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1.
J Card Surg ; 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31449687

RESUMO

Surgical management of complex congenital heart disease (CHD) is challenging. Three-dimensional (3D) printing can improve multidisciplinary team decision-making, patient and family understanding, and education of medical professionals. We describe 3D printing for surgical management of five patients with complex CHD. The anatomical details of the 3D printed models were instrumental in planning surgical techniques especially in determining between single ventricle, 1.5 ventricle, and biventricular repair.

2.
Congenit Heart Dis ; 14(3): 356-361, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30825270

RESUMO

BACKGROUND: Physician burnout has many undesirable consequences, including negative impact on patient care delivery and physician career satisfaction. Electronic health records (EHRs) may exacerbate burnout by increasing physician workload. OBJECTIVE: To determine burnout in adult congenital heart disease (ACHD) specialists by assessing stress associated with EHRs. DESIGN: Electronic survey study of ACHD providers. SETTING: Canada and United States. PARTICIPANTS: Three hundred eighty-three ACHD specialists listed on the Adult Congenital Heart Association directory between February and April 2017. OUTCOME MEASURES: Burnout was measured using the Maslach Burnout Inventory (MBI) to understand factors contributing to work life and EHR satisfaction. Chi-square and Wilcoxon Rank Sum tests were used for statistical analysis. RESULTS: Of the 383 invited participants, 110 (28.7%) completed surveys with the majority (n = 88, 80.7%) reporting from an academic medical center. Burnout was defined as high scores on the emotional exhaustion and/or depersonalization MBI subscales. When comparing the 40% (n = 44) that met criteria for burnout with those that did not, there was strong disagreement that a reasonable amount of time is spent on clerical tasks related to direct (P = .0043) or indirect (P = .0004) patient care. There was strong disagreement that EHRs increased efficiency (P = .006) or the patient portal improved patient care (P = .0215). Finally, physicians who met criteria for burnout had lower personal accomplishment scores (P = .0355). CONCLUSIONS: Our results suggest time spent on EHRs creates clerical burden exacerbating ACHD physician burnout. The high levels of emotional exhaustion may decrease quality of ACHD care by directing focus away from physician-patient interaction. Health care systems must develop best practice for EHR design and implementation to optimize patient advocacy and care, and decrease physician burnout.

4.
Pediatr Cardiol ; 39(8): 1657-1662, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30105467

RESUMO

Embolization of systemic to pulmonary artery collaterals to regulate pulmonary arterial flow or pressure of the cavopulmonary circulation in patients with single ventricle is a common practice. The relative incidence and impact of this practice on future interventions like coronary artery bypass grafting is poorly understood. This study aims to evaluate the frequency and implications of internal mammary artery (IMA) embolization in the single ventricle (SV) population. A retrospective chart review was performed of SV patients who underwent cardiac catheterization before and after Fontan procedure between February 2007 and 2017. Data were collected from two tertiary care centers in the Midwest. Of the 304 SV patients, 62 (20.4%) underwent embolization of one or more IMAs, whereas 242 (79.6%) did not. The rate of embolization of IMA was 40.5% in one center and 14.5% in the second center. Among patients who received IMA embolization, left internal mammary artery (LIMA) embolization was seen in 6 (9.7%) patients. Majority of patients underwent either right internal mammary artery (RIMA) embolization (n = 25; 40.3%) or RIMA and LIMA embolization (n = 27; 43.5%). IMA embolization in SV patients is common. Embolizing IMAs early in life will likely eliminate a valuable graft option for coronary artery bypass grafting should it be required in the future care of these patients. Multi-center, prospective, nation-wide studies are warranted to examine coronary artery disease in the SV population and true frequency of IMA embolization. Delineation of which IMAs were embolized is a necessary in surgical and cardiac intervention national data, such as Society of Thoracic Surgeons (STS) database. All measures should be taken to preserve IMAs patency, if deemed feasible and safe.

