International journal of cardiology
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Experimental studies showed that extracardiac total cavopulmonary connection provides superior hemodynamics than atriopulmonary Fontan. ⋯ Data indicate that conversion to extracardiac total cavopulmonary connection is associated with an improvement of cardiopulmonary function and heart failure symptoms. Improved exercise capacity is due to an increase in O(2) pulse and may reflect an improved cardiac stroke volume after the operation.
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After Mustard or Senning repair for transposition of the great arteries (d-TGA), qualitative assessment of the systemic right ventricle remains difficult. We wanted to evaluate the relationship between demographic and echocardiographic variables, and exercise performance. ⋯ Maximal exercise capacity is reduced in adult patients after Mustard or Senning repair. Standard echocardiographic 2D-measurements are insufficient to determine the reduction in their functional capacity. The inverse relationship between age and the cardiac indices suggests an age dependent and progressive diminution of systemic ventricular function.
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Clonidine-induced delirium has rarely been reported. To the best of our knowledge, there are six related case reports in the literature. We describe one such case here and review the six previously published cases. ⋯ However, there are no clearly identifiable risk factors for the development of severe psychological side effects, including dose of medication, duration of treatment, and predisposing mental illness. Treatment for clonidine-induced delirium involves cessation of the medication and patient observation. Given the large clinical burden of hypertension and the not uncommon requirement for polypharmacy to achieve blood pressure goals, heightened clinical awareness of this potential side effect appears justified.