RESUMEN
Troponin-I (TN-I) levels are elevated following pediatric cardiac surgery with speculation that particular patterns may have prognostic significance. There is lack of procedure-specific data regarding postoperative TN-I levels in infants undergoing cardiac surgery. We hypothesized that TN-I elevation varies with type of surgery and persistent elevation predicts poor prognosis. We prospectively measured serial TN-I levels (preoperatively, 4, 8, 12, 24, and 48 hours postoperatively) in 90 infants (age < 1 year) undergoing cardiac surgery: off cardiopulmonary bypass (CPB) (nâ¯=â¯15), on CPB (nâ¯=â¯43), and on CPB with ventricular incision (CPB with ventricular incision; nâ¯=â¯32). All patients had undetectable baseline TN-I levels. The area under the curve of TN-I levels over the 48-hour period was significantly different among the surgical groups (P < 0.002), and highest in patients with CPB with ventricular incision. Generally, TN-I levels peaked by 4 hours after surgery and returned to near-normal levels within 48 hours. A persistent TN-I rise beyond 8 hours after surgery was a strong predictor of postoperative hypoperfusion injury (defined as a composite endpoint of end-organ injury resulting from inadequate perfusion, odds ratio 21.5; P = 0.001) and mortality (30% in those with persistently high TN-I, compared with 3.5% in the remaining patients; P < 0.001), independent of patient age, anatomy and/or complexity of surgery, and level of postoperative support. Our data provide benchmark values for TN-I levels following cardiac surgery in infants. Extent of TN-I elevation correlates with type of surgery. Persistent TN-I elevation beyond 8 hours after surgery is strongly associated with postoperative hypoperfusion injury and mortality.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente Cardiopulmonar/efectos adversos , Cardiopatías Congénitas/cirugía , Complicaciones Posoperatorias/sangre , Troponina I/sangre , Biomarcadores/sangre , Femenino , Cardiopatías Congénitas/sangre , Cardiopatías Congénitas/diagnóstico , Humanos , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia ArribaRESUMEN
A clinician-driven home monitoring program can improve interstage outcomes in single-ventricle patients. Sociodemographic factors have been independently associated with mortality in interstage patients. We hypothesized that even in a population with high-risk sociodemographic characteristics, a home monitoring program is effective in reducing interstage mortality. We defined interstage period as the time period between discharge following Norwood palliation and second-stage surgery. We reviewed the charts of patients for the three-year period before (group 1) and after (group 2) implementation of the home monitoring program. Clinical variables around Norwood palliation, during the interstage period, and at the time of second-stage surgery were analyzed. There were 74 patients in group 1 and 52 in group 2. 59 % patients were Hispanic, and 84 % lived in neighborhoods where over 5 % families lived below poverty line. There was no significant difference in pre-Norwood variables, Norwood discharge variables, age at second surgery, or outcomes at second surgery. There were more Sano shunts performed at the Norwood procedure as the source of pulmonary blood flow in group 2 (p value <0.05). There were more unplanned hospital admissions and percutaneous re-interventions in group 2. Patients in group 2 whose admission criteria included desaturation had a 45 % likelihood of having an unplanned re-intervention. Group 2 noted an 80 % relative reduction in interstage mortality (p < 0.01). In a multiple regression analysis, after accounting for ethnicity, socio-economic status, and source of pulmonary blood flow, enrollment in a home monitoring program independently predicted improved interstage survival (p < 0.01). A clinician-driven home monitoring program reduces interstage mortality even when the majority of patients has high-risk sociodemographic characteristics.
Asunto(s)
Ventrículos Cardíacos , Humanos , Síndrome del Corazón Izquierdo Hipoplásico , Procedimientos de Norwood , Cuidados Paliativos , Alta del Paciente , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
In this study, we present a case of prenatally diagnosed tetralogy of Fallot with a double aortic arch, correlating images from fetal echocardiography, transthoracic echocardiography, and cardiac MRI.
