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1.
Pediatr Radiol ; 54(8): 1261-1269, 2024 07.
Artículo en Inglés | MEDLINE | ID: mdl-38637337

RESUMEN

A transseptal coronary artery course, also known as a transconal course, is an anomalous course of the left main coronary artery (LMCA) or the left anterior descending artery (LAD) through the conal septal myocardium. The conal septal myocardium is the posterior wall of the right ventricular outflow tract (RVOT), acting as a dividing myocardial wall between the subaortic and subpulmonary outflow tracts. The initial segment of a transseptal coronary artery has an extraconal course between the aorta and the RVOT cranial to the true intramyocardial segment. The transseptal coronary artery then emerges out of the conal septal myocardium at the epicardial surface on the lateral aspect of the RVOT. Many consider the transseptal coronary artery to be a benign entity. However, there are few case reports of severe cardiac symptoms such as myocardial ischemia, arrhythmia, and even sudden cardiac deaths due to potential coronary artery compression in the systolic phase.​ In this article, we seek to describe the imaging findings of transseptal coronary artery course on coronary computed tomography angiography (CTA), discuss their clinical analysis, and briefly discuss the management of these lesions.


Asunto(s)
Angiografía por Tomografía Computarizada , Anomalías de los Vasos Coronarios , Humanos , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Niño , Tabiques Cardíacos/diagnóstico por imagen
2.
Catheter Cardiovasc Interv ; 101(6): 1088-1097, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36994891

RESUMEN

OBJECTIVES: To describe the techniques used for percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation and decannulation in children with the pediatric interventional cardiologist (PIC) as the primary operator, and present outcomes of this initial clinical experience. BACKGROUND: Percutaneous VA-ECMO during cardiopulmonary resuscitation (CPR) has been successfully performed in adults, but currently, not much data exists on children. METHODS: This is a single-center study including VA-ECMO cannulations performed by the PIC between 2019 and 2021. Efficacy was defined as the successful initiation of VA-ECMO without surgical cutdown. Safety was defined as the absence of additional procedures related to cannulation. RESULTS: Twenty-three percutaneous VA-ECMO cannulations were performed by PIC on 20 children with 100% success. Fourteen (61%) were performed during ongoing CPR, and nine for cardiogenic shock. The Median age was 15 (0.15-18) years, and the median weight was 65 (3.3-180) kg. All arterial cannulations were via the femoral artery except in one, 8-week-old infant who was cannulated in the carotid artery. A distal perfusion cannula was placed in the ipsilateral limb in 17 (78%). The median time from initiating cannulation to ECMO flow was 35 (13-112) minutes. Two patients required arterial graft placement at the time of decannulation and one needed below-knee amputation. ECMO support was maintained for a median of 4 (0.3-38) days. Thirty-day survival was 74%. CONCLUSION: Percutaneous VA-ECMO cannulations can be effectively performed, even during CPR with the Pediatric Interventional Cardiologist being the primary operator. This is an initial clinical experience. Future outcome studies compared with standard surgical cannulations are necessary to advocate routine percutaneous VA-ECMO in children.


Asunto(s)
Cateterismo Periférico , Oxigenación por Membrana Extracorpórea , Adulto , Humanos , Niño , Adolescente , Oxigenación por Membrana Extracorpórea/efectos adversos , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/métodos , Resultado del Tratamiento , Estudios Retrospectivos , Choque Cardiogénico
3.
Artif Organs ; 45(1): 38-45, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33180355

