Pediatric cardiology
-
Pediatric cardiology · Jan 1987
Case ReportsAcute hepatic failure after open-heart surgery in children.
Acute hepatic failure (AHF) combined with acute renal failure (ARF) is a well-known complication of open-heart surgery in adults. The occurrence of this complication in two children after open-heart surgery for correction of congenital heart disease is reported. Hypotension occurred during the operation and was treated by catecholamine vasopressors. ⋯ ARF also developed in both children. One of the patients survived the acute episode of hepatic failure. The importance of early diagnosis, routine close monitoring, and appropriate selection of vasopressors is emphasized.
-
Pediatric cardiology · Jan 1986
Pulmonary arterial changes in patients with ventricular septal defects and severe pulmonary hypertension.
In 25 patients, aged eight months to 31 years, with ventricular septal defect (VSD; isolated in 15, the others with atrial septal defect, PDA, coarctation or patent ductus arteriosus + coarctation), each with severe pulmonary artery hypertension (pulmonary artery systolic pressure [Ppa] at least 75% of systemic and an elevated pulmonary vascular resistance), we related morphologic and morphometric data from open-lung biopsy to hemodynamic measurements obtained at cardiac catheterization during the same hospital admission. Of the hemodynamic features measured, only the ratios of pulmonary-to-systemic flow and pulmonary-to-systemic resistance correlated significantly with structure. Neither pulmonary artery pressure (Ppa) nor pulmonary vascular resistance correlated significantly with any structural feature studied. ⋯ In the ten patients who underwent VSD closure, Ppa was measured postoperatively. The Heath-Edwards grade (no more than one grade-III lesion) and arterial density (at least one-half that normal for age) were the best correlates of the difference between preoperative Ppa and Ppa immediately after corrective surgery. The presurgical catheterization data, including pulmonary resistance and the resistance ratio, did not correlate significantly with change in Ppa following VSD closure.(ABSTRACT TRUNCATED AT 250 WORDS)
-
The pulmonary-to-systemic blood flow ratio (Qp/Qs) is critical in the appraisal of the need for surgery in patients with left-to-right shunts. Because of the drawbacks present with conventional Fick, indicator dilution, and radionuclide techniques of Qp/Qs measurement, we sought to determine whether an extension of thermodilution technology could accurately predict Qp/Qs. We studied 30 children with clinically suspected or postoperative atrial or ventricular septal defects. ⋯ Gamma variate curve fitting and area analysis were used to determine Qp/Qs. The correlation between Fick and thermodilution Qp/Qs values was excellent (r = 0.95). The thermodilution technique was rapid, and did not require either arterial entry, radiation after venous catheter placement, or multiple sampling.
-
Pediatric cardiology · Jan 1982
Comparative StudyQuantitative radionuclide angiocardiography for left-to-right cardiac shunts in children.
Pulmonary to systemic flow ratios (Qp/Qs) were estimated by quantitative radionuclide angiocardiography (QRAC) in 135 children. The Qp/Qs ratios were derived from pulmonary time/activity curves using a gamma variate model. Eighty-five of these children also had Qp/Qs ratios estimated by oximetry at cardiac catheterization. ⋯ The correlation between Qp/Qs, determined by QRAC and by oximetry was good (r = .93; SEE .31). This relatively noninvasive technique has now been used to estimate the Qp/Qs ratio in 34 children with a clinically suspected left-to-right shunt, and postoperatively in 16 cases with residual murmurs; it has obviated the need for catheterization in many of these patients. The technique may also be used serially to determine changes in the Qp/Qs ratio in patients with known left-to-right shunts.