinical signs and laboratory findings - especially in the presence of risk factors. Suspicion should prompt echocardiological examination and confirmation leads to cardiology referral.

Weighing the risks and benefits of these medications is a continuous process. Management of cardiological complications is possible and may involve a multidisciplinary approach.

No significant relationships.

To determine potentially modifiable risk factors for a complicated Glenn procedure (cGP) and whether a cGP predicted adverse neurodevelopmental and functional outcomes. A cGP was defined as post-operative death, heart transplant, extracorporeal life support, Glenn takedown, or prolonged ventilation.

All 169 patients having a Glenn procedure from 2012 to 2017 were included. Neurodevelopmental assessments were performed at age 2 years in consenting survivors (n = 156/159 survivors). The Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III) and the Adaptive Behavior Assessment System-2nd Edition (ABAS-II) were administered. Adaptive functional outcomes were determined by the General Adaptive Composite (GAC) score from the ABAS-II. Predictors of outcomes were determined using univariate and multiple variable linear or Cox regressions.

Of patients who had a Glenn procedure, 10/169 (6%) died by 2 years of age and 27/169 (16%) had a cGP. Variables statistically significantly associated with a cGP were the inotrope score on post-operative day 1 (HR 1.04, 95%CI 1.01, 1.06; p = 0.010) and use of inhaled nitric oxide post-operatively (HR 7.31, 95%CI 3.19, 16.76; p < 0.001). A cGP was independently statistically significantly associated with adverse Bayley-III Cognitive (ES −10.60, 95%CI −17.09, −4.11; p = 0.002) and Language (ES −11.43, 95%CI −19.25, −3.60; p = 0.004) scores and adverse GAC score (ES −14.89, 95%CI −22.86, −6.92; p < 0.001).

Higher inotrope score and inhaled nitric oxide used post-operatively were associated with a cGP. A cGP was independently associated with adverse 2-year neurodevelopmental and functional outcomes. Whether early recognition and intervention for risk of a cGP can prevent adverse outcomes warrants study.