High flow rates during modified ultrafiltration decrease cerebral blood flow velocity and venous oxygen saturation in infants.

Background: The intracranial hemodynamic effects of modified ultrafiltration in children are unknown. We investigated the effects of different blood flow rates during modified ultrafiltration on the cerebral hemodynamics of children with weights above and below 10 kg.

Methods: Thirty-one children (weights: < or = 10 kg, n = 21; > 10 kg, n = 10) undergoing cardiopulmonary bypass were studied.

Transcranial Doppler during suspected brain death in children: Potential limitation in patients with cardiac "shunt".

OBJECTIVES: We report a potential limitation of transcranial Doppler for assessing cerebral circulation during suspected brain death in children. DESIGN: Review of two case series identified during our clinical practice. PATIENTS: Eight children with suspected brain death and seven with intact-brain and cardiovascular anomalies.

A reusable training circuit for cardiopulmonary bypass.

At the turn of the millennium, perfusion teaching programs are faced with significant difficulties. The number of students in pediatric perfusion training has increased, and more importantly, the number of pediatric open-heart procedures has decreased because of a variety of reasons. Hence, they could barely satisfy the minimum requirements of pediatric cases established by the teaching programs.

Short procedure of GHRH plus arginine test in clinical practice.

Either in children or in adults, arginine (ARG) alone and combined with GHRH (GHRH+ARG) are reliable tests for the diagnosis of GH deficiency. The procedures of these tests generally include GH measurement every 15 min from baseline up to 90-120 min. Aim of our study was to verify if the procedure of these tests could be usefully shortened in clinical practice.

Effect of Trendelenburg head position during cardiac deairing on cerebral microemboli in children: a randomized controlled trial.

Objectives: We prospectively evaluated the effects of head position during cardiac deairing on the Doppler ultrasonography-detected cerebral microemboli in children and the association between the embolic counts and the clinical assessment of deairing.

Methods: Children requiring exposure of the systemic ventricle under cardiopulmonary bypass were randomized to Trendelenburg (-15 degrees ) and horizontal (0 degrees ) head positions during and after standard surgical deairing. Complexity of repair was categorized as follows: group I consisted of single simple lesions, and group II consisted of multiple complex lesions.

Cerebral vascular effects of aortovenous cannulations for pediatric cardiopulmonary bypass.

Background: The effects of aortovenous cannulations for pediatric cardiopulmonary bypass on cerebral blood flow velocity (CBFV) and electroencephalography (EEG) were evaluated.

Methods: CBFV and EEG were continuously recorded before (baseline), during, and after cannulations until initiation of cooling (mean +/- 95% confidence interval). Vasopressors and/or volume replacement were administered if mean arterial pressure (MAP) decreased below 35 mm Hg.

Cerebral blood flow velocity during tilt table test for pediatric syncope.

Background: Brain hypoperfusion during neurocardiogenic syncope develops as a consequence of hypotension and bradycardia. Transcranial Doppler indicates that an increase in cerebral vascular resistance occurs before or during the loss of consciousness.

Objective: Cerebral blood flow velocity was studied during tilt table testing in pediatric patients with neurocardiogenic syncope.

Cerebral blood flow velocity during occlusive manipulation of patent ductus arteriosus in children.

Patent ductus arteriosus (PDA) with left-to-right shunting modifies the Doppler flow pattern of the intracranial circulation. The ability of increases in cerebral blood flow velocity (CBFV) to predict shunt resolution during PDA occlusion was evaluated. A 2 MHz transcranial Doppler (TCD) monitored diastolic and mean CBFV, plus the systolic/mean CBFV ratio in the middle cerebral artery from before (baseline) to immediately after PDA occlusion.

Transoesophageal echocardiographic assessment of obstruction to the pulmonary venous pathway in children with Mustard or Senning repair.

The morphology and mechanism of obstruction to the pulmonary venous pathway in patients following either Mustard or Senning repair of complete transposition was assessed using transoesophageal echocardiography. Seven patients underwent catheterization and complete transoesophageal study in both transverse and longitudinal planes, followed by balloon dilation of the obstructed venous pathway in five of seven under transoesophageal echocardiography guidance. A complete scan of both systemic and venous pathway was obtained in all patients.

