Pediatric cardiology
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Pediatric cardiology · Jan 2013
Cerebral oximetry monitoring during preoperative phlebotomy to limit allogeneic blood use in patients undergoing cardiac surgery.
Preoperative phlebotomy can minimize the need for allogenic blood products. Frequently, removed blood is replaced with intravenous fluids to maintain euvolemia (acute normovolemic hemodilution [ANH]). During cardiopulmonary bypass (CPB), ANH may present problems when the circuit prime causes further hemodilution and unacceptably low hemoglobin. ⋯ A decrease in rSO(2) occurred more commonly in younger patients and those who had a larger volume of blood removed. Preoperative phlebotomy without significant volume replacement can be performed safely before CPB. Volume replacement may be more appropriately guided by rSO(2) than by hemodynamic variables.
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Pediatric cardiology · Jan 2013
Feasibility of pulse oximetry screening for critical congenital heart disease at 2643-foot elevation.
To evaluate the feasibility of implementing a pulse oximetry screening protocol at a city of mild elevation with a specific focus on the false-positive screening rate. Pulse oximetry screening was performed according to the proposed guidelines endorsed by the American Academy of Pediatrics at a center in Tucson, AZ, at an elevation of 2,643 ft (806 m). During a 10-month period in 2012, 1069 full-term asymptomatic newborns were screened ≥ 24 h after birth. ⋯ The pulse oximetry screening guidelines recommended by the American Academy of Pediatrics are feasible at an elevation of 2,643 ft (806 m) with a low false-positive rate. Adjustments to the protocol are not required for centers at elevations ≤ 2,643 ft. Future studies at greater elevations are warranted.
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Pediatric cardiology · Jan 2013
Case ReportsA triple challenge: thrombocytopenia in a 7-year-old girl with unrepaired d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension.
Thrombocytopenia can be a real challenge during cardiac surgery in children with cyanotic congenital heart disease. This report describes a 7-year-old girl with d-transposition of the great arteries, ventricular septal defect, pulmonary hypertension, chronic thrombocytopenia, polycythemia, and chronic renal impairment. The thrombocytopenia improved several days after splenectomy. The child then underwent a successful arterial switch operation with ventricular septal defect closure.
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Pediatric cardiology · Jan 2013
Case ReportsLeft thoracoscopic sympathectomy used as primary therapy for a young child with intractable long QT syndrome.
A 3-year-old boy with familial long QT syndrome type 2 presented with recurrent syncope despite adequate beta-blocker therapy. Two family members had experienced sudden cardiac arrest, and one other relative had experienced sudden cardiac death. ⋯ The chest tube was removed on day 1 after surgery, and the patient was discharged on postoperative day 4. During 14 months of follow-up evaluation, no intervening episodes of ventricular arrhythmia or syncope and no symptoms of Horner's syndrome were noted.
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Pediatric cardiology · Jan 2013
Case ReportsNoonan syndrome and different morphologic expressions of hypertrophic cardiomyopathy.
Hypertrophic cardiomyopathy is the disease with the largest heterogeneity in clinical cardiology. An underrecognized and incompletely described subgroup within this spectrum comprises patients with ventricular diverticulum, coronary myocardial bridging, and left ventricular crypts and crevices. This report presents the case of a Noonan syndrome patient with these four hypertrophic cardiomyopathy characteristics.