RESUMEN

Thromboembolic events and bleeding are major sources of morbidity among pediatric patients supported on a ventricular assist device (VAD). Pharmacokinetics and pharmacodynamics of enteral antiplatelet agents are affected and variable due to erratic enteral absorption in end-stage heart failure and VAD circulation. Additionally, 20%-40% of the population are poor metabolizers of clopidogrel, a prodrug, making cangrelor an alternative when antiplatelet therapy is crucial. Cangrelor has been used effectively and safely for short durations in adults during percutaneous coronary interventions, but the use of cangrelor is still under investigation in pediatrics. This case series utilized cangrelor, a novel short-acting, reversible, intravenous P2Y12 platelet inhibitor in managing pediatric patients supported with a VAD. We performed a retrospective, single-center review of patients admitted to a tertiary medical center with end-stage heart failure requiring mechanical circulatory support and concomitant cangrelor administration between January 2019 and March 2020. Platelet function testing, cangrelor dose, bleeding complications, thromboembolic events, and frequency of circuit interventions during the use of cangrelor were recorded. Optimal platelet reactivity, defined as P2Y12 < 180 platelet reaction units (PRU), was measured with serial point-of-care testing (VerifyNow). Seven patients, median age of 4.9 years, met the above criteria. Three patients had a diagnosis of complex congenital heart disease. Four patients had dilated or restrictive cardiomyopathy. All patients were on continuous flow VADs. The median VAD duration was 84.5 days (IQR 61.5-103). The median duration on cangrelor was 43 days (IQR 8-70). The median cangrelor dose to reach the therapeutic threshold was 0.75 µg/kg/min with the mean P2Y12 , while on cangrelor of 164.75 PRU. Bleeding complications included mild gastrointestinal bleeding and hematuria. There was one patient with pump thrombosis requiring intervention. There were no cerebrovascular events while on cangrelor. We report the first successful long-term use of cangrelor in pediatric patients. The reversibility and short half-life of cangrelor make it a feasible antiplatelet agent in selected patients. This data supports the use of cangrelor in children as a viable antiplatelet option; with minimal bleeding complications and no cerebrovascular events demonstrated in this cohort.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Insuficiencia Cardíaca/terapia , Corazón Auxiliar/efectos adversos , Hemorragia/epidemiología , Inhibidores de Agregación Plaquetaria/administración & dosificación , Trombosis/epidemiología , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/efectos adversos , Adolescente , Niño , Preescolar , Femenino , Hemorragia/etiología , Hemorragia/prevención & control , Humanos , Lactante , Masculino , Proyectos Piloto , Inhibidores de Agregación Plaquetaria/efectos adversos , Pruebas de Función Plaquetaria , Estudios Retrospectivos , Trombosis/etiología , Trombosis/prevención & control , Resultado del Tratamiento
4.
Pediatr Radiol ; 51(2): 296-306, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32889583

RESUMEN

Anomalous origin of the coronary arteries, though uncommon, is of great clinical concern. It can be the cause of sudden cardiac death and abnormal cardiac hemodynamics. Advances in electrocardiographically (ECG)-gated multi-detector CT have increased diagnostic accuracy in detecting anomalous origin of coronary arteries and their interarterial and intramural courses. Recent advances in multi-detector CT image processing software have allowed the creation of virtual endoluminal views of the aortic root and improved assessment of the intramural course (the length and relationship to the intercoronary commissure) of the coronary artery, which is of considerable surgical importance. We review our experience with virtual endoluminal imaging in our first 19 cases of interarterial coronary artery anomalies (17 cases of interarterial with intramural segment and 2 cases of purely interarterial course) diagnosed preoperatively and proven surgically.


Asunto(s)
Angiografía por Tomografía Computarizada , Anomalías de los Vasos Coronarios , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Humanos , Tomografía Computarizada por Rayos X
5.
Cardiol Young ; 29(3): 389-397, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30739623

RESUMEN

OBJECTIVE: Shunt-related adverse events are frequent in infants after modified Blalock-Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock-Taussig. METHODS: In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock-Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose. RESULTS: There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2-23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3-71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7-10), p=0.16] was not associated with decrease in these events. CONCLUSIONS: High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock-Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock-Taussig.