Aortic cusp prolapse in ventricular septal defect and its association with aortic regurgitation--appropriate timing of surgical repair and outcomes.

Objectives: To determine the appropriate indications and timing for surgery in children with either a perimembranous or a subarterial type of ventricular septal defect (VSD) associated with aortic cusp prolapse.

Design: Retrospective review of children with VSD and associated aortic cusp prolapse with or without aortic regurgitation. This review was based on data obtained from clinical findings, two-dimensional echocardiography, cardiac catheterization and angiocardiography.

Cerebral effects of aortic clamping during coarctation repair in children: a transcranial Doppler study.

Objective: Haemodynamic changes as a consequence of application and release of aortic clamps for surgical repair of aortic coarctation are compensated by cerebrovascular autoregulation. Transcranial Doppler was used to study the effect of these haemodynamic changes upon brain circulation in children during aortic coarctation repair.

Method: A 2-MHz transcranial Doppler system continuously recorded mean cerebral blood flow velocities from the left middle cerebral artery in 13 children (aged from 5 days to 14 years) during repair of their coarctation.

Cerebral blood flow velocities monitored by transcranial Doppler during cardiac catheterizations in children.

Transcranial Doppler (TCD) was used to evaluate brain circulation during cardiac catheterizations in 32 children requiring pulmonary (n=10) or aortic balloon dilatations (n=2), ductus arteriosus coil insertions (n=5), or angiography (n=15). Cerebral blood flow velocity (CBFV) in the middle cerebral artery was measured before (baseline), during, and after each procedure (mean+/-95%ci). High-intensity transient signals (HITS) were also detected during these maneuvers.

Cerebral effects in superior vena caval cannula obstruction: the role of brain monitoring.

A pediatric cardiac case of transient obstruction of the superior vena cava by the venous cannula before cardiopulmonary bypass is presented. With venous obstruction and increase in central venous pressure, reduced cerebral blood flow velocities and absence of diastolic Doppler flow were detected. This was followed by regional cerebral venous oxygen desaturation and global electroencephalographic slowing.

The Hemopump as a left ventricular assist device in pediatric applications: initial Canadian applications.

Three children aged 11 months, and eight and nine years were supported with a Hemopump as a potentially life saving measure for circulatory failure. Left ventricular assist time ranged from 10 to 32 h. None of the three patients could be successfully weaned from the device because of complications of bleeding, arrhythmia or neurological insult.

Liposomal amphotericin B for postoperative Aspergillus fumigatus endocarditis.

A 10-month-old infant girl presented with Aspergillus fumigatus endocarditis localized to a Gore-Tex patch used as part of the repair for double-outlet right ventricle. A new liposomal preparation of amphotericin B combined with surgical vegectomy resulted in a successful outcome with no evidence of disease recurrence at 15 months' follow-up. Echocardiography provided an optimal modality for ongoing evaluation of therapeutic outcome.

Subendocardial abscess as a complication of prolonged central venous access for parenteral nutrition.

Patients with chronic gastrointestinal diseases may require long-term parenteral nutrition. The authors describe a case in which a subendocardial abscess developed in the right atrium in association with staphylococcal septicemia. The patient, a 15-year-old boy, had a malpositioned Silastic catheter, the tip of which was in his right atrium.

Familial coarctation of the aortic arch with bilateral ptosis: a new syndrome?

A Newfoundland family with the apparently unique syndrome of complex coarctation of the aortic arch, bilateral stenoses of the subclavian arteries, bilateral ptosis, sensorineural deafness, and bronchial asthma is reported. This syndrome appears to have affected at least four generations, and has the characteristics of autosomal dominant inheritance.

Echocardiography of intracardiac filling defects in infants and children.

Intracardiac masses are rare in infants and children. Early detection is essential to their successful management. We present seven patients in whom echocardiography established the diagnosis and was crucial in the management.

Successful one stage repair of coarctation of the aorta and aneurysm of the ascending aorta in a child.

A case of successful one stage repair of aortic coarctation and ascending aortic aneurysm in a 10 year old boy with cystic medial necrosis and congenital bicuspid aortic valve is presented. The patient underwent correction of both lesions at the same operation through two separate incisions. The coarctation was repaired first.