Pediatric cardiology
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Pediatric cardiology · Jun 2013
Multicenter StudySurgical volume and center effects on early mortality after pediatric cardiac surgery: 25-year North American experience from a multi-institutional registry.
Mortality after pediatric cardiac surgery varies among centers. Previous research suggests that surgical volume is an important predictor of this variation. This report characterizes the relative contribution of patient factors, center surgical volume, and a volume-independent center effect on early postoperative mortality in a retrospective cohort study of North American centers in the Pediatric Cardiac Care Consortium (up to 500 cases/center/year). ⋯ In conclusion, center-specific variation exists but is only partially explained by operative volume. Low-risk operations are safely performed at centers in all volume categories, whereas regionalization or other quality improvement strategies appear to be warranted for moderate- and high-risk operations. Potentially preventable mortality occurs at centers in all volume categories studied, so referral or regionalization strategies must target centers by observed outcomes rather than assume that volume predicts quality.
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Pediatric cardiology · Jun 2013
Case ReportsSymptomatic upper-extremity deep venous thrombosis after pacemaker placement in a pediatric patient: how to treat?
Symptomatic upper-extremity deep venous thrombosis (UEDVT) after pacemaker placement in adults has been reported, but the occurrence of UEDVT in pediatric patients is poorly defined, and no treatment guidelines exist. This report describes a 14-year old girl with a history of complete atrioventricular block who experienced a symptomatic UEDVT 8 months after placement of a transvenous pacemaker. The girl was treated initially with anticoagulation including subcutaneous enoxaparin and a heparin drip, which did not resolve the venous obstruction. ⋯ She continued to receive aspirin therapy, with no recurrence of symptoms. In conclusion, symptomatic UEDVT after pacemaker placement in a pediatric patient can be treated successfully with both anticoagulation and interventional therapies. Further studies are needed to evaluate the incidence of thrombus formation among children with transvenous pacemaker placement together with the development of guidelines based on the safety and effectiveness of differing treatments.
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Pediatric cardiology · Jun 2013
Management of refractory chylothorax after pediatric cardiovascular surgery.
We investigated the optimal treatment for refractory chylothorax after pediatric cardiovascular surgery. We retrospectively reviewed the cases of 15 consecutive patients who developed chylothorax after congenital heart surgery performed between December 2004 and November 2010. Among the 15 patients (12 male and 3 female; median age 13.9 months) who developed postoperative chylothorax, 10 recovered with conservative therapy, such as a low-fat diet, medium chain triglyceride-enriched diet, or total parenteral nutrition. ⋯ Surgical patients tended to be younger with lower body weight. Significant risk factors for surgical intervention were age <4 months, body weight <4 kg, and duration of drainage >10 days. In cases of refractory postoperative chylothorax, surgical therapy such as thoracic duct ligation should be considered when discharge from the drainage tube is >30 ml/kg/day or chylothorax is not improved within 10 days.
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Pediatric cardiology · Jun 2013
Reference values of aortic flow velocity integral in 1193 healthy infants, children, and adolescents to quickly estimate cardiac stroke volume.
The aortic velocity time integral (VTI) is an echocardiographic tool used to estimate cardiac output (CO) by multiplying it with the aortic valve (AV) area and heart rate (HR). Inaccurate measurement of AV diameter will lead to squared miscalculation of CO. The aortic VTI itself can serve as a left-ventricular (LV) output parameter. ⋯ Aortic VTI ranged from mean 13.8 cm (10.0-18.4 cm 5-95th percentile) in neonates to 25.1 cm (19.6-32.8 cm 5-95th percentile) in children >17 years of age and had a positive correlation with age (r = 0.685, p < 0.001), BSA (r = 0.645, p < 0.001) and a negative correlation with HR (r = -0.710, p < 0.001). Interobserver and intraobserver variability were excellent (3.9 ± 3.1 and 4.6 ± 3.7 %, respectively). Calculated mean values and percentile charts for the different age groups can serve as reference data to easily judge LV output in patients with or without congenital heart disease without enlargement or dysfunction of the AV.
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Pediatric cardiology · Jun 2013
Effects of circuit residual volume salvage reinfusion on the postoperative clinical outcome for pediatric patients undergoing cardiac surgery.
This study aimed to evaluate the effects of washed cardiopulmonary (CPB) circuit residual blood reinfusion on the postoperative clinical outcome for pediatric patients undergoing cardiac surgery. A total of 309 consecutive Chinese cardiac patients receiving CPB between October 2010 and April 2011 were prospectively analyzed. For 217 patients, CPB circuit residual blood was reinfused after the cell-saving procedure [cell-salvage group (CS)]. ⋯ The two groups did not differ in terms of chest tube drainage during the first 24 h postoperatively, intrahospital mortality, or respiratory morbidity. The incidence of serum creatinine (≥ 2-folds) during the first 72 h after the operation was significantly lower in the CS group (2.3 %) than in the CON group (8.7 %) (p = 0.010). Reinfusion of washed CPB circuit residual blood significantly raised the postoperative HCT level, reduced the allogeneic blood transfusion, decreased the incidence of early postoperative renal dysfunction, and did not increase the chest tube drainage after the operation in pediatric cardiac surgery.