Cardiac Perioperative Management of Patients with DiGeorge Syndrome Undergoing Surgery

Objective: DiGeorge syndrome is a genetic disorder with multisystem involvement resulting in craniofacial and cardiac anomalies and parathyroid and immune system dysfunction. This study describes perioperative management of a large cohort of patients with DiGeorge syndrome undergoing cardiac surgery. Design: Retrospective cohort study. Setting: Major academic tertiary institution. Participants: The medical records of patients diagnosed with DiGeorge syndrome and undergoing cardiac surgery at this institution, from January 1, 1976, to July 31, 2012, were reviewed for phenotypic characteristics and intraoperative and postoperative complications, with specific attention to hemodynamic instability, perioperative perturbations of plasma calcium homeostasis, and airway difficulty. Interventions: None. Measurements and Main Results: Sixty-two patients underwent 136 cardiac surgical procedures; 47 patients (76%) had multiple operations. Sternotomies for reoperations often were complex (8 complicated by vascular injury or difficulty achieving hemostasis and 5 requiring bypass

[1]  S. Heinrich,et al.  Incidence and predictors of difficult laryngoscopy in 11.219 pediatric anesthesia procedures , 2012, Paediatric anaesthesia.

[2]  Y. Roth,et al.  Head and neck manifestations of 22q11.2 deletion syndromes , 2012, European Archives of Oto-Rhino-Laryngology.

[3]  K. Devriendt,et al.  Practical guidelines for managing patients with 22q11.2 deletion syndrome. , 2011, The Journal of pediatrics.

[4]  P. Cullinan,et al.  Predicting 22q11.2 deletion syndrome: a novel method using the routine full blood count. , 2011, International journal of cardiology.

[5]  K. Sullivan,et al.  Chromosome 22q11.2 Deletion Syndrome (DiGeorge Syndrome/Velocardiofacial Syndrome) , 2011, Medicine.

[6]  K. Coleman,et al.  Do neonates with genetic abnormalities have an increased morbidity and mortality following cardiac surgery? , 2009, Congenital heart disease.

[7]  Barbara A Castro The immunocompromised pediatric patient and surgery. , 2008, Best practice & research. Clinical anaesthesiology.

[8]  E. Goldmuntz DiGeorge syndrome: new insights. , 2005, Clinics in perinatology.

[9]  E. Zackai,et al.  Increased prevalence of unprovoked seizures in patients with a 22q11.2 deletion , 2004, American journal of medical genetics. Part A.

[10]  P. Ljungman Risk of cytomegalovirus transmission by blood products to immunocompromised patients and means for reduction , 2004, British journal of haematology.

[11]  K. Sullivan,et al.  Chromosome 22q11.2 deletion syndrome (DiGeorge and velocardiofacial syndromes) , 2002, Current opinion in pediatrics.

[12]  E. Zackai,et al.  Immunologic features of chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome). , 2001, The Journal of pediatrics.

[13]  B. Cuneo 22q11.2 deletion syndrome: DiGeorge, velocardiofacial, and conotruncal anomaly face syndromes , 2001, Current opinion in pediatrics.

[14]  M. Elder T-cell immunodeficiencies. , 2000, Pediatric clinics of North America.

[15]  M. Markert,et al.  Possible extrathymic development of nonfunctional T cells in a patient with complete DiGeorge syndrome. , 1999, Clinical immunology.

[16]  L. Melton,et al.  Potential effect of authorization bias on medical record research. , 1999, Mayo Clinic proceedings.

[17]  A. Chang,et al.  Pulmonary diseases in children with severe combined immune deficiency and DiGeorge syndrome , 1997, Pediatric pulmonology.

[18]  V. Singh,et al.  Anesthesia for DiGeorge's syndrome. , 1997, Journal of cardiothoracic and vascular anesthesia.

[19]  B. Cuneo,et al.  Latent hypoparathyroidism in children with conotruncal cardiac defects. , 1996, Circulation.

[20]  D. Driscoll,et al.  DNA fluorescent probes for diagnosis of velocardiofacial and related syndromes. , 1995, Mayo Clinic proceedings.

[21]  R. Cormack Difficult tracheal intubation in obstetrics , 1986 .

[22]  L. Marmon,et al.  Congenital cardiac anomalies associated with the DiGeorge syndrome: a neonatal experience. , 1984, The Annals of thoracic surgery.

[23]  M. Flashburg,et al.  Anesthesia for surgery in an infant with DiGeorge syndrome. , 1983, Anesthesiology.

[24]  E. Zackai,et al.  Genetic counseling for the 22q11.2 deletion. , 2008, Developmental disabilities research reviews.

[25]  M. Digilio,et al.  Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome. , 2008, Developmental disabilities research reviews.

[26]  A. Schinzel,et al.  The Fate of Children with Microdeletion 22q11.2 Syndrome and Congenital Heart Defect: Clinical Course and Cardiac Outcome , 2007, Pediatric Cardiology.

[27]  Julio Cesar Sampaio P. Leite,et al.  Cardiac Surgery Unmasks Latent Hypoparathyroidism in a Child with the 22q11.2 Deletion Syndrome , 2006, Journal of pediatric endocrinology & metabolism : JPEM.

[28]  A. Wiktor,et al.  Prenatal diagnosis of 22q11.2 deletion when ultrasound examination reveals a heart defect , 2001, Genetics in Medicine.