Congenital heart disease
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Congenital heart disease · Sep 2011
Randomized Controlled TrialClinical efficacy of phosphodiesterase-5 inhibitor tadalafil in Eisenmenger syndrome--a randomized, placebo-controlled, double-blind crossover study.
In a randomized double-blind crossover trial, we compared the efficacy of phosphodiesterase-5 (PDE-5) inhibitor tadalafil with placebo in patients of Eisenmenger Syndrome (ES). The primary end point was the change in 6-minute walk test distance (6 MWD). Secondary end points were the effect of the drug on systemic oxygen saturation (SO(2) ), pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), effective pulmonary blood flow (EPBF), and World Health Organization (WHO) functional class. ⋯ In this first short-term placebo-controlled trial of tadalafil in patients of ES, the drug was well tolerated and significantly improved exercise capacity, functional class, SO(2) , and pulmonary hemodynamics.
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Congenital heart disease · Sep 2011
Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection with end-to-end anastomosis.
Atherosclerotic plaque in the descending thoracic aorta (dAo) is related to altered wall shear stress (WSS) for normal patients. Resection with end-to-end anastomosis (RWEA) is the gold standard for coarctation of the aorta (CoA) repair, but may lead to altered WSS indices that contribute to morbidity. ⋯ Localized differences in WSS indices within the dAo of CoA patients treated by RWEA suggest that plaque may form in unique locations influenced by the surgical repair. These regions can be visualized in familiar and intuitive ways allowing clinicians to track their contribution to morbidity in longitudinal studies.
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Congenital heart disease · Sep 2011
Pericardiocentesis of noncircumferential effusions using nonstandard catheter entry sites guided by echocardiography and fluoroscopy.
Classically pericardiocentesis has been described and performed through the subxiphiod approach, which is feasible if the pericardial fluid is circumferential or collected inferior or anterior to the heart. However, not uncommonly, the collection of fluid is at the base of the heart or in the posterior or apical portion of the pericardium, necessitating a different approach. The purpose of this study is to describe echo and fluoroscopic guided pericardiocentesis to evacuate noncircumferential effusions, which are not accessible from the standard subcostal approach. ⋯ Echocardiographic and fluoroscopic guided pericardiocentesis is a feasible, relatively safe, and reliable technique to drain loculated pericardial effusions using nonstandard entry sites.
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Congenital heart disease · Sep 2011
Implementation of a routine developmental follow-up program for children with congenital heart disease: early results.
To describe the implementation of a routine developmental follow-up program for children with congenital heart disease, summarize the developmental outcomes of the first clinic visits of the referred patients, and determine what factors predict variability in early developmental outcomes. ⋯ Implementation of a routine developmental follow-up program for congenital heart disease patients is possible and useful in identifying those patients who would benefit most from early intervention.
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Congenital heart disease · Sep 2011
Case ReportsKounis syndrome or allergic coronary vasospasm in a two-year-old.
Kounis syndrome is coronary vasospasm because of mast cell degranulation in the context of an allergic reaction. The syndrome has known associations with several drugs used during anesthesia, including rocuronium and isoflurane. In this case report, we discuss a 2-year-old patient who developed signs and symptoms of an acute coronary syndrome soon after anesthesia for atrial septal defect repair. ⋯ Subsequent angiography after clinical improvement showed essentially normal coronary anatomy. We report the clinical course of this patient and postulate that Kounis syndrome was the explanation for his transient coronary vasospasm. To date, this is the youngest known patient with reported Kounis syndrome.