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1.
J Cardiovasc Comput Tomogr ; 18(3): 267-273, 2024.
Article in English | MEDLINE | ID: mdl-38360501

ABSTRACT

BACKGROUND: The use of cardiac CT (CCT) has increased dramatically in recent years among patients with pediatric and congenital heart disease (CHD), but little is known about trends and practice pattern variation in CCT utilization for this population among centers. METHODS: A 21-item survey was created to assess CCT utilization in the pediatric/CHD population in calendar years 2011 and 2021. The survey was sent to all non-invasive cardiac imaging directors of pediatric cardiology centers in North America in September 2022. RESULTS: Forty-one centers completed the survey. In 2021, 98% of centers performed CCT in pediatric and CHD patients (vs. 73% in 2011), and 61% of centers performed >100 CCTs annually (vs. 5% in 2011). While 62% of centers in 2021 utilized dual-source technology for high-pitch helical acquisition, 15% of centers reported primarily performing CCT on a 64-slice scanner. Anesthesia utilization, use of medications for heart rate control, and type of subspecialty training for physicians interpreting CCT varied widely among centers. 50% of centers reported barriers to CCT performance, with the most commonly cited concerns being radiation exposure, the need for anesthesia, and limited CT scan staffing or machine access. 37% (11/30) of centers with a pediatric cardiology fellowship program offer no clinical or didactic CCT training for categorical fellows. CONCLUSION: While CCT usage in the CHD/pediatric population has risen significantly in the past decade, there is broad center variability in CCT acquisition techniques, staffing, workflow, and utilization. Potential areas for improvement include expanding CT scanner access and staffing, formal CCT education for pediatric cardiology fellows, and increasing utilization of existing technological advances.


Subject(s)
Health Care Surveys , Heart Defects, Congenital , Practice Patterns, Physicians' , Predictive Value of Tests , Humans , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/therapy , Practice Patterns, Physicians'/trends , North America , Child , Age Factors , Child, Preschool , Infant , Tomography, X-Ray Computed/trends , Adolescent , Infant, Newborn , Time Factors , Male , Female , Radiation Exposure , Coronary Angiography/trends , Coronary Angiography/statistics & numerical data
2.
Cardiol Young ; 34(2): 325-333, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37415565

ABSTRACT

OBJECTIVES: There are limited data documenting sources of medical information that families use to learn about paediatric cardiac conditions. Our study aims to characterise these resources and to identify any disparities in resource utilisation. We hypothesise there are significant variations in the resources utilised by families from different educational and socio-economic backgrounds. METHODS: A survey evaluating what resources families use (websites, healthcare professionals, social media, etc.) to better understand paediatric cardiac conditions was administered to caretakers and paediatric patients at Morgan Stanley Children's Hospital. Patients with a prior diagnosis of CHD, cardiac arrhythmia, and/or heart failure were included. Caretakers' levels of education (fewer than 16 years vs. 16 years or more) and patients' medical insurance types (public vs. private) were compared with regard to the utilisation of resources. RESULTS: Surveys completed by 137 (91%) caretakers and 27 (90%) patients were analysed. Websites were utilised by 72% of caretakers and 56% of patients. Both private insurance and higher education were associated with greater reported utilisation of websites, healthcare professionals, and personal networks (by insurance p = 0.009, p = 0.001, p = 0.006; by education p = 0.022, p < 0.001, p = 0.018). They were also more likely to report use of electronic devices (such as a computer) compared to those with public medical insurance and fewer than 16 years of education (p < 0.001, p < 0.001, respectively). CONCLUSION: Both levels of education and insurance status are associated with the utilisation of informative resources and digital devices by families seeking to learn more about cardiac conditions in children.


