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Early Mortality in Infants Born with Neonatally Operated Congenital Heart Defects and Low or Very-Low Birthweight: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2023; 10:jcdd10020047. [PMID: 36826543 PMCID: PMC9966697 DOI: 10.3390/jcdd10020047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
Mortality outcomes of children with isolated neonatally operated congenital heart defects (CHDs) born with a low (LBW), moderately low (MLBW) or very-low birthweight (VLBW) remain ambiguous. We searched Medline and Embase (inception until October 2021) and included studies that evaluated early mortality. The risk of bias was assessed using the Critical Appraisal Skills Program cohort checklist. Meta-analysis involved random-effects models. We explored variability in mortality across birthweight subgroups, CHD types, and study designs. From 2035 reports, we included 23 studies in qualitative synthesis, and the meta-analysis included 11 studies (1658 CHD cases), divided into 30 subcohorts. The risk of bias was low in 4/11 studies included in the meta-analysis. Summary mortality before discharge or within one month after surgery was 37% (95%CI 27-47). Early mortality varied by birthweight (VLBW 56%, MLBW 15%, LBW 16%; p = 0.003) and CHD types (hypoplastic left heart syndrome (HLHS) 50%, total anomalous pulmonary venous return (TAPVR) 47%, transposition of the great arteries (TGA) 34%, coarctation of the aorta (CoA) 16%; p = 0.13). Mortality was higher in population-based studies (49% vs. 10%; p = 0.006). One-third of infants born with neonatally operated isolated CHDs and LBW, MLBW, or VLBW died within 30 days after surgery. Mortality varied across infant and study characteristics. These results may help clinicians assess neonatal prognosis. PROSPERO registration CRD42020170289.
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Kashav RC, Kohli JK, Magoon R. TIVA versus Inhalational Agents for Pediatric Cardiac Intensive Care. JOURNAL OF CARDIAC CRITICAL CARE TSS 2021. [DOI: 10.1055/s-0041-1732834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractThe field of pediatric intensive care has come a long way, especially with the recognition that adequate sedation and analgesia form an imperative cornerstone of patient management. With various drugs available for the same, the debate continues as to which is the better: total intravenous anesthesia (TIVA) or inhalational agents. While each have their own advantages and disadvantages, in the present era of balance toward the IV agents, we should not forget the edge our volatile agents (VAs) might have in special scenarios. And ultimately as anesthesiologists, let us not forget that be it knob and dial, or syringe and plunger, our aim is to put pain to sleep and awaken a new faith to breathe.
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Affiliation(s)
- Ramesh Chand Kashav
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
- Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Jasvinder Kaur Kohli
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
- Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
- Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
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Hosokawa T, Tanami Y, Sato Y, Ko Y, Nomura K, Oguma E. Comparison of sonographic findings between pediatric patients with mediastinitis and without mediastinitis after cardiovascular surgery. J Med Ultrason (2001) 2020; 47:625-633. [DOI: 10.1007/s10396-020-01029-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/17/2020] [Indexed: 01/10/2023]
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Hosokawa T, Yamada Y, Tanami Y, Sato Y, Ko Y, Nomura K, Oguma E. Computed tomography findings of mediastinitis after cardiovascular surgery. Pediatr Int 2020; 62:206-213. [PMID: 31845441 DOI: 10.1111/ped.14101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/11/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To our knowledge, no systematic study has been conducted on computed tomography (CT) imaging of mediastinitis in children post-cardiovascular surgery. We aimed to assess the CT findings of pediatric patients diagnosed with mediastinitis after cardiovascular surgery. METHODS We included 28 pediatric patients with suspected mediastinitis after undergoing cardiovascular surgery and who underwent CT. Patients were divided into a group with mediastinitis requiring antibiotic therapy (n = 15) confirmed by positive bacterial culture from the mediastinum and a group without mediastinitis (n = 13). Fisher's exact test was used to compare the following CT findings between the two groups: (i) mediastinal fluid collection; (ii) free gas bubble within fluid collection; (iii) sternal destruction; and (iv) capsular ring enhancement. The enhancement extent was categorized into the following four grades: whole rim enhancement, >50% of the rim enhancement, <50% of the rim enhancement, and no rim enhancement. A receiver operating characteristic curve analysis was performed to establish a cut-off point for obtaining the maximum diagnostic accuracy. RESULTS A significant difference was observed between patients, with and without mediastinitis in sternal destruction (73.6% vs 0%, P = <0.0001) and capsular ring enhancement (100.0% vs 38.5%, P = 0.0004). By using a cut-off grade of the whole rim enhancement, the estimated sensitivity and specificity for mediastinitis diagnosis were 100% and 92.3%, respectively. CONCLUSION Computed tomography findings of sternal destruction and capsular ring enhancement were observed more in patients with mediastinitis than in those without mediastinitis, and should be assessed carefully to diagnose mediastinitis accurately in pediatric patients who have undergone cardiac surgery.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshihiro Ko