5.
Curr Cardiol Rev ; 14(2): 121-127, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29485000

RESUMO

BACKGROUND: To develop an understanding of current practices in the management of transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients. METHODS: Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume pediatric heart centers in the United States and United Kingdom. Survey participants included cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective chart review was also performed at a large regional referral center in the Midwest on subjects 0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier, date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid Function Test (TFT) ordered. RESULTS: 1,153 individuals from 64 congenital heart centers were contacted via email to participate in the electronic survey. In the 3-month response window, 129 completed surveys were received from cardiologists (55%), intensivists (17%), surgeons (15%), "other" (8%), and advanced practice providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10 providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine. Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the events, 20 patients received preoperative TFT testing while 11 received postoperative testing. CONCLUSIONS: There is a general lack of uniformity in the evaluation, diagnosis, and treatment of transient secondary hypothyroidism in pediatric postoperative CPB patients.


Assuntos
Ponte Cardiopulmonar/métodos , Terapia de Reposição Hormonal/métodos , Hipotireoidismo/etiologia , Tireotropina/uso terapêutico , Criança , Estudos Transversais , Feminino , Humanos , Hipotireoidismo/patologia , Masculino , Período Pós-Operatório , Tireotropina/farmacologia
6.
Curr Pediatr Rev ; 12(2): 106-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27197951

RESUMO

The care of extremely premature neonates with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is a frequent challenge for pediatric nurses. It is important for nurses to have adequate knowledge of the normal postnatal changes in cardiovascular and pulmonary function to recognize any adverse symptoms. Nurses caring for these vulnerable neonates must have a thorough understanding of the pathophysiology of a PDA in order to assess, plan, and implement patient-centered care. Recognition of characteristic symptoms of PDA in a timely manner is essential for optimal management and outcomes. Understanding the science behind treatment options is also imperative for pediatric nurses to provide the best care and effectively educate parents. Pediatric nurses are a significant resource in managing extremely premature neonates through comprehensive assessment, effective parent education, and high-quality patient-centered care.


Assuntos
Permeabilidade do Canal Arterial/enfermagem , Lactente Extremamente Prematuro , Doenças do Prematuro/enfermagem , Avaliação em Enfermagem , Enfermagem Pediátrica/educação , Inibidores de Ciclo-Oxigenase/administração & dosagem , Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/terapia , Humanos , Indometacina/administração & dosagem , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/terapia , Enfermagem Pediátrica/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Guias de Prática Clínica como Assunto
7.
J Digit Imaging ; 29(6): 665-669, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27072399

RESUMO

Three-dimensional (3D) printing is an emerging technology aiding diagnostics, education, and interventional, and surgical planning in congenital heart disease (CHD). Three-dimensional printing has been derived from computed tomography, cardiac magnetic resonance, and 3D echocardiography. However, individually the imaging modalities may not provide adequate visualization of complex CHD. The integration of the strengths of two or more imaging modalities has the potential to enhance visualization of cardiac pathomorphology. We describe the feasibility of hybrid 3D printing from two imaging modalities in a patient with congenitally corrected transposition of the great arteries (L-TGA). Hybrid 3D printing may be useful as an additional tool for cardiologists and cardiothoracic surgeons in planning interventions in children and adults with CHD.


Assuntos
Ecocardiografia Tridimensional , Cardiopatias Congênitas/diagnóstico por imagem , Impressão Tridimensional/instrumentação , Tomografia Computadorizada por Raios X , Estudos de Viabilidade , Humanos , Imagem Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Transposição dos Grandes Vasos/diagnóstico por imagem
8.
Ann Thorac Surg ; 101(4): 1574-6, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27000578

RESUMO

Fontan palliation is used when biventricular repair (BVR) is not possible. Early outcomes are acceptable; however, the long-term sequelae include protein-losing enteropathy, declining functional status, increased pulmonary vascular resistance, heart failure, and hepatic and renal dysfunction. These adverse events are characteristic of persistent venous hypertension and may be avoided if restoring biventricular circulation is possible. Arrhythmias are a common adverse event, particularly in patients with an atriopulmonary connection, which may lead to acute decompensation and early death. We describe a 30-year-old woman who underwent successful BVR for pulmonary atresia with intact ventricular septum and demonstrate that where favorable anatomy exists with a failing Fontan, BVR should be considered.


