Management of Complex Pulmonary Vein Stenosis at Altitude Combining Comprehensive Percutaneous Interventional Treatment with Sirolimus, Pulmonary Hypertension Medications and Intraluminal Imaging with Optical Coherence Tomography
ConclusionOur study suggests that the addition of sirolimus in patients with moderate-severe PVS helps to decrease disease progression with decrease frequency of interventions. Reaching therapeutic levels for sirolimus is critical and medication interactions and side-effects need careful consideration. OCT continues to be important for evaluation and treatment guidance in this patient population. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - May 28, 2023 Category: Cardiology Source Type: research
Measured Oxygen Consumption During Pediatric Cardiac Catheterization is More Accurate than Assumed Oxygen Consumption
Abstract When calculating cardiac index (C.I.) by the Fick method, oxygen consumption (VO2) is often unknown, so assumed values are typically used. This practice introduces a known source of inaccuracy into the calculation. Using a measured VO2 (mVO2) from the CARESCAPE E-sCAiOVX module provides an alternative that may improve accuracy of C.I. calculations. Our aim is to validate this measurement in a general pediatric catheterization population and compare its accuracy with assumed VO2 (aVO2). mVO2 was recorded for all patients undergoing cardiac catheterization with general anesthesia and controlled ventilation du...
Source: Pediatric Cardiology - May 27, 2023 Category: Cardiology Source Type: research
Coarctation Angioplasty in Young Children: Does IMPACT Registry Data Accurately Reflect Clinical Outcomes?
AbstractBalloon angioplasty for recoarctation of the aorta is routinely performed in young children and is considered successful when the systolic gradient is reduced to < 10 mmHg. IMPACT defines acute procedural success solely based on a final gradient of < 10 mmHg and stratifies participating institutions based on these acute outcomes. Between February 2012 and December 2020, IMPACT data was analyzed for 110 coarctation interventions. Electronic medical records were reviewed, and primary endpoints were one of the following: (1) final analysis end date (June 2021), (2) patient death, or (3) most recent ...
Source: Pediatric Cardiology - May 27, 2023 Category: Cardiology Source Type: research
Does High-Intensity Exercise Cause Acute Liver Injury in Patients with Fontan Circulation? A Prospective Pilot Study
AbstractThe Fontan procedure results in chronic hepatic congestion and Fontan-associated liver disease (FALD) characterized by progressive liver fibrosis and cirrhosis. Exercise is recommended in this population, but may accelerate the progression of FALD from abrupt elevations in central venous pressure. The aim of this study was to assess if acute liver injury occurs after high-intensity exercise in patients with Fontan physiology. Ten patients were enrolled. Nine had normal systolic ventricular function and one had an ejection fraction < 40%. During cardiopulmonary exercise testing, patients had near-infrared s...
Source: Pediatric Cardiology - May 23, 2023 Category: Cardiology Source Type: research
Pre-Fontan Assessment Utilizing Combined Cardiac Catheterization and Cardiac MRI: Comparison to the Pre-Fontan Catheterization
We describe our center ’s outcomes in patients undergoing pre-Fontan catheterization combined with cardiac magnetic resonance imaging. A retrospective review of patients undergoing pre-Fontan catheterization from 10/2018 to 04/2022 at Texas Children’s Hospital was performed. Patients were divided into 2 groups: combin ed cardiac magnetic resonance imaging and catheterization (combined group) and those who underwent catheterization only (catheterization only group). There were 37 patients in the combined group and 40 in the catheterization only group. Both groups were similar in age and weight. Patients undergoing combi...
Source: Pediatric Cardiology - May 21, 2023 Category: Cardiology Source Type: research
Extracardiac Findings on Cardiac Magnetic Resonance: A Children ’s Hospital Experience
AbstractCardiac magnetic resonance (CMR) incorporates a field of view that has the potential to capture clinically relevant extracardiac findings (ECF); however, there has been minimal investigation of ECF prevalence in children ’s hospitals, where the patient population varies in age and diagnosis. We retrospectively reviewed consecutive, clinically indicated, CMR studies performed at a tertiary care children’s hospital during a 1-year period from January 1 to December 31, 2019. ECFs were classified as significant or n on-significant based on whether they were described in the final impression of the CMR report. A tot...
Source: Pediatric Cardiology - May 20, 2023 Category: Cardiology Source Type: research
Multicenter Evaluation of Pre-operative Feeding in Infants with Ductal Dependent Circulation
We describe a multicenter cohort of these neonates who were fed pre-operatively. We also give a granular description of vital sign measurements and other risk factors prior to feeding. A retrospective chart review was performed at seven centers. Inclusion criteria were full-term neonates under one month of age with ductal dependent lesions receiving prostaglandins. These neonates were fed for at least 24 h during the pre-operative period. Premature neonates were excluded. Using the inclusion criteria, 127 neonates were identified. While being fed, 20.5% of the neonates were intubated, 10.2% were on inotropes, and 55.9% h...