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Koji Nomura
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Fourdain S, Caron-Desrochers L, Simard MN, Provost S, Doussau A, Gagnon K, Dagenais L, Presutto É, Prud'homme J, Boudreault-Trudeau A, Constantin IM, Desnous B, Poirier N, Gallagher A. Impacts of an Interdisciplinary Developmental Follow-Up Program on Neurodevelopment in Congenital Heart Disease: The CINC Study. Front Pediatr 2020; 8:539451. [PMID: 33123502 PMCID: PMC7573208 DOI: 10.3389/fped.2020.539451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study investigates the impact of an early systematic interdisciplinary developmental follow-up and individualized intervention program on the neurodevelopment of children with complex congenital heart disease (CHD) who required cardiac surgery. Study Design: We prospectively enrolled 80 children with CHD: 41 were already followed at our neurocardiac developmental follow-up clinic from the age of 4 months, while 39 were born before the establishment of the program and therefore received standard health care. We conducted cognitive, motor, and behavioral assessments at 3 years of age. We used one-way multivariate analyses of variance to compare the neurodevelopmental outcome of both groups. Results: Between-group analyses revealed a distinct neurodevelopmental profile with clinically significant effect size (P < 0.001, partial η2 = 0.366). Children followed at our clinic demonstrated better receptive language performances (P = 0.048) and tended to show higher scores on visuo-constructive tasks (P = 0.080). Children who received standard health care exhibited greater performances in working memory tasks (P = 0.032). We found no group differences on global intellectual functioning, gross and fine motor skills, and behaviors. Referral rates for specific remedial services were higher in patients followed at our neurocardiac clinic compared to the historical cohort (P < 0.005). Conclusions: Overall, the impact of the developmental follow-up and individualized intervention program on neurodevelopmental outcomes remains subtle. Nevertheless, results, although limited by several factors, point toward an advantage for the children who took part in the program regarding receptive language skills over children who received standard health care. We hypothesize that group differences may be greater with growing age. Further research involving larger cohorts is needed to clearly assess the effectiveness of neurocardiac developmental follow-up programs at school age.
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Affiliation(s)
- Solène Fourdain
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Laura Caron-Desrochers
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Marie-Noëlle Simard
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Sarah Provost
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Karine Gagnon
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Lynn Dagenais
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Émilie Presutto
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Joëlle Prud'homme
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | | | - Ioana Medeleine Constantin
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Béatrice Desnous
- Division of Neurology, Department of Pediatrics, La Timone Hospital, Marseille, France
| | - Nancy Poirier
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anne Gallagher
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
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Gallagher A, Dagenais L, Doussau A, Décarie JC, Materassi M, Gagnon K, Prud'homme J, Vobecky S, Poirier N, Carmant L. Significant motor improvement in an infant with congenital heart disease and a rolandic stroke: The impact of early intervention. Dev Neurorehabil 2017; 20:165-168. [PMID: 26889873 DOI: 10.3109/17518423.2015.1132280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To report the impact of early motor intervention in an infant with congenital heart disease (CHD) and a stroke. METHODS AND RESULTS A 35-week newborn with a complex CHD and a normal MRI presented with early motor developmental delay at 2 months. She began an intervention program, which included biweekly motor developmental therapy with a physiotherapist, parental education, and daily home exercises. At 4 months, she underwent cardiac surgery. Following surgery, she was diagnosed with a stroke involving the right sylvian artery territory. She continued her intensive intervention program. The 12-month assessment revealed an evident gain of motor function. Despite MRI evidence of a chronic infarct involving the primary motor cortex, the child had normal motor functions. CONCLUSION This case report supports the positive impact of early intervention in infants with CHD and its potential effect on enhancing neuroplasticity, even in children with cerebro-vascular accidents involving areas of motor function.
