RESUMEN
Background: Hypoplastic left heart syndrome (HLHS) accounts for 2.6% of congenital heart disease and is an invariably fatal cardiac anomaly if left untreated. Approximately 33,750 babies are born annually with HLHS in developing countries. Unfortunately, the majority will not survive due to the scarcity of resources and the limited availability of surgical management. Aim: To describe and analyze our experience with the hybrid approach in the management of HLHS in a developing country. Methods: We performed a retrospective single-center study involving all neonates born with HLHS over five years at the Children's Heart Center at the American University of Beirut. The medical records of patients who underwent the hybrid stage 1 palliation were reviewed, and data related to baseline characteristics, procedure details and outcomes were collected to describe the experience at a tertiary care center in a developing country. Results: A total of 18 patients were diagnosed with HLHS over a five-year period at our institution, with male to female ratio of 1:1. Of those, eight patients underwent the hybrid stage I procedure. The mean weight at the time of the procedure was 3.3 ± 0.3â kg with an average age of 6.4 ± 4 days. The mean hospital length of stay was 27.25 days, with an interquartile range of 33 days. The cohort's follow-up duration averaged 5.9 ± 3.5 years. The surgical mortality was zero. Only one mortality was recorded during the interstage period between stage I and II and was attributed to sepsis. Notably, all surviving patients maintained preserved and satisfactory cardiac function with good clinical status. Conclusion: Our limited experience underscores the potential of developing countries with proper foundations to adopt the hybrid procedure for HLHS, yielding outcomes on par with those observed in developed countries. This demonstrates the viability of establishing a more balanced global landscape for children with congenital heart disease.
RESUMEN
BACKGROUND: The purpose of this study was to evaluate the roles of cervical spine radiographs (CSR) and computed tomography of the cervical spine (CTC) in the exclusion of cervical spine injury for adult blunt trauma patients. METHODS: At the authors' institution, all adult blunt trauma patients with physical findings of posterior midline neck tenderness, altered mental status, or neurologic deficit are considered at risk of cervical spine injury and undergo both CSR and CTC for evaluation of the cervical spine. The TRACS database at level 1 of the trauma center at this institution was queried for all blunt trauma patients from November 2000 to October 2001. Patient injury severity score (ISS), Glascow Coma Score (GCS), age, gender, CSR results, CTC results, and treatment data were analyzed. RESULTS: The review included 3,018 blunt trauma patients with appropriate data. For 1,199 of these patients (779 men and 420 women) (40%) at risk for cervical spine injury, both CSR and CTC were performed for cervical spine evaluation. The average age of these patients was 39.4 years (range, 18-89 years). The average GCS was 13 and the average ISS was 8.4 in this study population. In 116 (9.5%) of these patients, a cervical spine injury (fracture or subluxation) was detected. The injury was identified on both CSR and CTC in 75 of these patients. In the remaining 41 patients (3.2%), the CSR results were negative, but injury was detected by CTC. All these injuries missed by CSR required treatment. For this group with false-negative CSR, the average GCS was 12 and the average ISS was 14.6. There were no missed cervical spine injuries among the patients with negative CTC results. CONCLUSION: No identifiable factors predicted false-negative CSR. There does not appear to be any role for CSR screening in this setting. The data from this study add to the growing body of evidence that CTC should replace CSR for the evaluation of the cervical spine in blunt trauma.