Pediatric cardiology
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Pediatric cardiology · Apr 2018
Age-Dependent Association Between Pre-transplant Blood Transfusion and Outcomes of Pediatric Heart Transplantation.
Avoidance of red blood cell (RBC) transfusions in patients awaiting heart transplantation (HTx) has been suggested to minimize the risk of allosensitization. Although recent studies have suggested that an immature immune system in younger HTx recipients may reduce risks associated with RBC transfusion, the role of age in moderating the influence of transfusion on HTx outcomes remains unclear. We used available data from a national transplant registry to explore whether the association between pre-transplant transfusions and outcomes of pediatric HTx varies by patient age. ⋯ By age 8, the association between pre-transplant transfusions and post-transplant mortality was no longer statistically significant (HR = 1.15; 95% CI 0.99, 1.32; p = 0.060). Pre-transplant transfusions were associated with increased mortality hazard only among younger children (age < 8 years) undergoing HTx. These data support the current practices of transfusion avoidance prior to HTx, particularly in younger patients.
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Pediatric cardiology · Mar 2018
Correction to: Routine Sildenafil Does Not Improve Clinical Outcomes After Fontan Operation.
The original version of this article unfortunately contained a mistake. The presentation of Table 2 was incorrect. The corrected table is given below.
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Pediatric cardiology · Mar 2018
Impact of Bicuspid Aortic Valve Morphology on Aortic Valve Disease and Aortic Dilation in Pediatric Patients.
Bicuspid aortic valve (BAV) is the most common congenital heart defect. BAV is associated with aortic stenosis and insufficiency, and aortic dilation in adult groups, but data in pediatric groups are limited. We sought to assess the impact of BAV morphology on aortic valve disease and aortic dilation in pediatric patients. ⋯ Patients with the highest weights had larger aortas (p < 0.001), but the absolute difference between the highest and lowest weight groups was small (1.5 mm). The impact of BAV morphology on aortic valve disease and aortic dilation in pediatric patients presages that seen in adults. Patient body weight does not make significant clinical impacts on aortic diameters, suggesting that Z scores for aortic diameters should be based on ideal body weights.
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Pediatric cardiology · Mar 2018
Low Peak dP/dt in the Descending Aorta in Patients After Successful Aortic Arch Repair.
One of the most important problems in patients with aortic coarctation or interruption of the aortic arch after successful aortic arch repair is developing cardiovascular disease in the future. It has been reported that the repaired site is stiff and generates a new pressure wave reflection, which could lead to cardiovascular disease. The purpose of this study was to clarify the influence of the repaired portion's stiffness on the pressure waveform in patients. ⋯ Although no difference existed in the peak dP/dt in the AAo between the aortic arch repair patients and the controls (572.1 ± 100.1 vs. 543.3 ± 110.2 mmHg/s, p = 0.460), the peak dP/dt in the DAo in the aortic arch repair patients was significantly lower than that in the controls (489.3 ± 75.2 vs. 579.4 ± 106.0 mmHg/s, p = 0.013). The peak dP/dt in the DAo in aortic arch repair patients is low. The stiff repaired site may attenuate pulsation.
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Pediatric cardiology · Feb 2018
Multicenter StudyLongitudinal Myocardial Deformation Does Not Predict Single Ventricle Ejection Fraction Assessed by Cardiac Magnetic Resonance Imaging in Children with a Total Cavopulmonary Connection.
Survival of children with single ventricle heart defects after the total cavopulmonary connection (TCPC) has improved, but impaired cardiac function remains a major cause of morbidity and mortality. Cardiac magnetic resonance imaging (cMRI) is the gold standard in assessing single ventricle volume and function, but high costs and limited availability hamper its routine use. A cheaper and more available alternative is echocardiography. ⋯ Pearson R for cMRI EF versus global longitudinal strain and SR was - 0.25 (p = 0.06) and - 0.03 (p = 0.82), respectively. Global single ventricle longitudinal strain and SR was similar in patients after TCPC with single left and single right ventricular morphology (- 19.0 ± 3.1% vs 19.2 ± 3.2%, p = 0.94). STE myocardial deformation parameters do not correlate with single ventricle ejection fraction assessed by cMRI.