RESUMO
We tested the adequacy of a videoconferencing system using a single integrated systems digital network (ISDN) line (128 kilobits per second) for the remote diagnosis of children with suspected congenital heart disease (CHD). Real-time echocardiogram interpretation was compared to subsequent videotape review in 401 studies with concordance in 383 (95.5%) studies. A new diagnosis of CHD was made in 98 studies. Immediate patient transfer was arranged based upon a real-time diagnosis in five studies. In 300 studies, a normal diagnosis obviated further evaluation. A single ISDN line is adequate for transmission of pediatric echocardiograms and it allows for remote management of patients with CHD.
Assuntos
Redes de Comunicação de Computadores/instrumentação , Ecocardiografia/instrumentação , Cardiopatias Congênitas/diagnóstico por imagem , Microcomputadores , Consulta Remota/instrumentação , Gravação de Videoteipe/instrumentação , Adolescente , Criança , Pré-Escolar , Periféricos de Computador , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Equipe de Assistência ao PacienteRESUMO
Patients with obstructed total anomalous pulmonary venous connection (TAPVC) usually present critically ill and continue to be extremely challenging with presurgical stabilization. We present an extra corporeal membrane oxygenation (ECMO)-dependent neonate with obstructed TAPVC that was successfully palliated with transvenous stent placement in the obstructed vertical vein.
Assuntos
Anormalidades Cardiovasculares/terapia , Cuidados Paliativos/métodos , Veias Pulmonares/anormalidades , Stents , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/cirurgia , Oxigenação por Membrana Extracorpórea , Humanos , Recém-Nascido , RadiografiaAssuntos
Ecocardiografia Tridimensional , Doenças das Valvas Cardíacas/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/anormalidades , Músculos Papilares/anormalidades , Criança , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Insuficiência da Valva Mitral/congênitoRESUMO
PURPOSE: The prevalence of infective endocarditis (IE) among children with Staphylococcus aureus bacteremia (SAB) is unknown. The objective of this study was to determine prospectively the prevalence of IE among pediatric patients with SAB in a large tertiary care center. METHODS: Between July 1998 and June 2001, all children who developed SAB whose parent/guardian signed informed consent underwent echocardiography. Clinical and follow-up results were collected prospectively. Endocarditis was classified according to the modified Duke criteria. RESULTS: Fifty-one children developed SAB during the study interval. Definite (6 patients [11.8%]) or possible (4 patients [7.8%]) IE was present in 10 of 51 (20%) children with SAB. Most children (73%) developed bacteremia as a consequence of an infected intravascular device. Children with underlying congenital heart disease had a significantly higher prevalence of definite or possible IE, compared with those with structurally normal hearts (53% vs 3%). All patients with definite IE had multiple positive blood cultures. Mortality was high among patients with and without IE (40% vs 12%). CONCLUSIONS: In this study, the prevalence of definite IE among children with SAB was approximately 12% and was frequently associated with congenital heart disease and multiple positive blood cultures. The mortality for children with SAB and definite or possible S aureus IE is high.