Medical missions for the provision of paediatric cardiac surgery in low- and middle-income countries.

This review will outline the role of visiting cardiac surgical teams in low- and middle-income countries drawing on the collective experience of the authors in a wide range of locations. Requests for assistance can emerge from local programmes at a beginner or advanced stage. However, in all circumstances, careful pre-trip planning is necessary in conjunction with clinical and non-clinical local partners.

Experience with an Acuity Adaptable Care Model for Pediatric Cardiac Surgery.

Background: We describe the implementation of and outcomes associated with an acuity adaptable care model for pediatric patients undergoing cardiac surgery.

Methods: Consecutive patients undergoing an index cardiac operation between July 2007 and June 2015 were included. From July 2007 through June 2010, a conventional model existed in which patients moved among units and care teams based on age, severity of illness, and operative status (conventional group).

Fluid Management: Pharmacologic and Renal Replacement Therapies.

Objectives: Focusing on critically ill children with cardiac disease, we will review common causes of fluid perturbations, clinical recognition, and strategies to minimize and treat fluid-related complications.

Data Source: MEDLINE and PubMed.

Conclusions: Meticulous fluid management is vital in critically ill children with cardiac disease.

Pharmacological Manipulation of Peripheral Vascular Resistance in Special Clinical Situations after Pediatric Cardiac Surgery.

Pediatric cardiac surgery patients commonly suffer from alterations in vascular tone in the early post-operative period. Pharmacologic manipulation of systemic vascular resistance (SVR) can be complex in a variety of special patient situations including extremes of age, presence of left sided valvar lesions and the use of mechanical circulatory support. Familiarity with how these special circumstances alter SVR and the response to pharmacologic intervention will allow for tailored therapy and hopefully, optimized outcomes.

Paediatric cardiac surgery in low-income and middle-income countries: a continuing challenge.

Despite advances in surgical and catheter-based treatment for congenital heart disease (CHD), there remain wide disparities across the globe. Ongoing international humanitarian and in-country programmes are working to address these issues with the ultimate goal to increase the quality and quantity of paediatric cardiac care, particularly in under-served regions of the world. This review aims to illustrate the reasons for these inequalities and suggests novel ways of improving access and sustainability of CHD programmes in low-income and middle-income countries.

Current Perioperative Anticoagulation Practices in Children with Prosthetic Mechanical Heart Valves.

Objective: This study investigated the clinician practices on perioperative anticoagulation in children with prosthetic mechanical heart valves who undergo elective surgeries.

Design: An online survey was administered to members of PediHeartNet. The survey consisted of multiple choice questions and clinical scenarios.

Pediatric cardiac surgery in low- and middle-income countries or emerging economies: a continuing challenge.

A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas.

Survey of nongovernmental organizations providing pediatric cardiovascular care in low- and middle-income countries.

Background: Nearly 90% of the children with heart disease in low- and middle-income countries (LMICs) cannot access cardiovascular (CV) services. Limitations include inadequate financial, human, and infrastructure resources. Nongovernmental organizations (NGOs) have played crucial roles in providing clinical services and infrastructure supports to LMICs CV programs; however, these outreach efforts are dispersed, inadequate, and lack coordination.

Genetic and clinical determinants influencing warfarin dosing in children with heart disease.

Warfarin is a common anticoagulant with narrow therapeutic window and variable anticoagulation effects. Single gene polymorphisms in cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1) have been shown to impact warfarin dosing in adults. Insufficient data exists on genetic and clinical factors which influence warfarin dosing in children.

Bilateral coronary artery fistulas and left ventricle noncompaction in a neonate: diagnosis and management.

This report describes a neonate with heart failure resulting from bilateral coronary artery fistulas and left ventricle noncompaction. The patient underwent successful surgical ligation of the fistulas.