Asunto(s)
Aspirina/administración & dosificación , Procedimiento de Blalock-Taussing/efectos adversos , Cardiopatías Congénitas/cirugía , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/prevención & control , Trombosis/prevención & control , Administración Oral , Angiografía por Tomografía Computarizada , Relación Dosis-Respuesta a Droga , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Inhibidores de Agregación Plaquetaria/administración & dosificación , Complicaciones Posoperatorias/diagnóstico , Pronóstico , Estudios Retrospectivos , Trombosis/diagnóstico
6.
Cardiol Young ; 28(1): 118-125, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28847337

RESUMEN

OBJECTIVE: To evaluate differences in interstage growth of pulmonary arteries between use of polytetrafluoroethylene and femoral vein homograft as Sano shunt during stage-I Norwood palliation. METHODS: A retrospective review of all patients who survived to the second stage following Norwood-Sano operation at two institutions was performed. Either polytetrafluoroethylene or the valved segment of femoral vein homograft was used for construction of the Sano shunt. The size of pulmonary arteries was compared at pre-Glenn catheterisation. RESULTS: A total of 48 neonates with the diagnosis of hypoplastic left heart syndrome or its variants comprised the study population. Femoral vein homograft of 5-6 mm diameter was used in 14 and polytetrafluoroethylene graft of 5 mm was used in 34 patients. The two groups were comparable in terms of preoperative demographics and age at time of pre-Glenn catheterisation (3.9±0.7 versus 3.4±0.8 months, p=0.06). Patients who received femoral vein homograft demonstrated a significantly higher pre-Glenn Nakata index [264 (130-460) versus 165 (108-234) mm2/m2, p=0.004]. The individual branch pulmonary arteries were significantly larger in the femoral vein group (right, 7.8±3.6 versus 5.0±1.2, p=0.014; left, 7.2±2.1 versus 5.6±1.9, p=0.02). There were no differences in cardiac index, Qp:Qs, ventricular end-diastolic pressure or systemic oxygen saturations. CONCLUSIONS: Utilisation of a valved segment of femoral vein homograft as right ventricle to pulmonary artery conduit during Norwood-Sano operation confers better interstage growth of the pulmonary arteries. Further studies are needed to evaluate the impact of femoral vein homograft on single ventricle function.


Asunto(s)
Prótesis Vascular , Vena Femoral/trasplante , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Procedimientos de Norwood , Arteria Pulmonar/cirugía , Femenino , Ventrículos Cardíacos/fisiopatología , Humanos , Recién Nacido , Masculino , Politetrafluoroetileno , Prótesis e Implantes , Estudios Retrospectivos , Trasplante Homólogo , Presión Ventricular
7.
Cardiol Young ; : 1-7, 2017 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-28552087

RESUMEN

BACKGROUND: The porcine small intestinal extracellular matrix reportedly has the potential to differentiate into viable myocardial cells. When used in tetralogy of Fallot repair, it may improve right ventricular function. We evaluated right ventricular function after repair of tetralogy of Fallot with extracellular matrix versus bovine pericardium. METHOD: Subjects with non-transannular repair of tetralogy of Fallot with at least 1 year of follow-up were selected. The extracellular matrix and bovine pericardium groups were compared. We used three-dimensional right ventricular ejection fraction, right ventricle global longitudinal strain, and tricuspid annular plane systolic excursion to assess right ventricular function. RESULTS: The extracellular matrix group had 11 patients, whereas the bovine pericardium group had 10 patients. No differences between the groups were found regarding sex ratio, age at surgery, and cardiopulmonary bypass time. The follow-up period was 28±12.6 months in the extracellular matrix group and 50.05±17.6 months in the bovine pericardium group (p=0.001). The mean three-dimensional right ventricular ejection fraction (55.7±5.0% versus 55.3±5.2%, p=0.73), right ventricular global longitudinal strain (-18.5±3.0% versus -18.0±2.2%, p=0.44), and tricuspid annular plane systolic excursions (1.59±0.16 versus 1.59±0.2, p=0.93) were similar in the extracellular matrix group and in the bovine pericardium group, respectively. Right ventricular global longitudinal strain in healthy children is reported at -29±3% in literature. CONCLUSION: In a small cohort of the patients undergoing non-transannular repair of tetralogy of Fallot, there was no significant difference in right ventricular function between groups having extracellular matrix versus bovine pericardium patches followed-up for more than 1 year. Lower right ventricular longitudinal strain noted in both the groups compared to healthy children.

