ABSTRACT
Troponin-I (TN-I) levels are elevated following pediatric cardiac surgery with speculation that particular patterns may have prognostic significance. There is lack of procedure-specific data regarding postoperative TN-I levels in infants undergoing cardiac surgery. We hypothesized that TN-I elevation varies with type of surgery and persistent elevation predicts poor prognosis. We prospectively measured serial TN-I levels (preoperatively, 4, 8, 12, 24, and 48 hours postoperatively) in 90 infants (age < 1 year) undergoing cardiac surgery: off cardiopulmonary bypass (CPB) (nâ¯=â¯15), on CPB (nâ¯=â¯43), and on CPB with ventricular incision (CPB with ventricular incision; nâ¯=â¯32). All patients had undetectable baseline TN-I levels. The area under the curve of TN-I levels over the 48-hour period was significantly different among the surgical groups (P < 0.002), and highest in patients with CPB with ventricular incision. Generally, TN-I levels peaked by 4 hours after surgery and returned to near-normal levels within 48 hours. A persistent TN-I rise beyond 8 hours after surgery was a strong predictor of postoperative hypoperfusion injury (defined as a composite endpoint of end-organ injury resulting from inadequate perfusion, odds ratio 21.5; P = 0.001) and mortality (30% in those with persistently high TN-I, compared with 3.5% in the remaining patients; P < 0.001), independent of patient age, anatomy and/or complexity of surgery, and level of postoperative support. Our data provide benchmark values for TN-I levels following cardiac surgery in infants. Extent of TN-I elevation correlates with type of surgery. Persistent TN-I elevation beyond 8 hours after surgery is strongly associated with postoperative hypoperfusion injury and mortality.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Cardiopulmonary Bypass/adverse effects , Heart Defects, Congenital/surgery , Postoperative Complications/blood , Troponin I/blood , Biomarkers/blood , Female , Heart Defects, Congenital/blood , Heart Defects, Congenital/diagnosis , Humans , Infant , Infant, Newborn , Male , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Predictive Value of Tests , Prospective Studies , Risk Factors , Time Factors , Treatment Outcome , Up-RegulationABSTRACT
A clinician-driven home monitoring program can improve interstage outcomes in single-ventricle patients. Sociodemographic factors have been independently associated with mortality in interstage patients. We hypothesized that even in a population with high-risk sociodemographic characteristics, a home monitoring program is effective in reducing interstage mortality. We defined interstage period as the time period between discharge following Norwood palliation and second-stage surgery. We reviewed the charts of patients for the three-year period before (group 1) and after (group 2) implementation of the home monitoring program. Clinical variables around Norwood palliation, during the interstage period, and at the time of second-stage surgery were analyzed. There were 74 patients in group 1 and 52 in group 2. 59 % patients were Hispanic, and 84 % lived in neighborhoods where over 5 % families lived below poverty line. There was no significant difference in pre-Norwood variables, Norwood discharge variables, age at second surgery, or outcomes at second surgery. There were more Sano shunts performed at the Norwood procedure as the source of pulmonary blood flow in group 2 (p value <0.05). There were more unplanned hospital admissions and percutaneous re-interventions in group 2. Patients in group 2 whose admission criteria included desaturation had a 45 % likelihood of having an unplanned re-intervention. Group 2 noted an 80 % relative reduction in interstage mortality (p < 0.01). In a multiple regression analysis, after accounting for ethnicity, socio-economic status, and source of pulmonary blood flow, enrollment in a home monitoring program independently predicted improved interstage survival (p < 0.01). A clinician-driven home monitoring program reduces interstage mortality even when the majority of patients has high-risk sociodemographic characteristics.
Subject(s)
Heart Ventricles , Humans , Hypoplastic Left Heart Syndrome , Norwood Procedures , Palliative Care , Patient Discharge , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
In this study, we present a case of prenatally diagnosed tetralogy of Fallot with a double aortic arch, correlating images from fetal echocardiography, transthoracic echocardiography, and cardiac MRI.
