Pediatric cardiology
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Pediatric cardiology · Aug 2013
Comparative StudySupplemental tube feeding does not mitigate weight loss in infants with shunt-dependent single-ventricle physiology.
Infants with shunt-dependent single-ventricle (SV) physiology are at risk for poor weight gain before superior cavopulmonary connection (SCPC). Lower weight-for-age z-score is a risk factor for prolonged length of stay (LOS) after SCPC. We sought to characterize infant growth and feeding and determine the effect of method of feeding on outcomes. ⋯ Poor growth is common among infants with shunt-dependent SV physiology. Infants who require GT have lower weight-for-age z-scores at hospital discharge and remain smaller at SCPC than those fed PO. Although GT after initial palliation is associated with longer LOS after SCPC, it is not associated with an increase in interstage morbidity or mortality.
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Pediatric cardiology · Aug 2013
Comparative StudyWhat factors predict long-term survival and valve durability in patients with atrioventricular valve regurgitation in single-ventricle physiology?
Although significant atrioventricular valve regurgitation (AVVR) is well known for its association with increased morbidity and mortality in patients with single-ventricle physiology, there is a lack of consensus in management of AVVR. The purpose of this study was to analyze the clinical outcomes in patients receiving AVV repair or replacement. From 2001 to 2010, a total of 33 patients (25 male and 8 female) with more than moderate-degree AVVR among 160 patients who underwent staged single-ventricle palliation were included. ⋯ Early valve regurgitation affects valve durability. Thus, successful repair in the early stage may improve later outcomes. Therefore, aggressive valve surgery was required and AVV replacement might be one of the options for selected patients.
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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
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.