Early and long-term results of ventricular septal defect repair in children with severe pulmonary hypertension and elevated pulmonary vascular resistance by the double or traditional patch technique.

Objectives: In upper-income countries, infants undergo low-risk ventricular septal defect (VSD) repair. Children in low- and middle-income countries frequently present at older ages with elevated pulmonary vascular resistance (PVR) and pulmonary arterial hypertension (PAH). Expensive interventions for pulmonary hypertensive crisis are not available, and children are often denied an operation due to the mortality risk.

Sildenafil's Early, Late Impact on Ventricular Septal Repair: Older Children Using the Double Patch.

Background: Delayed diagnosis in children with a ventricular septal defect (VSD) is common in low- and middle-income countries. Consequently, these children present with elevated pulmonary vascular resistance (PVR) and pulmonary arterial hypertension (PAH). The study investigators introduced the double-flap valve VSD patch closure technique (DFV) in 1996 to reduce early postoperative risk.

Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery Programs in Low- and Middle-Income Countries.

Importance: Endorsement of global humanitarian interventions is based on either proven cost-effectiveness or perceived public health benefits. The cost-effectiveness and long-term benefits of global humanitarian pediatric cardiac surgery are unknown, and funding for this intervention is insufficient.

Objectives: To determine the cost-effectiveness of the intervention (multiple 2-week-long humanitarian pediatric cardiac surgery program assistance trips to various low- and middle-income countries [LMICs]) and to produce a measure of the long-lasting effects of global humanitarian programs.

Echocardiography and coronary CT angiography imaging of variations in coronary anatomy and coronary abnormalities in athletic children: detection of coronary abnormalities that create a risk for sudden death.

In a recent publication, Maron et al. reported the causes of sudden death in athletes from data collected in the US National Registry of Sudden Death in Athletes at the Minneapolis Heart Institute Registry. It is not surprising that in this study, cardiovascular disease is reported as the most common cause of sudden death in athletes (56%).

Frequent ventricular premature beats in children with a structurally normal heart: a cause for reversible left ventricular dysfunction?

Ventricular premature beats (VPBs) in a structurally normal heart generally are a benign condition. Rarely, however, reversible cardiomyopathy may develop. This study aimed to evaluate the incidence of cardiomyopathy among pediatric patients in a cohort with frequent VPBs and to examine the characteristics of the ventricular ectopic beats as well as therapeutic options.

Left ventricular geometry in children and adolescents with primary hypertension.

Background: Children with hypertension (HTN) are at increased risk for left ventricular hypertrophy (LVH). Increased left ventricular (LV) mass (LVM) by the process of remodeling in response to volume or pressure loading may be eccentric (increased LV diameter) or concentric (increased wall thickness). Our objective was to classify LV geometry among children with primary HTN and examine differences in ambulatory blood pressure (ABP).

Blood aldosterone-to-renin ratio, ambulatory blood pressure, and left ventricular mass in children.

Objective: To assess the blood aldosterone-to-renin ratio (ARR) and its relationship to ambulatory blood pressure (ABP) and left ventricular mass (LVM) in children.

Study Design: A cross-sectional clinical study was conducted in 102 children (71.6% African American; 62.

Ambulatory blood pressure and increased left ventricular mass in children at risk for hypertension.

Objective: To relate ambulatory blood pressure (ABP) to cardiac target organ measurement in children at risk for primary hypertension (HTN).

Study Design: Left ventricular mass index (LVMI) and ABP were measured concomitantly in children (6 to 18 years) at risk for hypertension using a cross-sectional study design.

Results: LVMI showed a significant positive correlation with 24-hour systolic blood pressure (SBP) load, SBP index (SBPI), and standard deviation score (SDS).

Predominance of nocturnal hypertension in pediatric renal allograft recipients.

Hypertension is common in children with end-stage renal disease who have undergone renal transplantation. We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post-transplant. Echocardiographic measurement of left ventricular mass index (LVMI) was obtained at the time of ABPM.

[Transluminal balloon valvuloplasty in neonates and infants with critical aortic stenosis].

The purpose of this study was to evaluate children who underwent balloon valvuloplasty due to critical aortic stenosis following clinical (low cardiac output, cardiogenic shock, congestive heart failure) and echocardiographic criteria (morphological evidence of left ventricular hypertrophy, with depression of left ventricular function, irrespective of transvalvular gradient). We assessed the effectiveness of balloon valvuloplasty in 5 children (all male) who were submitted to aortic valve balloon dilatation over 3.5 years (10.

Postoperative fluid balance influences the need for antihypertensive therapy following coarctation repair.

Objective: The purpose of the investigation was to determine the effect of fluid management on the need for perioperative antihypertensive therapy following coarctation repair.

Design: Retrospective case study.

Setting: Pediatric intensive care unit.

The wandering pacemaker: intraperitoneal migration of an epicardially placed pacemaker and femoral nerve stimulation.

