Comorbid risk factors in TRAM flap failure.

Women having transverse abdominal muscle (TRAM) breast reconstruction have often suffered through mastectomy, perhaps chemotherapy, and certainly survived a brush with death. To finally reach a time when the missing breast can be reconstructed affords them a sense of return to normally. Unfortunately for some women, the risk of complications looms large. The purpose of this paper is to address the co-morbid risk factors for TRAM flap failure and the nurses' role in minimizing their impact.

Rare combined heart and kidney transplant in a pediatric patient: a case study.

Multiple reports of successful combined heart and kidney transplants adults suggest that this may be a viable option for a small subset of patients with coexisting end-stage heart and kidney failure. A review of the literature, however, reveals that few combined heart and kidney transplants have been reported in children. This article presents the case of a 13-year-old boy who underwent unsuccessful palliative surgery for a congenital heart defect. The patient developed heart failure with subsequent acute renal failure, and ultimately required a combined heart and kidney transplant. The combined procedure was successful in this patient and he is alive and well 27 months postoperatively.

Dobutamine stress echocardiography for assessing coronary artery disease after transplantation in children.

OBJECTIVES: The purpose of this study was to determine the feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography (DSE) for evaluating posttransplant coronary artery disease (TxCAD) in children, and to determine the frequency of selected cardiac events after normal or abnormal DSE. BACKGROUND: Posttransplant coronary artery disease is the most common cause of graft loss (late death or retransplantation) after cardiac transplantation (CTx) in children. Coronary angiography, routinely performed to screen for TxCAD, is an invasive procedure with limited sensitivity. The efficacy of DSE for detecting atherosclerotic coronary artery disease is established, but is unknown in children after CTx. METHODS: Of the 78 children (median age 5.7 years, range 3 to 18) entered into the study, 72 (92%) underwent diagnostic DSE by means of a standard protocol, 4.6 +/- 1.9 years after CTx. The results of coronary angiography performed in 70 patients were compared with DSE findings. After DSE, subjects were monitored for TxCAD-related cardiac events, including death, retransplantation and new angiographic diagnosis of TxCAD. RESULTS: No major complications occurred. Minor complications, most often hypertension, occurred in 11% of the 72 subjects. The sensitivity and specificity of DSE were 72% and 80%, respectively, when compared with coronary angiography. At follow-up (21 +/- 8 months), TxCAD-related cardiac events occurred in 2 of 50 children (4%) with negative DSE, versus 6 of 22 children (27%) with positive DSE (p < 0.01). CONCLUSIONS: DSE is a feasible, safe and accurate screening method for TxCAD in children. Positive DSE identifies patients at increased risk of TxCAD-related cardiac events. Negative DSE predicts short-term freedom from such events.