Effects of donor cause of death, ischemia time, inotrope exposure, troponin values, cardiopulmonary resuscitation, electrocardiographic and echocardiographic data on recipient outcomes: A review of the literature

BackgroundHeart transplantation has become standard of care for pediatric patients with either end‐stage heart failure or inoperable congenital heart defects. Despite increasing surgical complexity and overall volume, however, annual transplant rates remain largely unchanged. Data demonstrating pediatric donor heart refusal rates of 50% suggest optimizing donor utilization is critical. This review evaluated the impact of donor characteristics surrounding the time of death on pediatric heart transplant recipient outcomes.MethodsAn extensive literature review was performed to identify articles focused on donor characteristics surrounding the time of death and their impact on pediatric heart transplant recipient outcomes.ResultsPotential pediatric heart transplant recipient institutions commonly receive data from seven different donor death‐related categories with which to determine organ acceptance: cause of death, need for CPR, serum troponin, inotrope exposure, projected donor ischemia time, electrocardiographic, and echocardiographic results. Although DITs up to 8 hours have been reported with comparable recipient outcomes, most data support minimizing this period to <4 hours. CVA as a cause of death may be associated with decreased recipient survival but is rare in the pediatric population. Otherwise, however, in the setting of an acceptable donor heart with a normal echocardiogram, none of the other data categories surrounding donor death negatively impact pediatric heart transplant recipient survival.ConclusionsEchocardiographic evaluation is the most important donor clinical information following declaration of brain death provided to potential recipient institutions. Considering its relative importance, every effort should be made to allow direct image visualization.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154939/1/petr13676.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154939/2/petr13676_am.pd

Malignancy following heart transplantation: differences in incidence and prognosis between sexes – a multicenter cohort study

[Abstract] Male patients are at increased risk for developing malignancy postheart transplantation (HT); however, real incidence and prognosis in both genders remain unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs, and NSSCs were lower in females [all tumors: 25.7 vs. 44.8 per 1000 person‐years; rate ratio (RR) 0.68, (0.60–0.78), P < 0.001]. Mortality rates were also lower in females for all tumors [94.0 (77.3–114.3) vs. 129.6 (120.9–138.9) per 1000 person‐years; RR 0.76, (0.62–0.94), P = 0.01] and for NSSCs [125.0 (95.2–164.0) vs 234.7 (214.0–257.5) per 1000 person‐years; RR 0.60 (0.44–0.80), P = 0.001], albeit not for SCs or lymphoma. Female sex was associated with a better survival after diagnosis of malignancy [log‐rank p test = 0.0037; HR 0.74 (0.60–0.91), P = 0.004]. In conclusion, incidence of malignancies post‐HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males

Adult congenital heart disease training in Europe:current status, disparities and potential solutions

Objectives:This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe.Methods:A questionnaire was sent to ACHD cardiologists from 34 European countries.Results:Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p&lt;0.001).Conclusion: Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care

Ecocardiografia doppler y doppler tisular en recien nacido pretérmino: influencia del ductus arterioso y foramen oval en el llenado ventricular izquierdo y su correlación con la evolución clínica