8.
Cardiol Young ; 27(9): 1778-1785, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28651677

RESUMEN

BACKGROUND: Numerous advances in surgical techniques and understanding of single-ventricle physiology have resulted in improved survival. We sought to determine the influence of various demographic, perioperative, and patient-specific factors on the survival of single-ventricle patients following stage 1 palliation at our institution. METHODS: We conducted a retrospective study of all single-ventricle patients who had undergone staged palliation at our institution over an 8-year period. Data were collected from the Society of Thoracic Surgeons Congenital Heart Surgery database and from patient charts. Information on age, weight at stage 1 palliation, prematurity, genetic abnormalities, non-cardiac anomalies, ventricular dominance, and type of palliation was collected. Information on mortality and unplanned reinterventions was also collected. RESULTS: A total of 72 patients underwent stage 1 palliation over an 8-year period. There were 12 deaths before and one death after stage 2 palliation. There was no hospital mortality following Glenn or Fontan procedures. On univariate analysis, low weight at the time of stage 1 palliation and prematurity were found to be risk factors for mortality following stage 1 palliation. However, multivariable Cox regression analysis revealed weight at stage 1 palliation to be a strong predictor of mortality. The type of stage 1 palliation did not have any influence on the outcome. No difference in survival was noted following the Glenn procedure. CONCLUSION: Low weight has a deleterious impact on survival following stage 1 palliation. This is mitigated by stage 2 palliation. The type of stage 1 palliation itself has no bearing on the outcome.


Asunto(s)
Peso Corporal/fisiología , Cardiopatías Congénitas/mortalidad , Ventrículos Cardíacos/anomalías , Procedimientos Quirúrgicos Cardíacos/métodos , Bases de Datos Factuales , Femenino , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/cirugía , Humanos , Recién Nacido , Masculino , Complicaciones Posoperatorias , Nacimiento Prematuro , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Sobrevida , Tennessee/epidemiología , Resultado del Tratamiento
9.
Pediatr Transplant ; 20(2): 256-70, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26899454

RESUMEN

The management of decompensating critically ill children with severe PH is extremely challenging and requires a multidisciplinary approach. Unfortunately, even with optimal care, these children might continue to deteriorate and develop inadequate systemic perfusion and at times cardiac arrest secondary to a pulmonary hypertensive crisis. Tools to support these children are limited, and at times, the team should proceed with offering extracorporeal support, especially in newly diagnosed patients who have not benefitted from medical therapy prior to their acute deterioration, in patients with severe pulmonary venous disease and in patients with alveolar capillary dysplasia. Currently, the only approved mode for extracorporeal support in pediatric patients with PH eligible for lung transplantation is ECMO. To decrease the risks associated with ECMO, and offer potential for increased duration of support, extubation, and rehabilitation, we transitioned four small children with refractory PH from ECMO to a device comprising an oxygenator interposed between the PA and LA. This work describes in great detail our experience with this mode of support with emphasis on exclusion criteria, the implantation procedure, and the post-implantation management.


Asunto(s)
Oxigenación por Membrana Extracorpórea/instrumentación , Hipertensión Pulmonar/terapia , Ecocardiografía , Diseño de Equipo , Oxigenación por Membrana Extracorpórea/métodos , Hemodinámica , Humanos , Lactante , Recién Nacido , Pulmón/fisiología , Oxígeno/química , Perfusión , Guías de Práctica Clínica como Asunto , Pronóstico , Riesgo , Espectroscopía Infrarroja Corta , Esteroides/uso terapéutico
11.
Pediatr Transplant ; 18(5): 477-84, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24922348

