293: Transcatheter closure of ASD in infancy with the Amplatzer septal occluder

Many devices are available for atrial septal defect (ASD) usually in adults and children. We report here one center experience in transcatheter closure of ASD in infancy, using the Amplatzer septal occluder. From January 2003 to March 2010, 10 males and 5 female, mean age 10.9±6.4 months, with weight 6.7±2.5kg underwent transcatheter closure of atrial septal defect. The patients had significant left-to-right shunting (n=12), right-to-left shunting with hypoxemia (n=3). For the left-to-right shunting, the ASD was closed for pulmonary hypertension (n=10), for recurrent chest infection and bronchiolitis (n=5). The ASD was associated with other congenital heart defect (n=5), prematurity and bronchopulmonary dysplasia (n=6), foetopathy (n=1) and encephalopathy (n=1).The ASD was evaluated by transthoracic echocardiography (TEE) before the procedure. Percutaneous closure was realized with TEE for all patients. They received intravenous heparin. For 4 patients implantation was performed after a balloon test occlusion (mean 11±3.4mm diameter). The ASO device size was 10.4±3.9mm. The fluoroscopy time was 7.9±3.9 minutes and the time of the procedure 55.6±21.8 minutes. No per procedural complications were observed for all but for two (one anomalous device deployment and one insufficient rim). These two patients were subsequently surgically repaired. Patients left the hospital with a low dose of aspirin for 6 months.During follow-up, four patients had a minimal residual shunt on TEE performed up to one year after the implantation. No later cardiac complication was observed.To conclude, transcatheter closure of atrial septal defect in infant with the ASO is feasible and a possible alternative to surgical closure. In addition, ASD occlusion improves the respiratory status and reduces the level of pulmonary hypertension. Additional long-term results and a large study are both necessary to establish the future of this populatio

0398: Transcatheter closure of traumatic induced VSD

Traumatic induced VSD is a rare but serious disease because of the acute hemodynamic changes. We reported one center experience in the interventional catheterization closure of traumatic induced VSD during the last ten years. We had 3 patients with four VSD. Mean age was 60 (40-71) years. VSD was muscular secondary to external trauma in one patient, and to transapical transcatheter replacement of both of the aortic and mitral valves in the second. Last patient had membranous and muscular VSD post Ross-Konno intervention. All patients had acute congestive heart failure. All procedures were performed under general anesthesia and transesophageal echocardiography control. Arteriovenous loop was always used to introduce the delivery sheath to the left ventricle. VSDs diameter was evaluated by echography and ranged from 9 to 13mm. Device diameter was chosen 1 to 2mm over the echo-graphic measures. Multiple devices were used (Amplatzer® septal occluder, Amplatzer® muscular VSD occluder, Occlutech® Figulla septal occluder). Mean procedures time was 113 (100-145) min, and mean irradiation dose was 160 (103-203) Gycm2. Non significant residual shunt was observed in all patients, but the heart failure was resolved in all. Complications were registered in three procedures: transient hemolytic anemia, severe bradycardia, tricuspid cordage rupture and groin hematoma.ConclusionTraumatic VSD closure is required because of the acute hemo-dynamic changes. Trancatheter closure is effective. Complications are frequents because of the critical clinical status

Enhance quality care performance: Determination of the variables for establishing a common database in French paediatric critical care units

Abstract Selected variables for the French Paediatric Intensive Care registry. Rationale, aims, and objectives Providing quality care requires follow-up in regard to clinical and economic activities. Over the past decade, medical databases and patient registries have expanded considerably, particularly in paediatric critical care medicine (eg, the Paediatric Intensive Care Audit Network (PICANet) in the UK, the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry in Australia and New Zealand, and the Virtual Paediatric Intensive Care Unit Performance System (VPS) in the USA). Such a registry is not yet available in France. The aim of this study was to determine variables that ought to be included in a French paediatric critical care registry. Methods Variables, items, and subitems from 3 foreign registries and 2 French local databases were used. Items described each variable, and subitems described items. The Delphi method was used to evaluate and rate 65 variables, 90 items, and 17 subitems taking into account importance or relevance based on input from 28 French physicians affiliated with the French Paediatric Critical Care Group. Two ratings were used between January and May 2013. Results Fifteen files from 10 paediatric intensive care units were included. Out of 65 potential variables, 48 (74%) were considered to be indispensable, 16 (25%) were considered to be optional, and 1 (2%) was considered to be irrelevant. Out of 90 potential items, 62 (69%) were considered to be relevant, 23 (26%) were considered to be of little relevance, and 5 (6%) were considered to be irrelevant. Out of 17 potential subitems, 9 (53%) were considered to be relevant, 6 (35%) were considered to be of little relevance, and 2 (12%) were considered to be irrelevant. Conclusions The necessary variables that ought to be included in a French paediatric critical care registry were identified. The challenge now is to develop the French registry for paediatric intensive care units

