Heart transplantation in children with congenital heart disease

ObjectivesThe aim of this study was to describe heart transplantation in children with congenital heart disease and to compare the results with those in children undergoing transplantation for other cardiac diseases.BackgroundReports describe decreased survival after heart transplantation in children with congenital heart disease compared with those with cardiomyopathy. However, transplantation is increasingly being considered in the surgical management of children with complex congenital heart disease. Present-day results from this group require reassessment.MethodsThe diagnoses, previous operations and indications for transplantation were characterized in children with congenital heart disease. Pretransplant course, graft ischemia time, posttransplant survival and outcome (rejection frequency, infection rate, length of hospital stay) were compared with those in children undergoing transplantation for other reasons (n = 47).ResultsThirty-seven children (mean [±SD] age 9 ± 6 years) with congenital heart disease underwent transplantation; 86% had undergone one or more previous operations. Repair of extracardiac defects at transplantation was necessary in 23 patients. Causes of death after transplantation were donor failure in two patients, surgical bleeding in two, pulmonary hemorrhage in one, infection in four, rejection in three and graft atherosclerosis in one. No difference in 1- and 5-year survival rates (70% vs. 77% and 64% vs. 65%, respectively), rejection frequency or length of hospital stay was seen between children with and without congenital heart disease. Cardiopulmonary bypass and donor ischemia time were significantly longer in patients with congenital heart disease. Serious infections were more common in children with than without congenital heart disease (13 of 37 vs. 6 of 47, respectively, p = 0.01).ConclusionsDespite the more complex cardiac surgery required at implantation and longer donor ischemic time, heart transplantation can be performed in children with complex congenital heart disease with success similar to that in patients with other cardiac diseases

Coming from behind to win - A Qualitative research about psychological conditions of adolescents who have undergone open-heart surgery for single ventricle between the ages 0-5

Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the analysis was "to be strong and resistive". We reached the conclusion that this condition was not a pathological build up but an attitude of coping, as it did not cause loss of functionality. The defensive psychological mechanisms used by these adolescents consisted of repression, compensation and reaction formation. We believe that this information is important to understand the real meaning of the manners displayed when these adolescents and their families pursue their daily lives, communicate and make relationships with their environment and especially professionals in the health services

Schooling for conflict transformation : a case study from Northern Uganda

Civil wars impede progress towards the Millennium Development Goals. As many conflicts erupt within a short time, it is important to know what may increase the chances of sustainable peace. Access to education is a factor but relatively little is known about the contribution of what students learn in school. This thesis aims to respond to a research gap by addressing the foll owing question: 'How can schooling contribute to conflict transformation?' Significant curricular approaches that may be used after civil war - peace education, human rights education and citizenship education - are assessed for their strengths and weaknesses. As no single approach is found to be sufficient for conflict transformation, a framework is proposed based on three fundamental concepts: (i) truth seeking; (ii) reconciliation; and (iii) inclusive citizenship. This framework is examined through a qualitative case study of curriculum in seven schools in a district in northern Uganda that is emerging from a twenty-year civil war. The curriculum of four primary schools, two secondary schools, one special school and one teacher training college was studied over a three-month period. A structure of knowledge, skills and values was used to research the framework at a detailed level. It is found that schools exhibit good socialization of reconciliation values and some development of problem-solving and communication skills. There is some understanding of human rights, but little knowledge of history, or of local, national and international political/legal systems. There is minimal development of discussion and critical thinking skills. It is argued that the framework can be used to investigate other schools and to inform the design of a curriculum that can contribute to conflict transformation, with the ultimate aim of reducing the risk of civil war re-eruption

Auxiliary Armed Forces and Innovations in Security Governance in Mozambique’s Civil War

Who rules during the civil war? This article argues that the concept of armed group governance must be expanded to include auxiliary armed forces linked to rebels or the government. Comparing the organization of rebel and government auxiliaries, the article demonstrates that security governance during war is never static, but evolves over time. Evidence from the civil war in Mozambique (1976–1992) shows that the auxiliary’s origin shapes its initial level of autonomy. Second, auxiliary contribution to battlefield success of one side may induce innovations adopted by auxiliaries on the other. Both have distinct consequences for the nature of governance.The Institutions of Politics; Design, Workings, and implications ( do not use, ended 1-1-2020

Aortic atheromas and acute ischemic stroke: a transesophageal echocardiographic study in an ethnically mixed population

Proximal aortic atheromas have been suggested as a potential ischemic stroke determinant in the elderly, especially in cases of unexplained (cryptogenic) stroke. Our aim was to assess the potential role of proximal aortic atheromas as an independent risk factor for stroke by comparing their frequency in patients with acute ischemic stroke and in stroke-free control subjects. The frequency of atheromas was also compared among different ethnic groups. A case-control study was conducted in 106 patients with acute ischemic stroke and 114 stroke-free control subjects. The presence of atheromas of the proximal portion of the aorta was assessed by biplane transesophageal echocardiography. Atheromas were categorized on the basis of their thickness (0.2 to 0.4 cm, small; > or = 0.5 cm, large) and complexity (i.e., ulceration or mobility). The association between aortic atheromas and ischemic stroke was tested, controlling for patients' demographic variables and stroke risk factors. In stroke patients, subgroup analyses were performed to test the associations between aortic atheromas and stroke diagnostic subtypes (determined cause versus cryptogenic) and presence and degree of carotid stenoses by duplex Doppler examination. The frequency of large aortic atheromas was greater in stroke patients than in controls (26% versus 13%; crude odds ratio [OR] 2.4, 95% CI 1.2 to 4.7); ulcerated or mobile atheromas also tended to be more frequent in stroke patients (12% versus 5%; OR 2.5, 95% CI 1.0 to 6.8). Differences were entirely attributable to the subgroup of patients aged 60 years or older, in whom the frequency of ulcerated or mobile atheromas was particularly high among cryptogenic stroke patients (22% versus 8% in control subjects; OR 3.4, 95% CI 1.1 to 11.2). Multivariate analysis showed the presence of large atheromas to be independently associated with stroke in the entire study group (adjusted OR 2.6, 95% CI 1.1 to 5.9) and in the older subgroup (OR 2.4, 95% CI 1.1 to 5.7). Carotid stenosis > or = 60% was more frequent with increasing size and complexity of aortic atheromas but had low predictive value (16%) for presence of large atheromas; moreover, 36% of patients with mild or no carotid stenosis had large or complex aortic atheromas. No significant differences were found in the frequency of atheromas by ethnic group. Proximal aortic atheromas > or = 0.5 cm in size are a risk factor for ischemic stroke in patients aged 60 years or older. Ulcerated or mobile atheromas may play a role in explaining some cryptogenic strokes in the elderly. The risk for stroke of patients with aortic atheromas may be similar across different ethnic groups. The absence of carotid stenosis does not exclude aortic atheromas as a potential cause for ischemic stroke