Insulin Resistance after Fontan Palliation.

Patients with a single ventricle heart who had Fontan palliation (S/P Fontan) are at increased risk for acquired morbidity. Insulin resistance (IR) is a predictor of cardiac morbidity and mortality. A single-center, cross-sectional study using S/P Fontan and controls was designed to assess IR S/P Fontan.

Colchicine in post-operative Fontan patients.

Background: Prolonged effusions post-Fontan procedure are associated with morbidity. Fontan patients have higher pro-inflammatory cytokines in chest tube drainage compared to controls. Colchicine, an anti-inflammatory medication, decreases effusions in adults after cardiac surgery.

Analysis of inflammatory cytokines in the chest tube drainage of post-operative superior cavopulmonary connection patients.

Introduction: Prolonged pleural effusions are common post Fontan operation and are associated with morbidity. Fontan pleural effusions have elevated proinflammatory cytokines. Little is known about the chest tube drainage after a superior cavopulmonary connection.

Acute Hemodynamic Effects of Negative Extrathoracic Pressure in Fontan Physiology.

We sought to assess acute hemodynamic changes after implementation of negative extrathoracic pressure (NEP) in spontaneously breathing ambulatory Fontan patients with symptomatic heart failure. We hypothesized that application of NEP would result in an acute decrease in pulmonary artery pressure. Ten patients with clinical evidence of Fontan failure underwent baseline hemodynamic catheterization while breathing spontaneously.

Analysis of Inflammatory Cytokines in Postoperative Fontan Pleural Drainage.

Prolonged pleural drainage is a common complication in patients after Fontan palliation and is associated with short- and long- term morbidities. Among many potential etiologies, prolonged drainage has an inflammatory component, but there are no descriptions of cytokines in Fontan pleural drainage to date. This study aimed to examine the inflammatory make-up of Fontan pleural drainage.

Relation of Increased Epicardial Fat After Fontan Palliation to Cardiac Output and Systemic Ventricular Ejection Fraction.

Epicardial fat produces multiple proinflammatory cytokines and is associated with adverse cardiovascular events. Inflammation and resultant endothelial dysfunction may play a role in progressive myocardial dysfunction among adults with single ventricle physiology after Fontan palliation, but the potential impact of increased epicardial fat volume (EFV) has not been studied. This study sought to determine if there is greater EFV in Fontan patients compared with a group of repaired tetralogy of Fallot (rTOF) patients.

Long-Term Outcomes After Surgical Pulmonary Arterioplasty and Risk Factors for Reintervention.

Background: Although surgical patch arterioplasty is the conventional therapy for branch pulmonary artery (PA) stenosis, limited data exist on long-term outcomes. We examined the incidence of and risk factors for reintervention after surgical arterioplasty for branch PA stenosis in biventricular congenital heart disease.

Methods: This retrospective cohort study included patients with 2-ventricle physiology who underwent patch arterioplasty for PA stenosis at a single high-volume congenital heart center during a 10-year period.

Temporal relationship between instantaneous pressure gradients and peak-to-peak systolic ejection gradient in congenital aortic stenosis.

Objective: We sought to identify a time during cardiac ejection when the instantaneous pressure gradient (IPG) correlated best, and near unity, with peak-to-peak systolic ejection gradient (PPSG) in patients with congenital aortic stenosis. Noninvasive echocardiographic measurement of IPG has limited correlation with cardiac catheterization measured PPSG across the spectrum of disease severity of congenital aortic stenosis. A major contributor is the observation that these measures are inherently different with a variable relationship dependent on the degree of stenosis.

Twenty years of experience with intraoperative pulmonary artery stenting.

Objectives: To describe our 20-year experience with intraoperative pulmonary artery (PA) stent placement and evaluate long-term patient outcomes, specifically the need and risk factors for reintervention.

Background: Intraoperative PA stent placement is an alternative to surgical patch arterioplasty and percutaneous angioplasty or stent placement to treat branch PA stenosis.

Methods: We performed a retrospective review of all intraoperative PA stents placed at our institution from 1994-2013.

Altered Cholesterol Metabolism and Hypocholesterolemia in Patients with Single Ventricle following Fontan Palliation.

Objective: To assess whether an abnormality in cholesterol absorption or synthesis may be associated with hypocholesterolemia in patients with single ventricle anatomy following Fontan palliation.

Study Design: This is a cross-sectional study of 21 patients with hypocholesterolemia following Fontan procedure and age/sex-matched healthy controls, with median age of 13.4 (IQR 10.

Elective ECMO support for pulmonary artery stent placement in a 4.9-kg shunt-dependent patient.