Subject(s)
Heart Diseases , Heart Failure , Child , Humans , Surveys and Questionnaires , Health Personnel , Educational Status , Heart Failure/therapy
3.
Clin Pediatr (Phila) ; 63(4): 441-443, 2024 May.
Article in English | MEDLINE | ID: mdl-37309865

Subject(s)
Firearms , Schools , Humans
4.
Curr Opin Pediatr ; 35(5): 546-552, 2023 10 01.
Article in English | MEDLINE | ID: mdl-37555798

ABSTRACT

PURPOSE OF REVIEW: Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice. RECENT FINDINGS: Numerous studies have evaluated various preparticipation screening practices, particularly regarding the inclusion of ECG as part of an initial evaluation to identify conditions with an increased risk of SCD. Some analyses have shown ECG inclusion to provide increased screening sensitivity and specificity, though others have shown no benefit when compared with evaluation with history and physical examination alone. Furthermore, in countries for which more extensive screening protocols have been employed, postimplementation statistics have not shown a significant decrease in SCD. SUMMARY: SCD in young athletes primarily results from underlying cardiac disease. Various preparticipation screening recommendations exist globally, with the common goal of decreasing the rates of SCD by identifying youth at risk during sports participation. Current guidelines in the United States support universal preparticipation evaluation using history and physical examination, with cardiology referral if abnormalities are identified.


Subject(s)
Electrocardiography , Sports , Adolescent , Humans , United States , Electrocardiography/adverse effects , Electrocardiography/methods , Mass Screening/adverse effects , Athletes , Heart , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Physical Examination/methods
5.
Cardiol Young ; 33(7): 1217-1219, 2023 Jul.
Article in English | MEDLINE | ID: mdl-36503590

ABSTRACT

Chylous pericardial effusions are extremely rare outside of thoracic and cardiac surgery patients. We report the case of an 8-year-old girl with history of recurrent benign giant cell granulomas who developed a large chylous pericardial effusion with cardiac tamponade soon after beginning therapy with imatinib. In this article, we discuss the presentation, diagnosis, and management and review the published literature of this rarely reported side effect of this medication.


Subject(s)
Cardiac Surgical Procedures , Cardiac Tamponade , Pericardial Effusion , Respiration Disorders , Female , Humans , Child , Pericardial Effusion/chemically induced , Pericardial Effusion/diagnosis , Cardiac Tamponade/chemically induced , Cardiac Tamponade/diagnosis , Imatinib Mesylate/adverse effects
6.
Pediatr Emerg Care ; 39(3): 201-203, 2023 Mar 01.
Article in English | MEDLINE | ID: mdl-36173337

ABSTRACT

ABSTRACT: Point-of-care ultrasound is a valuable tool in the evaluation of undifferentiated respiratory distress in children. This case report describes a 9-month-old male infant who presented with 4 months of progressively worsening cough and was found to be tachypneic in the emergency department. Chest radiography revealed complete opacification of the left hemithorax with cardiomegaly. Point-of-care ultrasound demonstrated atelectasis of the entire left lung and severe dilation of the left ventricle with poor function. Electrocardiogram and echocardiogram findings were consistent with a diagnosis of anomalous left coronary artery from the pulmonary artery. The patient underwent successful cardiac surgery to improve myocardial perfusion. Bronchoscopy visualized the etiology of his atelectasis, pulsatile compression of the left mainstem bronchus by the dilated heart. Focused cardiac and lung ultrasound techniques, as well as pertinent sonographic findings, are reviewed.


Subject(s)
Anomalous Left Coronary Artery , Pulmonary Atelectasis , Child , Infant , Humans , Male , Anomalous Left Coronary Artery/complications , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/abnormalities , Point-of-Care Systems , Ultrasonography
7.
Pediatr Transplant ; 26(3): e14201, 2022 05.
Article in English | MEDLINE | ID: mdl-34889487

