Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis.

Pericardiocentesis is traditionally performed using a subxiphoid approach. Hepatomegaly or loculated and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made these less traditional, non-subxiphoid approaches feasible. The study is aimed at comparing clinical outcomes of the subxiphoid and non-subxiphoid approaches to percutaneous pericardiocentesis in a pediatric population.

Echocardiographic imaging of the Medtronic Micro Vascular Plug during off label placement in the premature infant with patent ductus arteriosus.

Objectives: To report the usefulness of harmonic imaging in echocardiography to visualize and direct the implantation of the Medtronic micro vascular plug (MVP).

Background: Off label use of the MVP was reported for transcatheter occlusion of patent ductus arteriosus (PDA) in premature infants. The device is poorly visible on fluoroscopy and echocardiography.

The thoracic duct and the Fontan patient.

Background: Ultrasound imaging of adults with heart failure and increased central venous pressure (CVP) has shown significant thoracic duct (TD) dilation from impedance in lymphatic drainage. Elevated CVP and abnormal lymphatic drainage are implicated in severe Fontan complications, including protein losing enteropathy (PLE) and plastic bronchitis (PB). Systematic studies of TD and lymphatic circulation in children are limited, and their cervical TD normative values have not been established.

An Evaluation of Induced Failure Modes in the Belmont® Rapid Infuser.

Background: Rapid infusers are vital tools during massive hemorrhage and resuscitation. Sporadic reports of overheating and shutdown of the Belmont® Rapid Infuser, a commonly used system, have been attributed to 1-sided clot blockage of the fluid path. We investigated multiple causes of failure of this device.

Severe bradycardia associated with suspension laryngoscopy.

Suspension laryngoscopy is one of the most common procedures performed for visualizing and diagnosing diseases of the larynx. A relatively uncommon yet potentially life-threatening complication is that of severe bradycardia or asystole during manipulation of the larynx. This case report highlights the occurrence of this complication during a routine removal of a true vocal fold lesion at a tertiary medical center and discusses the potential pathophysiological mechanisms and proposed management options for this phenomenon.

Ultrasonographic imaging of the cervical thoracic duct in children with congenital or acquired heart disease.

Conditions that increase central venous pressure lead to secondary dilation of the thoracic duct and impaired lymphatic circulation. We report the use of ultrasound to directly image the cervical part of the thoracic duct in children without the need for invasive techniques or contrast agents. Systematic evaluation of the thoracic duct may be useful in cardiovascular conditions with congestion of the lymphatic system such as single ventricle following Glenn or Fontan procedures.

Two-ventricle repairs in the unbalanced atrioventricular canal defect spectrum with midterm follow-up.

Objectives: Unbalanced atrioventricular (AV) canal defects include a hypoplastic ventricle (HV) and AV valve (HAVV) precluding complete 2-ventricle repairs (2VRs). Catch-up growth would solve this problem and was induced by increasing HAVV flow. The objectives were to assess reliability of HV and HAVV growth and provide 5- to 15-year 2VR follow-up.

Mitral and tricuspid valve repair and growth in unbalanced atrial ventricular canal defects.

Objective: Congenital mitral and tricuspid valve abnormalities in unbalanced atrioventricular canal defects are complex. We designed procedures to both repair and induce growth of hypoplastic atrioventricular valves and ventricles to achieve 2-ventricle repairs. Midterm data were assessed for reliability of catch-up growth, resulting quality of atrioventricular valves, and adequacy of 2-ventricle repairs.

Technical communication: An initial evaluation of a novel anesthetic scavenging interface.

Waste anesthetic gas scavenging technology has not changed appreciably in the past 30 years. Open reservoir systems entrain high volumes of room air and dilute waste gases before emission into the atmosphere. This process requires a large vacuum pump, which is both costly to install and, although efficient, operates continuously and at near-full capacity.

Risk of burnout in perioperative clinicians: a survey study and literature review.

Background: Burnout can lead to health and psychologic problems and is apparently increasing in physicians and nurses. Previous studies have not evaluated all healthcare workers within a single work unit. This study evaluates the risk of burnout in all medical personnel in one perioperative unit.

