Pediatric cardiology
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Pediatric cardiology · Jul 2002
Randomized Controlled Trial Comparative Study Clinical TrialSystemic inflammatory response related to cardiopulmonary bypass and its modification by methyl prednisolone: high dose versus low dose.
The objective of our study was to investigate the safety and efficacy of high-dose methyl prednisolone (MP) in modifying the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) and to compare its efficacy with low-dose MP in children undergoing cardiac surgery for congenital heart disease. Thirty children with congenital heart disease undergoing CPB were randomly assigned to two groups: group 1 (n = 15) received 30 mg/kg MP by an intravenous infusion for 30 minutes and group 2 (n = 15) received 2 mg/kg intravenously, before the onset of CPB. Postoperative clinical parameters were recorded, and serum interleukin (IL)-6 and 8 levels, acute phase reactants, and blood biochemistry were determined serially for both groups. ⋯ Although postoperative IL and CRP levels indicated a SIR in our patients, the clinical picture was apparently affected in only 1 patient and she was in the high-dose MP group. CPB initiates a SIR that is associated with an increase in neutrophil count, CRP, and IL-6 and 8 levels. High-dose (30 mg/kg) MP was not superior to low-dose (2 mg/kg) in blunting the SIR to CPB in pediatric patients undergoing open-heart surgery.
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Pediatric cardiology · Jul 2002
Comparative StudyExperience with use of multiplane transesophageal echocardiography to guide closure of atrial septal defects using the amplatzer device.
By providing unlimited imaging planes, multiplane transesophageal echocardiography (MTEE) should improve real-time guidance of interventional procedures. The potential advantages of MTEE in this scenario have not been systematically evaluated. We retrospectively reviewed our experience with MTEE-guided Amplatzer device closure of atrial septal defects (ASDs) MTEE angles used to obtain images for guiding all measurements and maneuvers were recorded. ⋯ At follow-up, 79 of 89 (88.7%) patients had no residual ASDs. Each of the remaining 10 patients (11.3%) had a small (<3 mm) residual defect. MTEE played an important role in guiding device closure of ASD, particularly during the phases of balloon sizing and device deployment.
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Pediatric cardiology · Jul 2002
Comparative StudyPulmonary vascular changes induced by unilateral pulmonary venous obstruction.
The relation of pulmonary hemodynamics to pathological change in the pulmonary vasculature was examined in a model of unilateral pulmonary venous (PV) obstruction. The left upper pulmonary vein (A group, n=6) or both the left upper and left lower pulmonary veins (B group, n=6) of two-week-old piglets were banded; the control group (n=6) was sham operated. ⋯ For all animals from three groups, left pulmonary arterial wedge pressure (PAWP) correlated with medial thickness of the pulmonary arteries of the right lung (r=0.76, p=0.003), the left upper lobe (r=0.54, p<0.03), the left lower lobe (r=0.49, p=0.04). This finding suggests that the pathogenesis of PAWP-related medial thickening of the bilateral lung pulmonary artery begins with the sensing by the bilateral lung of PV pressure buildup in the unilateral lung.