Overview of the current use of levosimendan in France: a prospective observational cohort study

Abstract Background Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. Method The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. Results The patients included ( n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock ( n = 250, 41.5%), decompensated heart failure ( n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment ( n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation ( n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. Conclusions We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied

Etude du système nerveux autonome du fœtus à l’enfant : modélisation de son fonctionnement chez le fœtus et application chez l’enfant en réanimation pédiatrique

The autonomic nervous system (ANS) maintains homeostasis through its twoopposing components, the sympathetic system (Σ) and the parasympathetic system(paraΣ). It regulates many of the body's autonomous functions (regulation of heart rate,blood pressure, thermoregulation, digestion, urination, etc.). In particular, the ANScontrols the heart rate and its rapid variations. The analysis of the sinus variability ofthe heart rate is a method to evaluate the variations in the ANS tone. There are manymethods for measuring the heart rate variability (HRV), which have been validated formany years, making it possible to assess the normal or pathological functioning of theANS. Thus, the HRV can be apprehended by temporal methods, spectral methods,geometric methods or non-linear methods for example. The application of thesedifferent approaches has made it possible to design several ANS evaluation devices,particularly for the parasympathetic system, whether for adult patients with theAnalgesia Nociception Index (ANI), which monitors the analgesia/nociception balance,for premature children with the Newborn Infant Parasympathetic Evaluation (NIPE),which monitors well-being, and for the fetus with the Fetal Stress Index (FSI), which is currently being studied by our team. However, there are still limitations limiting the useof these devices with, in particular for the fetus: (1) the lack of consensus on the roleof the Σ and paraΣ components of ANS during maternal labor, (2) difficulties ininterpreting variations in ANS of multifactorial origin; and for children from 1 month to18 years of age: (3) the lack of validation of these analytical methods.The main goal of this study was: for the fetus (1) to assess the involvement ofthe Σ and paraΣ components of the ANS during labor, (2) to assess the fetal ANSresponse during opioid administration to the mother; and for children hospitalized inpediatric intensive care units (3) to validate the NIPE for children under 3 years of ageas a tool for monitoring the analgesia/nociception balance.Le système nerveux autonome (SNA) assure le maintien de l’homéostasie parses deux composantes opposées que sont le système sympathique (Σ) et le systèmeparasympathique (paraΣ). Il régule de nombreuses fonctions autonomes del’organisme (régulation du rythme cardiaque, pression artérielle, thermorégulation,digestion, miction etc.). Ce système contrôle en particulier le rythme cardiaque et ses variations rapides. L’analyse de la variabilité sinusale du rythme cardiaque est une méthode permettant d’évaluer les variations de tonus du SNA. Les méthodes de mesure de la variabilité du rythme cardiaque (Heart Rate Variability, HRV) sont nombreuses et validées depuis de nombreuses années, permettant d’apprécier lefonctionnement normal ou pathologique du SNA. Ainsi, l’HRV peut être appréhendé par des méthodes temporelles, des méthodes spectrales, des méthodes géométriques ou des méthodes non linéaires par exemple. L’application de ces différentes approches a permis de concevoir plusieurs dispositifs d’évaluation du SNA,notamment du système parasympathique, que ce soient pour les patients adultes avec l’Analgesia Nociception Index (ANI), permettant de monitorer la balance analgésie/nociception, pour les enfants prématurés avec le Newborn InfantParasympathetic Evaluation (NIPE) permettant de monitorer le bien être, et pour lefoetus le Fetal Stress Index (FSI) en cours d’étude par notre équipe d’accueil.Cependant, il existe encore des limitations empêchant l’utilisation de ces dispositifsavec, en particulier pour le foetus : (1) l’absence de consensus quant au rôle descomposants Σ et paraΣ du SNA pendant le travail maternel, (2) les difficultésd’interprétation de variations du SNA d’origine multifactorielle ; et pour les enfants de1 mois à 18 ans : (3) l’absence de validation de ces méthodes d’analyse.Le but principal de cette série de travaux était : pour le foetus (1) d’évaluer l’implication des composants Σ et paraΣ du SNA lors du travail, (2) d’évaluer la réponse du SNA du foetus lors de l’administration d’opioïdes à la maman ; et pour les enfants hospitalisés en réanimation pédiatrique (3) de valider le NIPE pour les moins de 3 ans comme outil de monitorage de la balance analgésie/nociception