Source: Pediatric Cardiology - May 20, 2023 Category: Cardiology Source Type: research
Frequency and Predictors of Acute and Persistent Femoral Artery Occlusion in Infants with Congenital Heart Disease: A Study Using Ultrasonography for Arterial Access and the Diagnosis of Arterial Occlusion
This study showed that younger age at procedure was a risk factor for both ALAP and PFAO, while aortic coarctation, previous arterial catheterization, use of a larger sheath and longer duration of cannulation were risk factors for ALAP in infants. The majority of FAO is reversible and seco ndary to arterial spasm, and the of FAO increases inversely with patient age. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - May 19, 2023 Category: Cardiology Source Type: research
Echocardiographic Strain to Predict Need for Transplant or Mortality in Fontan Patients with Hypoplastic Left Heart Syndrome
This study aims to correlate systemic ventricular strain by echocardiography to transplant-free survival. HLHS patients who had Fontan palliation at our institution were included. Patients were divided into: 1) Required transplant or experienced mortality (composite end point); 2) Did not require transplant or survived. For those who experienced the composite endpoint, the last echocardiogram prior to the composite outcome was used, while for those who did not experience the composite endpoint the last echocardiogram obtained was used. Several qualitative and quantitative parameters were analyzed with focus on strain param...
Source: Pediatric Cardiology - May 19, 2023 Category: Cardiology Source Type: research
3D-Printed Cardiac Models for Fetal Counseling: A Pilot Study and Novel Approach to Improve Communication
AbstractA fetal cardiology consultation involves using two-dimensional drawings to explain the cardiac anatomy which can result in inherent variation in how the congenital heart disease (CHD) is conveyed. In this pilot study, we incorporated three-dimensional printed (3DP) models into fetal counseling to demonstrate feasibility and evaluate the impact on parental knowledge, understanding, and anxiety. Parents with a prenatal diagnosis of a muscular ventricular septal defect (VSD) and/or coarctation of aorta were enrolled. Providers were randomized into a Model or Drawing Group and crossed after six months. Parents complete...
Source: Pediatric Cardiology - May 18, 2023 Category: Cardiology Source Type: research
Avoiding Overreaction to Propranolol-Induced Hypoglycemia
(Source: Pediatric Cardiology)
Source: Pediatric Cardiology - May 18, 2023 Category: Cardiology Source Type: research
Tomographic Plane Visualization (ToPlaV); a Tool to Enhance Echocardiographic Training
AbstractVisual learning is an important part of echocardiographic training. Our aim is to describe and evaluate a visual teaching tool, tomographic plane visualization (ToPlaV) as an adjunct to skills training in pediatric echocardiography image acquisition. This tool incorporates learning theory by applying psychomotor skills that closely emulate the skills used in echocardiography. ToPlaV was used as part of a transthoracic bootcamp for first year cardiology fellows. A qualitative survey was given to trainees to evaluate their perceptions of its usefulness. There was universal agreement among fellow trainees that ToPlaV ...
Source: Pediatric Cardiology - May 16, 2023 Category: Cardiology Source Type: research
Novel Score to Predict Immunoglobulin Resistance in Kawasaki Disease
AbstractTo evaluate existing scoring systems and develop a new model to predict intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD). A retrospective cohort study performed between 2004 and 2017 identified 115 patients treated with IVIG for classic or incomplete KD. In our practice, IVIG resistance was defined as fever for > 24 h and patients were divided into responders and non-responders. A univariate analysis was performed to identify independent predictors of IVIG resistance. The predictors were combined into a new scoring system and compared with existing scoring systems. Sixty...
Source: Pediatric Cardiology - May 12, 2023 Category: Cardiology Source Type: research
Patch Materials for Pulmonary Artery Arterioplasty and Right Ventricular Outflow Tract Augmentation: A Review
AbstractPatch augmentation of the right ventricular outflow tract (RVOT) and pulmonary artery (PA) arterioplasty are relatively common procedures in the surgical treatment of patients with congenital heart disease. To date, several patch materials have been applied with no agreed upon clinical standard. Each patch type has unique performance characteristics, cost, and availability. There are limited data describing the various advantages and disadvantages of different patch materials. We performed a review of studies describing the clinical performance of various RVOT and PA patch materials and found a limited but growing ...
Source: Pediatric Cardiology - May 7, 2023 Category: Cardiology Source Type: research
