Pediatr Crit Care Me
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The objectives of this review are to discuss the global epidemiology of cardiovascular disease, emphasizing congenital heart disease; to discuss the concept of epidemiologic transition and its role in studying the evolving epidemiology of disease; and to assess and address the global burden of congenital heart disease including its prevention and treatment. ⋯ Despite impressive reductions in mortality from congenital and acquired cardiovascular disease in high-income countries, these reductions have not been observed on a global scale. It will be necessary to continue our attempts to extend rational programs of care to middle- and low-income countries based on community empowerment, economics, and population health. The specialist in pediatric cardiac critical care can be a central driver of these programs.
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Pediatr Crit Care Me · Aug 2016
ReviewFluid Management: Pharmacologic and Renal Replacement Therapies.
Focusing on critically ill children with cardiac disease, we will review common causes of fluid perturbations, clinical recognition, and strategies to minimize and treat fluid-related complications. ⋯ Meticulous fluid management is vital in critically ill children with cardiac disease. Fluid therapy is important to maintain adequate blood volume and perfusion pressure in order to support cardiac output, tissue perfusion, and oxygen delivery. However, fluid overload and acute kidney injury are common and are associated with increased morbidity and mortality. Understanding the etiologies for disturbances in volume status and the pathophysiology surrounding those conditions is crucial for providing optimal care.
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Pediatr Crit Care Me · Aug 2016
ReviewVentricular Assist Devices in Pediatric Cardiac Intensive Care.
The objectives of this review are to discuss the process of patient and mechanical device selection, operative management, and postoperative care with a focus on the management of right ventricular failure, anticoagulation strategies, device-related infections and neurologic sequelae. ⋯ The number of patients with advanced heart failure due to either acquired or congenital heart disease continues to increase, necessitating in some mechanical circulatory support and in others cardiac transplantation. With a limited cardiac donor pool, mechanical circulatory support is playing a greater role in the management of this population. The perioperative morbidity associated with mechanical circulatory support has lessened with improved postoperative management strategies.
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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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The objectives of this review are to discuss the spectrum of coronary artery anomalies and the evidence behind current treatment strategies. ⋯ Coronary artery anomalies exist in up to 1% of the population and most of these do not cause symptoms or ischemia and do not require any surgical intervention whereas others are potentially fatal. The type of surgical intervention is often dictated by the type of lesion, and upon the unique anatomic and physiologic variables associated with each lesion. Postoperative care can be challenging particularly after surgical repair of anomalous left coronary artery from the pulmonary artery.