Cardiac repair for congenital heart disease in children awaiting liver transplantation presents unique therapeutic challenges and dilemmas. We tested the hypothesis that operations in these children ...requiring cardiopulmonary bypass (CPB) were not associated with prohibitive morbidity and mortality.
Over the last 10 years (1994–2004), five infants were identified in our database with end-stage liver disease and awaiting liver transplantation that required cardiac surgery. Primary end point for the study was mortality. Secondary end points included morbidity and time to liver transplantation. The new pediatric end-stage liver disease (PELD) model was used to score liver disease severity.
Three boys and two girls with mean age of 8.6 months (range, 1.5–21 months) and mean PELD of 18.0 (range, 10–29) required CPB for repair. The only early mortality in the series occurred after cardiac arrest during creation of a central shunt. The child expired two days later despite extracorporeal membrane oxygenation support. The patient had important myocardial hypertrophy. All other patients survived and underwent successful liver transplantation.
Children with significant congenital heart disease awaiting liver transplantation can undergo safe cardiac repair with judicious perioperative support thereby reducing the risks of subsequent liver transplantation.
Paraplegia after an open heart operation in a neonate is a rare complication. We report a case of a infant in whom paraplegia developed after a successful arterial switch operation for transposition ...of the great arteries. The infant was monitored and resuscitated in the preoperative period with umbilical arterial and venous catheter tips located in the midthoracic region. He likely suffered a clinically silent thromboembolic event predisposing him to a localized hemorrhagic infarction during the repair.
The incisional pulmonary artery band Laks, Hillel; Odim, Jonah N.K.; Sadeghi, Ali M. ...
The Annals of thoracic surgery,
06/1999, Volume:
67, Issue:
6
Journal Article, Conference Proceeding
Peer reviewed
Occasionally early definitive repair of congenital heart disease carries prohibitive mortality, and interval pulmonary artery banding is necessary to protect the pulmonary arterial bed and improve ...systemic perfusion or prepare a systemic left ventricle for a later arterial switch operation. We describe our technique for effectively banding the pulmonary artery.
Early repair of complex congenital heart malformations may lead to life-threatening respiratory and hemodynamic embarrassment on sternal closure. To avoid a fatal outcome in these situations, we ...postponed sternal closure in nine critically ill neonates by suturing silicone elastomer sheeting to the skin edges. This maneuver, in a setting of optimal inotropic and ventilatory support, allowed eight of the nine neonates to survive. The mean age at operation was 10.2 days (range 3 to 31). The mean preoperative weight was 3004.4 gm (range 1550 to 3780). The sternal wound was protected with an impervious silicone elastomer sheeting for a mean of 5.6 days (range 2 to 12). There was no instance of wound infection. The judicious application of this technique after operations for complex congenital heart disease can provide the necessary compliance vital for immediate cardiopulmonary performance and ultimate survival.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Skeletal muscle possesses inherent plasticity of gene expression. Low frequency pulse-train stimulation can remodel the biochemical machinery that confers physiological expression and fatigue ...resistance approaching that of the myocardium. This fatigue-resistant muscle can generate sufficient force to meet the power requirements for useful cardiac work. This ultimate goal is currently being pursued in models of cardiomyoplasty and muscle-powered cardiac assist devices. In this article, we review the three major subcellular systems subserving canine skeletal muscle transformation and compare them to those of cardiac muscle. The magnitude of the problem of clinical heart failure and the feasibility of fatigue-resistant skeletal muscle joining the therapeutic armamentarium are addressed. The adaptation and transformation of fast-twitch skeletal muscle in response to chronic electrical stimulation augers therapeutic potential as an endogenous, readily available power source for myocardial assistance. The basis mechanisms of skeletal muscle fatigue require elucidation to gain a complete and thorough understanding of how to manipulate this property to provide continuous hemodynamic work.
Percutaneous tracheostomy is increasingly being used for patients needing prolonged ventilatory support. The purpose of this study was to assess the feasibility of widespread application of ...endoscopic guided percutaneous tracheostomy. Sixty-one consecutive ICU patients requiring prolonged mechanical ventilation underwent bedside endoscopic guided percutaneous tracheostomy. Using a modified Ciaglia technique, a #6-10 tracheostomy tube was introduced between the second and third tracheal rings. Bronchoscopic transillumination facilitated identification of the appropriate tracheostomy site, and verified satisfactory placement of dilators and tracheostomy tube. There was one procedure-related death due to arrhythmia. Procedure-related complications included (n = 7): bleeding (controlled with local pressure), two infections, two cuff tears, and two obstructions of the tracheal tube. The tracheostomy was eventually removed in 13 patients. Bronchoscopic evaluation of three patients at 4 months post-tracheostomy removal was normal and there has been no clinical evidence suggestive of tracheal stenosis in the remaining ten extubated patients. There was a 50% reduction in cost when compared to operative tracheostomy. Percutaneous tracheostomy is a simple, safe, cost-effective bedside procedure for critically ill ventilator-dependent patients. Endoscopic guidance appears to increase the safety of this procedure and may prevent complications of pneumothorax, subcutaneous emphysema, and paratracheal false passage previously reported with blinded percutaneous methods.
We tested the hypothesis that external synchronized compression of the cardiovascular system can achieve effective hemodynamic assistance while circumventing problems associated with the ...blood-polymer interface in traditional cardiac assist devices. Ten dogs were studied to develop and test prototype devices and evaluate their hemodynamic effectiveness. Copulsation assistance was studied in animals with fibrillating hearts using Anstadt pericardiac cups. Mean systolic arterial pressure of 81.2 mm Hg and cardiac output of 2.9 L/min were achieved. Counterpulsation assistance was studied by inflating during diastole a balloon placed between the thoracic aorta and periaortic sheath and deflating the balloon during systole. In 4 dogs, 25 +/- 8.6% (SEM) of diastolic augmentation and 8.3 +/- 1.2% of systolic unloading were achieved. These preliminary results indicate the feasibility of a pericardiovascular approach to cardiac assistance. Further device development and the integration of copulsation and counterpulsation may improve cardiac output, reduce cardiac afterload, augment coronary perfusion, and ultimately benefit patients with severe heart failure.
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