Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2008
ReviewPerioperative neuroprotective strategies.
Long-term neurodevelopmental impairment is common in newborns and infants undergoing corrective or palliative congenital heart surgery. The etiologies of neurodevelopmental morbidity in these children are multifactorial and include prenatal, preoperative, intraoperative, and postoperative factors. Perioperative neurologic monitoring is thought to be integral to prevention or rescue from adverse neurologic events. ⋯ Periventricular leukomalacia and other serious neurologic injury can be minimized by an optimized perfusion strategy of continuous high-flow, high hematocrit cardiopulmonary bypass, minimal use of deep hypothermic circulatory arrest, antegrade cerebral perfusion during aortic arch reconstruction, pH-stat blood gas strategy, and cerebral monitoring with NIRS and trans-cranial Doppler. Because there is evidence that brain injury can also occur in the prenatal, preoperative, and postoperative periods, improved strategies to prevent injury in these arenas are much needed. Extensive further clinical investigation is warranted to identify neuroprotective management strategies for the operating room and intensive care unit to preserve neurologic function and optimize long-term neurodevelopmental outcomes in children with congenital heart disease.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2008
ReviewCongenital heart surgery in developing countries.
This article reviews the challenges in caring for individuals with congenital heart disease in developing countries and is drawn in part from the author's Presidential Address to the American Association for Thoracic Surgery in Philadelphia, May 2006. Economic globalization is resulting in demographic and lifestyle changes which are increasing the incidence of ischemic heart disease worldwide. ⋯ The incidence of congenital heart disease is stable, but earlier and more accurate diagnosis is rapidly increasing the numbers of children needing the services of a congenital cardiac surgery team. Many opportunities for philanthropy are available, but care should be taken to assist in the most meaningful way by working with a long-term educational program and avoiding surgical tourism.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2008
ReviewPediatric lung transplantation: a therapy in its adolescence.
Pediatric lung transplant was born at the University of Toronto as an extension of the pioneering work of Cooper and Patterson in adult lung transplant in the 1980s. Through the 1990s, the field of pediatric lung transplantation grew with clinical outcomes in the largest centers being comparable to those in adult lung transplantation. For children and adults, the largest obstacle to long-term survival remains chronic allograft rejection secondary to the development of bronchiolitis obliterans, for which little advancement has been made in prevention or treatment. ⋯ Another factor limiting pediatric lung transplant has been the paucity of suitable donor lungs. In 2002, Texas Children's Hospital and the Baylor College of Medicine successfully collaborated in developing an active and successful pediatric lung transplant program. Through our own work and an international collaborative of pediatric transplant pulmonologists and surgeons, we are hoping to move the field of pediatric lung transplant out of its "adolescence" into adulthood.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2007
ReviewIntraoperative echocardiography for atrioventricular canal: decision-making for surgeons.
Intraoperative echocardiography has become a standard patient management tool in the assessment of the patient undergoing surgical repair of a congenital cardiac defect. Over the past 15 years transesophageal echocardiography has emerged as an integral part of the intraoperative assessment of the congenital cardiac surgery patient. ⋯ Intracardiac defects are particularly suited to the strengths of intraoperative transesophageal echocardiography because of the unobstructed windows that can be obtained. This article focuses on how intraoperative echocardiography can guide surgical decision-making in the patient undergoing repair of an atrioventricular canal defect.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2007
The double patch repair for complete atrioventricularis communis.
This article is a review of our experience with the two-patch repair of complete atrioventricularis communis. From October 1988 through December 2005, 222 infants and children underwent surgery. ⋯ All patients survived second operations and no child required early or late mitral valve replacement. The two-patch repair is a reliable surgical technique resulting in low mortality and a low need for reoperation.