Pediatric cardiology
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Pediatric cardiology · Apr 2011
Comparative StudyAtypical Shone's complex diagnosed by echocardiography.
Shone's complex is a rare and severe type of congenital left-sided obstructive lesion of multiple cardiovascular levels. This report aims to present the authors' experience diagnosing atypical Shone's complex using echocardiography. Atypical Shone's complex was diagnosed for 38 consecutive patients (18 boys and 20 girls, ages 1 day to 15 years) using echocardiography. ⋯ Of these, focal coarctation was described in 15 cases, long segment coarctation in 7 cases, and dysplastic isthmus and/or descending aorta in 4 cases. Secondary changes in Shone's complex manifested as left atrial dilation (26 cases), left ventricular hypertrophy (26 cases), and pulmonary hypertension (19 cases). Echocardiography plays an important role in the diagnosis of atypical Shone's complex, in comprehensive evaluation of the number, position, morphology, and severity of left-sided obstructions.
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Pediatric cardiology · Apr 2011
Randomized Controlled Trial Multicenter Study Comparative StudyCeliac artery flow pattern in infants with single right ventricle following the Norwood procedure with a modified Blalock-Taussig or right ventricle to pulmonary artery shunt.
A potential advantage of the right ventricle to pulmonary artery versus modified Blalock-Taussig shunt in patients undergoing the Norwood procedure is limitation of diastolic runoff from the systemic to pulmonary circulation. We evaluated mesenteric flow patterns and gastrointestinal outcomes following the Norwood procedure associated with either shunt type. Patients randomized to a right ventricle to pulmonary artery versus modified Blalock-Taussig shunt in the Pediatric Heart Network Single Ventricle Reconstruction Trial at centers participating in this ancillary study were eligible for inclusion; those with active necrotizing enterocolitis, sepsis, or end-organ dysfunction were excluded. ⋯ Median celiac artery resistive index (an indicator of resistance to perfusion) was higher in the modified Blalock-Taussig shunt group (n = 19) versus the right ventricle to pulmonary artery shunt group (n = 25) [1.00 (IQR = 0.84-1.14) vs. 0.82 (IQR = 0.74-1.00), p = 0.02]. There was no difference in interstage weight gain, necrotizing enterocolitis, or feeding intolerance episodes between the groups. The celiac artery resistive index was higher in patients with the modified Blalock-Taussig shunt versus the right ventricle to pulmonary artery shunt but was not associated with measured gastrointestinal outcomes.
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Pediatric cardiology · Apr 2011
Comparative StudyMeasurement of cardiac output in children by bioreactance.
The objective of this study was to evaluate a new bioreactance method for noninvasive cardiac output (CO) measurement (NICOM) in children. Ten patients between 1 and 144 months of age and with no hemodynamic disturbances were studied. Using bioreactance, heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) measurements were made every 6-8 h. ⋯ Significant differences in CI (P < 0.001) were detected between children weighing <10 kg (1.9 ± 0.73 l/min/1.73 m(2); range 1-3.2), 10-20 kg (2.07 ± 0.7 l/min/1.73 m(2); range 1-3.6), and >20 kg (3.7 ± 0.8 l/min/1.73 m(2); range 2.4-4.9). We conclude that the CI measured by bioreactance in children varies with the age and weight of the patients and is lower than the normal range in a large percentage of measurements. These data suggest that this method is not useful for evaluating CI in small children.
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Pediatric cardiology · Apr 2011
Comparative StudyRed blood cell transfusion for infants with single-ventricle physiology.
The purpose of this study was to assess how red blood cell (RBC) transfusions impact hemodynamic parameters in infants with single-ventricle lesions. This was a retrospective chart review. The setting was a pediatric cardiac intensive care unit at a tertiary care children's hospital. ⋯ In group C, only arterial saturation values increased significantly. RBC transfusions can improve hemodynamics and markers of oxygen delivery in infants with single-ventricle physiology, but further studies are needed to determine an optimal Hgb level in this population. Interventions to increase Hgb above this level may be of limited benefit.
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Pediatric cardiology · Apr 2011
Comparative StudyComparison of gastrointestinal morbidity after Norwood and hybrid palliation for complex heart defects.
This study aimed to compare the incidence of gastrointestinal complications among infants with single-ventricle heart defects after three first-stage palliation strategies: Norwood-modified Blalock-Taussig shunt (mBTS), Norwood right ventricle-to-pulmonary artery conduit (Sano), and hybrid procedures. A retrospective chart review was performed in a pediatric cardiac intensive care unit at a tertiary care medical center. The subjects were 32 neonates who had undergone single-ventricle palliation including 13 Norwood-mBTS, 11 Sano, and 8 hybrid procedures. ⋯ Gastrointestinal morbidity was common regardless of the palliative approach, although the hybrid patients had the highest incidence of intraabdominal complications. This supports the need for caution in using enteral nutrition with all single-ventricle patients, including the hybrid population. Patients undergoing the hybrid procedure may benefit from implementation of standardized feeding protocols.