Pediatric cardiology
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Pediatric cardiology · Nov 2009
Case ReportsVentricular septal rupture in a 4-year-old child following blunt chest injury.
We report on a 4-year-old child who developed rupture of the ventricular septum after a blunt chest injury. The symptoms appeared more than 12 h later with progressive deterioration in his hemodynamic status. The diagnosis was made by echocardiography and the large defect in the muscular part of the ventricular septum was successfully closed at surgery.
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Pediatric cardiology · Nov 2009
Mean pulmonary artery pressure estimated from systolic and diastolic pulmonary artery pressure in children with congenital heart disease: an invasive study.
This hemodynamic study documented the accuracy and precision of six empirical formulas relating mean (mPAP), systolic (sPAP), and diastolic (dPAP) pulmonary artery pressures in children with congenital heart disease. Fluid-filled PAPs of 61 children (age, 26 +/- 40 months) were analyzed over an mPAP range of 7 to 74 mmHg. All formulas were accurate (mean bias, -2 to 1 mmHg). ⋯ They were less precise (bias SD, 5-6 mmHg), with biases greater than 7 mmHg for 10% to 16% patients. Accurate estimates of mPAP were obtained from sPAP alone, and this could be valuable for cross-checking the self-consistency of the pressure database obtained in the echo-Doppler laboratory. For cases that had reliable dPAP estimates available, empirical formulas relying on both sPAP and dPAP were more precise and thus must be preferred.
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This study aimed to determine the prevalence of hyperglycemia among pediatric postoperative cardiac patients, its impact on outcomes, and whether hyperglycemia can be controlled effectively in this population. A retrospective chart review of 100 postoperative patients admitted to the authors' pediatric cardiac intensive care unit (ICU) was conducted. Patients were evaluated for incidence of hyperglycemia, defined as blood glucose (BG) level exceeding 7.7 mmol/l (140 mg/dl), and outcomes. ⋯ No patient had a BG level lower than 2.2 mmol/l (40 mg/dl) during glycemic management. Severe hyperglycemia is prevalent among postoperative pediatric cardiac patients and correlates with morbidity and mortality. Hyperglycemia may be controlled effectively in these patients using a pediatric-specific glycemic control protocol without increasing the incidence of hypoglycemia.
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Pediatric cardiology · Oct 2009
Case ReportsTetralogy of Fallot with aortic stenosis: repair without aortic valve intervention.
A 14-day-old boy with tetralogy of Fallot (ToF), ductus-dependent pulmonary circulation, and significant aortic valve stenosis (AVS) underwent primary repair of ToF without aortic valve intervention. The pressure gradient through the aortic valve decreased spontaneously after the operation. This may have been due to the reduction of blood flow through the aortic valve postoperatively. For patients with ToF, AVS, and ductus-dependent circulation, ToF repair alone may alleviate the severity of the AVS.
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Pediatric cardiology · Oct 2009
Comparative StudyComparison of S100B and NSE between cardiac surgery and interventional therapy for children.
This study aimed to compare the release of S100B and NSE between cardiac surgery and interventional therapy for children and to investigate whether S100B serum concentration correlates with cardiopulmonary bypass in children. For this study, 40 children with congenital heart disease were selected and assigned to two groups: group A (20 children undergoing surgical therapy) and group B (20 children undergoing interventional therapy). In group A, blood samples were drawn 10 min after the induction of anesthesia, immediately after aortic cross-clamping, immediately at the end of cardiopulmonary bypass (CPB), immediately at the end of the operation, then 6 and 24 h after the operation. ⋯ In group B, the differences in S100B and NSE between the post- and preoperative levels were not statistically significant (p > 0.05). The perioperative cerebral impairment indirectly evaluated by the release of NSE and S100B protein is greater in children undergoing CPB than in children undergoing interventional therapy. The release of S100B had a strong correlation with the durations of CPB and aortic cross-clamping in children.