Pediatric cardiology
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Pediatric cardiology · Jul 2004
Comparative StudyB-type natriuretic peptide levels in congenital heart disease.
The objective of this study was to evaluate the potential role of B-type natriuretic peptide (BNP) levels in children with congenital heart disease undergoing cardiac catheterization. Measurement of plasma BNP concentration has been shown to be useful in the diagnosis, risk stratification, and management of adult patients with congestive heart failure, but little is known about the role of BNP in children with structural congenital heart disease. We measured plasma BNP levels using the Triage BNP test in patients with congenital heart disease referred for diagnostic or interventional cardiac catheterization. ⋯ The pressure difference between the left ventricle and ascending aorta was 10-110 mmHg in 21 patients. BNP concentrations for this cohort ranged from < 5.0 to 1060.0 pg/ml and correlated with the degree of left ventricular outflow obstruction (correlation coefficient, 0.661; p = 0.001). This study suggests that with additional research, BNP concentration may prove to be a useful clinical tool in managing children and adults with congenital heart disease.
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Pediatric cardiology · Jul 2004
Comparative StudyRisk factors for neo-aortic root enlargement and aortic regurgitation following arterial switch operation.
The objectives of this study were to evaluate changes in dimension of the neo-aortic annulus, aortic root, and aortic anastomosis following arterial switch operation (ASO) and to identify risk factors for developing abnormal neo-aortic root enlargement and aortic regurgitation (AR). Prior studies report development of neo-aortic root dilatation and AR in a small subset of patients after ASO. Predisposing factors for neo-aortic root dilatation and development of moderate/severe AR are poorly understood. ⋯ Despite the significant prevalence of neo-aortic root enlargement at intermediate follow-up after ASO, there is a low incidence of significant AR. Prior PA banding, the presence of VSD, and Taussig-Bing anatomy are risk factors for severe root enlargement. Surgical intervention for AR was rare (2%), however, serial surveillance of such patients is vital to monitor for neo-aortic root enlargement and potential aortic valve dysfunction.
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Pediatric cardiology · Jul 2004
Comparative StudyUtility of B-type natriuretic peptide in differentiating congestive heart failure from lung disease in pediatric patients with respiratory distress.
Plasma B-type natriuretic peptide (BNP) has been reported to be helpful in differentiating cardiac from pulmonary etiologies of dyspnea in adults. We investigated whether BNP concentration could be applied similarly in children with respiratory distress. BNP levels were measured using a rapid immunoassay in 49 infants and children presenting with acute respiratory distress. ⋯ Fifteen of 23 CHF patients had ventricular volume overload from left-to-right shunting congenital heart defects and 8/23 had left ventricular systolic dysfunction. Age-adjusted comparison of the two subgroups of CHF patients revealed that children with left ventricular systolic dysfunction had significantly higher mean BNP levels than those with left-to-right shunts (1181+/-487 vs 433+/-471 pg/ml, p = 0.0074). We conclude that BNP level is of value in differentiating cardiac from pulmonary causes of respiratory distress in children.
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Pediatric cardiology · Jul 2004
Case ReportsDefibrillator implantation in a child with long QT syndrome.
We report the placement of an implantable cardiac defibrillator as preventative treatment in a 2-year-old with long QT syndrome.
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Pediatric cardiology · Mar 2004
Comparative StudyComparison between cardiac output measured by the pulmonary arterial thermodilution technique and that measured by the femoral arterial thermodilution technique in a pediatric animal model.
This study compares the correlation between two methods for the determination of cardiac output-the pulmonary arterial thermodilution technique using the Swan-Ganz catheter and the femoral arterial thermodilution technique using a pulse contour analysis computer (PiCCO) catheter. We performed a prospective animal study using 16 immature Maryland pigs weighing 9 to 16 kg. A 5.5- or 7.5-Fr Swan-Ganz catheter was introduced into the femoral or jugular vein, and a 4- or 5-Fr arterial PiCCO catheter was introduced into the femoral artery. ⋯ Good correlation was found between the two methods: single-measure intraclass correlation was 0.8892 (95% confidence interval, 0.54-0.95). There were no differences between the 5.5- and 7.5-FR Swan-Ganz catheters or between the 4- and 5-Fr PiCCO catheters. Femoral arterial thermodilution cardiac output measurements correlated well with pulmonary arterial thermodilution cardiac output measurements in a pediatric animal model.