INTRODUCCIÓN: La persistencia del ductus arterioso (PCA) esta asociada a una elevada morbilidad y mortalidad en los recién nacidos prematuros (RNP). Son muchos RNP en los que durante las primeras horas de vida se detecta la presencia de un PCA. En ese momento se desconoce cual provocará patología en las horas o días siguientes, por lo que persiste la controversia sobre la indicación de administrar tratamiento médico para el cierre profiláctico precoz. La medición de las presiones de llenado ventricular izquierdo (VI) y la estimación de la presión capilar pulmonar (PCP) por medios no invasivos como el Doppler tisular (DTI) es un tema de actualidad en cardiología pediátrica. La relación E/E' mitral se ha correlacionado con la PCP. El Tei¬tisular (expresado como la suma del tiempo de relajación y contracción isovolumétrica dividido por el tiempo de eyección) es un índice de función global y se está utilizando ampliamente en la valoración de diferentes patologías. Sabemos que la persistencia de un PCA amplio supone una sobrecarga en el llenado del VI y que la existencia de un Foramen ovale (FOP) puede influir en el llenado ventricular. HIPÓTESIS DE TRABAJO: La existencia de un FOP, en presencia de un ductus amplio, puede disminuir la sobrecarga ventricular izquierda provocada por el hiperaflujo del ductus e influir en la evolución del paciente. OBJETIVOS: En este estudio intentamos demostrar, por Ecocardiografía (ECO) Doppler y DTI, cambios en el llenado del VI en RNP con ductus amplio, en relación a la existencia o no de un FOP. Estudiamos además diferencias según Edad gestacional(EG), entre RNP de 1,4mm/kg de peso. Se utilizó el ecógrafo Vivid-i (GE®) con el transductor de 10Hz, y se realizó estudio off-line posterior de las imágenes almacenadas. El paquete estadístico utilizado en el estudio fue el SPSS v15.0® RESULTADOS Y DISCUSIÓN: Se incluyeron 72 RNP, con edad gestacional mediana de 27 semanas (rango 24 -30) y con un peso de 860 g (rango 420 -1590 g). Se realizaron un total de 180 ECO, la primera entre las 6 -24 horas de vida postnatal (media 14,5). Se siguió el protocolo de tratamiento del PCA vigente en el Servicio de Neonatología del Hospital Universitario Vall d'Hebron. Se trataron 36 RNP (29 se cerraron con 1 tanda de tratamiento médico, 2 con 2 tandas y 5 precisaron cierre quirúrgico). Se establecieron 2 Grupos: I con los 35 RNP de EG 0,61 mostraba una especificidad del 87% de tratarse de un PCAs. Sin embargo la relación E/E' mitral con y sin PCA no mostraba diferencias: mediana de 14,583 (7,3 -72,5) y de 14,167 (6,1 -39,2) respectivamente. Tampoco observamos diferencias en el índice Tei-mitral con o sin PCA: 0,4969 (0,37 -0,70) y 0,5035 (0,35 ¬0,83) respectivamente. A pesar del tratamiento, hasta en un 60% de los RNP del grupo I persistía el PCA a las 100 horas de vida, mientras que en el Grupo II el cierre era del 100% en ese mismo momento. La presencia de un PCAs en la primera ECO tenía una sensibilidad del 100% y especificidad del 72% en predecir la presencia de un PCAs en los controles siguientes. El estudio de correlación mostraba una asociación estadísticamente significativa entre la presencia de un PCAs en la 1ª ECO antes de las 24 horas con la existencia de un PCAs en controles posteriores, con un índice de correlación de 0,762 (p 0,01) CONCLUSIONES: El ductus es un factor de riesgo independiente relacionado con una peor evolución clínica en los RNP. Tener un FOP 1.4 mm / kg. We used the ultrasound Vivid-i (GE ®) with the transducer of 10Hz, and performed later off-line study of stored images. The statistical package used in this study was SPSS ® v15.0. RESULTS AND DISCUSSION: A total of 72 RNP, median gestational age 27 weeks (range 24-30) and weighing 860 g (range 420-1590 g). A total of 180 ECO was carried out, the first between 6 to 24 hours of postnatal life (mean 14.5). We followed the current treatment protocol for PCA in Neonatology Service of our hospital (Hospital Vall d'Hebron). Thirty-six patients were treated (29 with a round of medical treatment, 2 with 2 and 5 required surgical closure). Two groups were established: Group I 35 patients with GA 0.61/Kg showed a specificity of 87% to be a PCA. However, the ratio E / E' mitral with or without PCA showed no differences: median of 14.583 (7.3 to 72.5) and 14.167 (6.1 to 39.2) respectively. We did not observe differences in the Tei index, mitral with or without PCA: 0.4969 (from 0.37 to 0.70) and 0.5035 (0.35 -0.83) respectively. Despite treatment, as much as 60% of the RNP group I remained the PDA to the 100 hours of life, while in Group II closure was 100% over the same time. The presence of PDAs in the first ECO had a sensitivity of 100% and 72% specificity in predicting the presence of PDAs in the following controls. The correlation study showed a statistically significant association between the presence of PDAs in the 1stECO within 24 hours with the existence of a PDA in later test, a correlation indes of 0,762 (0 0,01). CONCLUSIONS: The ductus is an independent risk factor associated with poor outcome in the RNP. Having a PFO <2mm and be <27 weeks are also risk factors, although not significantly. No differences in the values of the DTI and Tei-tissue between GA < and &#8805;27 weeks, or in patients with and without PCA. DTI measures has similar values between the compared groups and is a technique with low reproducibility. This study suggests that when in the RNP <27 weeks notice a significant PDA in ECO practiced before 24 hours of postnatal life, medical treatment to induce its closure without having to wait for the following controls was to be carried out

Neonatal supraventricular extrasystole as early clinical debut of cardiac rhabdomyoma

We are reporting the case of a newborn with a diagnosis of frequent supraventricular extrasystoles, up to 25% of beats at Holter monitoring, and partial response to beta-blockers. Initial echocardiographic studies were normal until the identification of a right atrial mass at 4 months of life. Given the progressive growth of the mass and the suspicion of myxoma or thrombus in the magnetic resonance study, surgical resection of the tumor was performed. The surgical specimen was histologically diagnostic of rhabdomyoma. Currently, the patient remains asymptomatic after a 6-year follow-up period. A single rhabdomyoma is described, located in an atypical situation, near the crista terminalis, and diagnosed from frequent extrasystoles which appeared before the echocardiographic resolution was able to identify it. Magnetic resonance showed nondiagnostic tissue enhancement characteristics

Ecocardiografía Doppler y Doppler tisular en recién nacido pretérmino : influencia del ductus arterioso y foramen oval en el llenado ventricular izquierdo y su correlación con la evolución clínica /

Descripció del recurs: 26 gener 2011INTRODUCCIÓN: La persistencia del ductus arterioso (PCA) esta asociada a una elevada morbilidad y mortalidad en los recién nacidos prematuros (RNP). Son muchos RNP en los que durante las primeras horas de vida se detecta la presencia de un PCA. En ese momento se desconoce cual provocará patología en las horas o días siguientes, por lo que persiste la controversia sobre la indicación de administrar tratamiento médico para el cierre profiláctico precoz. La medición de las presiones de llenado ventricular izquierdo (VI) y la estimación de la presión capilar pulmonar (PCP) por medios no invasivos como el Doppler tisular (DTI) es un tema de actualidad en cardiología pediátrica. La relación E/E' mitral se ha correlacionado con la PCP. El Tei¬tisular (expresado como la suma del tiempo de relajación y contracción isovolumétrica dividido por el tiempo de eyección) es un índice de función global y se está utilizando ampliamente en la valoración de diferentes patologías. Sabemos que la persistencia de un PCA amplio supone una sobrecarga en el llenado del VI y que la existencia de un Foramen ovale (FOP) puede influir en el llenado ventricular. HIPÓTESIS DE TRABAJO: La existencia de un FOP, en presencia de un ductus amplio, puede disminuir la sobrecarga ventricular izquierda provocada por el hiperaflujo del ductus e influir en la evolución del paciente. OBJETIVOS: En este estudio intentamos demostrar, por Ecocardiografía (ECO) Doppler y DTI, cambios en el llenado del VI en RNP con ductus amplio, en relación a la existencia o no de un FOP. Estudiamos además diferencias según Edad gestacional(EG), entre RNP de y ≥ 7 semanas. Medimos los valores del DTI y Tei¬tisular en RNP con y sin PCA, así como el valor predictivo de la ECO realizada antes de las 24 horas sobre la presencia de Ductus clínicamente significativo (PCAs) en la evolución posterior del paciente. MATERIAL Y MÉTODOS: Estudio longitudinal prospectivo observacional. Se estudiaron todos los RNP 1,4mm/kg de peso. Se utilizó el ecógrafo Vivid-i (GE®) con el transductor de 10Hz, y se realizó estudio off-line posterior de las imágenes almacenadas. El paquete estadístico utilizado en el estudio fue el SPSS v15.0® RESULTADOS Y DISCUSIÓN: Se incluyeron 72 RNP, con edad gestacional mediana de 27 semanas (rango 24 -30) y con un peso de 860 g (rango 420 -1590 g). Se realizaron un total de 180 ECO, la primera entre las 6 -24 horas de vida postnatal (media 14,5). Se siguió el protocolo de tratamiento del PCA vigente en el Servicio de Neonatología del Hospital Universitario Vall d'Hebron. Se trataron 36 RNP (29 se cerraron con 1 tanda de tratamiento médico, 2 con 2 tandas y 5 precisaron cierre quirúrgico). Se establecieron 2 Grupos: I con los 35 RNP de EG 0,61 mostraba una especificidad del 87% de tratarse de un PCAs. Sin embargo la relación E/E' mitral con y sin PCA no mostraba diferencias: mediana de 14,583 (7,3 -72,5) y de 14,167 (6,1 -39,2) respectivamente. Tampoco observamos diferencias en el índice Tei-mitral con o sin PCA: 0,4969 (0,37 -0,70) y 0,5035 (0,35 ¬0,83) respectivamente. A pesar del tratamiento, hasta en un 60% de los RNP del grupo I persistía el PCA a las 100 horas de vida, mientras que en el Grupo II el cierre era del 100% en ese mismo momento. La presencia de un PCAs en la primera ECO tenía una sensibilidad del 100% y especificidad del 72% en predecir la presencia de un PCAs en los controles siguientes. El estudio de correlación mostraba una asociación estadísticamente significativa entre la presencia de un PCAs en la 1ª ECO antes de las 24 horas con la existencia de un PCAs en controles posteriores, con un índice de correlación de 0,762 (p 0,01) CONCLUSIONES: El ductus es un factor de riesgo independiente relacionado con una peor evolución clínica en los RNP. Tener un FOP 2mm y ser 27 semanas son también factores de riesgo, aunque de manera no significativa. No existen diferencias en los valores del DTI y Tei-tisular entre los RNP de EG 27s y los de EG ≥ 27s, ni en los pacientes con/sin PCA. Las medidas de DTI tienen valores similares entre los grupos comparados y es una técnica con poca reproducibilidad. De este estudio se deduce que cuando en los RNP 27 semanas se observe un PCA significativo en la ECO practicada antes de las 24 horas de vida postnatal, se debe iniciar el tratamiento médico para inducir su cierre, sin necesidad de esperar a los siguientes controles.INTRODUCTION: Patent ductus arteriosus (PDA) are associated with high morbidity and mortality in preterm infants (RNP). There are many RNP in which during the first hours of life a PCA was detected. Which of them will cause disease is unknown, so medical treatment for early prophylactic closure is still controversial. Measurement of left ventricular filling pressures (LV) and the estimation of pulmonary capillary pressure (PCP) for non-invasive means such as Doppler tissue imaging (DTI) is a topical issue in pediatric cardiology. The E / E 'mitral has been correlated with PCP. The Tei-tissue (expressed as the sum of the relaxation time and isovolumic contraction time divided by ejection time) is an index of global function and is being used extensively in the evaluation of different pathologies. We know that the persistence of a large ductus is an overload in the LV filling and the existence of a patent foramen ovale (PFO) can affect ventricular filling. HYPOTHESIS: The existence of a PFO in the presence of a large ductus, can decrease the left ventricular overload caused by the outflow of the ductus and could influence patient outcome. OBJECTIVES: This study tried to demonstrate, by echocardiography (ECO) Doppler and DTI, changes in LV filling in RNP with large ductus, in relation to the existence of a PFO. We also studied differences according to gestational age (GA), including RNP and ≥ 27 weeks. We measure the values of the DTI and Tei-tissue in RNP with and without PCA, and the predictive value of the ECO carried out within 24 hours on the presence of clinically significant ductus (PDAs) in the subsequent evolution of the patient. MATERIAL AND METHODS: Prospective observational study. We studied all RNP 1.4 mm / kg. We used the ultrasound Vivid-i (GE ®) with the transducer of 10Hz, and performed later off-line study of stored images. The statistical package used in this study was SPSS ® v15.0. RESULTS AND DISCUSSION: A total of 72 RNP, median gestational age 27 weeks (range 24-30) and weighing 860 g (range 420-1590 g). A total of 180 ECO was carried out, the first between 6 to 24 hours of postnatal life (mean 14.5). We followed the current treatment protocol for PCA in Neonatology Service of our hospital (Hospital Vall d'Hebron). Thirty-six patients were treated (29 with a round of medical treatment, 2 with 2 and 5 required surgical closure). Two groups were established: Group I 35 patients with GA 0.61/Kg showed a specificity of 87% to be a PCA. However, the ratio E / E' mitral with or without PCA showed no differences: median of 14.583 (7.3 to 72.5) and 14.167 (6.1 to 39.2) respectively. We did not observe differences in the Tei index, mitral with or without PCA: 0.4969 (from 0.37 to 0.70) and 0.5035 (0.35 -0.83) respectively. Despite treatment, as much as 60% of the RNP group I remained the PDA to the 100 hours of life, while in Group II closure was 100% over the same time. The presence of PDAs in the first ECO had a sensitivity of 100% and 72% specificity in predicting the presence of PDAs in the following controls. The correlation study showed a statistically significant association between the presence of PDAs in the 1stECO within 24 hours with the existence of a PDA in later test, a correlation indes of 0,762 (0 0,01). CONCLUSIONS: The ductus is an independent risk factor associated with poor outcome in the RNP. Having a PFO 2mm and be 27 weeks are also risk factors, although not significantly. No differences in the values of the DTI and Tei-tissue between GA and ≥ 27 weeks, or in patients with and without PCA. DTI measures has similar values between the compared groups and is a technique with low reproducibility. This study suggests that when in the RNP 27 weeks notice a significant PDA in ECO practiced before 24 hours of postnatal life, medical treatment to induce its closure without having to wait for the following controls was to be carried out

Assessment for learning of paediatric cardiology trainees in 41 centres from 19 European countries

BACKGROUND: Limited data exist on how trainees in paediatric cardiology are assessed among countries affiliated with the Association of European Paediatric and Congenital Cardiology. METHODS: A structured and approved questionnaire was circulated to educationalists/trainers in 95 Association for European Paediatric and Congenital Cardiology training centres. RESULTS: Trainers from 46 centres responded with complete data in 41 centres. Instructional design included bedside teaching (41/41), didactic teaching (38/41), problem-based learning (28/41), cardiac catheterisation calculations (34/41), journal club (31/41), fellows presenting in the multidisciplinary meeting (41/41), fellows reporting on echocardiograms (34/41), clinical simulation (17/41), echocardiography simulation (10/41), and catheterisation simulation (3/41). Assessment included case-based discussion (n = 27), mini-clinical evaluation exercise (mini-CEX) (n = 12), directly observed procedures (n = 12), oral examination (n = 16), long cases (n = 11), written essay questions (n = 6), multiple choice questions (n = 5), and objective structured clinical examination (n = 2). Entrustable professional activities were utilised in 10 (24%) centres. Feedback was summative only in 17/41 (41%) centres, formative only in 12/41 (29%) centres and a combination of formative and summative feedback in 10/41 (24%) centres. Written feedback was provided in 10/41 (24%) centres. Verbal feedback was most common in 37/41 (90 %) centres. CONCLUSION: There is a marked variation in instructional design and assessment across European paediatric cardiac centres. A wide mix of assessment tools are used. Feedback is provided by the majority of centres, mostly verbal summative feedback. Adopting a programmatic assessment focusing on competency/capability using multiple assessment tools with regular formative multisource feedback may promote assessment for learning of paediatric cardiology trainees