Subject(s)
Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Prenatal Diagnosis , Tetralogy of Fallot/diagnostic imaging , Tetralogy of Fallot/surgery , Adult , Echocardiography, Doppler , Female , Fetus/diagnostic imaging , Humans , Infant, Newborn , Magnetic Resonance Imaging , Pregnancy , Term BirthABSTRACT
Takayasu's arteritis is a granulomatous giant-cell arteritis of the aorta and its major branches. It primarily affects East Asian women in their second or third decade of life but is well known to affect all ethnicities across the world. Given its systemic nature, Takayasu's arteritis has multiorgan involvement, with the majority of disease morbidity related to the cardiovascular, central nervous, and renal systems. This report describes an unusual presentation of Takayasu's arteritis in a 2½-year-old boy. This is the first report in the literature describing the presence of both severe aortic regurgitation and diffuse coronary artery involvement in a patient so young.
Subject(s)
Takayasu Arteritis/diagnosis , Child, Preschool , Humans , Magnetic Resonance Imaging , Male , Severity of Illness IndexABSTRACT
The association of cardiac defects with Kabuki syndrome has been well described. The majority of these defects are isolated shunt lesions, conotruncal abnormalities, or various forms of arch obstruction. This report describes a series of three patients with hypoplastic left heart syndrome and Kabuki syndrome. The series illustrates the full spectrum of left-sided obstructive lesions and expands the phenotype of cardiac defects associated with Kabuki syndrome.
Subject(s)
Abnormalities, Multiple , Facies , Hypoplastic Left Heart Syndrome , Developmental Disabilities , Female , Humans , Infant, Newborn , Male , SyndromeSubject(s)
Cardiac Surgical Procedures/methods , Cor Triatriatum/diagnostic imaging , Cor Triatriatum/surgery , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/surgery , Abnormalities, Multiple/diagnostic imaging , Abnormalities, Multiple/surgery , Cardiopulmonary Bypass , Cor Triatriatum/complications , Echocardiography, Transesophageal , Failure to Thrive/diagnosis , Failure to Thrive/etiology , Female , Follow-Up Studies , Heart Septal Defects, Atrial/complications , Humans , Infant , Risk Assessment , Severity of Illness Index , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/etiology , Treatment OutcomeABSTRACT
Little is known about the characteristics and outcomes of fetuses with pericardial effusions (PEs); therefore, this study sought to identify factors associated with fetal PEs and the natural histories and outcomes of fetuses with PEs. Large PEs are associated with a greater likelihood of structural heart disease, impaired cardiac function, and chromosomal abnormalities, and PEs with hydrops or extracardiac malformations are associated with death. Most fetal PEs resolve, and fetuses with isolated PEs have a very good prognosis.
Subject(s)
Fetal Diseases/diagnostic imaging , Pericardial Effusion/etiology , Adolescent , Adult , Chromosome Aberrations/embryology , Echocardiography, Doppler , Female , Fetal Death/epidemiology , Fetal Diseases/embryology , Fetal Diseases/mortality , Follow-Up Studies , Gestational Age , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/embryology , Humans , Hydrops Fetalis/complications , Hydrops Fetalis/diagnostic imaging , Hydrops Fetalis/embryology , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/mortality , Pregnancy , Retrospective Studies , Survival Rate , Ultrasonography, PrenatalABSTRACT
Navigator coronary magnetic resonance imaging (MRI) was evaluated in assessing coronary artery origins in a pediatric and adolescent population. Sixty-five consecutive infants, children, or adolescents (age range 11 days to 21 years) were referred for MRI evaluations to assess coronary artery origins. Coronary artery origins were unambiguously delineated in 62 of 65 patients. In 3 patients, irregular arrhythmias precluded cardiac gating of the magnetic resonance acquisition. Two patients had anomalous coronary artery origins detected. Twenty-six patients required sedation for the studies. Free-breathing 3-dimensional MRI with real-time navigator correction is a robust method for delineating the coronary artery origins in pediatric and adolescent patients.
