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Pediatric cardiac vascular thoracic surgery

Stephanie M Ware, Amy Shikany, Benjamin J Landis, Jeanne F James, Robert B Hinton
Thoracic aortic aneurysm (TAA) is a genetically mediated disease with variable age of onset. In the pediatric age range, nonsyndromic TAA frequently has a milder course than syndromic forms of TAA, such as Marfan syndrome or Loeys-Dietz syndrome. Herein, we describe 17-year-old identical twin brothers with severe progressive TAA due to a novel de novo ACTA2 mutation. Interestingly, both boys were diagnosed at age 11 with congenital mydriasis, a recently recognized manifestation of some ACTA2 mutations due to smooth muscle dysfunction...
October 2014: Pediatrics
C Spadaccio, A Rainer, R Barbato, M Trombetta, M Chello, B Meyns
Synthetic grafts have been widely used in cardiac and vascular surgery since the mid1970s. Considering the relative lack of randomized clinical trials or systematic analyses in the field of prosthetic large vessel diameter replacement, we reviewed the literature on the longterm performance and surgical management of complications of Dacron® grafts in both thoracic and abdominal aorta reconstruction and in the pediatric population. MedLine, Embase and Cochrane Library databases were searched for metaanalyses, reviews, clinical trials, and case reports pertinent to the study object...
April 14, 2014: Journal of Cardiovascular Surgery
Lisa Reinshagen, Janez Vodiskar, Eberhard Mühler, Hedwig H Hövels-Gürich, Jaime F Vazquez-Jimenez
BACKGROUND: Bicarotid trunk is the most common variation of aortic arch branching patterns. Bicarotid trunk can be a decisive factor in the surgical management of congenital heart defects. Our objective was to determine the prevalence of the bicarotid trunk among pediatric patients with congenital heart defects and to identify whether there is an association between bicarotid trunk and aortic coarctation. METHODS: From a total of 4,371 pediatric cardiac catheterizations between the years 1979 and 2010, a group of 2,033 patients were selected...
March 2014: Annals of Thoracic Surgery
James L Hoffman, Robert G Gray, L LuAnn Minich, Stephen E Wilkinson, Mason Heywood, Reggie Edwards, Hsin Ti Weng, Jason T Su
Isolated coarctation of the aorta (CoA) occurs in 6-8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified...
January 2014: Pediatric Cardiology
H Riha, J Fassl, P Patel, T Wyckoff, J Choi, J G Augoustides
Significant variability in transfusion practice persists despite guidelines. Although the lysine analogues are effective antifibrinolytics, safety concerns exist with high doses tranexamic acid. Despite recombinant activated factor VII promising results in massive bleeding after cardiac surgery, it significantly increases arterial thromboembolic risk. Aortic valve repair may evolve to standard of care. Transcatheter aortic valve implantation is an established therapy for aortic stenosis. The cardiovascular anesthesiologist features prominently in the new guidelines for thoracic aortic disease...
2011: HSR Proceedings in Intensive Care & Cardiovascular Anesthesia
Daniel Ansari, Luca Gianotti, Jörg Schröder, Roland Andersson
INTRODUCTION: Fast-track (FT) surgery can be defined as a coordinated perioperative approach aimed at reducing surgical stress and facilitating postoperative recovery. The objective of this review was to examine the literature on the procedure-specific application of FT surgery. DISCUSSION: The concept of FT rehabilitation has been applied mainly in colorectal surgery, but positive data have appeared also in other areas such as orthopedic, hepatopancreaticobiliary, urological, upper gastrointestinal, gynecological, thoracic, vascular, endocrine, breast, and pediatric surgeries...
January 2013: Langenbeck's Archives of Surgery
Martin C J Kneyber
In the previous issue of Critical Care, Bojan and colleagues reported their experiences with high-frequency oscillatory ventilation (HFOV) after pediatric cardiac surgery. A total of 120 patients were treated with HFOV on the day of surgery, thus excluding rescue HFOV use. The main finding of the authors was that the duration of mechanical ventilation was significantly shorter in patients in whom HFOV was initiated on the day of surgery. Especially interesting about this work is that the authors used HFOV when there was evidence of pulmonary hypertension or right ventricular (RV) failure in their patients...
2011: Critical Care: the Official Journal of the Critical Care Forum
Sami S Kabbani
Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose...
2011: Texas Heart Institute Journal
S Sarikouch, T Schilling, A Haverich
Translation of basic research results into routine patient care is delayed in parts by lack of institutionalization in clinical research. In this article the research structure and organization of our Department of Cardiac, Thoracic, Transplantation and Vascular Surgery are described.Basic research, separately directed, is accomplished in the Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO) and within the scope of the Excellence cluster "REBIRTH--from Regenerative Biology to Reconstructive Therapy"...
April 2010: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Leandro Gobbo Braz, Danilo Gobbo Braz, Deyvid Santos da Cruz, Luciano Augusto Fernandes, Norma Sueli Pinheiro Módolo, José Reinaldo Cerqueira Braz
This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s), study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed...
2009: Clinics
John G T Augoustides, Prakash Patel
There have been major advances in perioperative cardiothoracic and vascular medicine. Because of promising data, steroids, statins, and endothelin antagonists are being clinically tested in randomized trials with adult cardiac surgical patients. In vascular surgical patients, recent meta-analysis has revealed that interventions such as beta-blockade or endovascular stenting for peripheral vascular lesions may not improve outcome overall. Furthermore, a landmark trial has shown that anesthetic technique does not affect outcome after carotid endarterectomy...
