Congenital heart disease
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Congenital heart disease · Jan 2015
High resource use among adult congenital heart surgery admissions in adult hospitals: risk factors and association with death and comorbidities.
Adult hospitals are a common location of adult congenital heart disease (ACHD) admissions, including cardiac surgical admissions. Understanding the patterns and predictors of resource use could aid these institutions by identifying and targeting potentially modifiable determinants of high resource use (HRU). Our objectives were to examine resource use during adult congenital heart surgical admissions in adult hospitals, determine the association of HRU with mortality, and identify risk factors for HRU. ⋯ HRU admissions for adult congenital heart surgery consumed a disproportionate amount of resources and were associated with higher mortality. HRU risk factors included nonelective admissions, government insurance, heart failure, surgical complexity, renal failure, and complications. Complications, if preventable, may be a target for improvement strategies to decrease resource use. Other risk factors may require a broader patient care approach.
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Congenital heart disease · Nov 2014
Review Historical ArticlePublic health research in congenital heart disease.
Public health research is an integral part of the study of congenital heart disease. While this type of research has become more popular, particularly over the past decade, it has a history that stretches back to almost the beginnings of pediatric cardiology as a field. This review aims to introduce the concepts and methodologies of public health and how they relate to congenital heart disease, describe some of the challenges of traditional research methods in congenital heart disease, describe the history of public health research, and demonstrate the relevance of public health research, particularly databases, to pediatric cardiology fellows.
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Congenital heart disease · Nov 2014
Is there a benefit to postoperative fluid restriction following infant surgery?
Fluid restriction is often employed immediately following cardiac surgery in children. The goal of this approach is to achieve an early negative fluid balance, which theoretically should lead to less interstitial edema and earlier extubation. The purpose of this study was to determine whether time to negative fluid balance in infants after undergoing systemic-to-pulmonary artery shunt palliation impacts duration of mechanical ventilation and hospital length of stay. ⋯ Time to negative fluid balance is not associated with duration of mechanical ventilation, CICU, and hospital length of stay in patients after undergoing systemic-to-pulmonary artery shunt palliation. The utility of a restricted fluid strategy immediately following infant heart surgery is questionable.
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Congenital heart disease · Nov 2014
Elevated plasma B-type natriuretic peptide and C-reactive protein levels in children with restrictive right ventricular physiology following tetralogy of Fallot repair.
This study aimed to compare the levels of plasma B-type natriuretic peptide (BNP) and C-reactive protein (CRP) in relation to oxygen transport between patients with restrictive right ventricle (rRV) and those without (non-rRV) early after tetralogy of Fallot (TOF) repair. ⋯ rRV physiology is associated with significantly higher BNP and CRP levels with poorer balance of systemic oxygen transport. Information about these pathophysiological changes may help to identify appropriate treatment strategies in this difficult group of patients.
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Congenital heart disease · Sep 2014
Transient elastography may identify Fontan patients with unfavorable hemodynamics and advanced hepatic fibrosis.
Transient elastography (TE) offers a noninvasive correlate with the degree of hepatic fibrosis. However, factors other than fibrosis affect liver stiffness. We sought to determine whether hepatic congestion related to hemodynamics in Fontan circulation influences liver stiffness measurement (LSM) assessed by TE. ⋯ Higher LSM is associated with unfavorable Fontan hemodynamics and advanced centrilobular hepatic fibrosis. TE may be a useful tool for identifying Fontan patients who warrant invasive testing.