Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 5 de 5
Filter
2.
Heart Rhythm ; 13(9): 1913-9, 2016 09.
Article in English | MEDLINE | ID: mdl-27554948

ABSTRACT

BACKGROUND: The optimal treatment for fetal supraventricular tachycardia (SVT) with 1:1 atrioventricular relationship is unclear. OBJECTIVE: We compared the effectiveness of transplacental treatment protocols used in 2 centers. METHODS: Pharmacologic treatment was used in 84 fetuses. Maternal oral flecainide was the primary therapy in center 1 (n = 34) and intravenous maternal digoxin in center 2 (n = 50). SVT mechanism was classified by mechanical ventriculoatrial (VA) time intervals as short VA or long VA. Treatment success was defined as conversion to sinus rhythm (SR), or rate control, defined as >15% rate reduction. RESULTS: Short VA interval occurred in 67 fetuses (80%) and long VA in 17 (20%). Hydrops was present 28 of 84 (33%). For short VA SVT, conversion to SR was 29 of 42 (69%) for digoxin and 24 of 25 (96%) for flecainide (P = .01). For long VA SVT, conversion to SR and rate control was 4 of 8 (50%) and 0 of 8, respectively, for digoxin, and 6 of 9 (67%) and 2 of 9 (cumulative 89%) for flecainide (P = .13). In nonhydropic fetuses, digoxin was successful in 23 of 29 (79%) and flecainide in 26 of 27 (96%) (P = .10). In hydrops, digoxin was successful in 8 of 21 (38%), flecainide alone in 6 of 7 (86%, P = .07 vs digoxin), and flecainide ± amiodarone in 7 of 7 (100%) (P = .01). Intrauterine or neonatal death occurred in 9 of 21 hydropic fetuses treated with digoxin (43%), compared to 0 of 7 (P = .06) treated with flecainide. CONCLUSIONS: Flecainide was more effective than digoxin, especially when hydrops was present. No adverse fetal outcomes were attributed to flecainide.


Subject(s)
Anti-Arrhythmia Agents/administration & dosage , Digoxin/administration & dosage , Fetal Diseases/drug therapy , Flecainide/administration & dosage , Tachycardia, Supraventricular/drug therapy , Administration, Intravenous , Administration, Oral , Adult , Anti-Arrhythmia Agents/blood , Clinical Protocols , Digoxin/blood , Echocardiography , Edema/complications , Female , Fetal Diseases/diagnostic imaging , Fetal Therapies/methods , Flecainide/blood , Humans , Pregnancy , Retrospective Studies , Tachycardia, Supraventricular/classification , Tachycardia, Supraventricular/complications , Tachycardia, Supraventricular/diagnostic imaging , Ultrasonography, Prenatal , Young Adult
3.
Nurs Stand ; 24(45): 35-9, 2010.
Article in English | MEDLINE | ID: mdl-20701051

ABSTRACT

AIM: To adapt and promote a relevant track and trigger system based on modified early warning systems (MEWS) for use in rural community hospitals in Powys, Wales. METHOD: Track and trigger systems, including MEWS, were reviewed, compared and developed by senior nursing and medical staff using PDSA (Plan Do Study Act) cycles. RESULTS: A track and trigger system was developed, piloted and rolled out to all ten community hospitals in Powys. The system is not only used to monitor inpatients, but is also useful in determining appropriateness of patient transfer to district general hospitals. CONCLUSION: The track and trigger scoring system has proved useful in assessing patients and alerting staff if their condition is deteriorating. It has ensured, when necessary, timely, appropriate and safe transfer of patients to the district general hospital. The scoring system has been extended to determine appropriateness of accepting patients from the district general hospital to the community hospital.


Subject(s)
Hospitals, Community/organization & administration , Patient Transfer , Monitoring, Physiologic/methods , Safety Management/organization & administration , United Kingdom
4.
Eur J Echocardiogr ; 10(1): 160-2, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18757861

ABSTRACT

Persistent left-sided superior caval veins (SVC) are present in 0.4% of the population. In the majority of cases, the persistent left SVC drains into the right atrium via the coronary sinus, but direct connection to the left atrium is also recognized. Previous reports have described re-opening of persistent left SVCs in patients with congenital heart disease following bidirectional cavopulmonary connection or Fontan-type procedures, suggesting that the lumen of the left SVC obliterates during embryological development, rather than disappears. The case described in this report is, to our knowledge, the first description of obliteration of the left SVC in post-natal life, associated with spontaneous closure of a ventricular septal defect. Our observation lends further support to the hypothesis that venous structures obliterate but do not completely disappear in foetal life.


Subject(s)
Echocardiography, Doppler, Color , Heart Defects, Congenital/diagnostic imaging , Heart Septal Defects, Ventricular/diagnostic imaging , Vena Cava, Superior/abnormalities , Female , Follow-Up Studies , Heart Atria/abnormalities , Heart Defects, Congenital/physiopathology , Heart Septal Defects, Ventricular/physiopathology , Humans , Infant, Newborn , Infant, Premature , Remission, Spontaneous , Risk Assessment
5.
Int J Cardiol ; 113(1): 39-47, 2006 Oct 26.
Article in English | MEDLINE | ID: mdl-16360223

ABSTRACT

UNLABELLED: Current echocardiographic assessment of fetal ventricular function uses relatively crude measures and this has led to inconsistencies in assessment of diastolic function. Long axis parameters may be more insightful. OBJECTIVE: To describe fetal long axis cardiac function and construct reference ranges. DESIGN: 159 normal fetuses were studied cross-sectionally using long axis M-mode to measure displacement of the atrioventricular ring and pulsed wave Doppler ultrasound to record myocardial tissue Doppler velocities at the base of the heart. RESULTS: There was a strong, almost linear gestational relationship for all but late left basal myocardial velocities. Systolic amplitude of the atrioventricular ring increased significantly. Wall thickness increased with gestation and heart rate reduced. Late diastolic mitral and tricuspid flow velocities showed no age-dependence. Right ventricular filling (p<0.0001) and myocardial lengthening (p<0.0001) and shortening velocities (p<0.0001) were higher than left. Aortic velocities were higher than pulmonary (p<0.0001). Right ventricular long axis amplitude was greater than left (p<0.0001). There were no significant differences in right (RV) and left (LV) ventricular and septal thicknesses (RV 2.5 mm [1.2-4.1]; LV (2.4 mm [1.0-4.0] and septum 2.6 mm [1.0-4.3]). Left and right myocardial tissue Doppler velocities showed similar maturation in systole (LV 0.14 vs. RV 0.10 cm/s/week) and early diastole (LV 0.16 vs. RV 0.14 cm/s/week). CONCLUSIONS: This study demonstrates maturational changes occur in both fetal systolic and diastolic ventricular function and moreover the maturational rate of myocardial tissue velocities is similar in both ventricles, despite differential loading conditions.


Subject(s)
Echocardiography, Doppler , Fetal Heart/diagnostic imaging , Fetal Heart/physiology , Ultrasonography, Prenatal , Blood Flow Velocity , Coronary Circulation , Cross-Sectional Studies , Diastole , Gestational Age , Heart Rate , Heart Ventricles , Humans , Myocardial Contraction , Reproducibility of Results , Systole , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...