June 2009: Journal of Cardiothoracic and Vascular Anesthesia
Toshiharu Shinoka, Christopher Breuer
Pediatric cardiovascular surgeons often encounter patients requiring surgical intervention utilizing foreign materials to repair complex lesions. However, the materials that are commonly used lack growth potential, and long-term results have revealed several material-related failures, such as stenosis, thromboembolization, calcium deposition, and risk of infection. To solve these problems, in particular for children who require the implantation of dynamic material with growth potential, we sought to develop optimal filling materials with biocompatibility and growth potential...
December 2008: Yale Journal of Biology and Medicine
Henry L Walters, Howard E Jeffries, Gordon A Cohen, Thomas Klitzner
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention...
December 2008: Cardiology in the Young
Meng-Luen Lee
PURPOSE: The clinical and radiological characteristics of the double aortic arch (DAA) and its differentiation from conotruncal malformations (CTM) were reported in order to familiarize pediatric practitioners with these congenital heart diseases. MATERIALS AND METHODS: From July 1994 to December 2006, a total of 6 patients (4 male and 2 female, aged 16 days to 6.5 years) with DAA were enrolled in this retrospective study. The study modalities included chart recordings, plain chest radiographs, barium esophagograms, echocardiograms, cardiac catheterization, cardiac angiograms, surgery, magnetic resonance imaging, and chromosome analysis...
October 31, 2007: Yonsei Medical Journal
Ritu Sachdeva, Elora Hussain, M Michele Moss, Michael L Schmitz, Richard M Ray, Michiaki Imamura, Robert D B Jaquiss
OBJECTIVE: To evaluate the impact of vocal cord dysfunction on feeding in children after cardiovascular surgery. STUDY DESIGN: Of the 2255 children who had cardiovascular surgery between January 2000 to January 2006, 38 (1.7%) had postoperative vocal cord dysfunction confirmed at laryngoscopy. The following data were obtained retrospectively: type of surgery, laryngoscopic examination results, swallowing studies, upper gastrointestinal (UGI) studies, and feeding route: oral, nasogastric tube (NG), and gastrostomy...
September 2007: Journal of Pediatrics
Joanne Clifton, Christine Bradley, Rachel Cadeliña, York Hsiang
OBJECTIVE: The purpose of this study was to determine the satisfaction of members of an academic department who are funded by a Clinical Academic Service Contract (CASC), compared with those who are not. METHODS: We mailed a satisfaction questionnaire designed to examine surgeons' perceived effect of CASCs on their participation in their division or department and on professional activities (research, teaching, clinical) to members of the surgery department who perform operative interventions...
June 2007: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Jonathan R Egan, Marino Festa, Andrew D Cole, Graham R Nunn, Jonathan Gillis, David S Winlaw
OBJECTIVE: To compare clinical assessment of cardiac performance with an invasive method of haemodynamic monitoring. DESIGN AND SETTING: Prospective observational study in a 16-bed tertiary paediatric intensive care unit. PATIENTS AND PARTICIPANTS: Infants and children undergoing cardiopulmonary bypass and surgical repair of congenital heart lesions. INTERVENTIONS: Based on physical examination and routinely available haemodynamic monitoring in the paediatric intensive care unit, medical and nursing staff assessed cardiac index, systemic vascular resistance index and volume status...
April 2005: Intensive Care Medicine
Michael H Hines
BACKGROUND: Diaphragm paralysis after cardiac surgery may be secondary to phrenic nerve injury by ice, electrocautery, or dissection. Although most are asymptomatic, some patients, particularly children, have significant respiratory compromise. Video-assisted plication may offer more rapid improvement and recovery than thoracotomy in pediatric patients. METHODS: We performed five procedures. The diaphragm was elevated, clamped, oversewn, and tacked down into the pleural gutter...
July 2003: Annals of Thoracic Surgery
Eric Larousse, Karim Asehnoune, Bruno Dartayet, Pierre Albaladejo, Anne-Marie Dubousset, Frédéric Gauthier, Dan Benhamou
UNLABELLED: Pediatric caudal anesthesia is an effective method with an infrequent complication rate. However, little is known about its cardiovascular consequences. Transesophageal Doppler, a noninvasive method, provides the opportunity for a reappraisal of the hemodynamic effects of this technique. After parental informed consent, we studied 10 children aged 2 mo to 5 yr who were scheduled for lower abdominal surgery. General anesthesia was induced using sevoflurane and was followed by the insertion of a transesophageal Doppler probe...
May 2002: Anesthesia and Analgesia
C A Kingston, K McHugh, J Kumaradevan, E M Kiely, L Spitz
Conjoined twins are rare and present a unique challenge to pediatric surgeons and radiologists. Planning of surgical separation is aided by accurate preoperative imaging. Such twins are classified according to the most prominent site of connection: the thorax (thoracopagus), abdomen (omphalopagus), sacrum (pygopagus), pelvis (ischiopagus), skull (craniopagus), face (cephalopagus), or back (rachipagus). The area of fusion largely determines the imaging modalities used. Thoracic conjunction is most common and requires cardiac assessment...
September 2001: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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