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Affiliation(s)
- Anne Gallagher
- a CHU Sainte-Justine Research Centre, University of Montreal , Montréal , Canada
| | - Lynn Dagenais
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Amélie Doussau
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Jean-Claude Décarie
- c Department of Radiology , CHU Sainte-Justine, University of Montreal , Montréal , Canada
| | - Manuela Materassi
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Karine Gagnon
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Joelle Prud'homme
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Suzanne Vobecky
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Nancy Poirier
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Lionel Carmant
- a CHU Sainte-Justine Research Centre, University of Montreal , Montréal , Canada.,b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
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Postoperative Hyperglycemia and 4-Year Neurodevelopmental Outcome in Children Operated for Congenital Heart Disease. J Pediatr 2015; 167:1253-8.e1. [PMID: 26235664 DOI: 10.1016/j.jpeds.2015.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/27/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To study the long-term neurodevelopmental effects of hyperglycemia in infant bypass surgery for congenital heart disease (CHD). STUDY DESIGN Prospective cohort study on neurodevelopmental outcome after infant cardiac bypass surgery. EXCLUSION CRITERIA age older than 1 year at first surgery, genetic comorbidity, and birth weight <2000 g. Of 167 eligible infants, follow-up examination at 4 years was completed in 150 children (90%). Intraoperative and postoperative highest and lowest glucose levels within 24 hours after bypass surgery were prospectively collected. Neurodevelopmental outcome at 4 years of age was assessed using standardized IQ tests and the Movement Assessment Battery for Children-second version for motor outcome assessment. RESULTS Mean age at surgery was 2.8 months (0.1-10.7 months), 33% of children had an acyanotic CHD and 67% a cyanotic CHD. Glucose levels were elevated (>8 mmol/L) in 21 (14%) children in the first 24 postoperative hours. Glucose levels normalized in all children within 48 hours, 7 children (4%) received insulin infusions. Mean total IQ was within the normal range, but significantly lower than the normal population (92.5 [SD 15.0], P < .001). Higher postoperative glucose levels were related to better cognitive performance in the univariate analysis (P < .03), but not when other risk factors were taken into account. Independent risk factors for adverse outcome were lower socioeconomic status, higher risk adjustment for congenital heart surgery score, and longer duration of intensive care stay. CONCLUSION Hyperglycemia is common in the early postoperative course after infant bypass surgery for CHD and normalizes within 48 hours. Hyperglycemia has no adverse effect on long-term neurodevelopmental outcome.
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Perioperative mechanical circulatory support in children with critical heart disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:414-24. [PMID: 21748290 DOI: 10.1007/s11936-011-0140-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OPINION STATEMENT The treatment of cardiovascular failure in the perioperative period with the use of mechanical circulatory support is a well-recognized, well-developed, and commonly utilized treatment modality. Regardless of the exact circumstances of initiation, the use of a support device is a "bridge." Where there has been an acute myocardial insult, short-term assist devices can serve as a "bridge to immediate survival," a "bridge to recovery," or even a "bridge to the next decision." Mechanical circulatory support can serve as a treatment of cardiovascular decompensation caused by myocarditis, acute myocardial insult, low cardiac output following surgery, and congenital heart disease. The utilization of such support carries significant risks such as bleeding, infection, and thrombosis. However, these can be minimized in order to allow for the safe and effective deployment of this therapeutic strategy. One specific therapeutic domain in which these devices provide immediate impact is during cardiac arrest. Although outcomes of cardiac arrest remain poor, use of a mechanical device as an intervention has allowed salvage of otherwise certain mortality. However, it is important to note that the utility of support was most pronounced in patients that were not on either extreme of the survival prediction curve. This can be best summarized by the concept of "not too early, not too late." Therefore, it is the responsibility of the entire care team to find the appropriate patient population in which to "pull the trigger" on mechanical support as a therapy. This decision point is supported by a monitoring strategy that can be utilized to predict deterioration and intervene adequately. Most importantly, an effective monitoring strategy allows the practitioner to judge the effectiveness of treatment and support strategies and make adjustments in a timely manner, potentially with mechanical support in the perioperative period.
