World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Jul 2012
Plastic bronchitis in patients with fontan physiology: review of the literature and preliminary experience with fontan conversion and cardiac transplantation.
Plastic bronchitis is a rare, life-threatening condition characterized by the formation of mucofibrinous casts within the pulmonary bronchi. In patients with congenital heart disease, it is most frequently observed in single ventricular anatomies after Fontan palliation. The pathophysiology of plastic bronchitis remains unknown, and a consistently effective treatment strategy has yet to be identified. ⋯ The second underwent cardiac transplantation and has been free of bronchial casts for over one year. In addition, we explore the similarities between plastic bronchitis and protein-losing enteropathy, considering theories of their pathophysiologic mechanisms and reports of mutually effective treatment strategies. We propose that bronchial cast formation may result from the confluence of genetic makeup, inflammation, and the Fontan physiology and conclude that further investigation into therapies directed at these factors is merited.
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World J Pediatr Congenit Heart Surg · Jul 2012
Controlling oxygenation during initiation of cardiopulmonary bypass: can it improve immediate postoperative outcomes in cyanotic children undergoing cardiac surgery? A prospective randomized study.
Cardiopulmonary bypass (CPB) initiated with high oxygen levels may expose cyanotic children to reoxygenation injury. The ideal method of initiation of bypass to prevent this phenomenon still remains largely unproven. This study tested the hypothesis that controlling oxygenation during initiation of CPB improves early postoperative outcomes. ⋯ A controlled oxygenation protocol was associated with significantly lower postoperative CPK-MB levels. Evaluation of other end points including ventilation times requires a study with larger sample size for validation.