Pediatr Crit Care Me
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To describe the various surgical options, perioperative management strategies, and outcomes for this complex lesion. ⋯ L-transposition of the great arteries is a relatively rare defect, comprising less than 1% of all congenital heart defects. There is considerable heterogeneity in clinical presentation depending on the presence of associated defects. Surgery for this rare and complex defect has evolved from "physiologic" repair in which the right ventricle remains in the systemic position to the "anatomic" repair, which restores the left ventricle as the systemic ventricle. There has been a great interest in performing the anatomic repair or "double switch" operation, a rather complex operation that presents unique challenges in the postoperative period.
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In this review, we discuss the physiology, pathophysiology, and clinical role of troponin, lactate, and B-type natriuretic peptide in the assessment and management of children with critical cardiac disease. ⋯ Lactate, troponin, and B-type natriuretic peptide continue to be valuable biomarkers in the assessment and management of critically ill children with cardiac disease. However, the use of these markers as a single measurement is handicapped by the wide variety of clinical scenarios in which they may be increased. The overall trend may be more useful than any single level with a persistent or rising value of more importance than an elevated initial value.
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The objective of this article is to review the particular tendencies as well as specific concerns of bleeding and clotting in children with critical cardiac disease. ⋯ Children with critical heart disease are at particular risk for bleeding and clotting secondary to intrinsic as well as extrinsic factors. We hope that this review will aid the clinician in managing the unique challenges of bleeding and clotting in this patient population, and serve as a springboard for much needed research in this area.
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Pediatr Crit Care Me · Aug 2016
ReviewLeft Ventricular Outflow Tract Obstruction: Coarctation of the Aorta, Interrupted Aortic Arch, and Borderline Left Ventricle.
The objectives of this review are to discuss the perioperative management of coarctation of the aorta, interrupted aortic arch, and the borderline left ventricle. ⋯ Successful management of systemic obstructive lesions involves a thorough evaluation of the anatomy and pathophysiology to determine the most effective management strategy.
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Pediatr Crit Care Me · Aug 2016
ReviewFunction of the Left and Right Ventricles and the Interactions Between Them.
There has been a recent increase in our understanding of mechanisms whereby the two sides of the heart interact and modulate each other that may be particularly relevant to patients in the ICU. For this review, our objectives are to examine the function of the left ventricle, consider some of the ways in which the function of the right ventricle differs from that of the left, and examine the effects of the left ventricle on the function of the right and vice versa. ⋯ There are fundamental differences between the function of the left and right ventricles, which relate to a significant extent to differences in their respective arterial loads. Although traditionally it has been usual to consider the function of the left and right ventricle in isolation, it is now recognized that this approach is flawed and as a result there is an increasing appreciation of the continual cross talk between the two sides of the heart in both the normal and diseased states. A more rational approach to the use of standard therapies frequently used in the cardiac ICU will come from a better understanding of these important fundamental concepts, and novel therapeutic concepts are already emerging from new data regarding biventricular interactions.