Assuntos
Bioprótese , Técnica de Fontan/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/cirurgia , Atresia Pulmonar/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Adulto , Ecocardiografia Transesofagiana/métodos , Feminino , Seguimentos , Técnica de Fontan/métodos , Ventrículos do Coração/patologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Cuidados Paliativos/métodos , Atresia Pulmonar/diagnóstico por imagem , Radiografia , Recuperação de Função Fisiológica , Reoperação/métodos , Medição de Risco , Esternotomia/métodos , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico
10.
Pediatr Int ; 58(5): 397-399, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26710725

RESUMO

Cardiac rhabdomyoma is the primary feature of the genetic disease, tuberous sclerosis complex, the most common cardiac tumor diagnosed in neonates and infants. Spontaneous regression is observed in most cases, but these tumors may cause hemodynamic instability, arrhythmias or other complications. We describe the case of a critically ill neonate, resuscitated after cardiac arrest secondary to massive locally invasive cardiac rhabdomyoma, who was successfully treated with everolimus (mammalian target of rapamycin [mTOR] inhibitor). Rapid tumor regression was observed on echocardiography, but it was unlikely that it was confounded by the natural disease course of regression. The presented case suggests that mTOR inhibitors may play a significant role in the treatment of large cardiac rhabdomyomas in critically ill neonates.

11.
Ann Thorac Surg ; 101(1): 352-5, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26694277

RESUMO

Left main coronary artery atresia (LMCAA) is a rare congenital malformation with a nonspecific and varied clinical presentation. Ventricular dysfunction and mitral insufficiency are expected ischemic consequences in the neonatal period. Left internal mammary artery (LIMA) bypass grafting (CABG) is uncommon because of the technical difficulties in performing this procedure in neonates. We describe LMCAA revascularization with a LIMA graft and mitral valve repair in a 7-week-old neonate with successful outcome 1 year postoperatively.


Assuntos
Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Humanos , Lactente , Masculino
12.
Expert Rev Cardiovasc Ther ; 13(12): 1281-4, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26465262

RESUMO

Three-dimensional (3D) printing in congenital heart disease has the potential to increase procedural efficiency and patient safety by improving interventional and surgical planning and reducing radiation exposure. Cardiac magnetic resonance imaging and computed tomography are usually the source datasets to derive 3D printing. More recently, 3D echocardiography has been demonstrated to derive 3D-printed models. The integration of multiple imaging modalities for hybrid 3D printing has also been shown to create accurate printed heart models, which may prove to be beneficial for interventional cardiologists, cardiothoracic surgeons, and as an educational tool. Further advancements in the integration of different imaging modalities into a single platform for hybrid 3D printing and virtual 3D models will drive the future of personalized cardiac medicine.


Assuntos
Cardiopatias Congênitas , Modelos Cardiovasculares , Impressão Tridimensional , Ecocardiografia Tridimensional/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Medicina de Precisão/métodos , Tomografia Computadorizada por Raios X/métodos
13.
EuroIntervention ; 11(6): 706-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26477643

RESUMO

Pulmonary arterial hypertension (PAH) is a severe, progressive and fatal disease. The creation of an interatrial right-to-left shunt in patients with PAH may enhance systemic ventricular output at the expense of desaturation. However, creating sustainable restricted interatrial communication is challenging. We describe the successful use of an atrial flow regulator, a novel implantable atrial communication device, in a 54-year-old female with severe irreversible PAH.


