Pediatric cardiology
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Pediatric cardiology · Jan 2013
Impact of chest X-ray before discharge in asymptomatic children after cardiac surgery--prospective evaluation.
In many paediatric cardiac units chest radiographs are performed routinely before discharge after cardiac surgery. These radiographs contribute to radiation exposure. To evaluate the diagnostic impact of routine chest X-rays before discharge in children undergoing open heart surgery and to analyze certain risk factors predicting pathologic findings. ⋯ Risk factor analysis showed only pulmonary complications during PICU stay to be significantly associated (p = 0.005) with pathologic X-ray findings. Routine chest radiographs before discharge after cardiac surgery can be omitted in asymptomatic children with an uneventful and straightforward perioperative course. Chest radiographs before discharge are warrantable if pulmonary complications did occur during their PICU stay, as this is a risk factor for pathologic findings in chest X-rays before discharge.
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Pediatric cardiology · Jan 2013
Case ReportsIsolated total anomalous systemic venous drainage in an adult: case report.
Total anomalous systemic venous drainage is a rare form of congenital heart disease. All the systemic venous flow from the body (i.e., from the superior vena cava, inferior vena cava, and coronary sinus) drains abnormally into the left atrium. ⋯ This disorder may be associated with heterotaxy syndromes. This report describes a patient with unique total anomalous systemic venous drainage that was successfully corrected surgically.
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Pediatric cardiology · Jan 2013
Cerebral oximetry monitoring during preoperative phlebotomy to limit allogeneic blood use in patients undergoing cardiac surgery.
Preoperative phlebotomy can minimize the need for allogenic blood products. Frequently, removed blood is replaced with intravenous fluids to maintain euvolemia (acute normovolemic hemodilution [ANH]). During cardiopulmonary bypass (CPB), ANH may present problems when the circuit prime causes further hemodilution and unacceptably low hemoglobin. ⋯ A decrease in rSO(2) occurred more commonly in younger patients and those who had a larger volume of blood removed. Preoperative phlebotomy without significant volume replacement can be performed safely before CPB. Volume replacement may be more appropriately guided by rSO(2) than by hemodynamic variables.
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Pediatric cardiology · Jan 2013
Feasibility of pulse oximetry screening for critical congenital heart disease at 2643-foot elevation.
To evaluate the feasibility of implementing a pulse oximetry screening protocol at a city of mild elevation with a specific focus on the false-positive screening rate. Pulse oximetry screening was performed according to the proposed guidelines endorsed by the American Academy of Pediatrics at a center in Tucson, AZ, at an elevation of 2,643 ft (806 m). During a 10-month period in 2012, 1069 full-term asymptomatic newborns were screened ≥ 24 h after birth. ⋯ The pulse oximetry screening guidelines recommended by the American Academy of Pediatrics are feasible at an elevation of 2,643 ft (806 m) with a low false-positive rate. Adjustments to the protocol are not required for centers at elevations ≤ 2,643 ft. Future studies at greater elevations are warranted.
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Pediatric cardiology · Jan 2013
Case ReportsA triple challenge: thrombocytopenia in a 7-year-old girl with unrepaired d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension.
Thrombocytopenia can be a real challenge during cardiac surgery in children with cyanotic congenital heart disease. This report describes a 7-year-old girl with d-transposition of the great arteries, ventricular septal defect, pulmonary hypertension, chronic thrombocytopenia, polycythemia, and chronic renal impairment. The thrombocytopenia improved several days after splenectomy. The child then underwent a successful arterial switch operation with ventricular septal defect closure.