Appropriate Length and Position of the Central Venous Catheter Insertion via Right Internal Jugular Vein in Children.

Design: Observational study. Setting: Tertiary University Hospital. Participants/patients: Patients, aged 6 days to 19 years, who underwent contrast enhancement computerized tomography imaging of the thorax (CT-thorax). Main outcome measures: We measured three lengths consisting of length A in axial plane at the level of the lower border of the 6th C-spine from the skin to RIJV at its mid lumen, length B and C in sagittal plane from the RIJV at the level of the lower of the 6th C-spine to the superior vena cava (SVC) at carina and from carina to SVC-right atrium junction, respectively. Lengths A plus B represented the length of CVC where the tip was expected in the SVC at carina (CVCcarina). Lengths A plus B and C represented the length of CVC when the tip was expected in the SVC at SVCright atrium junction (CVCSVC-RA). Results: One hundred and sixty-five cases with mean age of 8.1 ± 4.7 years were reviewed. The CVCSVC-RA and CVC carina were significantly correlated with age and body surface area (BSA). Using multiple regression analysis, CVCSVC-RA (cm) was equal to 6.4 + 2.8[BSA (m2)] + 0.022[age (month)] and CVCcasina (cm) equal to 4.9 +2.7[BSA (m2)] +0.013[age (month)] (Adjusted Rsquared 0.7275, 0.7140). Conclusions: We recommended the appropriate CVC length via RIJV approach should be between these two calculated lengths and the CVC length in each age according to the BSA.

Echocardiographic Parameters of Patent Ductus Arteriosus in Preterm Infants.

Objective: To analyze cardiovascular parameters by echocardiography in preterm infants with patent ductus arteriosus (PDA). Setting: Tertiary-care pediatric university hospital. Design: Cross-sectional, hospital-based study. Participants: 58 preterm infants, gestational age less than 33 weeks. Measurements: A complete 2-dimension, M-mode, color doppler echocardiography was performed in each preterm infant at approximately 48 hours of life. Results: Each preterm was categorized into hemodynamically significant PDA (hsPDA) (n=17, 29.3%), non-hemodynamically significant PDA (non-hsPDA) (n = 12, 20.7%), and no PDA (non-PDA) (n=29, 50%). Gestational age (29.4 ± 1.2 wk) and birth weight (1237 ± 358 g) of infants in hsPDA were significantly lower than those in non-PDA group (30.8 ±1.3 wk, 1543 ± 361 g, P = 0.001), as compared to those in the non-hsPDA group (29.5 ± 2.3 wk, 1296 ± 462 g). Cardiovascular parameters including left atrium/aorta ratio, left atrium volume index, left ventricular dimensions and volumes, stroke volume, and cardiac output in hs-PDA were significantly greater than those in non-hsPDA and non-PDA. LV systolic and diastolic functions were not significantly different in each group. LV global function in hsPDA (0.34 ± 0.13) was significantly lower than that in non-PDA (0.45 ± 0.13, P = 0.01). Conclusions: In preterm infants with hsPDA, there was a volume load of the left heart causing increased stroke volume and cardiac output. The hsPDA could be detected by echocardiography even in the first 48 hours. The left atrial volume index may be a better indicator of the volume load of the heart.

Residual patent ductus arteriosus shunting after single Gianturco coil occluding.

Transcatheter occlusion with Gianturco coils has become the treatment of choice for small patent ductus arteriosus (PDA). Coil occlusion was attempted in 20 patients with ductus diameter less than 4 mm who did not require other cardiac surgery. Sixteen of 20 patients had successful implantation. The mean age was 4.2 years. Their mean weight was 14.1 +/- 5.9 kg. The mean ductus diameter was 2.21 +/- 0.91 mm (range 1-3.7 mm). Nine patients had complete occlusion but 7 had residual shunting immediately after the procedure. However, 4 patients had spontaneous resolution of residual shunts at 6 months after the procedure. The other 3 who had diameter of ductus greater than 3 mm still had significant residual shunt at 6 months and 1 year after the procedure. The second coil was successfully implanted in one of these 3 patients and the closure of PDA was accomplished. We concluded that the second coil should be implanted if the ductus diameter is greater than 3 mm and significant residual shunt is still demonstrated angiographically after the first coil implantation.

Factors affecting mortality in Ebstein's anomaly of the tricuspid valve.

Ebstein's anomaly of the tricuspid valve is a relatively uncommon congenital heart defect. Twenty-one patients (11 boys and 10 girls) with Ebstein's anomaly were reviewed regarding clinical characteristics and factors related to the outcome of this lesion. Their ages at presentation ranged from 1 day to 13 years (median = 11 months). Eleven patients presented in infancy period, 6 of them were neonates. Common clinical findings were systolic murmur (85.7%) and cyanosis (57.1%). Laboratory findings included cardiomegaly on chest X-rays (95.2%), right bundle branch block pattern (76.2%) and right atrial enlargement (61.9%) on electrocardiography. Diagnosis and grading of severity were established by echocardiography. Among 21 patients, 4 were lost during follow-up. Seventeen patients were followed for 3-72 months. Six patients (28.6%) required surgery, 5 of whom died following surgery. Two patients died during the medical follow-up. Factors affecting cardiac death were the younger age at presentation, onset of cyanosis in infancy period, associated PS or PA, the lower insertion of the septal leaflet of the tricuspid valve and the higher ratio of the combined area of right atrium and atrialized right ventricle to that of functional right ventricle and left heart chambers.

Balloon pulmonary valvuloplasty in children, one year follow-up experience at Ramathibodi Hospital.

Balloon valvuloplasty has become the treatment of choice in pulmonary valvular stenosis. The objective of this report is to review the experience of this procedure in children at the Department of Pediatrics, Ramathibodi Hospital in the past 4 years (1991-1994) with at least one year follow-up. During the study period, 19 children aged 2.1-14.3 years (mean 5.11 years) with the diagnosis of pulmonary valvular stenosis had successful pulmonary balloon valvuloplasty at this institution. The immediate peak systolic pressure gradient across the pulmonary valve by cardiac catheterization decreased from 92.05 +/- 46.92 to 34.26 +/- 25.30 mmHg, by Doppler from 78.58 +/- 26.55 to 34.83 +/- 15.60 mmHg. Peak pressure gradient across the pulmonary valve by Doppler of the last examinations, one to 4 years after the procedure (mean 1.9 years), was 23.05 +/- 9.40 mmHg in 17 patients. The mean ratio of balloon size and pulmonary valve ring was 1.06. One patient still has a residual gradient of 54 mmHg and two were lost to follow-up. No serious complication was encountered during the procedures. CONCLUSION: Balloon pulmonary valvuloplasty is effective in the management of children with valvular pulmonary stenosis. The intermediate term result is excellent.