ABSTRACT

BACKGROUND: Surgical repair for patients with congenital heart disease (CHD) often incorporates homograft tissue or other foreign material that can lead to allosensitization. We sought to identify the relationship between pre-sensitization prior to heart transplant and exposure to homograft tissue in CHD patients. METHODS: Retrospective chart review of all CHD patients who underwent heart transplant at a major pediatric transplant center between 1/1/2011-3/31/18. Operative records determined use of homograft tissue or foreign material. Panel reactive antibody (PRA) and LuminexTM single-antigen bead (SAB) testing results were reviewed. Statistical analysis determined odds of pre-sensitization in patients exposed to homograft tissue. RESULTS: Fifty-six CHD patients underwent transplant during the review period. Thirteen patients (23%) were pre-sensitized by PRA>10%. By SAB testing, 33 patients (59%) developed any anti-HLA antibody >0 MFI, 30 patients (54%) >2000 MFI, and 19 patients (34%) >6000 MFI. Patients with homografts were more likely to be pre-sensitized by PRA (OR = 7.31, p = .007), and to have developed any anti-HLA antibody at various levels, >0 (OR = 4.52, p = .034), >2000 (OR = 8.59, p = .003), and >6000 (OR = 8.50, p = .004). Of patients with homografts, those pre-sensitized by PRA had longer exposure times (9.80 vs 4.96 years, p = .025). There was no difference in exposure time with relation to pre-sensitization by SAB testing. CONCLUSIONS: Previous exposure to homograft tissue appears to increase the odds of pre-sensitization by either the PRA or SAB testing. Longer exposure time to homograft tissue prior to transplant is associated with increased pre-sensitization at transplant as determined by PRA, though not by SAB testing.


Subject(s)
Heart Defects, Congenital , Heart Transplantation , Allografts , Child , HLA Antigens , Heart Defects, Congenital/surgery , Histocompatibility Testing , Humans , Isoantibodies , Retrospective Studies
8.
Pediatr Transplant ; 24(7): e13801, 2020 11.
Article in English | MEDLINE | ID: mdl-32820859

ABSTRACT

Hypertension is a known complication of pediatric heart transplantation. We sought to identify factors associated with anti-hypertensive use in pediatric heart transplant recipients immediately post-transplant and oral anti-hypertensive use at discharge and 1-year post-transplant. Retrospective chart review was conducted of patients ≤18 years who underwent heart transplantation at two major heart transplant centers between August 1, 2009 and December 31, 2017 with ≥1-year follow-up. Exclusion criteria included re-transplant, multi-organ recipients, survival <1 year, and comorbidities associated with hypertension. Anti-hypertensive use was recorded during initial ICU stay, at discharge, and 1-year post-transplant. Univariate and multivariate analyses determined associations of demographic and diagnostic factors and need for anti-hypertensives. There were 188 patients that met inclusion criteria. Anti-hypertensive infusions were required in the ICU post-transplant in 46 patients (24.5%) for a median of 3 days (1-21 days). Oral anti-hypertensives were required in 58 patients (30.9%) at discharge and 1-year post-transplant. Anti-hypertensive infusion in the ICU post-transplant was associated with donor-to-recipient weight ratio. Oral anti-hypertensive use at discharge was associated with weight ratio and pretransplant VAD use, and at 1-year, post-transplant was associated with age at transplant, steroid use at discharge, and oral anti-hypertensive use at discharge. Hypertension is common immediately following and 1-year post-transplant. Weight ratio was the only independent predictor of anti-hypertensive use in the early post-transplant period, whereas VAD use was also associated with anti-hypertensive use at discharge. Anti-hypertensive use 1-year post-transplant was not associated with those factors, but rather with age at transplant and steroid use.


Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Heart Transplantation/adverse effects , Hypertension/drug therapy , Postoperative Complications/drug therapy , Tissue Donors , Adolescent , Adult , Age Factors , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Hypertension/etiology , Hypertension/physiopathology , Infant , Infant, Newborn , Male , Postoperative Complications/physiopathology , Postoperative Period , Retrospective Studies , Time Factors , Treatment Outcome , Young Adult
9.
Transplantation ; 101(3): 657-663, 2017 Mar.
Article in English | MEDLINE | ID: mdl-27214265