RESUMEN

BNP is increasingly utilized in the management of pediatric HT recipients. Performing a retrospective single-center chart review, we sought to describe BNP changes during the first year after HT and identify factors that affect its trend. After exclusion for rejection, 316 BNP levels from 50 patients were evaluated. BNP underwent an exponential decline 120 days after HT followed by a plateau. Log10 BNP decline strongly correlated with time (r = -0.70, p < 0.0001). Initial BNP was less in pretransplant VAD (p = 0.0016) and lower post-HT inotrope use (p = 0.0043). Infant recipients, IT >4 h, and those bridged medically were associated with higher plateau BNP. Multivariable logistic regression demonstrated IT >4 h independently predicted plateau BNP in the upper quartile (OR 7.1, p = 0.02). No significant change in BNP coincided with rejection (N = 6 patients) without severe hemodynamic compromise. BNP correlated modestly with right atrial pressure (r = 0.4652, p < 0.0001) and pulmonary capillary wedge pressure (r = 0.2660, p < 0.001), but poorly with echocardiogram (r = -0.18, p = 0.003). Trending BNP could help provide insight into how the graft recovers after HT and IT >4 h independently predicted higher plateau BNP and may reflect subtle changes in graft performance.


Asunto(s)
Biomarcadores/sangre , Trasplante de Corazón , Péptido Natriurético Encefálico/sangre , Adolescente , Cardiomiopatías/sangre , Cardiomiopatías/cirugía , Niño , Preescolar , Femenino , Rechazo de Injerto/fisiopatología , Cardiopatías Congénitas/sangre , Cardiopatías Congénitas/cirugía , Hemodinámica , Humanos , Lactante , Masculino , Miocardio/patología , Presión Esfenoidal Pulmonar , Estudios Retrospectivos , Resultado del Tratamiento
12.
World J Pediatr Congenit Heart Surg ; 15(1): 120-122, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37722806

RESUMEN

Percutaneous ductal device closure in neonates is gaining popularity. Cardiac perforation is a rare but catastrophic complication that can occur during this procedure. Surgical options to salvage this situation are limited in extremely low-weight babies. In this report, we describe one such case managed successfully and offer some suggestions to achieve a successful outcome.


Asunto(s)
Apéndice Atrial , Lesiones Cardíacas , Defectos del Tabique Interatrial , Dispositivo Oclusor Septal , Recién Nacido , Humanos , Esternotomía/efectos adversos , Dispositivo Oclusor Septal/efectos adversos , Atrios Cardíacos/cirugía , Apéndice Atrial/cirugía , Defectos del Tabique Interatrial/cirugía , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Resultado del Tratamiento , Cateterismo Cardíaco/métodos
13.
J Clin Med ; 13(8)2024 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-38673441

RESUMEN

Multi-system inflammatory syndrome in children (MIS-C) in the setting of COVID-19 can be associated with severe cardiopulmonary dysfunction. This clinical deterioration may sometimes necessitate veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. We describe an algorithmic approach including the role of balloon atrial septostomy in this cohort. This is the first reported series of percutaneous VA-ECMO in pediatric patients with MIS-C for better outcomes. The lessons from this approach can be replicated in other pediatric clinical conditions and adds to the armament of multiple pediatric specialties.

