Pediatric cardiology
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Pediatric cardiology · Apr 2014
Perventricular closure of perimembranous ventricular septal defects using the concentric occluder device.
This report summarizes the authors' clinical experience with perventricular closure of the perimembranous ventricular septal defect (PmVSD) using the concentric occluder as a minimally invasive technique without cardiopulmonary bypass and following transesophageal echocardiography (TEE) guidance. Between July 2011 and March 2013, 61 patients with PmVSD underwent perventricular concentric device closure using a minimally invasive inferior sternotomy approach. The basal diameter of the PmVSD ranged from 2.5 to 7 mm. ⋯ No complete atrioventricular block, position shift of the occlusion devices, thrombosis, or residual VSD occurred during the follow-up period. The perventricular concentric device closure of PmVSD with an inferior sternotomy in selected patients is a safe, feasible, and simple treatment. The concentric device is easier to anchor than the eccentric device and has proved to be a reasonable choice for PmVSD occlusion, especially in patients with a perimembranous aneurysm formation or PmVSD extending to the inflow tract.
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Pediatric cardiology · Apr 2014
Tachyarrhythmias after the Norwood procedure: relationship and effect of vasoactive agents.
Tachyarrhythmias are common after the Norwood stage I palliation. The effects of vasoactive medications on the development of post-operative tachyarrhythmias have not been studied. The primary objective was to identify associations between postoperative tachyarrhythmias and vasoactive medication usage after Norwood stage 1 palliation. ⋯ Postoperative tachyarrhythmias are common after the Norwood procedure and are associated with longer ICU and hospital stays. High doses of milrinone, longer duration of epinephrine treatment, and the right ventricle to pulmonary artery shunt were associated with for the development of tachyarrhythmias. Further studies are required to determine the effects of anatomy on post-operative tachyarrhythmias.
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Ventilator-associated pneumonia (VAP) is a nosocomially acquired infection that has a significant burden on intensive care units (ICUs). We investigated the incidence of VAP in children after cardiac surgery and its impact on morbidity and mortality. A prospective cross-sectional review was performed in the postoperative cardiac patients in pediatric cardiac intensive care unit (PCICU) patients from March 2010 until the end of September 2010. ⋯ VAP incidence is high in children after cardiac surgery mainly by GNB. VAP increases with longer CPB time, administration of TPN, and longer PCICU stay. VAP increases morbidity in postoperative cardiac patients.
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Pediatric cardiology · Apr 2014
Comparison of the therapeutic and side effects of tadalafil and sildenafil in children and adolescents with pulmonary arterial hypertension.
Pulmonary arterial hypertension (PAH) is a progressive disease. In recent years, phosphodiesterase type 5 inhibitors such as sildenafil have been used to treat this disease in children. Recently, tadalafil has been used in adults with similar efficacy but it has been used less often in children. ⋯ No significant side effects were seen; 15 patients continued tadalafil. Tadalafil may be a safe drug to treat children and young adults with PAH. We did not observe any significant side effects during usage; it improves functional capacity and oxygen saturation better than sildenafil in these patients, and requires fewer daily doses than sildenafil.
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Pediatric cardiology · Apr 2014
Observational StudyNoninvasive positive pressure ventilation in critically ill children with cardiac disease.
Noninvasive ventilation is effective in respiratory failure from various etiologies. This study aimed to analyze the efficacy of noninvasive positive pressure ventilation (NPPV) in pediatric cardiac patients. NPPV was used (1) as an alternative means of respiratory support in patients with hypoxemic or hypercarbic respiratory failure or with signs of respiratory distress that were considered to require intubation; or (2) as a preventive measure in patients with high risk for extubation failure. ⋯ The Aristotle Basic Complexity score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour were independent predictors of NPPV failure. We conclude that NPPV improved oxygenation and decreased respiratory effort in pediatric cardiac patients, 59.8% of whom eventually did not receive intubation. A high-complexity surgical score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour are predictors of NPPV failure, which occurs in most patients >24 h after the onset of therapy.