Although extracorporeal membrane oxygenation (ECMO) is traditionally used to emergently manage respiratory and/or cardiovascular failure, ECMO can also support cardiorespiratory function in nonemergent settings. Here we present the elective use of ECMO to support a 4.9-kg pediatric patient undergoing a complex percutaneous catheter-based intervention.

Pediatric Hypertension Specialists' Perspectives About Adolescent Hypertension Management: Implications for Primary Care Providers.

Background: The current specialty-centric hypertension paradigm is unsustainable given the high prevalence of primary hypertension in adolescents.

Objective: To describe specialists' perspectives on referral and comanagement for adolescents with hypertension.

Methods: Cross-sectional mailed survey of a national sample of 397 pediatric cardiologists and 389 pediatric nephrologists, conducted January to May 2014.

Obesity and elevated blood pressure following repair of coarctation of the aorta.

Objective: To determine whether patients with coarctation of the aorta (COA) were more likely to develop obesity compared with the general population or others with isolated forms of congenital heart disease.

Study Design: We conducted a cross-sectional study of 160 patients who underwent COA repair at our institution between 1974 and 2009. Body mass index (BMI) measurements were obtained from the most recent clinic visit and at 5, 10, 15, and 20 years of age from retrospective chart review.

Use of antihypertensive medications and diagnostic tests among privately insured adolescents and young adults with primary versus secondary hypertension.

Purpose: To compare the use of antihypertensive medications and diagnostic tests among adolescents and young adults with primary versus secondary hypertension.

Methods: We conducted retrospective cohort analysis of claims data for adolescents and young adults (12-21 years of age) with ≥3 years of insurance coverage (≥11 months/year) in a large private managed care plan during 2003-2009 with diagnosis of primary hypertension or secondary hypertension. We examined their use of antihypertensive medications and identified demographic characteristics and the presence of obesity-related comorbidities.

Low total, low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol levels in patients with complex congenital heart disease after Fontan palliation.

Objective: To test the hypothesis that patients with complex congenital heart disease who have undergone Fontan palliation have low total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels.

Study Design: We retrospectively reviewed the random serum lipid profiles obtained at cardiology clinic visits between May 2010 and November 2011 in patients who had undergone the Fontan procedure. We compared these serum lipid levels against age- and sex-matched established normal data from the Third National Health and Nutrition Examination Survey.

Underlying Rationale and Approach to Treat Hypertension in Adolescents by Physicians of Different Specialty.

Objective: To describe the underlying clinical decision-making rationale among general pediatricians, family physicians, pediatric cardiologists and pediatric nephrologists in their approach to an adolescent with hypertension.

Methods: We conducted semi-structured phone interviews with a convenience sample of physicians from the above-mentioned 4 specialties. Each participant was asked to "think aloud" regarding their approach to a hypothetical patient - 12 year old boy with persistent hypertension for 6 months.

Use of diagnostic tests in adolescents with essential hypertension.

Objective: To describe the use of diagnostic tests in adolescents with essential hypertension.

Design: Longitudinal analysis of administrative claims data.

Setting: Michigan Medicaid program during 2003 to 2008.

Clonidine utilization trends for Medicaid children.

Objective: To characterize clonidine utilization trends among children.

Design/methods: Serial cross-sectional analysis of Michigan Medicaid claims data for children aged 6 to 18 years. The authors identified children with ≥1 clonidine prescription; the authors examined their ICD-9 diagnoses categorized as simple and complex attention deficit hyperactivity disorder (ADHD), non-ADHD mental health disorder, hypertension, or others.

ED identification of patients with severe sepsis/septic shock decreases mortality in a community hospital.

Study Objectives: Our objective was to quantify the mortality difference between patients with severe sepsis/septic shock (SS/SS) identified in the emergency department (EDI) vs those not identified in the emergency department (NEDI) within our community hospital.

Methods: We conducted a retrospective review of all patients with SS/SS from July 2007 to January 2010 who were admitted to the intensive care unit within our community hospital. Our primary outcome measure was the difference in mortality rates of patients with SS/SS between the EDI and NEDI cohorts.

Impact of vitamin C on endothelial function and exercise capacity in patients with a Fontan circulation.

Objective:   To evaluate the impact of antioxidant therapy on functional health status in Fontan-palliated patients. Design.  Prospective, randomized, double-blind, placebo-controlled trial.

Antihypertensive prescribing patterns for adolescents with primary hypertension.

Background: Hypertension is an increasingly common problem in adolescents yet current medical management of primary hypertension in adolescents has not been well-described.

Methods: We identified adolescents with primary hypertension by International Classification of Diseases, Ninth Revision codes and looked at prescription patterns chronologically for antihypertensive drug class prescribed and the specialty of prescribing physician. We also examined patient demographics and presence of obesity-related comorbidities.