14.
Transl Pediatr ; 12(7): 1431-1438, 2023 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-37575895

RESUMEN

Cardiopulmonary bypass is an integral and indispensable part of surgical repair of congenital heart defects. While the complications and morbidity secondary to the use of cardiopulmonary bypass has decreased considerably, there remains a significant incidence of clinically relevant renal and neurological injury. To provide more physiological delivery of oxygenated blood to the end-organs, our center has been successfully using a high-flow, high hematocrit cardiopulmonary bypass strategy since 2006. The essential components of this strategy include maintaining high flows (typically 200 mL/kg/min in neonates, 150-175 mL/kg/min in older infants weighing <10 kg, and 2.6 L/min/m2 in older children) throughout the duration of cardiopulmonary bypass irrespective of patient temperature, as well as maintaining a hematocrit of at least 32% on cardiopulmonary bypass. The incidence of post-operative acute kidney injury (around 3%) and clinical acute neurological events (<1%) with this strategy is considerably less when compared to other contemporary publications using the conventional cardiopulmonary bypass strategy. In this review, we discuss the rationale behind our approach and present evidence to support the high-flow, high-hematocrit strategy. We also discuss the practical aspects of our strategy and describe the adjuncts we use to derive additional benefits. These adjuncts include the use of a hybrid pH/alpha stat strategy during cooling/rewarming, aggressive use of conventional ultrafiltration during cardiopulmonary bypass, a terminal hematocrit of 40-45%, and avoidance of milrinone and albumin in the early peri-operative period. This results in a very low incidence of post-operative bleeding, facilitates chest closure in the operating room even in most neonates, helps in reducing the need for post-operative blood product transfusion and helps in achieving a favorable post-operative fluid balance early after surgery.

15.
World J Pediatr Congenit Heart Surg ; 14(3): 375-379, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36872647

RESUMEN

Background: The incidence of new acute neurological injury occurring in neonates and infants during cardiac surgery utilizing cardiopulmonary bypass is reportedly 3% to 5%. In 2013, we adopted a high flow rate, and high hematocrit bypass strategy, and sought to assess the incidence of early neurological injuries associated with this strategy. Methods: Neonates and infants undergoing cardiopulmonary bypass between January 2013 and December 2019 (n = 714) comprise the study. Adverse neurological events (ANEs) were defined as any abnormality of pupils, delayed awakening, seizures, focal neurological deficits, concerns prompting neurological consultation, or any abnormality on neurological imaging in the postoperative period. Our bypass strategy included a high flow rate (150-200 mL/kg/min), without reduction of flow rates during cooling and maintaining a target hematocrit on bypass > 32% with a terminal hematocrit of > 42%. Results: Median weight at the time of the procedure was 4.6 kg (IQR 3.6-6.1 kg) with the smallest patient weighing 1.36 kg. There were 46 premature patients (6.4%). There were 149 patients (20.9%) patients who underwent deep hypothermic circulatory arrest with a median time of 26 min (IQR 21-41 min). Hospital mortality was 3.5% (24/714, 95% CI: 2.28-5.13). The incidence of neurological events as defined above was 0.84% (6/714, 95% CI: 0.31-1.82). Neurological imaging identified ischemic injury in 4 patients and intraventricular hemorrhage in 2. Conclusions: High flow/high hematocrit bypass strategy was associated with a low incidence of ANE in this vulnerable population.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Recién Nacido , Lactante , Humanos , Incidencia , Hematócrito , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente Cardiopulmonar/métodos , Periodo Posoperatorio
16.
J Card Surg ; 27(2): 242-4, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22273485

RESUMEN

A 2.8-kg infant underwent urgent repair of a large iatrogenic pseudoaneurysm of the innominate artery, which was compressing the airway and superior vena cava, creating critical respiratory instability. The pseudoaneurysm was repaired with complete resolution of all respiratory symptoms.


Asunto(s)
Aneurisma Falso/etiología , Tronco Braquiocefálico/patología , Cateterismo Venoso Central/efectos adversos , Síndrome de la Vena Cava Superior/etiología , Aneurisma Falso/diagnóstico , Aneurisma Falso/cirugía , Tronco Braquiocefálico/cirugía , Femenino , Humanos , Lactante , Insuficiencia Respiratoria/complicaciones , Insuficiencia Respiratoria/terapia , Sepsis/complicaciones , Sepsis/terapia , Síndrome de la Vena Cava Superior/diagnóstico , Síndrome de la Vena Cava Superior/cirugía
17.
J Card Surg ; 26(4): 444-5, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21554388

RESUMEN

Vascular access in children who require extracorporeal membrane oxygenation (ECMO) support can be a challenging endeavor particularly in those who have undergone prior median sternotomies or interventional procedures. We present an alternative cannulation strategy that can be utilized in pediatric patients requiring ECMO that involves utilization of the iliac vein via a retroperitoneal approach.


