Pediatric cardiology
-
Pediatric cardiology · Aug 2014
Cardiac mechanics in patients with human immunodeficiency virus: a study of systolic myocardial deformation in children and young adults.
Human immunodeficiency virus (HIV) infection causes dysfunction of different organ systems. Myocardial diastolic dysfunction has been reported previously in an adult HIV population. Our aim was to study myocardial strain in children and young adults infected by HIV who have apparently normal ejection fraction. ⋯ HIV infection affects longitudinal systolic cardiac strain and strain rate in children and young adults. Normal ejection fraction might be attributed to preserved circumferential myocardial deformation. Strain and strain rate may help identify HIV patients at high risk for cardiac dysfunction and allow early detection of silent myocardial depression.
-
Pediatric cardiology · Aug 2014
Aortopexy with preoperative computed tomography and intraoperative bronchoscopy for patients with central airway obstruction after surgery for congenital heart disease: postoperative computed tomography results and clinical outcomes.
Bronchoscopy-guided aortopexy is a surgical management option for patients with central airway obstruction after congenital heart surgery. This study aimed to evaluate the usefulness of bronchoscopy-guided aortopexy based on midterm follow-up evaluation with computed tomography (CT) and clinical outcome. From January 2004 to August 2011, bronchoscopy-guided aortopexy was performed for 16 patients (median age 0.5 years, M:F = 10:6) who had central airway obstruction caused by extrinsic compression (13 in the left main bronchus, 2 in the trachea, 1 in the diffuse trachea and bronchus) after congenital heart surgery. ⋯ Airway stenosis of more than 75% (p = 0.013), immediate diameter ratio improvement of <50% (p = 0.015), preoperative severe respiratory insufficiency (p = 0.038), and male sex (p = 0.024) were associated with recurrent minor respiratory susceptibility. Bronchoscopy-guided aortopexy is a safe and reliable surgical management choice for central airway obstruction after congenital heart surgery. Furthermore, airway improvement after aortopexy was maintained during the midterm follow-up evaluation, according to CT measurements.
-
Pediatric cardiology · Aug 2014
Incidence of adverse events requiring intervention after initiation of oral beta-blocker in pediatric cardiac intensive care patients.
Only limited clinical data are available to establish the risk factors for adverse events and their frequency among children who have received oral beta-blockers in a critical care unit setting. The authors aimed to analyze the frequency of adverse events experienced by children treated with oral beta-blockers in a cardiovascular intensive care unit (CVICU) and sought out independent risk factors for these adverse events in a tertiary care hospital. The primary end point in this retrospective descriptive study was the incidence of adverse events associated with enteral beta-blocker administration, and the secondary end point was the incidence of readmission to the CVICU after transfer of patients to an acute care floor. ⋯ The patients admitted after a cardiac procedure had fewer readmissions to the intensive care unit (ICU) during the same hospital admission (p = 0.002). The results demonstrated that adverse events are relatively common among patients receiving oral beta-blockers in a CVICU population. Because these children have less physiologic reserve, more must be done to ensure that the correct beta-blocker is prescribed to avoid clinically significant adverse events that may hamper the recovery of these patients and lead to increased ICU time.
-
Pediatric cardiology · Jun 2014
Observational StudyClinical course and interstage monitoring after the Norwood and hybrid procedures for hypoplastic left heart syndrome.
Infants with hypoplastic left heart syndrome (HLHS) are at risk for interstage morbidity and mortality, especially between the first and second surgical stages after the Norwood and hybrid procedures. This study compared the morbidity and mortality of patients treated by either the Norwood or the hybrid procedure for HLHS between the first and second stages who were undergoing interstage monitoring. Between October 2008 and December 2011, 26 infants (14 boys) with HLHS (n = 16) and other univentricular heart malformations with aortic arch anomaly (n = 10) were scheduled for interstage monitoring after Norwood I (n = 12) and hybrid (n = 14) procedures. ⋯ In conclusion, morbidity among infants treated for HLHS remains high, either before or after hospital discharge, emphasizing the need of interstage monitoring programs. Despite retrograde aortic flow in infants with HLHS after the hybrid procedure, the mortality rate was comparable between the two groups. Mortality occurs after early second-stage surgery (<90 days).
-
Pediatric cardiology · Jun 2014
Practice variation and resource use in the evaluation of pediatric vasovagal syncope: are pediatric cardiologists over-testing?
Syncope is a common problem in children and adolescents. Usually vasovagal in etiology, this benign problem often results in considerable testing and expense. We sought to define the current practice, practice variation, and resource utilization as well as evaluate a screening strategy for syncope at an academic tertiary care center. ⋯ Although practice variation existed, it was not explained by provider experience or electrophysiology training. Factors associated with increased testing included greater number of clinic visits and increased frequency of events, whereas those associated with decreased testing included increased number of syncopal episodes and history of psychiatric medication use. A more standardized approach to syncope is needed to decrease resource use and cost while maintaining quality of care.