World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Jul 2012
Plastic bronchitis in patients with fontan physiology: review of the literature and preliminary experience with fontan conversion and cardiac transplantation.
Plastic bronchitis is a rare, life-threatening condition characterized by the formation of mucofibrinous casts within the pulmonary bronchi. In patients with congenital heart disease, it is most frequently observed in single ventricular anatomies after Fontan palliation. The pathophysiology of plastic bronchitis remains unknown, and a consistently effective treatment strategy has yet to be identified. ⋯ The second underwent cardiac transplantation and has been free of bronchial casts for over one year. In addition, we explore the similarities between plastic bronchitis and protein-losing enteropathy, considering theories of their pathophysiologic mechanisms and reports of mutually effective treatment strategies. We propose that bronchial cast formation may result from the confluence of genetic makeup, inflammation, and the Fontan physiology and conclude that further investigation into therapies directed at these factors is merited.
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World J Pediatr Congenit Heart Surg · Apr 2012
Prognostic value of perioperative near-infrared spectroscopy during neonatal and infant congenital heart surgery for adverse in-hospital clinical events.
Perioperative monitoring with multisite near-infrared spectroscopy (NIRS) for congenital cardiac surgery with cardiopulmonary bypass may aid in predicting adverse clinical outcomes. ⋯ At bypass conclusion, 10 minutes of MUF does not adversely affect cerebral or renal NIRS. Left and right cerebral NIRS are equal, so that biparietal cerebral NIRS monitoring is probably not warranted. Perioperative cerebral and renal NIRS readings, respectively, below 45% and 40% correlate with ECMO/death and renal NIRS below 30% with prolonged ICU stay. Cerebral NIRS and lactate levels showed a strong inverse correlation during the first six postoperative hours.
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World J Pediatr Congenit Heart Surg · Apr 2012
Air transported pediatric rescue extracorporeal membrane oxygenation: a single institutional review.
Pediatric extracorporeal membrane oxygenation (ECMO) programs are sophisticated endeavors usually found only in high-volume cardiac surgical programs. Worldwide, many cardiology programs do not have on-site pediatric cardiac surgery expertise. Our single-center experience shows that an organized multidisciplinary rescue-ECMO program, in collaboration with an accepting facility, can achieve survival rates comparable to modern era on-site ECMO. ⋯ Our rescue-ECMO survival results were comparable to that of current published results from established pediatric ECMO programs. Air transport of ECMO patients can be performed safely using an organized multidisciplinary team approach.
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World J Pediatr Congenit Heart Surg · Jan 2012
Dexmedetomidine-ketamine sedation in a child with a mediastinal mass.
Sedation during invasive procedures provides appropriate humanitarian care as well as facilitates the completion of procedures. Although generally safe and effective, adverse effects may occur especially in patients with comorbid diseases. ⋯ We present the use of a dexmedetomidine-ketamine combination for procedural sedation in a three-year-old child who presented with a large mediastinal mass and respiratory compromise. Previous reports regarding the use of dexmedetomidine and ketamine for procedural sedation are reviewed and the potential efficacy of this combination is discussed.
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World J Pediatr Congenit Heart Surg · Jan 2012
To cool or not to cool during cardiopulmonary resuscitation.
Therapeutic hypothermia following cardiac arrest improves neurologic outcome following adult ventricular fibrillation (VF) cardiac arrest and perinatal hypoxic ischemic encephalopathy. Evaluation of therapeutic hypothermia in the pediatric cardiac arrest population has been limited thus far to retrospective evaluations and to date there have been no published prospective efficacy trials. Two retrospective pediatric cohort studies showed no benefit from hypothermia compared to usual care. ⋯ Despite this, rewarming has been identified as a vulnerable time for hypotension and seizure activity and may attribute to worse outcome. The American Heart Association's current recommendation is "therapeutic hypothermia (32-34°C) may be considered for children who remain comatose after resuscitation from cardiac arrest. It is reasonable for adolescents resuscitated from sudden, witnessed, out-of-hospital VF cardiac arrest." Ongoing research will help delineate whether induced hypothermia following pediatric cardiac arrest improves neurologic outcome.