World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Jan 2013
Case ReportsCardiopulmonary bypass in an infant with a recent history of malaria.
Severe malarial infection is associated with impaired cardiac function. We report a child who underwent repair of tetralogy of Fallot two weeks after being treated for malaria. The postoperative course was complicated by impaired left ventricular function. The pathogenesis of malaria is discussed as well as the potential complications of cardiopulmonary bypass (CPB).
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World J Pediatr Congenit Heart Surg · Jan 2013
Report from the Society of Thoracic Surgeons National Database Workforce: clarifying the definition of operative mortality.
Several distinct definitions of postoperative death have been used in various quality reporting programs. Some have defined postoperative mortality as the occurrence of death after a surgical procedure when the patient dies while still in the hospital, while others have considered all deaths occurring within a predetermined, standardized time interval after surgery to be postoperative mortality. ⋯ Operative Mortality is defined in all STS databases as (1) all deaths, regardless of cause, occurring during the hospitalization in which the operation was performed, even if after 30 days (including patients transferred to other acute care facilities); and (2) all deaths, regardless of cause, occurring after discharge from the hospital, but before the end of the 30th postoperative day. This article provides clarification for some uncommon but important scenarios in which the correct application of this definition may be challenging.
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World J Pediatr Congenit Heart Surg · Oct 2012
Conservative management of iatrogenic esophageal perforation during neonatal cardiac surgery.
Esophageal perforation is a rare, but life threatening, entity in children. The most common iatrogenic causes include nasogastric tube insertion, stricture dilation, or endotracheal intubation. ⋯ The safety of TEE in children is still controversial and complications such as airway obstruction, hemodynamic compromise, and esophageal injury have been reported. We recently experienced a case of esophageal perforation caused by TEE probe insertion during neonatal cardiac surgery; two weeks of conservative management resulted in complete resolution of the injury.
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World J Pediatr Congenit Heart Surg · Oct 2012
Thromboelastography in the assessment of bleeding following surgery for congenital heart disease.
Perioperative bleeding is common in pediatric cardiac surgery patients. Traditional laboratory tests do not adequately characterize coagulation derangements in patients with bleeding. We sought to establish preoperative thromboelastography parameters in children prior to cardiopulmonary bypass, to compare thromboelastography assessment with standard coagulation parameters postoperatively, and to assess thromboelastography in children with significant hemorrhage. ⋯ Pediatric patients with significant postoperative bleeding after surgery are more likely to have abnormal thromboelastography early after cessation of cardiopulmonary bypass. Thromboelastography illustrates derangements in the coagulation system and may aid in the treatment of postoperative bleeding.
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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.