Pediatric cardiology
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Pediatric cardiology · Feb 2016
Observational StudyProspective Evaluation of Sleep Apnea as Manifestation of Heart Failure in Children.
In adults with heart failure, central sleep apnea (CSA), often manifested as Cheyne-Stokes respiration, is common, and has been associated with adverse outcome. Heart failure in children is commonly caused by dilated cardiomyopathy (DCM). It is unknown whether children with heart failure secondary to DCM have CSA, and whether CSA is related to the severity of heart failure. ⋯ CSA was found in 19 % of the children with heart failure secondary to DCM. No relation was found with the severity of heart failure. In a small subset of children with severe DCM, a pattern mimicking Cheyne-Stokes respiration was registered.
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Pediatric cardiology · Feb 2016
Characterization of Cardiac Troponin Elevation in the Setting of Pediatric Supraventricular Tachycardia.
Cardiac troponin (cTn) is currently considered the gold standard biomarker for detection of myocardial necrosis. Patients with supraventricular tachycardia (SVT) often present with symptoms resulting in cTn assessment; however, there are no data on the results of such testing in childhood. We hypothesized that cTn elevation would be common in the pediatric SVT population and would portend a benign prognosis. ⋯ Cardiac Tn elevation is common in the pediatric population presenting with SVT. Episode severity, characterized by respiratory or gastrointestinal symptoms, lower mean blood pressure, and increased tachycardia rate and duration are predictive. Clinical follow-up is favorable.
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Pediatric cardiology · Jan 2016
Observational StudyValidation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients.
The aim of our study was to determine the validity of cardiac output (CO) measurements taken with the ultrasonic cardiac output monitor (USCOM) by comparing to CO measured by pulmonary arterial catheter (PAC) thermodilution during cardiac catheterization. We enrolled thirty-one children (<18 years) undergoing cardiac catheterization in this double-blinded, prospective, observational study. The median CO measured by USCOM was 4.37 L/min (IQR 3.73, 5.60 L/min) compared to 4.28 L/min (IQR 3.52, 5.26 L/min) by PAC thermodilution. ⋯ Bias (mean difference) between the two methods was -0.6 Wood Units, and the 95% limits of agreement were -8.2 to 6.9 Wood Units. We found that the estimation of CO and by extension SVRI with USCOM is reliable against pulmonary artery catheter thermodilution in children with normal cardiac anatomy. Given the noninvasive nature of USCOM, speed of measurement, and relative ease of use, it may be useful as a bedside tool for pediatric patients.
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Pediatric cardiology · Jan 2016
Radiation Reduction Capabilities of a Next-Generation Pediatric Imaging Platform.
The aims of this study were to quantify patient radiation exposure for a single interventional procedure during transition from an adult catheterization laboratory to a next-generation imaging system with pediatric settings, and to compare this radiation data to published benchmarks. Radiation exposure occurs with any X-ray-directed pediatric catheterization. Technologies and imaging techniques that limit dose while preserving image quality benefit patient care. ⋯ This degree of dose reduction was similar when Group 2 data (Kerma 28 mGy, DAP 199 µGy m(2)) was compared to published benchmarks for PDA closure (Kerma 76 mGy, DAP 500 µGy m(2)). This is the first clinical study documenting the radiation reduction capabilities of a next-generation pediatric imaging platform. The true benefit of this dose reduction will be seen in patients requiring complex and often recurrent catheterizations.
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Pediatric cardiology · Jan 2016
Risk Factors for Interstage Mortality Following the Norwood Procedure: Impact of Sociodemographic Factors.
Interstage mortality remains significant for patients undergoing staged palliation for hypoplastic left heart syndrome and other related single right ventricle malformations (HLV). The purpose of this study was to identify factors related to demographics, socioeconomic position, and perioperative course associated with post-Norwood hospital discharge, pre-stage 2, interstage mortality (ISM). Medical record review was conducted for patients with HLV, born from 1/2000 to 7/2009 and discharged alive following the Norwood procedure. ⋯ Anatomic and surgical course variables were not associated with ISM in multivariable analysis. Patients with HLV are at increased risk of ISM if born to a teen mother, if they lived in a home with only one adult caregiver, suffered a postoperative dysrhythmia, or experienced a prolonged ICU stay. These risk factors are identifiable, and thus these infants may be targeted for interventions to reduce ISM.