World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Jan 2014
Comparative Study Observational StudyPerioperative levels of tumor necrosis factor-α correlate with outcomes in children and adults with tetralogy of Fallot undergoing corrective surgery.
Previous studies reporting on tumor necrosis factor-α (TNF-α) as a marker of inflammatory response (IR) in patients with congenital heart disease were limited by small sample size and variability in diagnosis. We report perioperative changes in TNF-α levels and their correlation with preoperative factors and clinical outcomes in a large homogenous group of patients with tetralogy of Fallot (TOF) undergoing definitive repair at a tertiary care center. ⋯ We demonstrated a rise in serum TNF-α levels in patients with TOF undergoing definitive repair on CPB, which correlated with preoperative severity of cyanosis, nutritional status, and adverse clinical outcomes. The TNF-α levels may be monitored to identify cyanotic patients at an increased risk of exhibiting augmented IR to CPB.
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World J Pediatr Congenit Heart Surg · Jan 2014
Multicenter StudyRelationship between risk-adjustment tools and the pediatric logistic organ dysfunction score.
The Risk-Adjusted Classification for Congenital Heart Surgery (RACHS-1) method and Aristotle Basic Complexity (ABC) scores correlate with mortality. However, low mortality rates in congenital heart disease (CHD) make use of mortality as the primary outcome measure insufficient. Demonstrating correlation between risk-adjustment tools and the Pediatric Logistic Organ Dysfunction (PELOD) score might allow for risk-adjusted comparison of an outcome measure other than mortality. ⋯ Risk-Adjusted Classification for Congenital Heart Surgery categories and ABC levels correlate with postoperative organ dysfunction as measured by PELOD. However, the correlation was weak, potentially due to limitations of the PELOD score itself. Identification of a more accurate metric of morbidity for the congenital heart disease population is needed.
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World J Pediatr Congenit Heart Surg · Jan 2014
Comparative StudyA complete extracorporeal circulation-free approach to patients with functionally univentricular hearts provides superior early outcomes.
We compared the early outcomes of patients undergoing extracardiac total cavopulmonary connection (TCPC) with or without cardiopulmonary bypass (CPB). ⋯ The TCPC without CPB is easy to perform, is cost-effective, and is associated with superior early postoperative outcomes as compared to TCPC on CPB. With appropriate modifications, this operation can be performed in almost all morphological subsets of patients who do not need an associated intracardiac procedure.
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World J Pediatr Congenit Heart Surg · Jan 2014
Case ReportsResuscitation of a neonate with medium chain acyl-coenzyme a dehydrogenase deficiency using extracorporeal life support.
We report a neonate with medium chain acyl-coenzyme A dehydrogenase deficiency (MCAD) who had a cardiac arrest due to ventricular tachycardia and fibrillation. Extracorporeal life support (ECLS) was deployed, from which the baby was subsequently separated and discharged from hospital. This case was a rare neonatal presentation of MCAD and an uncommon indication for ECLS. We discuss the presentations of patients with MCAD and the use of ECLS for patients with possible inborn errors of metabolism and other unknown primary diagnoses.
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World J Pediatr Congenit Heart Surg · Jan 2014
Case ReportsVideo fluoroscopy swallow study and nutritional support during ambulatory venovenous extracorporeal membrane oxygenation as a bridge to lung transplantation.
We present the successful completion of a video fluoroscopy swallow study and subsequent nutritional plan of a child bridged to lung transplantation with ambulatory venovenous (VV) extracorporeal membrane oxygenation (ECMO). With a limited number of programs bridging pediatric patients to lung transplantation with VV ECMO, a better understanding of nutritional support is needed to provide optimal care to this patient population awaiting organ donation.