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Siddiqui S.,Pediatric Cardiology | Patel D.R.,Michigan State University
Pediatric Clinics of North America | Year: 2010

A preparticipation cardiovascular screening is recommended for all athletes with the aim of identifying conditions that increase the risk for adverse cardiac event, including sudden death. History and physical examination are the mainstay of cardiovascular screening of young athletes. The ability to identify athletes at risk, however, based on history and physical examination alone is low, and inclusion of an electrocardiogram as a screening tool has been suggested to improve the sensitivity of screening. This article provides an overview of key aspects of cardiovascular screening currently recommended in the United States for young athletes. © 2010 Elsevier Inc.

Pauliks L.B.,Pennsylvania State University | Valdes-Cruz L.M.,Pediatric Cardiology | Perryman R.,Pediatric Cardiovascular Surgery | Scholl F.G.,Pediatric Cardiovascular Surgery
Echocardiography | Year: 2014

Background: Right ventricular (RV) dysfunction is a well-recognized complication of cardiopulmonary bypass surgery (CPB) in adults. Infants and neonates may also be at high risk for this due to immature myocardium. Conventional assessment of RV function is just qualitative, but novel tissue Doppler echocardiographic (TDI) markers including peak systolic strain rate (SR) and isovolumic contraction acceleration (IVA) permit noninvasive quantitation of RV function. This study assessed myocardial velocities, IVA and SR in infants and neonates undergoing open heart surgery using TDI to study regional myocardial function perioperatively. Methods: Transthoracic TDI data were obtained in the OR before and 24 hours post-CPB on 53 consecutive infants (age 0.39 ± 0.23 years). They were followed with TDI through hospital discharge. Results: Mean CPB time was 87 ± 49 min (cross-clamp 52 ± 26 min). Peak systolic (STDI) and diastolic myocardial velocities (ETDI, ATDI), IVA, and peak SR were recorded in RV and LV from standard views for offline analysis. Postoperatively, LV systolic function and diastolic longitudinal function were unchanged or improved from baseline. LV radial velocities were increased postoperatively indicating adequate support. In contrast, RV longitudinal systolic and diastolic function was significantly diminished after CPB. RV changes persisted through hospital discharge. Conclusions: In infants and neonates, perioperative measurements of systolic and diastolic tissue Doppler parameters are feasible and revealed significant RV systolic and diastolic dysfunction post-CPB with preserved LV function. As such, TDI provides a sensitive tool to monitor the infant heart after CPB and may potentially be useful to assess different myocardial protection strategies. © 2013, Wiley Periodicals, Inc.

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. © 2015 The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, The Heart Failure Society of America, and The Society for Thoracic Surgery.

Rosti L.,Pediatric Cardiology
La Pediatria medica e chirurgica : Medical and surgical pediatrics | Year: 2011

Calprotectin is a protein released into stools, used as a marker of inflammation in inflammatory bowel diseases. We tested the hypothesis that cow's milk protein in formula milk may increase the intestinal release of calprotectin, as a consequence of a subclinical inflammatory reaction. At 12 weeks of age, we measured fecal calprotectin by an immunoenzyme assay (Calprest, Eurospital, Trieste, Italy), in 38 exclusively breastfed and in 32 exclusively formula-fed infants. Fecal calprotectin levels were not different in the two groups (p = 0.09), although a trend to higher values in infants with colic, or with family history of allergies was noted. This suggest that, in general, formula milk does not promote activation of an intestinal inflammatory reaction, compared to human milk, although a subclinical activation of the inflammatory response in infants at risk for allergic diseases may be present.

Murtuza B.,Birmingham Childrens Hospital | Barron D.J.,Birmingham Childrens Hospital | Stumper O.,Pediatric Cardiology | Stickley J.,Birmingham Childrens Hospital | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2011

Objective(s): Anatomic repair for congenitally corrected transposition of the great arteries (ccTGA) has been shown to improve patient survival. We sought to examine long-term outcomes in patients after anatomic repair with focus on results in high-risk patients, the fate of the neo-aortic valve, and occurrence of morphologically left ventricular dysfunction. Methods: We conducted a retrospective, single-institution study of patients undergoing anatomic repair for ccTGA. A total of 113 patients from 1991 to March 2011 were included. Double-switch (DS) repair was performed in 68 patients, with Rastelli-Senning (RS)-type repair in 45. Pulmonary artery banding for retraining was performed in 23 cases. Patients were followed up for survival status, morbidity, and reinterventions. A subgroup of 17 high-risk patients in severe heart failure, ventilated, and on inotropes before repair, were included. Results: Median age at repair was 3.2 years (range, 25 days to 40 years) and weight was 14.3 kg (3.2-61.4). There were 5 (of 68; 7.4%) early deaths in the DS group and 0 (of 45) in the RS group. Actuarial survivals in the DS group were 87.6%, 83.9%, 83.9% at 1, 5, and 10 years versus 91.6%, 91.6%, 77.3% in the RS group (log-rank: P = .98). Freedom from death, transplantation, or heart failure was significantly better in the RS group at 10 years (P = .03). There was no difference in reintervention at 10 years (DS, 50.3%; RS, 49.1%; P = .44). In the DS group, the Lecompte maneuver was associated with late reinterventions on the pulmonary arteries. Overall survival in the high-risk group was 70.6%. During follow-up, 14.2% patients had poor function of the morphologically left ventricle, all in the DS group, but this was not related to preoperative status or previous banding. The majority of patients after DS had mild aortic incompetence, which appeared well tolerated. Annuloplasty of the aortic root at time of DS reduced the risk of late aortic valve replacement. Conclusions: There is significant morbidity after anatomic repair of ccTGA, which is higher in the DS than the RS group. Nevertheless, the majority of patients are free of heart failure at 10 years, including high-risk patients in severe heart failure before repair. Aortic annuloplasty may reduce risk of late aortic insufficiency. Copyright © 2011 by The American Association for Thoracic Surgery.

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