Pediatric cardiology
-
Pediatric cardiology · Feb 2015
Cumulative radiation exposure in pediatric patients with congenital heart disease.
Certain pediatric patients undergoing surgery for the most severe forms of congenital heart disease are exposed to high doses of ionizing radiation. The amount of cumulative radiation exposure from all modalities has not yet been evaluated. The purpose of our study was to evaluate the cumulative radiation exposure in a contemporary cohort of patients with congenital heart disease undergoing single-ventricle palliation. ⋯ Radiation exposure in patients with congenital heart disease undergoing single-ventricle palliation is quite variable. Most of the exposure to ionizing radiation occurs during cardiac catheterization. Strategies to utilize other imaging modalities such as MRI would decrease exposure in this particular group of patients who may be particularly vulnerable to its side effects.
-
Pediatric cardiology · Jan 2015
Droperidol transiently prolongs the QT interval in children undergoing single ventricle palliation.
Historically, droperidol was commonly used for postoperative sedation of critically ill children. A FDA black box warning regarding its arrhythmogenic potential greatly reduced its use. We hypothesized that administration of neuroleptic dose droperidol during volatile anesthesia would transiently prolong the corrected QT interval (QTc) in patients undergoing single ventricle palliation. ⋯ All QTc changes were transient and the postoperative QTc, while still prolonged relative to baseline, was significantly shorter than the QTc immediately postdroperidol. No episodes of Torsades de Pointes (TdP) or ventricular arrhythmias were observed. The administration of a neuroleptic dose of droperidol during volatile anesthesia in patients undergoing single ventricle palliation was associated with a significant prolongation of QTc, which was transient and did not result in TdP or other ventricular arrhythmias in our study population.
-
Pediatric cardiology · Jan 2015
Survival outcomes following norwood procedure for hypoplastic left heart.
Prior studies evaluating the association of HLHS anatomic variants and mortality report conflicting results. Our objective was to determine if antegrade flow across the mitral within variants of HLHS with aortic atresia is associated with increased mortality compared to ventricular hypoplasia variants without antegrade mitral flow. All patients with HLHS born between 2002 and 2011 year who underwent stage I Norwood palliation with complete history and echocardiograms for patency of the mitral and aortic valves were studied. ⋯ Patient weight at time of Norwood and length of regional perfusion were the highest predictors for hospital death following Norwood procedure. The Norwood procedure for mitral stenosis and aortic atresia is more often associated with use of extracorporeal membrane oxygenation and shunt revision compared to other variants. This HLHS variant has lowest long-term survival.
-
Pediatric cardiology · Jan 2015
Surgical volume, hospital quality, and hospitalization cost in congenital heart surgery in the United States.
Hospital volume has been associated with improved outcomes in congenital cardiac surgery. However, the relationship between hospital volume and hospitalization cost remains unclear. This study examines the relationship between hospital surgical volume and hospitalization costs, while accounting for measures of quality, in children undergoing congenital heart surgery. ⋯ However, when adjusting for hospital mortality rate, high-volume hospitals no longer demonstrated significant cost savings. When adjusting for hospital complication rate, high-volume hospitals continued to have the lowest hospitalization costs. High-volume hospitals are associated with a reduction in hospitalization costs that appear to be mediated through improvements in quality.
-
Pediatric cardiology · Dec 2014
Multicenter StudyExtracorporeal membrane oxygenation in children with heart disease and down syndrome: a multicenter analysis.
The data on the outcomes of children with heart disease and Down syndrome receiving extracorporeal membrane oxygenation (ECMO) for cardiac or respiratory failure are limited. This study aimed to evaluate morbidity and mortality associated with ECMO in children with Down syndrome and heart disease. Children younger than 18 years undergoing heart surgery and ECMO reported in the Extracorporeal Life Support Organization (ELSO) registry (1998-2011) were included in the study. ⋯ The duration of ECMO and length of hospital stay were similar in the two groups. The findings showed that ECMO can be used for children with heart disease and Down syndrome with good results. The outcomes were comparable between the children with Down syndrome and the children without Down syndrome.