Pediatric cardiology
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Pediatric cardiology · Nov 2009
Multicenter StudyStratification of complexity improves the utility and accuracy of outcomes analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database.
Quality-of-care evaluation must take into account variations in "ase mix."This study reviewed the application of two case-mix complexity-adjustment tools in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database: the Aristotle Basic Complexity (ABC) score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. The 2006 STS Congenital Heart Surgery Database Report, the first STS report to incorporate both methods, included 45,635 operations from 47 centers. Each operation was assigned an ABC score in a range from 1.5 (lowest complexity) to 15 (highest complexity), an ABC level in a range from 1 (lowest complexity) to 4 (highest complexity), and a RACHS-1 category in a range from 1 (lowest risk) to 6 (highest risk). ⋯ The ABC approach allows classification of more operations, whereas the RACHS-1 discriminates better at the higher end of complexity. Complexity stratification is a useful method for analyzing the impact of case mix on pediatric cardiac surgical outcomes. Both the RACHS-1 and ABC methods facilitate complexity stratification in the STS database.
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Pediatric cardiology · Nov 2009
Case ReportsStenting of ductus arteriosus in a neonate with truncus arteriosus and interrupted aortic arch associated with a right aortic arch.
This report describes a case in which successful stenting of ductus arteriosus (DA) was performed for a 27-day-old boy with truncus arteriosus (TA) and interrupted aortic arch (IAA). The patent DA was associated with a right aortic arch. ⋯ Additionally, the DA was longer than in previously reported cases with left aortic arch, thus requiring a longer stent. This experience suggests that DA stenting in neonates with TA and IAA averts surgical repair during the early neonatal period.
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Pediatric cardiology · Nov 2009
Case ReportsVentricular septal rupture in a 4-year-old child following blunt chest injury.
We report on a 4-year-old child who developed rupture of the ventricular septum after a blunt chest injury. The symptoms appeared more than 12 h later with progressive deterioration in his hemodynamic status. The diagnosis was made by echocardiography and the large defect in the muscular part of the ventricular septum was successfully closed at surgery.
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Pediatric cardiology · Nov 2009
Mean pulmonary artery pressure estimated from systolic and diastolic pulmonary artery pressure in children with congenital heart disease: an invasive study.
This hemodynamic study documented the accuracy and precision of six empirical formulas relating mean (mPAP), systolic (sPAP), and diastolic (dPAP) pulmonary artery pressures in children with congenital heart disease. Fluid-filled PAPs of 61 children (age, 26 +/- 40 months) were analyzed over an mPAP range of 7 to 74 mmHg. All formulas were accurate (mean bias, -2 to 1 mmHg). ⋯ They were less precise (bias SD, 5-6 mmHg), with biases greater than 7 mmHg for 10% to 16% patients. Accurate estimates of mPAP were obtained from sPAP alone, and this could be valuable for cross-checking the self-consistency of the pressure database obtained in the echo-Doppler laboratory. For cases that had reliable dPAP estimates available, empirical formulas relying on both sPAP and dPAP were more precise and thus must be preferred.
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This study aimed to determine the prevalence of hyperglycemia among pediatric postoperative cardiac patients, its impact on outcomes, and whether hyperglycemia can be controlled effectively in this population. A retrospective chart review of 100 postoperative patients admitted to the authors' pediatric cardiac intensive care unit (ICU) was conducted. Patients were evaluated for incidence of hyperglycemia, defined as blood glucose (BG) level exceeding 7.7 mmol/l (140 mg/dl), and outcomes. ⋯ No patient had a BG level lower than 2.2 mmol/l (40 mg/dl) during glycemic management. Severe hyperglycemia is prevalent among postoperative pediatric cardiac patients and correlates with morbidity and mortality. Hyperglycemia may be controlled effectively in these patients using a pediatric-specific glycemic control protocol without increasing the incidence of hypoglycemia.