World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Jan 2012
Arterial switch operation with unidirectional valved patch closure of ventricular septal defect in patients with transposition of great arteries and severe pulmonary hypertension.
For patients with dextro-transposition of great arteries (d-TGAs), ventricular septal defect (VSD), and severe pulmonary arterial hypertension (PAH), the common surgical options are palliative arterial switch operation (ASO) or palliative atrial switch operation leaving the VSD open. We evaluated the role of ASO with VSD closure using a fenestrated unidirectional valved patch (UVP). ⋯ Arterial switch operation with UVP VSD closure is feasible with acceptable early results. It avoids complications of palliative atrial switch (arrhythmia and baffle obstruction) and partially or completely open VSD.
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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.
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World J Pediatr Congenit Heart Surg · Jan 2012
Intensive care of the pediatric ventricular assist device patient.
Utilization of ventricular assist devices (VADs) in children is increasing, as is the complexity of patients supported. We review the intensive care management of pediatric patients with VAD in the perioperative and rehabilitation phases, highlighting the technical aspects and physiology of VADs which impact care. Indications for VAD placement and the preoperative assessment of risk are discussed. Specific aspects of postoperative and long-term care including device troubleshooting, hemostasis and anticoagulation, support of the right ventricle, incidence and prevention of neurologic injury, and other complications are reviewed.
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World J Pediatr Congenit Heart Surg · Oct 2011
Mechanical ventilation in the pediatric cardiac intensive care unit: the essentials.
Ventilating a child or newborn in the postoperative course after repair of congenital heart disease requires a solid basic understanding of respiratory system mechanics (pressure-volume relationship of the respiratory system and the concept of its time constants) and cardiopulmonary physiology. Furthermore, careful attention has to be paid to avoid damaging the lungs by potentially injurious mechanical ventilation. ⋯ In the search for being less invasive, the use of noninvasive ventilation in the cardiac intensive care setting is rapidly increasing despite still lacking evidence of its theoretical superiority and requires good knowledge of specific techniques and equipment available for this approach in this setting. This review will address many of these aspects and highlight the essentials to be known when ventilating a child in the Cardiac Intensive Care Unit (CICU).
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World J Pediatr Congenit Heart Surg · Oct 2011
Outcomes analysis and quality improvement for the treatment of patients with pediatric and congenital cardiac disease.
Tremendous progress has been made in the science of assessing the outcomes of the treatments of patients with pediatric and congenital cardiac disease. Multi-institutional databases have been developed that span subspecialty, geographic, and temporal boundaries. Linking of different databases enables additional analyses not possible using the individual data sets alone and can facilitate quality improvement initiatives. ⋯ Parents are an integral part of the health care team and are key partners with regard to quality improvement. The role of the parent in the process of health care delivery can be facilitated by enhancing the organizational culture and creating methods of transparency, empowering parents, and implementing effective strategies of communication. The professionals caring for patients with pediatric and congenital cardiac disease, in collaboration with the patients and their families, now have the opportunity to capitalize on the power of our databases and move beyond outcome assessment and benchmarking, to collaborative quality improvement.