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9
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Prolonged mechanical ventilation: does shorter duration of mechanical ventilation equal morbidity reduction for congenital heart disease patients? Pediatr Crit Care Med 2011; 12:368-9. [PMID: 21637153 DOI: 10.1097/pcc.0b013e3181f268be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Präoperative Azidose und Entwicklung von Säuglingen nach Operation angeborener Herzfehler. Herz 2010; 35:358-63. [DOI: 10.1007/s00059-010-3356-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 03/18/2010] [Indexed: 11/25/2022]
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Gazit AZ, Huddleston CB, Checchia PA, Fehr J, Pezzella AT. Care of the pediatric cardiac surgery patient--part 2. Curr Probl Surg 2010; 47:261-376. [PMID: 20207257 DOI: 10.1067/j.cpsurg.2009.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Avihu Z Gazit
- Pediatric Critical Care Medicine and Cardiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Innovative strategies for feeding and nutrition in infants with congenitally malformed hearts. Cardiol Young 2009; 19 Suppl 2:90-5. [PMID: 19857355 DOI: 10.1017/s1047951109991673] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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McCrossan BA, Grant B, Morgan GJ, Sands AJ, Craig B, Casey FA. Home support for children with complex congenital heart disease using videoconferencing via broadband: initial results. J Telemed Telecare 2008; 14:140-2. [PMID: 18430282 DOI: 10.1258/jtt.2008.003012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We originally developed a home support service for babies with complex congenital heart disease, in which videoconferencing was delivered via three ISDN lines. We have now investigated the feasibility of using broadband (Internet protocol) transmission instead of ISDN lines. Five patients were enrolled (age range 14-58 days) and 78 videoconferences were conducted over a six-month period. In 70 videoconferences (90%), a successful connection was established at the first attempt. In the last 56 videoconferences a connection bandwidth of 256 kbit/s was consistently achieved. The clinician's opinions of the videoconferences were good. Parental opinions on the videoconferences were very high. There was also a significant reduction in parental anxiety following the video consultations: the median reduction in the STAI score was 6 points (P < 0.05) (n = 78). Home support for infants or children with complex congenital heart disease can be provided successfully by video consultations utilizing home broadband links.
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Affiliation(s)
- Brian A McCrossan
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK.
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14
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McCrossan B, Morgan G, Grant B, Sands A, Craig B, Casey F. Assisting the transition from hospital to home for children with major congenital heart disease by telemedicine: a feasibility study and initial results. ACTA ACUST UNITED AC 2008; 32:297-304. [PMID: 18072006 DOI: 10.1080/14639230701791611] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Parents of children hospitalized with major congenital heart disease often state that the weeks following discharge from hospital are particularly difficult. There is a sudden change from 24-h medical supervision and care to outpatient reviews. Videoconferencing not only gives the family an opportunity to have visual and audio contact with staff but also allows clinicians to visually assess the patient. We have investigated the feasibility of using videoconferencing to provide support for families at home. We also report the early results of a randomized control trial comparing videoconference support with regular telephone support and the current clinic review follow-up.
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Affiliation(s)
- B McCrossan
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK.
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15
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Giannone PJ, Luce WA, Nankervis CA, Hoffman TM, Wold LE. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82:341-7. [DOI: 10.1016/j.lfs.2007.09.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 09/22/2007] [Accepted: 09/22/2007] [Indexed: 10/22/2022]
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16
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Assessment of hydraulic performance and biocompatibility of a MagLev centrifugal pump system designed for pediatric cardiac or cardiopulmonary support. ASAIO J 2008; 53:771-7. [PMID: 18043164 DOI: 10.1097/mat.0b013e31815dbf66] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The treatment of children with life-threatening cardiac and cardiopulmonary failure is a large and underappreciated public health concern. We have previously shown that the CentriMag is a magnetically levitated centrifugal pump system, having the utility for treating adults and large children (1,500 utilized worldwide). We present here the PediVAS, a pump system whose design was modified from the CentriMag to meet the physiological requirements of young pediatric and neonatal patients. The PediVAS is comprised of a single-use centrifugal blood pump, reusable motor, and console, and is suitable for right ventricular assist device (RVAD), left ventricular assist device (LVAD), biventricular assist device (BVAD), or extracorporeal membrane oxygenator (ECMO) applications. It is designed to operate without bearings, seals and valves, and without regions of blood stasis, friction, or wear. The PediVAS pump is compatible with the CentriMag hardware, although the priming volume was reduced from 31 to 14 ml, and the port size reduced from 3/8 to (1/4) in. For the expected range of pediatric flow (0.3-3.0 L/min), the PediVAS exhibited superior hydraulic efficiency compared with the CentriMag. The PediVAS was evaluated in 14 pediatric animals for up to 30 days, demonstrating acceptable hydraulic function and hemocompatibility. The current results substantiate the performance and biocompatibility of the PediVAS cardiac assist system and are likely to support initiation of a US clinical trial in the future.
