Pediatric cardiology
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Pediatric cardiology · Oct 2018
Risk Factors for Failure of Systemic-to-Pulmonary Artery Shunts in Biventricular Circulation.
Systemic-to-pulmonary artery shunt placement is an established palliative procedure for congenital heart disease, but it is associated with high morbidity and mortality. Data of all patients with biventricular circulation who underwent systemic-to-pulmonary artery shunt implantation between 2000 and 2016 were reviewed. Endpoints of the study were shunt failure and shunt-related mortality. ⋯ The ideal shunt size in patients with biventricular circulation requiring a systemic-to-pulmonary artery shunt is 3.5 mm or larger. Platelet transfusion increases the risk of shunt failure and should be avoided. Type of shunt and diagnosis have no influence on morbidity or mortality after shunt placement.
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Pediatric cardiology · Oct 2018
Observational StudyAmbulatory Intravenous Inotropic Support and or Levosimendan in Pediatric and Congenital Heart Failure: Safety, Survival, Improvement, or Transplantation.
End-stage heart failure (HF) frequently needs continuous inotropic support in hospital and has high morbidity and mortality in absence of heart transplantation. This study reports outcome, efficacy, and safety of continuous ambulatory inotropes (AI) and/or periodic levosimendan (LS) infusions in pediatric HF patients. The study included 27 patients, median age 9.4 (0.1-26.1) years, with severe HF (6 myocarditis, 13 dilated cardiomyopathy, 2 restrictive cardiomyopathy, 6 repaired congenital heart disease). ⋯ Therapy with AI was discontinued after 1.4-0.4 years in 6 improved myocarditis and 3 cardiomyopathy patients without deterioration. In conclusion, prolonged AI and/or LS infusions in HF are safe and beneficial even in small infants, allowing stabilization and reasonable social and family life out of the hospital. It may provide precious time for heart transplantation or myocardial remodeling, improvement, and possible discontinuation even after long periods of support.
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Pediatric cardiology · Oct 2018
Left Ventricular Ejection Fraction and Fractional Shortening are Useful for the Prediction of the Therapeutic Response to Metoprolol in Children with Vasovagal Syncope.
The objective of this manuscript was to explore if left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) could predict the efficacy of metoprolol therapy on vasovagal syncope (VVS) in children. Forty-nine children, including 30 with VVS and 19 gender- and age-matched healthy controls, were included in the study. Metoprolol was prescribed to the VVS subjects. ⋯ At the 6-month follow-up, the ROC analysis demonstrated that 70.5% as a cutoff value of baseline LVEF yielded a sensitivity of 81.3% and a specificity of 88.9% in the prediction of metoprolol efficacy. For baseline LVFS, 37.5% as a cutoff value yielded a sensitivity of 93.8% and a specificity of 66.7%. In conclusion, baseline LVEF and LVFS might be useful predictors of the efficacy of β-blocker therapy on VVS in children.