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
Multimodality neuromonitoring for pediatric cardiac surgery: our approach and a critical appraisal of the available evidence.
Brain injury remains a source of morbidity associated with congenital heart surgery. Intraoperative neuromonitoring is used by many centers to help minimize neurologic injury and improve outcomes. ⋯ A review of the literature regarding neuromonitoring studies in pediatric cardiac surgery shows that evidence is limited to demonstrate that intraoperative neuromonitoring is associated with improved neurologic outcomes. Further clinical research is needed to assess the utility and cost-effectiveness of intraoperative neuromonitoring for pediatric heart surgery.