Pediatric cardiology
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Pediatric cardiology · Jan 2006
Simplified pulmonary vasodilatory testing in the cardiac catheterization laboratory with nasal cannula nitric oxide.
In patients with pulmonary hypertension, pulmonary vasodilator testing with inhaled nitric oxide (NO) during cardiac catheterization provides valuable data for defining future care plans. Previously, the use of delivery systems for spontaneously breathing individuals required a tight-fitting seal by face mask and an approved delivery and dilution device. We hypothesized that a simplified delivery system using nasal cannula could be utilized to effectively deliver NO during cardiac catheterization. ⋯ The initial ratio of pulmonary to systemic vascular resistance (Rp:Rs) was 0.49 (range, 0.25-3.5) and decreased to 0.35 (range 0.1-2.6) (p = 0.002). No adverse side effects were noted. We found this NO delivery system to be a simple and effective method of pulmonary vasodilatory testing that may have wide applicability in the cardiac catheterization laboratory.
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To investigate the origin of the pulmonary systolic ejection innocent flow murmur (IFM), echocardiographic examinations were undertaken in 30 children with IFM and in a control group consisting of 28 healthy children without murmur. Compared to the controls, the diameters of the left ventricular outflow tract (LVOT) and aortic valve annulus and aortic valve area tended to be smaller, whereas stroke volume (SV) and cardiac output were slightly greater in children with IFM, but they were not statistically significant. Mean fractional shortening was significantly higher in children with IFM. ⋯ The variables of left-sided flow velocities in the same individuals with IFM were significantly higher compared to those derived from the right heart. The ratios of the SV to the LVOT diameter and to the aortic valve area were found to be significantly greater. It was concluded that IFM originates from higher blood flow velocities in the region of LVOT and aortic valve annulus, and that the increased flow velocity results from the larger SV passing through the relatively narrow LVOT and aortic valve in children with IFM.