Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to ...improve cardiovascular health. These guidelines, which are based on systematic methods to evaluate and classify evidence, provide a cornerstone for quality cardiovascular care. The ACC and AHA sponsor the development and publication of guidelines without commercial support, and members of each organization volunteer their time to the writing and review efforts. Guidelines are official policy of the ACC and AHA.
Abstract Objectives Describe quality outcomes of adults with congenital heart disease (ACHD) undergoing cardiovascular procedures and admissions in a free-standing children's hospital with a ...multi-disciplinary ACHD program and compared with pediatric outcomes. Background A challenge for the U.S. healthcare system is where to treat the > 1 million ACHD patients (pts): adult hospitals without CHD care, or pediatric hospitals without adult services. Methods We reviewed all CHD pts ≥ 18 yrs of age from 2002–2007. Procedural and hospital related morbidity and mortality were recorded. ANOVA and t -test compared adult with pediatric pts. Results Overall, 782 pts, mean age of 29.8 ± 9.9 yrs, encountered 1490 procedures/admissions. For 178 cardiac surgeries (72% reoperations), mortality was 1.8% and complication rate was 7.3%. There was 0% mortality for 412 cardiac catheterizations, 311 electrophysiological procedures, 401 transesophageal echocardiograms (TEE), 244 exercise tests (ETT) and 54 medical admissions. Major adverse event rate was 0.6% for cardiac catheterization and electrophysiological procedures. No adverse events occurred during TEE and ETT. Only 4 pts required transfer to an adult institution (0.25%). There was no significant difference in mortality or adverse events between pediatric and adult CHD pts, p > 0.05. Conclusions The optimal setting to provide ACHD care remains a complex issue. Our study is the first to demonstrate 1) a low incidence of morbidity and mortality for ACHD pts undergoing cardiovascular procedures or admissions at a free-standing children's hospital, 2) outcomes comparable to pediatric CHD pts. Future models incorporating ACHD programs within pediatric heart centers should be considered to care for this complex population.
The incidence of attention deficit hyperactivity disorder is higher among children born very preterm than among children who are mature at birth.
We studied 583 ten-year-old children who were born ...before 28 weeks of gestation whose IQ was above 84 and had a parent-completed Child Symptom Inventory-4, which allowed classification of the child as having or not having symptoms of attention deficit hyperactivity disorder. For 422 children, we also had a teacher report, and for 583 children, we also had a parent report of whether or not a physician made an attention deficit hyperactivity disorder diagnosis.
The risk profile of screening positive for attention deficit hyperactivity disorder based on a parent's report differed from the risk profile based on the teacher's report, whereas the risk profile according to a physician and according to any two observers closely resembled the parent-reported profile. Among the statistically significant risk factors were young maternal age (parent, physician, and two observers), maternal obesity (parent, physician, and two observers), maternal smoking (parent, physician, and two observers), magnesium given at delivery for seizure prophylaxis (parent and two observers), recovery of Mycoplasma sp. from the placenta (teacher and two observers), low gestational age (parent and two observers), low birth weight (teacher and physician), singleton (parent, physician, and two observers), male (parent, teacher, physician, and two observers), mechanical ventilation on postnatal day seven (physician), receipt of a sedative (parent and two observers), retinopathy of prematurity (parent), necrotizing enterocolitis (physician), antibiotic receipt (physician and two observers), and ventriculomegaly on brain scan (parent and two observers).
The multiplicity of risk factors identified can be subsumed as components of four broad themes: low socioeconomic state, immaturity or vulnerability, inflammation, and epigenetic phenomena.
Background Several investigators have studied the effects of exercise on pressure gradients and valve area measurements in patients with senile calcific aortic stenosis. However, there are limited ...data on young patients with congenital aortic stenosis. The current study was conducted to assess the dynamic effect of exercise on aortic valve area and to determine whether pressure gradients or valve area determinations correlate with duration of exercise in these patients.
Methods and Results Twenty-five young patients with congenital aortic stenosis and 10 normal control patients performed symptom-limited bicycle exercise stress tests with quantitative 2-dimensional and Doppler analysis. Compared with normal patients, there were no significant differences in the directional changes in blood pressure, left ventricular volumes, and ejection fraction. There was no correlation between either peak instantaneous or mean transaortic pressure gradient and exercise duration. A small but statistically significant correlation was detected between the continuity equation aortic valve area and duration of exercise (
r = 0.49,
P = .013). Aortic valve area did not change with exercise in the patient cohort (1.5 ± 0.6 vs 1.5 ± 0.6;
P = not significant).
Conclusions Aortic valve area does not change significantly with exercise in asymptomatic patients with congenital aortic stenosis. Consistent with prior studies, there was no correlation between the duration of exercise and the mean resting aortic valve gradient. A modest but statistically significant correlation was detected between exercise duration and aortic valve area. Further studies are required to determine whether aortic valve area measurements would provide useful adjunctive data on which to base recommendations for participation in competitive sports.
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