A premature child with congenital complete heart block had an epicardial single-chamber pacemaker implanted at 2 days of age. At 21 months of age, while sitting or standing, the patient's right anterior thigh muscles contracted at her pulse rate. Surgical exploration revealed a free-floating pacemaker in her peritoneum.

Double patch closure of ventricular septal defect with increased pulmonary vascular resistance.

Background: Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance is associated with significant morbidity and mortality. Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary vascular resistance.

Syncope recurrence in children: relation to tilt-test results.

Objectives: To examine the intermediate-term outcome of children with syncope and its relationship to tilt test.

Design: This was a retrospective study of 45 children. In 20, the tilt test was negative.

Serum electrolytes in children with neurocardiogenic syncope treated with fludrocortisone and salt.

We examined the changes in serum electrolytes of patients with syncope treated with salt and fludrocortisone. The most significant change was an increase in serum bicarbonate concentration, with minimal alteration of sodium, potassium, and chloride concentrations; none was clinically significant.

Contribution of superior vena caval flow to total cardiac output in children. A Doppler echocardiographic study.

Background: After a cavopulmonary anastomosis, the superior vena caval flow, by virtue of being the effective pulmonary blood flow, is the most important factor influencing the systemic arterial saturation. Determination of the amount of this blood flow will allow a better understanding of the physiology of the circulation after this anastomosis. The purposes of this study were to determine the volumetric flow in the superior vena cava and to evaluate its contribution to the cardiac output as children grow.

Patent ductus arteriosus ligation: are we doing better?

Limitation on health care resource use is stimulating critical evaluation of previous preoperative standards. We retrospectively reviewed the clinical and hospital financial records of all children admitted for patent ductus arteriosus ligation from July 1984 to April 1994 for age, perioperative length of stay, readmissions for postoperative surgical problem, and hospital charges adjusted to 1994 dollars. Patients with an isolated patent ductus arteriosus, greater than 3 months of age, without preoperative or postoperative complications were included in this study and stratified into two groups based on date of operation.

Pulmonary/systemic flow ratio in children after cavopulmonary anastomosis.

Objectives: This study attempted to provide a formula for calculation of the pulmonary/systemic flow ratio in children after bidirectional cavopulmonary anastomosis.

Background: With the bidirectional cavopulmonary anastomosis, only the superior vena cava blood is oxygenated by the lungs. The inferior vena cava flow recirculates into the systemic circulation.

The fate of homograft conduits in children with congenital heart disease: an angiographic study.

The use of homograft conduits in the repair of congenital heart disease is widely accepted. We reviewed the catheterization and angiographic data from 20 patients with homograft conduits. All conduits were to the pulmonary arteries.

A longitudinal study of cardiac output in normal human pregnancy.

Objective: Our purpose was to investigate the maternal hemodynamic and cardiac structural changes that occur during pregnancy.

Study Design: Eighteen women underwent serial echocardiography beginning at 8 to 11 weeks' gestation, then at monthly intervals throughout pregnancy and at 6 and 12 weeks post partum. Cardiac output was measured by pulsed- and continuous-wave Doppler at the aortic valve.

Evolution of traumatically acquired infracristal ventricular septal defect.

Nonpenetrating traumatic rupture of the ventricular septum is rare. This case report describes the evolution of such a lesion documented by echocardiography and color flow Doppler. Included is a brief discussion of postulated mechanisms for this rare phenomenon.

Anomalous systemic and pulmonary venous pathways diagnosed in utero by ultrasound.

Anomalies of systemic and pulmonary venous return are found as either isolated lesions or as part of a complex cardiac malformation. Specifically, these venous pathway malformations are associated frequently with the cardiac defects in asplenia or polysplenia. This report describes the prenatal ultrasound diagnosis of both anomalous pulmonary and systemic venous drainage in three late gestation fetuses with a splenic syndrome and complex congenital heart disease.

Significance of the Doppler-derived gradient across a residual aortic coarctation.

Few data exist which address the significance of the Doppler gradient across a residual narrowing in older children who have had a coarctation repaired. Therefore, we evaluated 11 patients with repaired aortic coarctation with and without residual obstruction by Doppler echocardiography. The Doppler-derived transcoarctation pressure gradient correlated poorly with catheter-measured peak-to-peak and catheter maximal instantaneous gradients when only the maximal velocity across the repair was utilized in the simplified Bernoulli equation, [r = 0.

The hyperdense choroid plexus: a CT finding associated with aortic arch obstruction in the newborn.

We report the first observation of choroid plexus hyperdensity depicted by CT in two newborns with aortic arch obstruction. Neither infant had intracranial hemorrhage or infarction demonstrated by autopsy or cranial ultrasonography. Although not proven, we believe that such hyperdensity in these two cases represents abnormal vascularity within the choroid plexus related to upper extremity hypertension.