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Paul D Losty - One of the best experts on this subject based on the ideXlab platform.

  • outcomes following prosthetic Patch Repair in newborns with congenital diaphragmatic hernia
    British Journal of Surgery, 2013
    Co-Authors: Wajid B Jawaid, E Qasem, Matthew O Jones, N J Shaw, Paul D Losty
    Abstract:

    Background The anatomical defect in congenital diaphragmatic hernia (CDH) can usually be closed primarily but prosthetic Patch Repair may be required in newborns with a deficient diaphragm. High rates of Patch failure and hernia recurrence (up to 50 per cent) have been reported. This study evaluated contemporary outcomes following Patch Repair of CDH at a UK paediatric surgical centre. Methods Medical records of newborns undergoing surgery for CDH between 1 February 1990 and 1 November 2010, and attending a multidisciplinary follow-up clinic, were examined. Operative details and Patch utilization are reported. Results Of 118 newborns with CDH, 37 required a Patch to the diaphragmatic defect. Gore-Tex® Patches were used in 35 and biological Surgisis® Patches in two. Eight babies additionally required an abdominal wall Patch. Seven infants had an abdominal Patch alone with primary diaphragm Repair. A total of 102 infants (86·4 per cent) survived after surgery. Two early recurrences were both related to the use of biological Patches, leading to revisional surgery with Gore-Tex® Patch reconstruction. Diaphragmatic Patch use was associated with a greater requirement for intensive cardiovascular and respiratory support, although there was no significant difference in mortality between Patch versus primary diaphragm Repair. The mortality rate was significantly higher among infants requiring abdominal wall Patching (with or without a diaphragmatic Patch): 40 per cent (6 of 15) versus 9·7 per cent (10 of 103) (P = 0·006). Postoperative survival rates for infants with a diaphragmatic Patch alone, abdominal wall Patch alone, and both abdominal and diaphragmatic Patches were 86 per cent (25 of 29), 57 per cent (4 of 7) and 63 per cent (5 of 8) respectively. Conclusion Prosthetic diaphragmatic hernia Repair at this centre has a good outcome and low rate of recurrence (5 per cent). The recognition of an inadequate abdominal domain prenatally may additionally prove to be a useful marker for predicting increased mortality in newborns with CDH.

Mahdi Ait Houssa - One of the best experts on this subject based on the ideXlab platform.

Glen S Van Arsdell - One of the best experts on this subject based on the ideXlab platform.

  • outcomes of prenatally diagnosed tetralogy of fallot implications for valve sparing Repair versus transannular Patch
    Canadian Journal of Cardiology, 2010
    Co-Authors: Alim Hirji, Alessandra Bernasconi, Brian W Mccrindle, Elizabeth Dunn, Rebecca Gurofsky, Cedric Manlhiot, Steven E S Miner, John Kingdom, Edgar Jaeggi, Glen S Van Arsdell
    Abstract:

    Objectives To assess outcomes of prenatally diagnosed tetralogy of Fallot and determine factors associated with the choice to undergo a valvesparing Repair versus transannular Patch, and the use of prostaglandins at birth. Methods All cases at The Hospital for Sick Children (Toronto, Ontario) with a fetal diagnosis of tetralogy of Fallot from 1998 to 2006, were reviewed for demographic and fetal echocardiographic data to determine factors associated with the valve-sparing Repair and need for perinatal support. Results Sixty-four fetuses met inclusion criteria (median gestational age 22 weeks) with 47 live births. Twenty-six underwent valve-sparing Repair (median age 5.7 months) and 14 underwent transannular Patch Repair (median age 4.5 months). There were seven deaths before surgery and one post-transannular Patch Repair. One patient required a transannular Patch Repair after the initial valve-sparing Repair. Twelve of 29 (41%) patients received prostaglandins at birth. Type of surgical Repair, use of prostaglandins and postnatal death were among the outcomes investigated. The mean pulmonary valve (PV) z-score was −3.0±2.0 and the mean PV/aortic valve (AoV) ratio was 0.65±0.10. Lower PV z-score (P=0.04), smaller PV/AoV ratio (P=0.04) and the presence of nonantegrade arterial duct flow (P=0.02) were associated with prostaglandin use. A higher PV/AoV ratio was associated with valvesparing Repair (P=0.04). Fetal z-scores of the PV, AoV and right pulmonary artery at 29 to 32 weeks gestational age correlated with respective postnatal z-scores (P=0.01). Conclusion Fetal echocardiographic variables were associated with the use of prostaglandins and valve-sparing Repair in fetuses with tetralogy of Fallot, and at 29 weeks, correlated with postnatal valve diameters.

D. Wyrzykowska - One of the best experts on this subject based on the ideXlab platform.

Wajid B Jawaid - One of the best experts on this subject based on the ideXlab platform.

  • outcomes following prosthetic Patch Repair in newborns with congenital diaphragmatic hernia
    British Journal of Surgery, 2013
    Co-Authors: Wajid B Jawaid, E Qasem, Matthew O Jones, N J Shaw, Paul D Losty
    Abstract:

    Background The anatomical defect in congenital diaphragmatic hernia (CDH) can usually be closed primarily but prosthetic Patch Repair may be required in newborns with a deficient diaphragm. High rates of Patch failure and hernia recurrence (up to 50 per cent) have been reported. This study evaluated contemporary outcomes following Patch Repair of CDH at a UK paediatric surgical centre. Methods Medical records of newborns undergoing surgery for CDH between 1 February 1990 and 1 November 2010, and attending a multidisciplinary follow-up clinic, were examined. Operative details and Patch utilization are reported. Results Of 118 newborns with CDH, 37 required a Patch to the diaphragmatic defect. Gore-Tex® Patches were used in 35 and biological Surgisis® Patches in two. Eight babies additionally required an abdominal wall Patch. Seven infants had an abdominal Patch alone with primary diaphragm Repair. A total of 102 infants (86·4 per cent) survived after surgery. Two early recurrences were both related to the use of biological Patches, leading to revisional surgery with Gore-Tex® Patch reconstruction. Diaphragmatic Patch use was associated with a greater requirement for intensive cardiovascular and respiratory support, although there was no significant difference in mortality between Patch versus primary diaphragm Repair. The mortality rate was significantly higher among infants requiring abdominal wall Patching (with or without a diaphragmatic Patch): 40 per cent (6 of 15) versus 9·7 per cent (10 of 103) (P = 0·006). Postoperative survival rates for infants with a diaphragmatic Patch alone, abdominal wall Patch alone, and both abdominal and diaphragmatic Patches were 86 per cent (25 of 29), 57 per cent (4 of 7) and 63 per cent (5 of 8) respectively. Conclusion Prosthetic diaphragmatic hernia Repair at this centre has a good outcome and low rate of recurrence (5 per cent). The recognition of an inadequate abdominal domain prenatally may additionally prove to be a useful marker for predicting increased mortality in newborns with CDH.