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Ware SM, Harutyunyan KG, Belmont JW. Heart defects in X-linked heterotaxy: evidence for a genetic interaction of Zic3 with the nodal signaling pathway. Dev Dyn 2007; 235:1631-7. [PMID: 16496285 DOI: 10.1002/dvdy.20719] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The complex cardiac defects that occur in heterotaxy result from abnormal left-right patterning. Mutations in the zinc finger transcription factor ZIC3 cause X-linked heterotaxy, HTX1. We previously have generated a targeted deletion of the murine Zic3 locus and demonstrated that these knockout mice correctly model HTX1. Fifty percent of Zic3 null embryos have cardiac looping anomalies at embryonic day 10.5 to 14.5, with ventral looping and sinistral looping as the predominant phenotypes. The penetrance of these phenotypes is increased in mice that are also haploinsufficient for Nodal. Zic3(+/-); Nodal (+/-) compound heterozygous mice are born in significantly reduced numbers (P=0.0001), indicating a genetic interaction between the loci. Furthermore, an upstream Nodal enhancer is responsive to Zic3 in both Xenopus and mouse. These studies provide evidence that Zic3 interacts genetically with Nodal in left-right patterning and subsequent cardiac development and delineate a critical Zic3-responsive enhancer required for mediating Nodal expression at the node.
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Affiliation(s)
- Stephanie M Ware
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio, USA
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18
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Hsia TY, Gruber PJ. Factors influencing neurologic outcome after neonatal cardiopulmonary bypass: what we can and cannot control. Ann Thorac Surg 2007; 81:S2381-8. [PMID: 16731107 DOI: 10.1016/j.athoracsur.2006.02.074] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 02/10/2006] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Abstract
Advances in cardiopulmonary bypass and surgical techniques have led to progress in the early repair of congenital heart defects in children. However, as increasing numbers survive their initial cardiac operation, an awareness is emerging that significant early and late neurologic morbidities continue to complicate otherwise successful operative repairs. Adverse neurologic outcomes after neonatal cardiac surgery are multifactorial and relate to both fixed and modifiable mechanisms. The purpose of this review is to (1) review mechanisms of brain injury after neonatal cardiopulmonary bypass, (2) examine risk factors, and (3) speculate on how investigations may improve our understanding of neurologic injury.
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MESH Headings
- Alkalosis/prevention & control
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/physiopathology
- Brain Damage, Chronic/prevention & control
- Cardiopulmonary Bypass/adverse effects
- Cardiopulmonary Bypass/instrumentation
- Circulatory Arrest, Deep Hypothermia Induced
- Collateral Circulation
- Contraindications
- Disease Susceptibility
- Embolism, Air/etiology
- Embolism, Air/prevention & control
- Genetic Predisposition to Disease
- Heart Defects, Congenital/surgery
- Hemodilution
- Humans
- Hypoxia-Ischemia, Brain/etiology
- Hypoxia-Ischemia, Brain/prevention & control
- Infant
- Infant, Newborn
- Intracranial Embolism/etiology
- Intracranial Embolism/prevention & control
- Intraoperative Complications/etiology
- Intraoperative Complications/prevention & control
- Leukomalacia, Periventricular/epidemiology
- Leukomalacia, Periventricular/etiology
- Leukomalacia, Periventricular/prevention & control
- Monitoring, Intraoperative/methods
- Monitoring, Intraoperative/trends
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Preoperative Care
- Risk Factors
- Systemic Inflammatory Response Syndrome/etiology
- Systemic Inflammatory Response Syndrome/prevention & control
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Affiliation(s)
- Tain-Yen Hsia
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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Lee JW, Ovadia B, Azakie A, Salas S, Goerke J, Fineman JR, Gutierrez JA. Increased pulmonary blood flow does not alter surfactant protein gene expression in lambs within the first week of life. Am J Physiol Lung Cell Mol Physiol 2004; 286:L1237-43. [PMID: 14751849 DOI: 10.1152/ajplung.00271.2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neonates and infants with congenital heart disease with increased pulmonary blood flow suffer morbidity from poor oxygenation and decreased lung compliance. In a previous experiment involving 4-wk-old lambs with pulmonary hypertension secondary to increased pulmonary blood flow following an in utero placement of an aortopulmonary vascular graft, we found a decrease in surfactant protein (SP)-A gene expression as well as a decrease in SP-A and SP-B protein contents. To determine the timing of these changes, the objective of the present study was to characterize the effect of increased pulmonary blood flow and pulmonary hypertension on SP-A, -B, and -C gene expressions and protein contents within the first week of life. Of eight fetal lambs that underwent the in utero placement of the shunt, there was no difference in the expression of SP-A, -B, and -C mRNA levels or SP-A and -B protein contents compared with age-matched controls. The results showed that, in this model of congenital heart disease with pulmonary hypertension and increased pulmonary blood flow, the effect of the shunt on SP gene expression and protein content was not apparent within the first week of life.
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Affiliation(s)
- Jae W Lee
- Department of Anesthesiology, University of California, CA 94143, USA.
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