Pediatric cardiology
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Pediatric cardiology · Apr 2013
ReviewDexmedetomidine: antiarrhythmic effects in the pediatric cardiac patient.
This report aims to provide a general description of the cardiovascular effects of dexmedetomidine, emphasizing its effects on conduction, and to give an evidence-based review of the literature regarding the use of dexmedetomidine to treat and prevent tachyarrhythmias in infants and children. A computerized bibliographic search of the literature on the use of dexmedetomidine to treat and prevent arrhythmias in infants and children was conducted. The cardiovascular effects of dexmedetomidine have been well studied in animal and adult human models. ⋯ Additionally, its use during cardiac surgery has been associated with a decreased incidence of postoperative ventricular and supraventricular tachyarrhythmias. Although dexmedetomidine is not currently approved by the Food and Drug Administration for the pediatric population, findings have shown it to be effective in various clinical scenarios for sedation. In addition, recent studies show that dexmedetomidine may have promising properties for the acute treatment and prevention of tachyarrhythmias.
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Pediatric cardiology · Apr 2013
Comparative StudyComparison of urinary biomarkers for early detection of acute kidney injury after cardiopulmonary bypass surgery in infants and young children.
Acute kidney injury (AKI) is a potential complication for children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) surgery. This study was designed to investigate and compare the predictive values of urinary biomarkers for AKI after CPB surgery in infants and young children and to determine the optimal timing of testing and the cutoff value for each biomarker. The study prospectively enrolled 58 CHD children 3 years of age or younger who were undergoing CPB surgery. ⋯ At this time point, NAG had the minimum area under the curve (AUC) (0.747), which was significantly lower than that of the others (AUC, 0.82-0.85; P < 0.05). The optimal cutoff value of each biomarker was 290 ng/mg UCr for NAGL, 1,477 pg/mg UCr for IL-18, 400 mg/g UCr for MA, 225 U/g UCr for NAG, and 290 mg/g UCr for α1-MG. In conclusion, urinary NGAL, IL-18, MA, and α1-MG had similar predictive performances for the early detection of AKI after CPB surgery in infants and young children.
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Pediatric cardiology · Apr 2013
Acute pulmonary vasodilator testing with inhaled treprostinil in children with pulmonary arterial hypertension.
Acute pulmonary vasodilator testing (AVT) is essential to determining the initial therapy for children with pulmonary arterial hypertension (PAH). This study aimed to report the initial experience with inhaled treprostinil used for AVT in children with PAH and to evaluate the hemodynamic change after inhaled treprostinil compared with inhaled nitric oxide. This prospective cohort study was designed for 13 children who underwent AVT with inhaled treprostinil or oxygen plus inhaled nitric oxide (iNO) during catheterization. ⋯ All adverse events resolved without any intervention. This study report is the first to describe the use of inhaled treprostinil for AVT in children with PAH. In this small pediatric cohort, inhaled treprostinil was effectively delivered and well tolerated and may be useful for AVT.
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Pediatric cardiology · Apr 2013
Efficacy and predictors of success of noninvasive ventilation for prevention of extubation failure in critically ill children with heart disease.
The study aimed primarily to evaluate the efficacy of noninvasive ventilation (NIV) and to identify possible predictors for success of NIV therapy in preventing extubation failure in critically ill children with heart disease. The secondary objectives of this study were to assess the efficacy of prophylactic NIV therapy initiated immediately after tracheal extubation and to determine the characteristics, outcomes, and complications associated with NIV therapy in pediatric cardiac patients. A retrospective review examined the medical records of all children between the ages 1 day and 18 years who sustained acute respiratory failure (ARF) that required NIV in the cardiovascular intensive care unit (CVICU) at Lucile Packard Children's Hospital between January 2008 and June 2010. ⋯ Significant variables identifying a responder included a lower risk-adjusted classification for congenital heart surgery (RACHS-1) score (1-3), a good left ventricular ejection fraction, a normal respiratory rate (RR), normal or appropriate oxygen saturation, prophylactic or therapeutic glucocorticoid therapy within 24 h of NIV initiation, presence of atelectasis, fewer than two organ system dysfunctions, fewer days of intubation before extubation, no clinical or microbiologic evidence of sepsis, and no history of reactive airway disease. As a well-tolerated therapy, NIV can be safely and successfully applied in critically ill children with cardiac disease to prevent extubation failure. The independent predictors of NIV success include lower RACHS-1 classification, presence of atelectasis, steroid therapy received within 24 h after NIV, and normal heart rate and oxygen saturations demonstrated within 24 h after initiation of NIV.
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Pediatric cardiology · Apr 2013
Case ReportsCoronary sinus ostial atresia associated with functionally single ventricle: persistent left superior vena cava should be ligated upon coronary sinus unroofing and bidirectional Glenn shunt.
An 11-month-old boy with a functionally single ventricle, coronary sinus ostial atresia, and bilateral superior vena cava (SVC) underwent coronary sinus unroofing upon a right bidirectional cavopulmonary shunt. A persistent left SVC left open to guarantee dual coronary venous drainage became dilated with cephalocaudal blood flow reversal and desaturation. The left SVC was surgically ligated on postoperative day 35.