Pediatric cardiology
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Pediatric cardiology · May 2007
Glucocorticoid therapy for hypotension in the cardiac intensive care unit.
In recent years, it has been our practice to treat persistent hypotension in the cardiac intensive care unit with glucocorticoids. We undertook a retrospective review in an attempt to identify predictors of a hemodynamic response to steroids and of survival in these patients. Patients who had received glucocorticoids for hypotension over a 2-year period were identified retrospectively. ⋯ No predictors of a hemodynamic response to steroid were identified. Some critically ill children with cardiac disease and inotrope refractory hypotension demonstrated hemodynamic improvement following glucocorticoid administration. An improvement in blood pressure following administration of glucocorticoid was associated with survival, but we were unable to identify predictors of that response.
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Ventricular assist device therapy is continuing to evolve in the practice of pediatric cardiac surgery. Although ECMO is still the most often applied mechanical support for infants and young children, a broader range of pulsatile, paracorporeal, as well as implantable ventricular assist devices are now available for pediatric application. ⋯ Unlike ECMO, these devices can offer medium- to long-term support and have been successfully utilized as a bridge to transplant as well as a bridge to recovery. This review examines the different types of devices currently available, their clinical indications for use, future devices, and the current results of pediatric ventricular assist device therapy in the treatment of heart failure in the pediatric population.
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Pediatric cardiology · Mar 2007
ReviewNomenclature and databases - the past, the present, and the future : a primer for the congenital heart surgeon.
This review discusses the historical aspects, current state of the art, and potential future advances in the areas of nomenclature and databases for congenital heart disease. Five areas will be reviewed: (1) common language = nomenclature, (2) mechanism of data collection (database or registry) with an established uniform core data set, (3) mechanism of evaluating case complexity, (4) mechanism to ensure and verify data completeness and accuracy, and (5) collaboration between medical subspecialties. During the 1990s, both the Society of Thoracic Surgeons (STS) and the European Association for Cardiothoracic Surgery (EACTS) created congenital heart surgery outcomes databases. ⋯ Collaborative efforts involving the EACTS and STS are under way to develop mechanisms to verify data completeness and accuracy. Further collaborative efforts are also ongoing between pediatric and congenital heart surgeons and other subspecialties, including pediatric cardiac anesthesiologists (via the Congenital Cardiac Anesthesia Society), pediatric cardiac intensivists (via the Pediatric Cardiac Intensive Care Society), and pediatric cardiologists (via the Joint Council on Congenital Heart Disease). Clearly, methods of congenital heart disease outcomes analysis continue to evolve, with continued advances in five areas: nomenclature, database, complexity adjustment, data verification, and subspecialty collaboration.
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Pediatric cardiology · Mar 2007
ReviewThe modified Blalock-Taussig shunt versus the right ventricle-to-pulmonary artery conduit for the Norwood procedure.
The initial Norwood procedure remains the highest risk operation for the staged repair of univentricular congenital malformations with associated systemic outflow obstruction. The modified Blalock-Taussig shunt (MBTS) has been implicated as a major cause of not only the operative mortality, but also associated morbidity and interstage attrition. ⋯ The current literature is contradictory, retrospective, and predominantly historically controlled. The Trial of Right Ventricular vs Modified Blalock-Taussig Shunt in Infants with Single Ventricle Defect Undergoing Staged Reconstruction, a randomized controlled clinical trial comparing the two techniques, is ongoing and may provide answers to this controversy.
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Pediatric cardiology · Mar 2007
Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience.
The outcome of patients with hypoplastic left heart (HLH) is determined by many factors, particularly by the first-step palliative procedure in newborns undergoing the Norwood procedure, its Sano modification, or, rarely, through challenging biventricular repairs. Duct stenting combined with bilateral pulmonary artery banding (PAB) is a new method employed as an alternative first-step approach in a number of centers worldwide. We describe this interventional-surgical "hybrid approach" as an additional strategy for the treatment of newborns with HLH syndrome and HLH complex. ⋯ The actuarial survival rate for patients with BVR is 93%. Postnatal transcatheter-surgical hybrid palliation expands the surgical options for newborns with HLH. Using hybrid palliation, Norwood stage I operation can be avoided in the neonatal period, the waiting period for children scheduled for cardiac transplantation can be extended, and observation for left ventricular growth suitable for biventricular repair as well.