Objectives: We aimed to validate the vasoactive-ventilation-renal (VVR) score and to compare it with other indices as a predictor of outcome in neonates recovering from surgery for critical congenital heart disease. We also sought to determine the optimal time at which the VVR score should be measured. Methods: We retrospectively reviewed neonates recovering from cardiac surgery between July 2017 and June 2020. The VVR score was calculated at admission, 24, 48, and 72 hours postoperatively. Max values, defined as the highest of the four scores, were also recorded. The main end result of interest was a composite outcome which included prolonged intensive care unit stay and mortality. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling was also performed. Results: We reviewed 73 neonates and 21 of them showed composite outcomes. The area under the curve value for VVR score as a predictor of composite outcome was greatest at postoperative 72-hour max (AUC= 0.967; 95% confidence interval, (0.927-1). On multivariable regression analysis, the VVR max 72 hours remained a strong independent predictor of prolonged ICU stay and mortality (odds ratio, 1.452; 95% confidence interval, 1.036-2.035). Conclusions: We validated the utility of the VVR score in neonatal cardiac surgery for critical congenital heart disease. The VVR follow-up in postoperative 72 hours is superior to other indices and especially the maximum VVR value is a potentially powerful clinical tool to predict ICU stay and mortality.

Objective: The aim of our study is to determine the relationship between exposure to hemodynamically significant patent ductus arteriosus and morbidities in premature babies, the optimal number of pharmacologic treatment cycles, and ideal ductus ligation timing. Materials and Methods: The study was a retrospective single-center study conducted in a 3-year period between July 2017 and June 2020. Premature babies, born ≤30 weeks of gestation and transferred to our unit for bedside ductus ligation, were included in the study. The subjects were divided into 2 groups; Group A consisted of the patients who received ≥3 pharmacologic treatment cycles, and group B consisted of the patients who received ≤2 cycles. The groups were compared according to preoperative and postoperative features. The main outcome of the study was the presence of severe bronchopulmonary dysplasia. The secondary outcomes were specified as the length of stay in the neonatal intensive care unit and the duration of invasive mechanical ventilation (MV). Results: The study group consisted of 24 patients. There were 10 patients in group A and 14 patients in group B. The mean gestational week and the mean birthweight were found to be 26,7 ± 2.2 weeks and 928 ± 190 g, respectively. The incidence of severe bronchopulmonary dysplasia was significantly higher in group A (70% vs. 14.3%; P = .019). Post-ligation invasive MV, duration, and length of stay in the intensive care unit were found to be significantly longer in group A. None of the patients had hemodynamic disturbances or complications during and after the operation. Conclusions: Bedside surgical ductus ligation is a safe procedure. Prolonging pharmacologic treatment in order to avoid surgery increases the risk of severe bronchopulmonary dysplasia and prolongs hospital stay. Cite this article as: Zubarioglu AU, Yildirim O, Zeybek C, et al. The ideal timing of bedside surgical ligation of patent ductus arteriosus in premature babies less than 30 gestational weeks. Turk Arch Pediatr. 2021; 56(4): 300-307.

Background: This study evaluated the diagnostic efficacy of transthoracic echocardiography (TTE) and 128-slice multislice computed tomography (MSCT) angiography in congenital heart disease (CHD). Methods: Between January 2018 and August 2022, 50 patients diagnosed with CHD underwent both TTE and ECG-gated 128-MSCT. The imaging findings were compared with intraoperative observations, categorizing pathologies into cardiac, heart–great vessel, and great vessel malformations. Results: The median age of the patients was 0.45 months, and the median weight was 5 kg. Echocardiography showed a sensitivity of 89.8% and specificity of 99.12%, with an overall accuracy of 98%. MSCT had a sensitivity of 87.9%, specificity of 98.95%, and accuracy of 97.62%. There was no significant difference in diagnostic accuracy between the two modalities (χ² = 31.796, p = 0.215), with substantial agreement (kappa = 0.901). For surgically confirmed cardiac malformations (n = 69), echocardiography had a 100% sensitivity, whereas MSCT had an 88.41% sensitivity (χ² = 20.633, p = 0.039), with high concordance (kappa = 0.931). For heart–great vessel connection anomalies (n = 27), both modalities had an 81.48% sensitivity (χ² = 14.115, p = 0.481), with substantial agreement (kappa = 0.887). For great vessel malformations (n = 61), the echocardiography and MSCT sensitivities were 81.97% and 88.52%, respectively, with no significant difference in performance (χ² = 30.303, p = 0.063), indicating substantial concordance (kappa = 0.863). Conclusions: Both TTE and MSCT are highly accurate for CHD diagnosis, each with unique advantages. Their complementary use, especially where one modality is limited, enables a more comprehensive assessment, supporting clinical decision-making and surgical planning.

Objectives: Low cardiac output syndrome (LCOS) is a critical complication following pediatric cardiac surgery that is characterized by myocardial dysfunction, hemodynamic instability, and insufficient organ perfusion. Levosimendan, an inotropic agent that enhances calcium sensitivity in cardiac muscle and causes vasodilation, has been proposed as a therapeutic option for managing LCOS in children. This study aimed to evaluate the efficacy and safety of levosimendan in the 23 management of LCOS in pediatric patients following cardiac surgery. Methods: This study retrospectively included patients who underwent surgery in our clinic between 2020 and 2023 and received levosimendan due to post-operative LCOS. The patients’ medical records were accessed through the hospital information system and archival review. Results: The median age of the patients was 8 months (interquartile range: 5.0–16.0 months). Post-operative echocardiographic assessments revealed a significant improvement in ejection fraction, with a median increase from 40.0% to 57.5% in survivors (p<0.001). No significant difference in mortality, intensive care unit stay, or hospital stay was observed between survivors and non-survivors, although non-survivors had a higher post-operative heart rate (p=0.025). Levosimendan was well tolerated, with minimal adverse effects, and no arrhythmias were recorded. Hypotension was effectively managed with norepinephrine. Conclusion: Levosimendan appears to be an effective and safe treatment option for managing LCOS in pediatric patients after cardiac surgery. While the drug significantly improved cardiac function, further large-scale studies are necessary to evaluate its long-term efficacy and safety. Individualized dosing and careful monitoring are essential to optimize patient outcomes.