Staged Approach: The Role of Delayed Repair Following Complete Unifocalization of Major Aortopulmonary Collateral Arteries with Ventricular Septal Defect and Pulmonary Atresia.

The presentation of pulmonary vasculature in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCA) is highly variable-as is the number, size and position of the MAPCAs and their relationship with the native pulmonary artery system. The priority in the management of this disease should be attaining timely and complete unifocalization, as opposed to single-stage full repair in every case. The merit of early unifocalization is that it secures the pulmonary vascular bed by (a) avoiding loss of lung segments from progressive stenosis/atresia of MAPCA origins, (b) preventing lung injury from high pressure/flow in areas fed by large, unobstructed MAPCAs, and (c) restoring central continuity of the pulmonary vasculature.

Extracorporeal Membrane Oxygenation in Pediatric Patients with Congenital Heart Disease: Surgical Considerations.

The use of extracorporeal membrane oxygenation (ECMO) in the pediatric population has increased over time, with the ability to rescue pulmonary and cardiovascular deterioration. ECMO can be utilized by neonates and children with congenital heart disease in both the preoperative and post-operative setting to improve survival and minimize morbidity. ECMO cannulation strategy must be tailored to age, weight and physiological state of the patient.

Is there any role for an atrial septal defect in off-loading a borderline left ventricle?

A small atrial septal defect with right-to-left shunt is useful for off-loading a dysfunctional right ventricle postoperatively. However, an atrial septal defect with left-to-right shunt may not be as useful for a dysfunctional left ventricle. Experimental data are limited at present.

Pain can't be carved at the joints: defining function-based pain profiles and their relevance to chronic disease management in healthcare delivery design.

Background: Pain is a complex problem that is triaged, diagnosed, treated, and billed based on which body part is painful, almost without exception. While the "body part framework" guides the organization and treatment of individual patients' pain conditions, it remains unclear how to best conceptualize, study, and treat pain conditions at the population level. Here, we investigate (1) how the body part framework agrees with population-level, biologically derived pain profiles; (2) how do data-derived pain profiles interface with other symptom domains from a whole-body perspective; and (3) whether biologically derived pain profiles capture clinically salient differences in medical history.