Subject(s)
Coronary Vessel Anomalies/diagnosis , Magnetic Resonance Angiography/methods , Adolescent , Adult , Child , Child, Preschool , Feasibility Studies , Female , Humans , Infant , Infant, Newborn , MaleABSTRACT
BACKGROUND: Patients undergoing operative repair of aortic obstruction are at a lifelong risk of recurrent obstruction, and there is controversy regarding the optimal surgical technique. We have used an alternative strategy for recurrent aortic obstruction, typically involving anatomic reconstruction by means of a median sternotomy, and describe our techniques and results. METHODS: Twenty-one patients presented with recurrent aortic arch obstruction. Mean age and weight were 7.8 +/- 5.4 years (range, 0.21 to 15.2 years) and 30.6 +/- 21.8 kg (range, 3.6 to 90 kg), respectively. Recurrence involved the aortic arch to some degree in each case, as the mean preoperative transverse aortic arch z score was -2.9 +/- 1.6 (range, -7.0 to 0.1). Thoracotomy was possible in 2 patients, using re-resection with end-to-end anastomosis (n = 1) and patch aortoplasty (n = 1). The remaining 19 patients required median sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest for complete relief of obstruction by aortic arch advancement (n = 10), patch aortoplasty (n = 8), or interposition grafting (n = 1). RESULTS: There was 1 hospital death. Invasive blood pressure monitoring revealed no residual arm-to-leg gradient in 19 patients and a 20-mm Hg gradient in 2 patients. There have been no late deaths. No patients have undergone subsequent aortic intervention, and all are asymptomatic up to 85 months postoperatively. Two patients are currently followed with a 10-mm Hg arm-to-leg blood pressure gradient. CONCLUSIONS: Anatomic reconstruction for recurrent aortic obstruction can be safely accomplished in the majority of patients. We favor median sternotomy because of the ability of establishing cardiopulmonary bypass, the facility of anatomic reconstruction techniques, and the ability to repair concomitant cardiovascular lesions.
Subject(s)
Aortic Arch Syndromes/surgery , Aortic Coarctation/surgery , Adolescent , Aortic Arch Syndromes/diagnosis , Child , Child, Preschool , Echocardiography , Female , Follow-Up Studies , Humans , Infant , Magnetic Resonance Imaging , Male , Recurrence , Reoperation , Retrospective Studies , Thoracotomy , Treatment Outcome , Ultrasonography, DopplerSubject(s)
Heart Aneurysm/congenital , Heart Aneurysm/physiopathology , Pulmonary Atresia/etiology , Pulmonary Atresia/physiopathology , Abnormalities, Multiple/diagnostic imaging , Abnormalities, Multiple/surgery , Anastomosis, Surgical , Cardiac Surgical Procedures , Ductus Arteriosus, Patent/diagnostic imaging , Ductus Arteriosus, Patent/etiology , Ductus Arteriosus, Patent/physiopathology , Ductus Arteriosus, Patent/surgery , Echocardiography , Female , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/surgery , Heart Septal Defects, Ventricular/diagnostic imaging , Heart Septal Defects, Ventricular/surgery , Humans , Hypoplastic Left Heart Syndrome/diagnostic imaging , Hypoplastic Left Heart Syndrome/surgery , Infant, Newborn , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Pulmonary Atresia/diagnostic imaging , Pulmonary Atresia/surgery , Pulmonary Valve Insufficiency/congenital , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/surgery , Transposition of Great Vessels/diagnostic imaging , Transposition of Great Vessels/surgery , Ultrasonography, Prenatal , Ventricular Outflow Obstruction/congenital , Ventricular Outflow Obstruction/diagnostic imaging , Ventricular Outflow Obstruction/surgeryABSTRACT
We report the success of transcatheter coil embolization of congenital coronary artery fistulas in infants and young children, primarily using a retrograde coaxial delivery system. Transcatheter coil embolization of coronary artery fistulas has been used successfully in the adult population with limited reports in the pediatric population, especially in infants. Ten patients underwent transcatheter coil embolization of congenital coronary artery fistulas between January 1993 and August 1999. The median age was 4.5 years (ranging from 5 weeks to 9.8 years). Coils were delivered exclusively using a retrograde arterial approach in 8 of 10 patients. A coaxial system was used in 8 patients. Angiography immediately after placement of coils revealed no residual shunt in any patient. Recent follow-up evaluation is available for 9 patients (median duration of follow-up, 7.9 months). Echocardiographic and clinical evaluations show complete occlusion in 8 of 9 patients. All patients are asymptomatic with normalization of chamber dimensions and coronary artery caliber. Transcatheter coil embolization of congenital coronary artery fistulas can be performed safely and successfully in infants and young children. The use of a retrograde approach and coaxial system is safe and effective and may provide better accuracy, stability and precision for placement of coils.