Study of the autonomous nervous system from fetus to child : modeling of its functioning in the fetus and application in pediatric intensive care

Le système nerveux autonome (SNA) assure le maintien de l’homéostasie parses deux composantes opposées que sont le système sympathique (Σ) et le systèmeparasympathique (paraΣ). Il régule de nombreuses fonctions autonomes del’organisme (régulation du rythme cardiaque, pression artérielle, thermorégulation,digestion, miction etc.). Ce système contrôle en particulier le rythme cardiaque et ses variations rapides. L’analyse de la variabilité sinusale du rythme cardiaque est une méthode permettant d’évaluer les variations de tonus du SNA. Les méthodes de mesure de la variabilité du rythme cardiaque (Heart Rate Variability, HRV) sont nombreuses et validées depuis de nombreuses années, permettant d’apprécier lefonctionnement normal ou pathologique du SNA. Ainsi, l’HRV peut être appréhendé par des méthodes temporelles, des méthodes spectrales, des méthodes géométriques ou des méthodes non linéaires par exemple. L’application de ces différentes approches a permis de concevoir plusieurs dispositifs d’évaluation du SNA,notamment du système parasympathique, que ce soient pour les patients adultes avec l’Analgesia Nociception Index (ANI), permettant de monitorer la balance analgésie/nociception, pour les enfants prématurés avec le Newborn InfantParasympathetic Evaluation (NIPE) permettant de monitorer le bien être, et pour lefoetus le Fetal Stress Index (FSI) en cours d’étude par notre équipe d’accueil.Cependant, il existe encore des limitations empêchant l’utilisation de ces dispositifsavec, en particulier pour le foetus : (1) l’absence de consensus quant au rôle descomposants Σ et paraΣ du SNA pendant le travail maternel, (2) les difficultésd’interprétation de variations du SNA d’origine multifactorielle ; et pour les enfants de1 mois à 18 ans : (3) l’absence de validation de ces méthodes d’analyse.Le but principal de cette série de travaux était : pour le foetus (1) d’évaluer l’implication des composants Σ et paraΣ du SNA lors du travail, (2) d’évaluer la réponse du SNA du foetus lors de l’administration d’opioïdes à la maman ; et pour les enfants hospitalisés en réanimation pédiatrique (3) de valider le NIPE pour les moins de 3 ans comme outil de monitorage de la balance analgésie/nociception.The autonomic nervous system (ANS) maintains homeostasis through its twoopposing components, the sympathetic system (Σ) and the parasympathetic system(paraΣ). It regulates many of the body's autonomous functions (regulation of heart rate,blood pressure, thermoregulation, digestion, urination, etc.). In particular, the ANScontrols the heart rate and its rapid variations. The analysis of the sinus variability ofthe heart rate is a method to evaluate the variations in the ANS tone. There are manymethods for measuring the heart rate variability (HRV), which have been validated formany years, making it possible to assess the normal or pathological functioning of theANS. Thus, the HRV can be apprehended by temporal methods, spectral methods,geometric methods or non-linear methods for example. The application of thesedifferent approaches has made it possible to design several ANS evaluation devices,particularly for the parasympathetic system, whether for adult patients with theAnalgesia Nociception Index (ANI), which monitors the analgesia/nociception balance,for premature children with the Newborn Infant Parasympathetic Evaluation (NIPE),which monitors well-being, and for the fetus with the Fetal Stress Index (FSI), which is currently being studied by our team. However, there are still limitations limiting the useof these devices with, in particular for the fetus: (1) the lack of consensus on the roleof the Σ and paraΣ components of ANS during maternal labor, (2) difficulties ininterpreting variations in ANS of multifactorial origin; and for children from 1 month to18 years of age: (3) the lack of validation of these analytical methods.The main goal of this study was: for the fetus (1) to assess the involvement ofthe Σ and paraΣ components of the ANS during labor, (2) to assess the fetal ANSresponse during opioid administration to the mother; and for children hospitalized inpediatric intensive care units (3) to validate the NIPE for children under 3 years of ageas a tool for monitoring the analgesia/nociception balance

Fermeture percutanée des communications interauriculaires chez les enfants de moins de 24 mois

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