World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Jan 2015
Case ReportsVascular access for pediatric coronary angiography on extracorporeal membrane oxygenation.
Vascular access for catheterization of a pediatric patient on extracorporeal membrane oxygenation (ECMO) was facilitated by adding an accessory limb to the ECMO circuit. This limb was terminated with a hemostatic valve allowing insertion of a catheter. Changes in support parameters compensated for the change in the effective diameter of the ECMO cannula on insertion of the catheter. This method can overcome difficulties in obtaining vascular access for patients on ECMO.
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World J Pediatr Congenit Heart Surg · Jan 2015
Surgical cardiac denervation therapy for treatment of congenital ion channelopathies in pediatric patients: a contemporary, single institutional experience.
Congenital ion channel disorders, including congenital long QT syndrome (LQTS), cause significant morbidity in pediatric patients. When medication therapy does not control symptoms or arrhythmias, more invasive treatment strategies may be necessary. This study examines our institution's clinical experience with surgical cardiac denervation therapy for management of these arrhythmogenic disorders in children. ⋯ Surgical cardiac denervation therapy via VATS is a useful treatment strategy for congenital LQTS patients who fail medical management, and its potential benefit in the management of CPVT is unclear. A prospective comparison of the efficacy of surgical cardiac denervation therapy and implantable cardioverter-defibrillator use in congenital ion channelopathies is timely and crucial.
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World J Pediatr Congenit Heart Surg · Jan 2015
Current outcomes of the Norwood operation in patients with single-ventricle malformations other than hypoplastic left heart syndrome.
Subsequent to increased experience with the Norwood operation in children with hypoplastic left heart syndrome (HLHS), its application has expanded to allow palliation of single-ventricle (SV) malformations other than HLHS. We describe current palliation outcomes in this group of SV patients. ⋯ Operative death and interstage mortality continue to be problematic following Norwood palliation for non-HLHS SV variants. Outcomes seem comparable to those reported for HLHS, however they are influenced by underlying pathology; children with dominant left ventricle morphology (tricuspid atresia and double inlet left ventricle) have superior survival compared to those with dominant right ventricle morphology (mitral atresia, unbalanced atrioventricular septal defect, and most patients with atrial isomerism). Unplanned reoperations for technical imperfections diminish survival. Large multicenter studies might be warranted to better identify high-risk patients and provide guidance toward improving their survival.
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World J Pediatr Congenit Heart Surg · Jan 2015
Disease-specific outcome analysis of palliation with the modified Blalock-Taussig shunt.
Albeit being a simple surgical procedure, adverse outcomes with the modified Blalock-Taussig shunt (MBTS) are commonly reported in generalizing terms, independent of the underlying heart disorder. ⋯ This study shows that the outcome of palliation with the MBTS is importantly affected by the occurrence of a shunt-related complication, whose circulatory effect is even more dismal in single ventricle hearts. Since an increased shunt size-to-weight ratio additionally compromises the shunt-dependent survival, it emphasizes that the choice of the shunt with regard to size as well as surgical approach remains critical.
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World J Pediatr Congenit Heart Surg · Jan 2015
Case ReportsPlasma exchange on venovenous extracorporeal membrane oxygenation with bivalirudin anticoagulation.
A pediatric patient requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation developed heparin-induced thrombocytopenia. Unfractionated heparin was discontinued, and a bivalirudin infusion was started. During the lung transplant evaluation, he was found to have allosensitization, requiring treatment with plasma exchange along with pulse methylprednisolone, rituximab, bortezomib, and pooled immunoglobulin infusion. We describe our experience with successful plasma exchange for allosensitization during bivalirudin anticoagulation on VV ECMO in a pediatric patient.