Pediatric cardiology
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Pediatric cardiology · Apr 2013
Intact right ventricle-pulmonary artery shunt after stage 2 palliation in hypoplastic left heart syndrome improves pulmonary artery growth.
For patients with hypoplastic left heart syndrome who have undergone the Norwood procedure with a right ventricle-pulmonary artery (RV-PA) shunt, the shunt can either be removed or left intact at the time of the stage 2 procedure. This study aimed to determine the effects of an intact shunt on pulmonary artery growth and clinical outcomes after the stage 2 procedure. A retrospective review of patients who underwent Norwood with an RV-PA shunt from 2005 to 2010 was performed. ⋯ Before Fontan, the group 2 patients had higher superior vena cava (SVC) pressures and more venovenous collaterals closed. There was increased pulmonary artery growth between the pre-stage 2 and pre-Fontan catheterizations in group 2 using both the Nakata Index (+148.5 vs -52.4 mm(2)/m(2); p = 0.01) and the McGoon Ratio (+0.36 vs +0.01; p = 0.01). These findings indicate that patients with an intact RV-PA shunt after stage 2 have greater pulmonary artery growth than patients with the shunt removed, with no increased risk of complications.
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Pediatric cardiology · Apr 2013
Coronary implantation using the autologous flap extension technique in complicated arterial switch operations.
The arterial switch operation (ASO) remains a challenging procedure, especially in cases with a complicated coronary anatomy. In recent years, the autologous flap extension technique has been used for coronary implantation in complicated ASOs. Operative techniques and indications are discussed in this report. ⋯ No ischemic electrocardiographic changes occurred. One patient underwent reoperation for supravalvular pulmonary stenosis 2 years later. The autologous flap extension technique for coronary implantation in complicated ASOs can decrease hospital mortality due to abnormal coronary arteries, especially for patients undergoing two-stage ASOs or patients whose main trunk of the right coronary artery or dilated right ventricular conus branch originates from the left- or right-facing sinus and follows an abnormal course of anterior looping to the aorta.
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Pediatric cardiology · Mar 2013
Comparative StudyMidterm survival of infants requiring postoperative extracorporeal membrane oxygenation after Norwood palliation.
This study reports the mid-term survival for neonates undergoing extracorporeal membrane oxygenation (ECMO) after Norwood palliation at a single center. Limited data exist on the mid-term survival of patients undergoing ECMO after Norwood palliation. We reviewed our ECMO experience from July 1994 to October 2008 and compared two groups: patients who required ECMO after Norwood palliation and patients who underwent Norwood palliation without ECMO. ⋯ Of the original Norwood/ECMO hospital survivors, only half of these patients survived a mean of nearly 4 years. ECMO after Norwood palliation is associated with significant mortality. Our data suggest that neonates who require ECMO after Norwood palliation are prone to continued attrition once discharged from the hospital.
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Pediatric cardiology · Mar 2013
Comparative StudyTissue Doppler imaging detects impaired biventricular performance shortly after congenital heart defect surgery.
Cardiac surgery with cardiopulmonary bypass is associated with the development of a systemic inflammatory response, which can lead to myocardial damage. However, knowledge concerning the time course of ventricular performance deterioration and restoration after correction of a congenital heart defect (CHD) in pediatric patients is sparse. Therefore, the authors perioperatively quantified left ventricular (LV) and right ventricular (RV) performance using echocardiography. ⋯ In conclusion, both systolic and diastolic biventricular performances were impaired shortly after CHD correction. This impairment was detected only by TDI parameters and TAPSE. Furthermore, a longer-lasting negative influence of cardiopulmonary bypass on myocardial performance was suggested.
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Pediatric cardiology · Mar 2013
Comparative StudyPrenatal diagnosis of congenital heart disease and birth outcomes.
This study was undertaken to examine the impact that prenatal diagnosis of congenital heart disease (CHD) has on birth and early neonatal outcomes. The prevalence of prenatally diagnosed CHD has risen over the past decade, but the effect that prenatal diagnosis of CHD has on peripartum decisions remains unclear. No consensus exists on the effect of prenatal diagnosis on neonatal outcomes. ⋯ Prenatal diagnosis did not have an impact on preoperative or predischarge mortality. Prenatal diagnosis was associated with increased odds of a scheduled delivery, birth before a gestational age of 39 weeks, and a decreased need for invasive respiratory support. Prenatal diagnosis of CHD was not associated with preoperative or predischarge mortality.