Congenital heart disease
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Congenital heart disease · Jul 2013
Echocardiographic predictors of left ventricular dysfunction after aortic valve surgery in children with chronic aortic regurgitation.
Postoperative left ventricular dysfunction is associated with poor prognosis in adults with severe chronic aortic regurgitation and published practice guidelines aim to minimize this risk. However, only limited information exists in pediatrics. The goal of this study was to define preoperative risk factors for postoperative left ventricular dysfunction in children with chronic aortic regurgitation. ⋯ Lower indices of left ventricular systolic function and severity of dilation identify children at risk for postoperative left ventricular dysfunction after aortic valve surgery. These identifiers are similar to predictors defined in adult patients albeit with different threshold values.
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Congenital heart disease · Jul 2013
Resting energy expenditure at 3 months of age following neonatal surgery for congenital heart disease.
Infants with Congenital Heart Disease (CHD) often exhibit growth failure. This can affect anthropometric and neurodevelopmental outcomes well into childhood. To determine the resting energy expenditure (REE), body composition, and growth in infants with CHD at 3 months of age, with the secondary aim to identify predictors of REE as compared with healthy infants. ⋯ At 3 months of age, there was no difference in REE between postsurgical infants with CHD and healthy infants. Infants with CHD had lower growth z-scores and %FAT. These data demonstrate decreased %FAT contributed to growth failure in the infants with CHD.
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Congenital heart disease · Jul 2013
Facilitators of and barriers to advance care planning in adult congenital heart disease.
Most adults with congenital heart disease (CHD) are interested in discussing matters related to advance care planning (ACP) early in the disease course, yet few such conversations actually occur. We aimed to evaluate factors that impact these discussions between patients and adult CHD providers. ⋯ Despite the fact that challenges to prognostication exist, discussions about ACP should not be reserved for patients with a severely reduced life expectancy. Most patients want these discussions regardless of the complexity of their disease. The trusting and close patient-doctor relationship in adult CHD, often evolving over many years, may provide an excellent platform from which to initiate such discussions.
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Congenital heart disease · May 2013
Transesophageal echocardiography probe insertion failure in infants undergoing cardiac surgery.
The use of intraoperative transesophageal echocardiography (iTEE) in neonates ≤4 kg has not been systematically described. We sought to describe the use of and determine risk factors for iTEE probe insertion failure in small infants. We also sought to develop an algorithm for predicting the likelihood of iTEE probe insertion failure. ⋯ iTEE can be successfully performed in the majority of neonates ≤4 kg undergoing cardiac surgery. However, there are identifiable risk factors for iTEE probe insertion failure. A weight-based algorithm may help determine neonates at risk for iTEE probe insertion failure. Smaller TEE probes may benefit this patient population.
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Congenital heart disease · May 2013
Restrictive lung disease is an independent predictor of exercise intolerance in the adult with congenital heart disease.
Following repair of congenital heart disease (CHD), adult patients are at risk for reduced exercise capacity. Restrictive lung disease (RLD) may contribute to reduced exercise capacity in this population. The aim of this study was to determine the prevalence of RLD and its impact on exercise tolerance in the adult with CHD. ⋯ Abnormal spirometry suggestive of RLD is common in the adult with CHD and is a significant risk factor for decreased exercise tolerance in this population. Further studies are needed to evaluate the relationship between RLD and exercise intolerance and its relationship to mortality in the adult with CHD.