Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 2 de 2
Filtrar
1.
J Am Soc Echocardiogr ; 30(5): 478-484, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28274715

RESUMO

INTRODUCTION: Single-ventricle patients with elevated pulmonary vascular resistance (PVR) or end-diastolic pressure (EDP) are excluded from undergoing total cavopulmonary connection (TCPC). However, a subset of patients deemed to be at acceptable risk experience prolonged length of stay (LOS) after TCPC. Routine assessment of ventricular function has been inadequate in identifying these high-risk patients. Speckle-tracking echocardiography (STE) is a novel method for assessment of myocardial deformation that may be useful in single-ventricle patients. The aim of this study was to perform a contemporary preoperative risk assessment for prolonged LOS to determine whether STE improves risk stratification before TCPC. METHODS: Our single institution's perioperative data were retrospectively collected. The primary outcome was postoperative LOS >14 days. Longitudinal and circumferential STE deformation measures were analyzed on echocardiograms obtained during preoperative catheterization. Patient-specific, echocardiographic, and catheterization data were included in multivariable logistic regression. Receiver operating characteristic area under the curves (AUC) were analyzed. RESULTS: From 2007 to 2014, 135 patients who underwent TCPC were included in the analysis. The median LOS was 11 (IQR 9-14) days. The PVR (P < .01) and circumferential strain rate (CSR) (P < .01) were the only variables independently associated with LOS >14 days. For every 0.1 s-1 CSR increased, there was a 20% increased odds of prolonged LOS. The AUC for CSR was 0.70. The AUC for PVR and EDP combined was 0.68. The AUC for PVR, EDP, and CSR combined was 0.73. CONCLUSION: Preoperative CSR is independently associated with LOS >14 days and improves preoperative risk stratification in patients undergoing TCPC.


Assuntos
Ecocardiografia/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Ventrículos do Coração/anormalidades , Ventrículos do Coração/cirurgia , Cuidados Pré-Operatórios/métodos , Pré-Escolar , Técnicas de Imagem por Elasticidade/métodos , Feminino , Derivação Cardíaca Direita , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Incidência , Masculino , Cuidados Pré-Operatórios/mortalidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Sensibilidade e Especificidade , South Carolina/epidemiologia , Taxa de Sobrevida , Resultado do Tratamento
2.
Pediatr Cardiol ; 36(3): 569-78, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25380963

RESUMO

The aim of the study is to describe the spectrum of indications for pediatric ECG-synchronized CT angiography (CTA), the main determinants of radiation exposure, and trends in radiation dose over time at a single, tertiary referral center. The study was IRB approved and HIPAA compliant with informed consent waived. Between 2005 and 2013, 324 pediatric patients underwent ECG-synchronized CTA to evaluate known or suspected cardiovascular abnormalities (109 female, median age 8.1 years). The effective dose (ED) was calculated using age-specific correction factors. Univariate and multivariate regression analyses were performed to identify predictors of radiation dose. The most common primary indications for the CTA examinations included known or suspected coronary pathologies (n = 166), complex congenital heart disease (n = 73), and aortic pathologies (n = 41). Median radiation exposure decreased from 12 mSv for patients examined in the years 2005-2007 to 1.2 mSv for patients examined in the years 2011-2013 (p < 0.001). Patients scanned using a tube potential of 80 kV (n = 259) had a significantly lower median radiation dose (1.4 mSv) compared to patients who were scanned at 100 kV (n = 46, median 6.3 mSv) or 120 kV (n = 19, median 19 mSv, p < 0.001). Tube voltage, followed by tube current and the method of ECG-synchronization were the strongest independent predictors of radiation dose. Growing experience with dose-saving techniques and CTA protocols tailored to the pediatric population have led to a tenfold reduction in radiation dose over recent years and now allow routinely performing ECG-synchronized CTA in children with a radiation dose on the order of 1 mSv.


Assuntos
Envelhecimento , Angiografia/efeitos adversos , Eletrocardiografia/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/efeitos adversos , Adolescente , Angiografia/métodos , Técnicas de Imagem de Sincronização Cardíaca/efeitos adversos , Técnicas de Imagem de Sincronização Cardíaca/métodos , Criança , Pré-Escolar , Meios de Contraste/administração & dosagem , Eletrocardiografia/métodos , Feminino , Cardiopatias Congênitas/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA