Family Stresses After Pediatric Heart Transplantation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73984/1/j.1751-7117.1989.tb00572.x.pd

Potential for reversibility of pulmonary vascular obstructive disease in children after cardiac transplantation

Patients with pulmonary vascular obstructive disease (PVOD) are usually not considered candidates for orthotopic cardiac transplantation, because the normal donor's right ventricle may be unable to function because of an acute increase in afterload, especially in the postischemic situation of the arrested and transported donar heart. The accepted guideline is that pulmonary vascular resistance (PVR) must be 8 Wood units (mm Hg/liters/min) or lower during maximal medical management.1,2 Patients whose PVR is between 4 and 8 Wood units are marginal candidates. Combined heart-lung transplantation or heterotopic cardiac transplantation is generally believed to be necessary when the PVR is 8 units. However, among children with a variety of congenital defects, PVOD is often reversible after correction, especially when correction is performed at a young age. This was the case in the patient described herein whose cardiac transplantation was successful despite a PVR of nearly 13 Wood units.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25979/1/0000045.pd

Clinical and hemodynamic follow-up of left ventricular to aortic conduits in patients with aortic stenosis

To assess the long-term results of left ventricular outflow tract reconstruction utilizing an apical left ventricular to aortic valved (porcine) conduit the clinical and hemodynamic data were reviewed from 24 patients who had placement of an apico-aortic conduit. Eighteen of the patients are asymptomatic and taking no cardiac medications. Three patients were reoperated on, one patient 1.5 years after his original operation for subacute bacterial endocarditis and two patients 3 to 4 years after their original operation for severe conduit valve insufficiency. None of the patients is taking anticoagulants and no thromboembolic events have occurred. Postoperative catheterization has been performed 1 to 1.5 years (mean 1.2) after repair in 15 of 21 patients. The rest left ventricular outflow tract gradient has decreased from 102.5 ± 20 mm Hg preoperatively to 14.8 ± 9.9 mm Hg postoperatively (probability [p] < 0.001). Some degree of conduit obstruction was demonstrated by catheter passage in 11 of the 15 patients. In these 11 patients, the obstruction occurred at three distant sites: at the egress of the left ventricle in 9, at the porcine valve in 5 and at the aortic to conduit junction in 1. Isometric exercise in five and supine bicycle exercise in six patients increased the left ventricular outflow tract gradient by 2.5 ± 1.1 and 20.8 ± 11.8 mm Hg, respectively, despite an increase in cardiac index of 1 ± 0.3 and 3.7 ± 0.4 liters/min per m2, respectively. The data suggest that a left ventricular to aortic conduit is an effective form of therapy for severe left ventricular outflow tract obstruction

Association of Pediatric Heart Transplant Coronary Vasculopathy with Abnormal Hemodynamic Measures

Objective.  Transplant coronary artery disease (TCAD) is the limiting factor to long‐term cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheter‐derived filling pressures with TCAD in pediatric heart transplant (HTx) recipients.Design, Patients, Outcome Measures.  Data from 52 presymptomatic pediatric HTx patients were analyzed. Catheter‐derived right ventricular end‐diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) were recorded. Biopsies were collected to verify the absence of rejection.Results.  TCAD was diagnosed an average of 8.3 years post‐HTx in 20 (38%) patients, six of whom died and four of whom underwent retransplantation. Catheter‐derived pressure measurements showed that RVEDP was elevated in TCAD compared with non‐TCAD patients (9.5 ± 6.0 vs. 5.4 ± 4.7; P= .005), as was the PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7; P= .012). Results from logistic regression analysis showed RVEDP > 10 mm Hg or PCWP > 12 mm Hg was associated with TCAD (OR = 5.2; P= .010).Conclusions.  In this series, elevated ventricular filling pressures measured during routine surveillance catheterizations were associated with angiographic TCAD. Recognizing the association between elevated RVEDP/PCWP and TCAD may prompt earlier diagnosis and treatment of this potentially lethal process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111940/1/j.1747-0803.2010.00470.x.pd

