Pediatric cardiology
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Pediatric cardiology · Sep 2007
ReviewSensitivity and specificity of echocardiographic evidence of tamponade: implications for ventricular interdependence and pulsus paradoxus.
The reported sensitivity of the echocardiographic finding of right atrial collapse for the diagnosis of tamponade ranges from 50% to100%; specificities have ranged from 33% to 100%. Its sensitivity in identifying right ventricular collapse ranges from 48% to 100% whereas the specificity ranges from 72% to 100%. Collapse of either the right atrium or right ventricle is not reliable except in cases where the risk of tamponade is high, consistent with Bayes' theorem. ⋯ To explain pulsus paradoxus, most echocardiographic reports have invoked Dornhorst's theory that inspiratory filling of the right ventricle actively collapses the left ventricle by successfully competing for a fixed total pericardial space ("ventricular interdependence"). However, the pericardial space is not fixed in tamponade but increases with inspiration, and the right heart is much more likely to collapse than the left, given their relative thickness. Pulsus paradoxus depends on the inspiratory surge to the right heart, exaggerated by the small stroke volume of both ventricles induced by tamponade, and vascular coupling between the pulmonary and systemic beds, with a transit time of one to two heart beats.
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Pediatric cardiology · Sep 2007
Case ReportsUse of dexmedetomidine in patients with trisomy 21 after cardiac surgery.
Children with trisomy 21 have a high incidence of congenital heart disease that frequently requires surgical repair. These patients often require multiple and higher dosage sedatives during the postoperative period. Dexmedetomidine is an alpha(2)-adrenergic receptor agonist that has sedative, analgesic, and anxiolytic properties. We report the successful use of dexmedetomidine in patients with trisomy 21 following surgical repair of congenital heart disease.
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Pediatric cardiology · Jul 2007
Case ReportsLong-term support with milrinone prior to cardiac transplantation in a neonate with left ventricular noncompaction cardiomyopathy.
A 2-week-old female infant presented with acute decompensated left ventricular failure. Echocardiography diagnosed left ventricular noncompaction cardiomyopathy with dilated phenotype and a left ventricular shortening fraction <10%. ⋯ She was maintained on intravenous milrinone for 6 months until she underwent successful orthotopic heart transplantation. Young children can be supported with inotropes for prolonged periods while awaiting heart transplantation.
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Pediatric cardiology · Jul 2007
Case ReportsSingle coronary artery with fistula, right aortic arch, bicuspid aortic valve, and pulmonary stenosis: a rare combination.
We report a case of a 10-month-old Chinese girl with single left coronary artery, left coronary artery-to-right ventricle fistula, pulmonary stenosis, and right aorta arch with bicuspid aortic valve. The diagnosis was made by transthoracic echocardiography and confirmed by angiography. A surgical repair was performed with closure of the fistula at the point where it drained into the right ventricle plus a pulmonary valvulotomy.
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Diverticulum of Kommerell is an outpouching from the descending aorta that, along with an aberrant subclavian artery and ductus arteriosus, may form a vascular ring compressing the trachea and/or the esophagus. It has been reported as an incidental finding as well as the cause of persistent dysphagia, cough, "asthma," or airway compromise at various ages but has never been reported as a cause of esophageal atresia in a newborn. We present a newborn with diverticulum of Kommerell, a vascular ring, and esophageal atresia.