Pediatric cardiology
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Pediatric cardiology · Jan 2017
Clinical Associations of Early Dysnatremias in Critically Ill Neonates and Infants Undergoing Cardiac Surgery.
Dysnatremias (DN) are common electrolyte disturbances in cardiac critical illness and are known risk factors for adverse outcomes in certain populations. Little information exists on DN in children with cardiac disease admitted to the cardiac intensive care unit (CICU) after undergoing cardiac surgery, either corrective or palliative. The aim was to determine the incidence and adverse outcomes associated with DN in neonates and infants undergoing cardiac surgery. Retrospective cohort and single center study performed at Children's Hospital Colorado from May 2013 to May 2014, in children under 1 year old admitted to the CICU after undergoing surgery for congenital or acquired cardiac disease. 183 subjects were analyzed.
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Pediatric cardiology · Jan 2017
Circulating microRNA as a Novel Biomarker for Pulmonary Arterial Hypertension Due to Congenital Heart Disease.
Circulating microRNAs (miRNAs) have recently been indicated as practical and promising biomarkers for various diseases. However, circulating miRNAs have not been found to be biomarkers for pulmonary arterial hypertension (PAH) due to congenital heart disease. PAH is defined by a mean pulmonary arterial pressure (mPAP) >25 mmHg at rest. ⋯ Circulating miR-19a turned out to be a pronounced marker for PAH. Our observations suggest that miR-19a expression is enhanced in PAH blood. Circulating miR-19a may be a novel biomarker for the diagnosis of PAH.
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Pediatric cardiology · Jan 2017
Observational StudyPrediction of Fluid Responsiveness Using Pulse Pressure Variation in Infants Undergoing Ventricular Septal Defect Repair with Median Sternotomy or Minimally Invasive Right Thoracotomy.
Fluid management is challenging in infants after cardiopulmonary bypass. Pulse pressure variation (PPV) derived from pressure recording analytical method (PRAM) is based on lung-heart interaction during mechanical ventilation. A prospective observational study conducted in operating room tested PPV to predict fluid responsiveness in ventricular septal defect infants. ⋯ PPV in responders was higher than that in non-responders (25.0 ± 6.8 vs. 18.2 ± 5.3, P < 0.01). Area under the curve was 0.83 (95 confidence interval, 0.66-0.98, P = 0.001) and cutoff value 18% with a sensitivity of 94% and a specificity of 69%. PPV sensitively predicts fluid responsiveness in ventricular septal defect infants after surgical repair in open chest conditions both with median sternotomy and minimally invasive right thoracotomy.
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Pediatric cardiology · Jan 2017
Observational StudyFeasibility and Accuracy of Cardiac Right-to-Left-Shunt Detection in Children by New Transpulmonary Ultrasound Dilution Method.
Transpulmonary ultrasound dilution (TPUD) method, a novel indicator dilution (ID) technique for cardiac output measurement, detects and quantifies shunts, both in children and adults. However, its accuracy and reproducibility in cardiac right-to-left-shunt (RLS) detection have not been investigated. In a prospective observational study, we assessed the validity of TPUD algorithm for RLS detection in children with congenital heart disease (CHD) and proven RLS in comparison with controls without shunts between February 2010 and October 2011. ⋯ Shortened AT and low CBVI are reliable parameters for RLS identification. RLS categories have specific implications for cardiac output, blood volume and RLS fraction measurements. TPUD is valuable to monitor shunt direction and magnitude to optimise haemodynamic and respiratory therapy.
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Pediatric cardiology · Jan 2017
Optimal Transducer Level for Atrial and Pulmonary Arterial Pressure Measurement in Patients with Functional Single Ventricle.
This study aimed to investigate the optimal transducer level for accurate measurement of atrial and pulmonary arterial pressures in the supine position for patients with functional single ventricle. Contrast-enhanced chest computed tomographic images of 108 patients who underwent either the bidirectional cavopulmonary shunt (BCPS) placement or the Fontan procedure were reviewed. Vertical distances from the skin of the back to the uppermost levels of fluid in the single atrium or the pulmonary artery confluence and their ratios to the greatest anteroposterior (AP) diameter of the thoracic cage were determined. ⋯ The distance (mm) between these two levels was calculated as 31.1 + 0.44 × age (years) (r 2 = 0.05, P < 0.11). The optimal transducer levels for measuring atrial and pulmonary arterial pressures in the supine position are 75-80 and 55-60 % of the AP diameter of the thorax, respectively, in patients with functional single ventricle. We should consider the difference of the pressure when atrial and pulmonary arterial pressures were measured with the same level of transducers.