Pediatric cardiology
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Pediatric cardiology · Jan 2013
Comparative StudyInterventions after Norwood procedure: comparison of Sano and modified Blalock-Taussig shunt.
Improved results have evolved from the modified Norwood procedure (NP). This study compares the incidence of interventions after NP with the Sano (n = 37) and modified Blalock-Taussig (BT n = 70) shunt. Incidence, location, interval of interventions, and weight were retrospectively analysed for 107 neonates undergoing NP during the period from October 2002 to December 2009. ⋯ Interventions after NP were common irrespective of shunt type. However, a significantly greater rate of shunt interventions was noted in the Sano group. In particular, interventions addressing the aortic arch and the shunt were related with a significant rate of complications.
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Pediatric cardiology · Jan 2013
Case ReportsSuccessful treatment of severe mechanical mitral valve thrombosis with tissue plasminogen activator in a 7-month-old infant.
Severe thrombosis of a mechanical valve is a rare complication in pediatric patients. Thrombolytic therapy as treatment of mechanical mitral valve thrombosis has rarely been reported in young infants. We report the successful treatment with recombinant tissue-type plasminogen activator of a mechanical mitral valve thrombus in a 7 month-old patient with trisomy 21, complete atrioventricular canal defect and pulmonary hypertension status post complete atrioventricular canal repair and subsequent prosthetic mitral valve replacement. ⋯ Serial echocardiograms showed significant resolution of the thrombus within 18 h of infusion with no major bleeding complications during the treatment course. Although a rare complication of mechanical valve placement in pediatrics, thrombosis of mechanical valves may result in severe hemodynamic and respiratory compromise. This case demonstrates that thrombolytic therapy is a feasible option for the treatment of critical thrombosis in pediatric patients after MVR.
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Pediatric cardiology · Jan 2013
Case ReportsA triple challenge: thrombocytopenia in a 7-year-old girl with unrepaired d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension.
Thrombocytopenia can be a real challenge during cardiac surgery in children with cyanotic congenital heart disease. This report describes a 7-year-old girl with d-transposition of the great arteries, ventricular septal defect, pulmonary hypertension, chronic thrombocytopenia, polycythemia, and chronic renal impairment. The thrombocytopenia improved several days after splenectomy. The child then underwent a successful arterial switch operation with ventricular septal defect closure.
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Pediatric cardiology · Jan 2013
Cerebral oximetry monitoring during preoperative phlebotomy to limit allogeneic blood use in patients undergoing cardiac surgery.
Preoperative phlebotomy can minimize the need for allogenic blood products. Frequently, removed blood is replaced with intravenous fluids to maintain euvolemia (acute normovolemic hemodilution [ANH]). During cardiopulmonary bypass (CPB), ANH may present problems when the circuit prime causes further hemodilution and unacceptably low hemoglobin. ⋯ A decrease in rSO(2) occurred more commonly in younger patients and those who had a larger volume of blood removed. Preoperative phlebotomy without significant volume replacement can be performed safely before CPB. Volume replacement may be more appropriately guided by rSO(2) than by hemodynamic variables.
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Pediatric cardiology · Jan 2013
Case ReportsNoonan syndrome and different morphologic expressions of hypertrophic cardiomyopathy.
Hypertrophic cardiomyopathy is the disease with the largest heterogeneity in clinical cardiology. An underrecognized and incompletely described subgroup within this spectrum comprises patients with ventricular diverticulum, coronary myocardial bridging, and left ventricular crypts and crevices. This report presents the case of a Noonan syndrome patient with these four hypertrophic cardiomyopathy characteristics.