I n t r o d u c t i o n: Hypoplastic left heart syndrome (HLHS) is a congenital heart anomaly that is diagnosed prenatally or postnatally. The prenatal diagnosis leads to limiting the rate of systemic complications in the preoperative period due to optimization of the early therapeutic management. O b j e c t i v e: The objective of the study is to determine the effect of prenatal diagnostic management of HLHS on the condition of newborns and the frequency of antibiotherapy employment prior to the first stage of surgical treatment. Me t h o d o l o g y: The study included 95 children with HLHS operated on in the years 2014–2016. The cohort was divided into two groups: newborns with a prenatally diagnosed heart defect (50 children — 52.6%) and neonates with the defect diagnosed after birth (45 children — 47.4%). The data of the patients were analyzed based on their medical records. R e s u l t s: The mean age of the children upon admission was 3.86 days in the group of patients with the prenatally diagnosed heart defect (PreHLHS) and 7.41 days in the group of newborns without the prenatal diagnosis (PostHLHS) (p = 0.001). In 60% of the PreHLHS group patients (30/50), at least one antibiotic was administered, while in the PostHLHS group, antibiotherapy was employed in 93.3% (42/45) cases (p = 0.001). Bacteriological tests demonstrated pathogen growth in 33 children (36% and 33.3%, respectively), what accounted for 34.7% of the entire cohort. On the average, the first antibiotic was introduced on the 6.55th day of life in the PreHLHS group and on the 2.73th day in the PostHLHS group (p = 0.005). Th e most profound differences in antibiotic employment involved aminoglycosides. The aforementioned type of antibiotic medications was administered to 6% of the children with the prenatal diagnosis and to 17.8% of the children diagnosed postnatally (p = 0.042). C o n c l u s i o n s: Preoperative antibiotherapy in children with HLHS was employed more frequently than it would be indicated by microbiology tests results. Antibiotics were observed to be introduced more commonly and earlier in the newborns with the postnatally diagnosed congenital heart defect.
Background: Recoarctation (reCoA) of the aorta is a common complication after the Norwood procedure. Untreated, it can lead to failure of the systemic ventricle and death. The main goal of the study is to defi ne risk factors of reCoA after the Norwood procedure in hypoplastic left heart syndrome (HLHS). Methods: We retrospectively analyzed the pre-, intra- and postoperative data of 96 successive patients who underwent the Norwood procedure between 2007 and 2011. In case of reCoA balloon angioplasty was performed. We analyzed and compared the data of the patients with reCoA and without reCoA using the StatSoft STATISTICA™ 10 soft ware. Results: ReCoA was noted in 23 patients (33.3%). Th is complication was diagnosed 95.1 days (49–156 days) on the average aft er the Norwood procedure. Balloon angioplasty successfully allowed for decreasing the mean gradient across the site of the narrowing from the average 27.5 mmHg to the average 9.7 mmHg (p = 0.008) and enlarged the neo-isthmus by the average of 2 mm (p <0.05). Th e risks factors seemed to be the diameter of the ascending aorta OR = 7.82 (p = 0.001), atresia of the mitral valve OR = 7.00 (p = 0.003) and atresia of the aortic valve — OR = 6.22 (p = 0.002). Conclusion: Balloon angioplasty seems to be an eff ective intervention in case of reCoA. A low diameter of the native ascending aorta (≤3mm) and the presence of atresia of the mitral and/or aortic valve should intensify the vigilance of a cardiologist in the search for signs of reCoA of the aorta.
T h e a i m: The aim of the study is to present the initial experience with continuous flow left ventricle assist device (CF-LVAD) in pediatric patients with BSA below 1.5 m2. M a t e ri a l a n d M e t h o d s: Between 2016 and 2017, CF-LVAD (the Heartware System) have been implanted in three pediatric patients in the Department of Pediatric Cardiac Surgery, Jagiellonian University, Krakow, Poland. The indications for initiating CF-LVAD were end-stage congestive heart failure due to dilated cardiomyopathy in all children. R e s u l t s: Implanted patients have had BSA of 1.09, 1.42, 1.2 m2, and 37, 34, 34 kg of body weight and the age 12, 11, 12 years, respectively. The time of support was 550 days in two patients and 127 in another one, and is ongoing. The main complication has been driveline infection. C o n c l u s i o n: The outcomes from our single-center experience using the HeartWare CF-LVAD have been excellent with a low incidence of complication and no necessity to reoperation in our patients. Children could be successfully and safely discharged home.
Telemedicine is one of the most innovative and promising applications of technology in contemporary medicine. Telemedical systems, a sort of distributed measurement systems, are used for continuous or periodic monitoring of human vital signals in the environment of living. This approach has several advantages in comparison to traditional medical care: e.g. patients experience fewer hospitalizations, emergency room visits, lost time from work, the costs of treatment are reduced, and the quality of life is improved. Currently, chronic respiratory diseases comprise one of the most serious public health problems. Simultaneously patients suffering from these diseases are well suitable for home monitoring. This paper describes the design and technical realization of a telemedical system that has been developed as a platform suitable for monitoring patients with chronic pulmonary diseases and fitted to Polish conditions. The paper focuses on the system's architecture, included medical tests, adopted hardware and software, and preliminary internal evaluation. The performed tests demonstrated good overall performance of the system. At present further work goes on to put it into practice.