World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Oct 2015
Unplanned Readmission to the Pediatric Cardiac Intensive Care Unit: Prevalence, Outcomes, and Risk Factors.
Factors leading to cardiac intensive care unit (CICU) readmission and the impact on mortality have yet to be well delineated. We sought to define the prevalence and outcome for unscheduled CICU readmission. Secondary objectives were to identify indications and risk factors for unscheduled CICU readmission. ⋯ Unscheduled readmission to the CICU within the same hospitalization was uncommon but associated with a higher mortality rate. Genetic anomaly and longer initial LOS were important risk factors for the entire cohort. Single-ventricle anatomy and longer intraoperative course were risk factors for surgical readmissions.
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World J Pediatr Congenit Heart Surg · Oct 2015
Are We Overdiagnosing Acute Kidney Injury in Pediatric Patients Following Cardiac Surgery?
The use of two diagnostic criteria in the current literature has led to some degree of ambiguity in the precise diagnosis of acute kidney injury in pediatric patients undergoing surgery for congenital heart disease. This study aims to determine which criteria is the most accurate diagnostic indicator of acute kidney injury and determine whether the incidence is being overestimated based on the current criteria. ⋯ Although recent research in this field identified the pediatric RIFLE criterion as the most sensitive indicator of acute kidney injury, the results of this study suggest the pediatric RIFLE criterion overestimates acute kidney injury incidence and that the Acute Kidney Injury Network criterion is the more accurate diagnostic indicator.
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World J Pediatr Congenit Heart Surg · Jul 2015
Observational StudySetting Up an ECMO Program in a South American Country: Outcomes of the First 104 Pediatric Patients.
Less than 1% of the extracorporeal life support organization (ELSO) registry patients are from South America. Extracorporeal membrane oxygenation (ECMO) is an expensive therapy not only in terms of direct financial cost but also with respect to technical and human resources. Finding a successful ECMO model that developing countries can afford is critical to the expansion of therapy to include the availability of this technology for patients in the developing world. ⋯ Despite limited availability of technical and economic resources, ECMO therapy can be done successfully in a developing country. A model of care based on nurses as ECMO specialists, supported by a multidisciplinary team, is cost-effective.
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World J Pediatr Congenit Heart Surg · Jul 2015
Case ReportsFollow-Up of Persistent Tracheal Stenosis After Surgery for a Double Aortic Arch.
Persistent respiratory symptoms often occur after surgical repair of double aortic arch (DAA). Most often, symptoms are relatively mild and tend to be self-limited and improve with growth. Multidetector computed tomography (MDCT) imaging can be used to obtain needed anatomic information regarding the potential for extrinsic airway compression and is minimally invasive, safe, and readily available after surgery. ⋯ One of the patients eventually required aortopexy in order to achieve complete relief from recurrent symptoms of airway compression. In the other case, wheezing persisted following surgical division of the vascular ring, but it resolved over time without further intervention. In both cases, serial follow-up imaging with computed tomography scans was informative and helped guide management decisions.
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World J Pediatr Congenit Heart Surg · Jul 2015
Observational StudyAchieving Benchmark Results for Neonatal Palliation of Hypoplastic Left Heart Syndrome and Related Anomalies in an Emerging Program.
Results of surgical management of hypoplastic left heart syndrome (HLHS) and related anomalies are often compared to published benchmark data which reflect the use of a variety of surgical and hybrid protocols. We report encouraging results achieved in an emerging program, despite a learning curve at all care levels. Rather than relying on a single preferred protocol, surgical management was based on matching surgical strategy to individual patient factors. ⋯ Our emerging program achieved outcomes that compare favorably to published benchmark data with respect to hospital survival. These results reflect rigorous interdisciplinary teamwork and a flexible approach to surgical palliation based on matching surgical strategy to patient factors. With major associated cardiac/noncardiac comorbidity and antegrade coronary flow, a true hybrid with ductal stenting was our preferred strategy. For high-risk situations such as aortic atresia with obstructed pulmonary venous return, the salvage hybrid-bridge-to-Norwood strategy may help achieve survival albeit with increased resource utilization.