Congenital heart disease
-
Congenital heart disease · Sep 2014
Value of speckle-tracking echocardiography and MRI-based feature tracking analysis in adult patients after Fontan-type palliation.
Patients are commonly affected by ventricular dysfunction and heart failure after Fontan palliation. Reliable quantification of ventricular function is of interest but hampered by complex ventricular anatomy and physiology. ⋯ Assessment of myocardial function using CMR cine-based feature tracking is feasible in Fontan patients. Unlike echocardiographic techniques, FT is independent of inadequate acoustic windows and FT measurements relate to clinical parameters, suggesting that this approach could have clinical relevance in future.
-
Congenital heart disease · Sep 2014
Comparative StudyImpact of change in delivery practice on neonatal and maternal outcomes in cases of significant congenital heart disease.
Because of data published in 2009 demonstrating improved outcomes among early- vs. late-term infants,practice shifted toward delivering infants at later gestational ages. We examined the effects of this change on neonates with congenital heart disease. ⋯ There were 878 infants with congenital heart disease born in 2004-2008 and 124 in 2010. The mean gestational age was higher in 2010 than in 2004-2008 (38.4 ± 1.9 vs. 37.8 ± 2.3 weeks, P = .001), and there were fewer preterm births in 2010 compared with 2004-2008 (P = .003, odds ratio [OR] = 0.4). Mean birth weight was also higher in 2010 (3134 ± 675 vs. 2975 ± 599 g, P = .008). In 2010, less than half as many infants were born via scheduled induction (P < .001, OR = 0.2) or scheduled cesarean delivery (P = .002, OR = 0.4) as in 2004-2008. However, in 2010, there were more urgent inductions (P = .002, OR = 3.1), cesarean deliveries after labor (P = .01, OR = 2.2),and unplanned cesarean deliveries in general (P = .02, OR = 1.7) compared with 2004-2008. In 2010, neonates were less likely to require preoperative vasopressors (P = .002), but there were no differences in 5 minutes APGAR,antibiotic administration, preoperative intubation, median length of stay, or mortality compared with 2004-2008.Conclusions. Despite increased gestational age and birth weight following the shift in delivery practice, there was no difference in length of stay, neonatal morbidity, or mortality in infants with congenital heart disease. The resultant increase in urgent cesarean delivery and urgent inductions may confer additional maternal morbidity.
-
Congenital heart disease · Sep 2014
Impact of fetal development on neurocognitive performance of adolescents with cyanotic and acyanotic congenital heart disease.
Our aims were to evaluate the neurocognitive performance in adolescents with congenital heart disease (CHD) and to determine whether parameters of fetal development evaluated in neonates, such as head circumference, length, weight, and Apgar scores, are somehow related to their neurocognitive performance. ⋯ Adolescents with CHD have worse neuropsychological performance than the control group, mainly the cyanotic patients. Fetal circulation seems to have impact on cerebral and somatic growth, predicting cognitive impairment in adolescents with CHD.
-
Congenital heart disease · Sep 2014
Repair of tetralogy of Fallot in or beyond the fourth decade of life.
Patients with tetralogy of Fallot (TOF) undergoing surgery in adulthood represent a challenge. We report our experience with such patients in or beyond the fourth decade of life. ⋯ Repair of TOF in and beyond the fourth decade of life is feasible with acceptable results. Patients with high hematocrit, lower oxygen saturation, right ventricular dysfunction, aortopulmonary collaterals, and high preoperative right ventricular outflow tract gradients have a prolonged postoperative course.
-
Congenital heart disease · Jul 2014
Comparative StudyValidation of cardiac output using real-time measurement of oxygen consumption during cardiac catheterization in children under 3 years of age.
To validate a method for determination of cardiac index (CI) using real-time measurement of oxygen consumption (VO2 ) in young children undergoing cardiac catheterization. ⋯ In children <3 years with a structurally normal heart, RT-VO2 generates highly accurate determinations of Fick CI as compared with TDCI. Additionally, in this population, VO2 derived from the LaFarge and Lundell equations generates accurate Fick CI compared with TDCI. Future studies are needed to identify factors associated with inaccurate VO2 generated from these predictive equations.