Assuntos
Função do Átrio Esquerdo , Função do Átrio Direito , Cateterismo Cardíaco/instrumentação , Circulação Coronária , Hemodinâmica , Hipertensão Pulmonar/terapia , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Emergências , Desenho de Equipamento , Feminino , Comunicação Interatrial/complicações , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Can J Cardiol ; 31(6): 819.e3-4, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26022992

RESUMO

Cor triatriatum sinister is a rare condition caused by a membrane in the left atrium, resulting in left ventricular inflow obstruction. This developmental anomaly is usually diagnosed in childhood. However, a rare presentation during adulthood is observed when the membrane is incomplete. Surgical excision of the membrane is the first line of treatment. We present a 51-year-old woman who underwent successful transcatheter balloon dilation with complete loss of the membrane waist and hemodynamic and symptomatic improvement.


Assuntos
Cateterismo Cardíaco/métodos , Coração Triatriado/diagnóstico por imagem , Coração Triatriado/terapia , Ecocardiografia Transesofagiana/métodos , Coração Triatriado/fisiopatologia , Ecocardiografia Tridimensional/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Pediatr Dermatol ; 32(4): e165-6, 2015 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25854548

RESUMO

Pulmonary arteriovenous malformations (PAVMs) are rare lesions known to cause cyanosis due to abnormal communication between the pulmonary arteries and veins. They are commonly seen in association with hereditary hemorrhagic telangiectasia, congenital heart disease, hepatopulmonary syndrome, and portopulmonary shunting, but rarely in patients with dyskeratosis congenita (DC). We describe a patient previously diagnosed with DC confirmed to have microscopic PAVMs after bone marrow transplantation and discuss possible pathogenic mechanisms.


Assuntos
Malformações Arteriovenosas/etiologia , Disceratose Congênita/complicações , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Malformações Arteriovenosas/diagnóstico , Transplante de Medula Óssea/efeitos adversos , Criança , Disceratose Congênita/diagnóstico , Humanos , Masculino
18.
J Digit Imaging ; 28(4): 459-61, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25537458

RESUMO

Three-dimensional printing technology has significant clinical implications for the management of congenital heart disease. Computed tomography and magnetic resonance imaging have been established as imaging tools for the creation of physical three-dimensional models. The potential use of non-invasive bedside imaging techniques such as three-dimensional echocardiography to derive three-dimensional printed models can revolutionize the planning of interventions for complex congenital malformations. The feasibility of deriving three-dimensional printing from ultrasound provides an additional cost-effective and patient-centered option for interventional cardiologists and surgeons for the management and care of congenital heart disease patients.


Assuntos
Ecocardiografia Tridimensional , Cardiopatias Congênitas/diagnóstico por imagem , Impressão Tridimensional , Humanos
19.
J Pediatr Nurs ; 29(4): 354-61, 2014 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24582649

RESUMO

Fecal microbiota transplantation (FMT) is an emerging experimental therapy for treatment of recurrent Clostridium difficile infection. In the future, FMT has the potential to be a treatment modality in other diseases that involve gut dysbiosis. As use of FMT is likely to expand, pediatric nurses need a clear understanding of FMT to provide appropriate education, assessment, and care for these patients. Pediatric research and clinical nurses are a resource to help children and parents understand the procedure. Important topics include donor screening, patient assessment before, during, and after treatment; routes of administration and positioning; preparation for discharge and followup evaluation.


Assuntos
Infecções por Clostridium/terapia , Transplante de Microbiota Fecal/métodos , Educação de Pacientes como Assunto , Enfermagem Pediátrica/educação , Adolescente , Criança , Pré-Escolar , Infecções por Clostridium/diagnóstico , Educação Continuada em Enfermagem/métodos , Transplante de Microbiota Fecal/enfermagem , Feminino , Humanos , Masculino , Papel do Profissional de Enfermagem , Avaliação em Enfermagem , Posicionamento do Paciente , Controle de Qualidade , Recidiva , Medição de Risco , Terapias em Estudo , Adulto Jovem
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