Asunto(s)
Aorta Torácica/anomalías , Aorta Torácica/cirugía , Diagnóstico Prenatal , Tetralogía de Fallot/diagnóstico por imagen , Tetralogía de Fallot/cirugía , Adulto , Ecocardiografía Doppler , Femenino , Feto/diagnóstico por imagen , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Embarazo , Nacimiento a TérminoRESUMEN
Takayasu's arteritis is a granulomatous giant-cell arteritis of the aorta and its major branches. It primarily affects East Asian women in their second or third decade of life but is well known to affect all ethnicities across the world. Given its systemic nature, Takayasu's arteritis has multiorgan involvement, with the majority of disease morbidity related to the cardiovascular, central nervous, and renal systems. This report describes an unusual presentation of Takayasu's arteritis in a 2½-year-old boy. This is the first report in the literature describing the presence of both severe aortic regurgitation and diffuse coronary artery involvement in a patient so young.
Asunto(s)
Arteritis de Takayasu/diagnóstico , Preescolar , Humanos , Imagen por Resonancia Magnética , Masculino , Índice de Severidad de la EnfermedadRESUMEN
The association of cardiac defects with Kabuki syndrome has been well described. The majority of these defects are isolated shunt lesions, conotruncal abnormalities, or various forms of arch obstruction. This report describes a series of three patients with hypoplastic left heart syndrome and Kabuki syndrome. The series illustrates the full spectrum of left-sided obstructive lesions and expands the phenotype of cardiac defects associated with Kabuki syndrome.
Asunto(s)
Anomalías Múltiples , Facies , Síndrome del Corazón Izquierdo Hipoplásico , Discapacidades del Desarrollo , Femenino , Humanos , Recién Nacido , Masculino , SíndromeAsunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Corazón Triatrial/diagnóstico por imagen , Corazón Triatrial/cirugía , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/cirugía , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/cirugía , Puente Cardiopulmonar , Corazón Triatrial/complicaciones , Ecocardiografía Transesofágica , Insuficiencia de Crecimiento/diagnóstico , Insuficiencia de Crecimiento/etiología , Femenino , Estudios de Seguimiento , Defectos del Tabique Interatrial/complicaciones , Humanos , Lactante , Medición de Riesgo , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/etiología , Resultado del TratamientoRESUMEN
Little is known about the characteristics and outcomes of fetuses with pericardial effusions (PEs); therefore, this study sought to identify factors associated with fetal PEs and the natural histories and outcomes of fetuses with PEs. Large PEs are associated with a greater likelihood of structural heart disease, impaired cardiac function, and chromosomal abnormalities, and PEs with hydrops or extracardiac malformations are associated with death. Most fetal PEs resolve, and fetuses with isolated PEs have a very good prognosis.
Asunto(s)
Enfermedades Fetales/diagnóstico por imagen , Derrame Pericárdico/etiología , Adolescente , Adulto , Aberraciones Cromosómicas/embriología , Ecocardiografía Doppler , Femenino , Muerte Fetal/epidemiología , Enfermedades Fetales/embriología , Enfermedades Fetales/mortalidad , Estudios de Seguimiento , Edad Gestacional , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/embriología , Humanos , Hidropesía Fetal/complicaciones , Hidropesía Fetal/diagnóstico por imagen , Hidropesía Fetal/embriología , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/mortalidad , Embarazo , Estudios Retrospectivos , Tasa de Supervivencia , Ultrasonografía PrenatalRESUMEN
Navigator coronary magnetic resonance imaging (MRI) was evaluated in assessing coronary artery origins in a pediatric and adolescent population. Sixty-five consecutive infants, children, or adolescents (age range 11 days to 21 years) were referred for MRI evaluations to assess coronary artery origins. Coronary artery origins were unambiguously delineated in 62 of 65 patients. In 3 patients, irregular arrhythmias precluded cardiac gating of the magnetic resonance acquisition. Two patients had anomalous coronary artery origins detected. Twenty-six patients required sedation for the studies. Free-breathing 3-dimensional MRI with real-time navigator correction is a robust method for delineating the coronary artery origins in pediatric and adolescent patients.