Selective local anesthetic placement using ultrasound guidance and neurostimulation for infraclavicular brachial plexus block.

Background: In this study, we performed the infraclavicular block with combined ultrasound guidance and neurostimulation to selectively target cords to compare the success rates of placing a single injection of local anesthetic either in a central or peripheral location.

Methods: Two hundred eighteen patients were enrolled in a consecutive, prospective study. Patients were randomized to injection of local anesthetic either centrally (posterior cord) or peripherally (medial or lateral cord) using ultrasound guidance and neurostimulation.

Acceptance criteria for reprocessed AcuNav catheters: comparison between functionality testing and clinical image assessment.

The AcuNav-catheter is a vector-phased array ultrasound catheter that has shown great utility for both diagnosis and electrophysiological interventions. To test the feasibility of limited catheter reuse and to ensure that reprocessed catheters would produce acceptable clinical images, the present study compared the 2-D and Doppler image quality, as determined by clinical assessment, with the catheter's functional status as determined by the FirstCall 2000 transducer tester. Reprocessed catheters from four functional categories, two acceptable and two unacceptable, were used to collect images, 2-D and Doppler, from a porcine heart.

Cardiac findings after enzyme replacement therapy for mucopolysaccharidosis type I.

Mucopolysaccharidosis type I is a lethal autosomal recessive storage disease caused by a deficiency of lysosomal alpha-L-iduronidase and the consequent systemic accumulation of glycosaminoglycan. Cardiomyopathy and valvar insufficiency occur as glycosaminoglycan accumulates in the myocardium, expands the spongiosa of cardiac valves, and proliferates within the myointima of the epicardial coronary arteries. Congestive heart failure and death occur within the first decade of life in the most severe cases.

Cardiac functional and histopathologic findings in humans and mice with mucopolysaccharidosis type I: implications for assessment of therapeutic interventions in hurler syndrome.

Hurler syndrome (mucopolysaccharidosis type I [MPS I]) is a uniformly lethal autosomal recessive storage disease caused by absence of the enzyme alpha-l-iduronidase (IDUA), which is involved in lysosomal degradation of sulfated glycosaminoglycans (GAGs). Cardiomyopathy and valvar insufficiency occur as GAGs accumulate in the myocardium, spongiosa of cardiac valves, and myointima of coronary arteries. Here we report the functional, biochemical, and morphologic cardiac findings in the MPS I mouse.

Use of a portable forced air system to convert existing hospital space into a mass casualty isolation area.

Study Objective: Patients with communicable diseases may require respiratory isolation to reduce the chance of transmission to health care workers and the public. This project was conducted to determine whether negative-pressure isolation for multiple patients can be achieved quickly and effectively using general hospital space not previously dedicated to respiratory isolation.

Methods: The physical therapy gymnasium was the area designated to test the ability to create a negative-pressure isolation environment in a large space.

The laryngeal mask airway for awake craniotomy in the pediatric patient: report of three cases.

The anesthetic management of three pediatric patients who underwent awake craniotomy with a combined, continuous intravenous infusion of propofol and alfentanil is described. The Laryngeal Mask Airway was effective in airway management during resection of epileptic foci with intraoperative cortical mapping and neuropsychological (speech) evaluation.

Off-pump mitral valve repair using the Coapsys device: a pilot study in a pacing-induced mitral regurgitation model.

Purpose: The purpose of this study was to evaluate the ability of the Myocor Coapsys device to restore leaflet apposition and valve competency off-pump in a canine model of functional mitral regurgitation (MR).

Description: The Coapsys device was surgically implanted in 10 dogs after MR induction by rapid ventricular pacing. The Coapsys consists of anterior and posterior epicardial pads connected by a subvalvular chord.

Usefulness of bone marrow transplantation in the Hurler syndrome.

The Hurler syndrome, an autosomal recessive storage disease of childhood, leads to death within the first decade of life from progressive deposition of glycosaminoglycans within the myointima of the coronary arteries and airways. Cardiac ultrasound findings of patients with this syndrome >10 years after successful bone marrow transplantation are described.