Pediatric cardiology
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Pediatric cardiology · Oct 2012
Case ReportsComplete transposition of great arteries with cor triatriatum: an unusual coexistence.
The combination of complete transposition of the great arteries and cor triatriatum is extremely rare. We report three infants with this rare combination and discuss the anatomic details apparently unique to the combined lesion.
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Pediatric cardiology · Oct 2012
ReviewLate complications after Takeuchi repair of anomalous left coronary artery from the pulmonary artery: case series and review of literature.
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart lesion that if left untreated, results in high mortality. Surgical treatment options include reimplantation of the anomalous coronary ostia, use of extracardiac arterial blood supply, or the Takeuchi procedure. The Takeuchi procedure involves creation of an aortopulmonary window and an intrapulmonary tunnel that baffles the aorta to the ostium of the anomalous left coronary artery. ⋯ Compared with patients after direct reimplantation for ALCAPA at our institution, there was no significant difference in late survival or freedom from reoperation. The Takeuchi procedure is a method to establish a two-coronary repair for ALCAPA. Late complications are common, necessitating lifelong care in a center experienced with caring for adults with congenital heart disease.
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Pediatric cardiology · Oct 2012
Pain management after surgery for single-ventricle palliation using the hybrid approach.
The hybrid pathway for the management of patients with hypoplastic left heart syndrome was pioneered at our institution and is the preferred approach compared with the traditional Norwood pathway. Patients undergoing this surgery are generally <6 months of age, and pain management in this age group after surgery for complex congenital heart disease (CHD) may be particularly challenging. We retrospectively reviewed our pain-management strategy after stage 1 hybrid procedure (HS1) and evaluated its efficacy, especially in the setting of early tracheal extubation. ⋯ Dexmedetomidine was used as an adjunct medication in 5 patients and resulted in decreased fentanyl use (6.3 ± 1.3 vs. 19 ± 15.9 μg/kg in the first 24 postoperative hours and 7.9 ± 3.5 vs. 19 ± 20.3 μg/kg in the second 24 postoperative hours). Fentanyl administered by way of continuous infusion or NCA provided effective postoperative analgesia with a limited adverse effect profile after HS1 surgery in neonates with complex CHD. Fentanyl requirements were lower in patients who achieved early tracheal extubation as well as those who received dexmedetomidine.
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Pediatric cardiology · Oct 2012
Myopericarditis in children: elevated troponin I level does not predict outcome.
Myopericarditis is primarily a pericarditic syndrome with some degree of myocardial involvement, as evident by elevated cardiac enzymes. Differentiating myopericarditis from acute coronary syndromes can be challenging and may require coronary angiography or perfusion studies. Data on myopericarditis and its outcome for children are scarce. ⋯ The inflammatory involvement of the myocardium appears to be self-limited without short-term, overt sequelae. An elevated troponin I level in myopericarditis, unlike acute coronary syndromes, does not seem to carry an adverse prognosis. Further studies are needed to evaluate the long-term prognosis for such patients.
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Pediatric cardiology · Oct 2012
Case ReportsAn unusual case of incomplete Kawasaki disease in an adolescent returning from holiday in Montana.
Here we present an unusual case of incomplete Kawasaki disease in a 15-year-old boy returning from a holiday with his family in Montana. His symptoms were initial diarrhoea and lethargy, with fever, rash, conjunctivitis, and arthralgia developing during the course of his illness. ⋯ The patient was started on intravenous immunoglobulin and high-dose aspirin and improved clinically. He was discharged home and remains under follow-up by the infectious diseases and cardiology teams.