الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
We performed a prospective and retrospective cross sectional study for one hundred patients under 6 years old with congenital heart disease admitted consecutively from July 2019 till July 2020 for surgery in Cardiothoracic Surgery Department, Alexandria Faculty of Medicine in New University Hospital, Alexandria, Egypt. Relevant data including sex, age, body weight, height, cardiac anatomy, the presence of Down syndrome were recorded, in addition to preoperative factors (such as preoperative mechanical circulatory support and preoperative mechanical ventilation to treat cardiorespiratory failure).
Transthoracic echocardiogram was done for all cases preoperatively. Cases were operated according to pathological finding with the use of heart lung machine or not. Intraoperative blood products were received in the operating room when needed.
Postoperatively, The data included blood products received in the ICU, mechanical ventilation duration, length of ICU stay, in-hospital mortality, postoperative cardiac arrest, post-operative complications like infection confirmed by positive wound culture or blood culture findings, delayed sternal closure, need for surgical exploration, need for mechanical circulatory support and mortality.
We recorded 34 (34%) bleeding cases postoperative by following our patient in ICU. Eight cases entered for exploration and 2 cases bleeding was due to surgical causes. The first significant bleeding cause was the use of CPB, about 79.4% from total bleeding as a result of increase in free radical synthesis caused by an exaggerated inflammatory response, edema, cell injury, and the development of a complex coagulopathy.
The second significant was the cyanotic congenital heart disease due to decreased platelet aggregation, prolonged bleeding with normal platelet count, and even mild chronic disseminated intravascular coagulation (DIC).
Postsurgical hemorrhage is associated with an increase in morbidity and mortality, length of ICU, cost and exposure to allogenic blood products.