Neonatal Cardiac Catheterization: A 10-Year Transition from Diagnosis to Therapy

To assess the changing role of cardiac catheterization in the care of the neonate, a retrospective review of all catheterizations between January 1984 to December 1985 (group I) and January 1994 to December 1995 (group II) at C.S. Mott Children's Hospital was performed. Neonatal cardiac catheterization was performed more frequently ( p = 0.02) in group I, comprising 14% (110 of 772) of all catheterizations versus 11% (93 of 880) in group II. Access was performed by cutdown in 15 patients (13 venous and 2 arterial), all in group I. In group I, 20 of 110 patients (18%) had balloon atrial septostomies; no other catheter interventions were performed. Interventions were more frequent ( p = 0.003) and varied in group II, including 15 septostomies, 17 balloon valvuloplasties (13 pulmonary and 4 aortic), 2 coil embolizations of collaterals, and 1 cardiac biopsy. Despite the higher prevalence and complexity of interventions in group II, fluoroscopy times (median; range: 16 min; 2–55 vs 16 min; 1–107) were similar in both groups ( p = not significant) as well as the prevalence of complications. Neonatal cardiac catheterizations are performed less frequently than they were a decade ago at our institution, and therapeutic interventions have become more common. Despite these changes, fluoroscopy time and the rate of complications have not increased.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42380/1/246-20-2-131_20n2p131.pd

Transient atrioventricular block resulting from left ventricular angiography in infants with ventricular septal defect

Conduction disturbances often occur with manipulation of catheters within the atria or ventricles during cardiac catheterization.1,2 Catheter movement may induce transient right or left bundle branch block, or complete heart block in patients with or without preexistent bundle branch block.3-6 To our knowledge, however, there have been no previous reports of complete heart block resulting from an intramyocardial stain in the region of the atrioventricular (AV) conduction system. This report describes 2 infants who developed transient complete heart block following injection of contrast medium in the left ventricle. In each, complete heart block resulted from the intra-myocardial injection of contrast medium in the region of the AV conduction system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27865/1/0000278.pd

Transposition of the great arteries, right aortic arch, coarctation, and isolation of the left subclavian artery: Report of surgical therapy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24449/1/0000723.pd

Aortic aneurysms after subclavian angioplasty repair of coarctation of the aorta

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27336/1/0000361.pd

Practice effects in a longitudinal, multi-center Alzheimer\u27s disease prevention clinical trial

BACKGROUND: Practice effects are a known threat to reliability and validity in clinical trials. Few studies have investigated the potential influence of practice on repeated screening measures in longitudinal clinical trials with a focus on dementia prevention. The current study investigates whether practice effects exist on a screening measure commonly used in aging research, the Memory Impairment Screen (MIS). METHODS: The PREADViSE trial is a clinical intervention study evaluating the efficacy of vitamin E and selenium for Alzheimer\u27s disease prevention. Participants are screened annually for incident dementia with the MIS. Participants with baseline and three consecutive follow-ups who made less than a perfect score at one or more assessments were included in the current analyses (N=1,803). An additional subset of participants with four consecutive assessments but who received the same version of the MIS at baseline and first follow-up (N=301) was also assessed to determine the effects of alternate forms on mitigating practice. We hypothesized that despite efforts to mitigate practice effects with alternate versions, MIS scores would improve with repeated screening. Linear mixed models were used to estimate mean MIS scores over time. RESULTS: Among men with four visits and alternating MIS versions, although there is little evidence of a significant practice effect at the first follow-up, mean scores clearly improve at the second and third follow-ups for all but the oldest participants. Unlike those who received alternate versions, men given the same version at first follow-up show significant practice effects. CONCLUSION: While increases in the overall means were small, they represent a significant number of men whose scores improved with repeated testing. Such improvements could bias case ascertainment if not taken into account

Pressure-Regulated Volume Control vs Volume Control Ventilation in Infants After Surgery for Congenital Heart Disease

The objective of this investigation was to compare how two modes of positive pressure ventilation affect cardiac output, airway pressures, oxygenation, and carbon dioxide removal in children with congenital heart disease in the immediate postoperative period. The investigation used a one group pretest–post-test study design and was performed in the pediatric cardiac intensive care unit in a university-affiliated children's hospital. Nine infants were enrolled immediately after repair of tetralogy of Fallot (2) or atrioventricular septal defects (7) with mean weight = 5.5 kg (4.2–7.3 kg). Children were admitted to the pediatric cardiothoracic intensive care unit after complete surgical repair of their cardiac defect and stabilized on a Siemen's Servo 300 ventilator in volume control mode (VCV1) (volume-targeted ventilation with a square flow wave pattern). Tidal volume was set at 15 cc/kg (total). Hemodynamic parameters, airway pressures and ventilator settings, and an arterial blood gas were measured. Patients were then changed to pressure-regulated volume control mode (PRVC) (volume-targeted ventilation with decelerating flow wave pattern) with the tidal volume set as before. Measurements were repeated after 30 minutes. Patients were then returned to volume control mode (VCV2) and final measurements made after 30 minutes. The measurements and results are as follows:Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42385/1/246-22-3-233_10220233.pd