Noninvasive cardiac output monitoring in the pediatric cardiac Intensive Care Unit.

PURPOSE OF REVIEW: The present article explores some of the newer noninvasive techniques for monitoring cardiac output in the pediatric population. These new techniques can be utilized in both a wide variety of patient sizes and the unique pathology of congenital cardiopathy. These techniques may assist in optimizing therapy in the intensive care setting. RECENT FINDINGS: Recently, Hoffman et al. found that near-infrared spectroscopy positively correlates with SvO2. Esophageal Doppler is an accurate method only if used by experienced personnel. Both impedance cardiography and electrical cardiometry use thoracic electrical bioimpedance. However, the algorithm differs between the two methods. Cardiometry may be more accurate in patients with a low cardiac output state. Calamandrei et al. found that an analytical method using arterial pulse pressure recording (pressure recording analytical method) shows a high correlation with Doppler echocardiography. Finally, a method like partial CO2 rebreathing was studied by Levy et al., who suggested that this method may be used to trend cardiac output continuously, but not for providing absolute values. SUMMARY: Although promising, studies validating the use of these methods in a variety of real clinical situations are needed before they will be widely used in pediatric practice.The currently available data suggest that pressure recording analytical method and electrical cardiometry will prove to be useful in the pediatric cardiac ICU to monitor trends in cardiac output.

Right aortic coarctation and ventricular septal defect: an unusual cause of tracheal compression in infancy.

OBJECTIVE: Acyanotic congenital heart diseases may occasionally present with tracheobronchial obstruction. Increased pulmonary blood flow against a high-resistance pulmonary bed may create significant pulmonary artery dilation. METHODS: We report an unusual case of ventricular septal defect and right aortic arch coarctation, complicated with distal tracheal compression secondary to a pincer effect created by a right aortic arch and a massively dilated pulmonary artery. RESULTS: High index of suspicion is required to anticipate tracheobronchial compression in acyanotic congenital heart diseases. CONCLUSION: Fiberoptic bronchoscopy is an invaluable tool to assess for tracheal compression relief following surgical repair and to identify tracheomalacia prior to extubation.

Horseshoe lung with left lung hypoplasia and critical pulmonary venous stenosis.

Horseshoe lung is a rare congenital anomaly characterized by an isthmus of the pulmonary parenchyma that extends posterior to the pericardial reflection at the cardiac apex and across the midline. There is unilateral, usually right-lung hypoplasia and most cases are associated with the scimitar syndrome. We present the case of an infant with horseshoe lung but with hypoplasia of the left lung and levocardia that was not associated with the scimitar syndrome.