Asunto(s)
Cateterismo/métodos , Oxigenación por Membrana Extracorpórea/métodos , Vena Ilíaca/cirugía , Femenino , Humanos , Lactante , Espacio Retroperitoneal
18.
JTCVS Tech ; 9: 128-134, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34647081

RESUMEN

The management of severely symptomatic neonates with Ebstein anomaly is challenging during the early neonatal period. Initial management goals should focus on mitigating a central shunt; providing respiratory mechanical support; providing an adequate but not excessive source of pulmonary blood flow; and minimizing pulmonary vascular resistance. For most patients thus stabilized, definitive repair should be prudently deferred until it is safe for a bailout bidirectional Glenn anastomosis to be added, usually at age 3 to 4 months. For those who remain critical, initial ligation of the large ductus and placing a more peripheral aortopulmonary shunt, or ligating the main pulmonary artery, should be weighed against a primary biventricular repair (Knott-Craig repair), or the Starnes' single-ventricle palliation. The Da Silva cone biventricular repair should generally be avoided during the early neonatal period. An initial Starnes' repair can be potentially converted to a biventricular repair in later infancy.

19.
Ann Thorac Surg ; 111(4): 1374-1379, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-32603703

RESUMEN

BACKGROUND: The purpose of this study is to compare the incidence and severity of acute kidney injury (AKI) after open heart surgery in neonates and infants for two different cardiopulmonary bypass (CPB) strategies. METHODS: In all, 151 infants undergoing cardiac surgery were prospectively enrolled between June 2017 and June 2018 at two centers, one using conventional CPB (2.4 L · min-1 · m-2, 150 mL · kg-1 · min-1) with reduction of flow rates with moderate hypothermia and with a targeted hematocrit greater than 25% (center 1, n = 91), and the other using higher bypass flow rates (175 to 200 mL · kg-1 · min-1) and higher minimum hematocrit (greater than 32%) CPB (center 2, n = 60). The primary endpoint was the incidence of postoperative AKI as defined by Acute Kidney Injury Network criteria and risk factors associated with AKI. RESULTS: Preoperative characteristics and complexity of surgery were comparable between centers. The overall incidence of early postoperative AKI was 10.6% (16 of 151), with 15.4% (14 of 91) in center 1 and 3.3% (2 of 60) in center 2 (P = .02). Mean lowest flow rates on CPB were 78 mL · kg-1 · min-1 vs 118 mL · kg-1 · min-1 and mean highest hematocrit on separation from CPB were 33% vs 43% at center 1 and 2, respectively (P < .001). Center 1 used less packed red blood cells but more fresh frozen plasma than center 2 (P = .001). By multivariate analysis, only lower flows on CPB (78 vs 96 mL · kg-1 · min-1, P = .043) and lower hematocrit at the end of CPB (33% vs 37%, P = .007) were associated with AKI. CONCLUSIONS: In this contemporary comparative study, higher flow rates and higher hematocrit during cardiopulmonary bypass were associated with better preservation of renal function.


Asunto(s)
Lesión Renal Aguda/epidemiología , Puente Cardiopulmonar/efectos adversos , Complicaciones Posoperatorias/epidemiología , Lesión Renal Aguda/etiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Masculino , Estudios Retrospectivos , Estados Unidos/epidemiología
20.
J Pediatr ; 156(5): 848-9, 849.e1, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20304430

RESUMEN

Intrapericardial teratomas often present as life-threatening problems when diagnosed during fetal life. They are large lesions that compress the heart and lungs and can result in tamponade if not treated expeditiously. We present a case of a large teratoma that was managed by prenatal pericardiocentesis followed by surgical resection.


Asunto(s)
Enfermedades Fetales/cirugía , Neoplasias Cardíacas/cirugía , Teratoma/cirugía , Femenino , Enfermedades Fetales/diagnóstico por imagen , Feto/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Humanos , Recién Nacido , Pericardiocentesis , Teratoma/diagnóstico por imagen , Ultrasonografía Prenatal
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