Congenital heart disease
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Congenital heart disease · Nov 2013
ReviewHemodynamic monitoring in the cardiac intensive care unit.
Hemodynamic monitoring is central to the management of critically ill patients in the cardiac intensive care unit (CICU). The goals of hemodynamic monitoring are to anticipate threats and complications before they arise, to gauge the effectiveness of interventions, and to avoid progression to a decompensated shock state. Although there are numerous modalities of hemodynamic monitoring in the CICU, discordance exists between assessments based on physical exam and standard hemodynamic parameters and those based on measurements of cardiac output. This article will review both the standard and advanced hemodynamic monitoring strategies employed in the CICU.
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Congenital heart disease · Nov 2013
Comparative StudyPrecordial R wave height does not correlate with echocardiographic findings in boys with Duchenne muscular dystrophy.
Cardiomyopathy (CM) is an inevitable consequence of Duchenne muscular dystrophy, and electrocardiographic changes, right ventricular hypertrophy in particular, have been proposed to serve as an early marker for CM. To evaluate this concept, we assessed the correlation between R wave height in lead V1 and echocardiographic findings in boys with Duchenne muscular dystrophy. ⋯ The precordial R wave height in V1 correlates poorly with the presence of depressed left ventricular function and is not prognostic for the development of CM. While not predictive for CM, the electrocardiogram remains vital to cardiac screening for boys with Duchenne muscular dystrophy due to risk for other cardiac manifestations such as arrhythmias.
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Congenital heart disease · Nov 2013
Case ReportsLong-term complications following surgical patch closure of multiple muscular ventricular septal defects.
Multiple muscular ventricular septal defects (VSDs) in children can be difficult to treat and a range of techniques has been advocated. These include pulmonary artery banding, interventional catheter closure, and a variety of surgical approaches. When there are apical muscular defects and associated coarse trabeculations in the right ventricle (RV) producing a "Swiss cheese" pattern, a large patch extending on to the RV free wall and excluding part of the apex has been used. ⋯ Surgical closure of muscular VSD by large patch with RV apical exclusion gives good early results. However, long term in adult life, the reduced size of RV, and diastolic dysfunction cause problems. These include reopening of PFO with cyanosis, right heart failure, cirrhosis, and arrhythmias.
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Congenital heart disease · Nov 2013
Outcomes of heart failure-related hospitalization in adults with congenital heart disease in the United States.
Heart failure (HF) accounts for >3 million hospital admissions annually in adults with acquired cardiovascular disease, but there are limited data on HF admissions in adults with congenital heart disease (ACHD). The purpose of this study was to test the hypotheses that HF admissions are common in ACHD and associated with significant morbidity and mortality. ⋯ In this large population-based study, HF-related hospitalizations were common in ACHD and associated with an increased risk of death compared to non-HF admissions. The risk of mortality is increased with the diagnoses of VSDs and the presence of specific comorbidities such as respiratory failure and sepsis.
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Congenital heart disease · Nov 2013
Case ReportsA case of life-threatening Staphylococcus aureus endocarditis involving percutaneous transcatheter prosthetic pulmonary valve.
While right ventricle to pulmonary artery homograft is the surgical procedure of choice for relieving right ventricle outflow tract obstruction; it is limited by the need for multiple surgical replacements owing to progressive conduit obstruction, valve dysfunction, or patient growth. Since January 2010, percutaneous transcatheter placement of prosthetic pulmonary valve (Melody valve) has emerged as an attractive alternative to surgical replacement of dysfunctional right ventricle to pulmonary artery homograft in the United States. ⋯ The infection caused multi-organ dysfunction despite bacteriological clearance and led to severe dysfunction of the valve which ultimately required surgical removal. The case highlights a rare but serious complication of percutaneous prosthetic pulmonary valves.