ABSTRACT

BACKGROUND: Posttransplant lymphoproliferative disorders (PTLD) are a common malignancy after renal transplantation with a high incidence of PTLD described in the first posttransplant year. We sought to determine incidence and risk determinants of PTLD in Irish kidney transplant recipients. METHODS: Retrospective observational study of 1996 adult first kidney transplant recipients between 1991 and 2010 in the Republic of Ireland. Recipients were cross-referenced with the National Cancer Registry to determine incidence of PTLD. Kaplan-Meier analysis was performed for PTLD-free survival, allograft survival, and patient survival after PTLD. Cox proportional hazards models were used to identify independent risk factors for PTLD in our population. RESULTS: We identified 31 cases of PTLD during the study period. Histological subgroups included: early lesions (n = 1); polymorphic PTLD (n = 1); monomorphic PTLD (n = 27), Hodgkin disease (n = 2). Median time to PTLD diagnosis was 8.3 (range, 1.2-13.9) years. Cumulative incidence (95% CI) of PTLD at 1, 2, 3, 5, 10, and 15 years was 0%, 0.16% (0.05-0.5%), 0.21% (0.08-0.57%), 0.21% (0.08-0.57%), 1.76% (1.15-2.69%), and 3.07% (2.1-4.43%), respectively. Allograft survival after PTLD diagnosis was 94.4% (66.6-99.2%) at 5 years. Patient survival after PTLD diagnosis was 64% at 1 year, 53% at 2 years, 48% at 5 years, and 37% at 10 years. No risk factors for PTLD were identified. CONCLUSIONS: We found a paucity of early onset PTLD in our cohort with no cases in the first posttransplant year. Potential contributing factors included a high prevalence of previous Epstein-Barr virus exposure and a relatively low immunological risk profile in our recipient cohort compared with prior studies. Further studies are required to reevaluate the epidemiology of PTLD in the modern era of transplant immunosuppression.


Subject(s)
Kidney Transplantation/adverse effects , Lymphoproliferative Disorders/epidemiology , Transplant Recipients , Adolescent , Adult , Allografts , Epstein-Barr Virus Infections/epidemiology , Epstein-Barr Virus Infections/immunology , Female , Graft Survival , Humans , Immunosuppressive Agents/adverse effects , Incidence , Ireland/epidemiology , Kaplan-Meier Estimate , Kidney Transplantation/mortality , Lymphoproliferative Disorders/diagnosis , Lymphoproliferative Disorders/immunology , Lymphoproliferative Disorders/mortality , Male , Middle Aged , Multivariate Analysis , Proportional Hazards Models , Registries , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Young Adult
10.
J Card Surg ; 30(8): 631-9, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26108804

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a significant complication of surgical aortic valve replacement (SAVR). This study sought to describe AKI following SAVR, its risk factors, predictors and effect on long-term survival. METHODS: We retrospectively reviewed 2169 patients who underwent isolated SAVR between 2000 and 2012. The main end-points were occurrence of AKI, postoperative complications, and short- and long-term survival rates following SAVR. Patients were divided into two groups: AKI+ (n = 181) and AKI- (n = 1945). RESULTS: AKI occurred in 8.5% of patients, of which 3.9% (n = 7) needed dialysis. Predictors of AKI after SAVR were body mass index (BMI) and intraoperative packed red blood cells (PRBC) transfusion. AKI+ patients had a more complicated postoperative course and higher cumulative mortality (25% vs. 17%, p = 0.012) with a median follow-up of 4.1 years. AKI was not found to be an independent predictor of mortality. CONCLUSIONS: Predictors of AKI after SAVR are increased BMI and intraoperative PRBC transfusion. AKI conferred an increase in hospital length of stay and cumulative mortality while the need for postoperative dialysis was associated with the most complicated hospital stays and the highest in-hospital and cumulative mortalities; therefore careful recognition of patients at risk of AKI is warranted for a better preoperative renal optimization. However, incidence of AKI was lower than what is reported after both on-CPB cardiac surgeries and transcatheter aortic valve replacement, moreover AKI was not found to be an independent predictor of mortality.


Subject(s)
Acute Kidney Injury , Aortic Valve/surgery , Heart Defects, Congenital/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Postoperative Complications , Acute Kidney Injury/epidemiology , Aged , Aged, 80 and over , Bicuspid Aortic Valve Disease , Body Mass Index , Dialysis , Erythrocyte Transfusion , Female , Forecasting , Heart Valve Prosthesis Implantation/mortality , Hospital Mortality , Humans , Incidence , Intraoperative Care , Length of Stay , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors , Severity of Illness Index , Survival Rate
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