The Heart Center at Arnold Palmer Hospital for Children

Orlando, FL, United States

The Heart Center at Arnold Palmer Hospital for Children

Orlando, FL, United States
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PubMed | The Heart Center at Arnold Palmer Hospital for Children, University of Central Florida and Embry - Riddle Aeronautical University
Type: Journal Article | Journal: Cardiovascular engineering and technology | Year: 2015

Despite improvements in ventricular assist devices (VAD) design, VAD-induced stroke rates remain remarkably high at 14-47%. We previously employed computational fluid dynamics (CFD) to propose adjustment of VAD outflow graft (VAD-OG) implantation to reduce stoke. Herein, we present an in-vitro model of cerebral vessel embolization in VAD-assisted circulation, and compare benchtop results to CFD predictions. The benchtop flow-loop consists of a 3D printed aortic bed using Accura 60 polymer driven by a continuous-flow pump. Three hundred spherical particles simulating thrombi of 2, 3.5, and 5 mm diameters were injected at the mock VAD-OG inlet. A water and glycerin mixture (3.8 cP viscosity) synthetically mimicked blood. The flowrate was adjusted to match the CFD Reynolds number. Catch cans were used to capture and count particles reaching cerebral vessels. VAD-OG geometries were evaluated using comparison of means Z-score range of -1.96 Z 1.96 to demonstrate overall agreement between computational and in-vitro techniques. Z-scores were: (i) Z = -1.05 for perpendicular (0), (ii) Z = 0.32 for intermediate (30), and (iii) Z = -0.52 for shallow (60) anastomosis and confirmed agreement for all geometries. This study confirmed added benefits of using a left carotid artery bypass-graft with percent embolization reduction: 22.6% for perpendicular, 21.2% for intermediate, and 11.9% for shallow anastomoses. The shallow anastomosis demonstrated lower degrees of aortic arch flow recirculation, consistent with steady-flow computations. Quantitatively and qualitatively, contemporary steady-flow computational models for predicting VAD-induced cerebral embolization can be achieved in-vitro to validate the CFD equivalent.


Piggott K.D.,University of Central Florida | Soni M.,University of Central Florida | Decampli W.M.,University of Central Florida | Ramirez J.A.,University of Central Florida | And 4 more authors.
World journal for pediatric & congenital heart surgery | Year: 2015

BACKGROUND: Acute kidney injury (AKI) and fluid overload have been shown to increase morbidity and mortality. The reported incidence of AKI in pediatric patients following surgery for congenital heart disease is between 15% and 59%. Limited data exist looking at risk factors and outcomes of AKI or fluid overload in neonates undergoing surgery for congenital heart disease.METHODS: Neonates aged 6 to 29 days who underwent surgery for congenital heart disease and who were without preoperative kidney disease were included in the study. The AKI was determined utilizing the Acute Kidney Injury Network criteria.RESULTS: Ninety-five neonates were included in the study. The incidence of neonatal AKI was 45% (n = 43), of which 86% had stage 1 AKI. Risk factors for AKI included cardiopulmonary bypass time, selective cerebral perfusion, preoperative aminoglycoside use, small kidneys by renal ultrasound, and risk adjustment for congenital heart surgery category. There were eight mortalities (five from stage 1 AKI group, three from stage 2, and zero from stage 3). Fluid overload and AKI both increased hospital length of stay and postoperative ventilator days.CONCLUSION: To avoid increased risk of morbidity and possibly mortality, every attempt should be made to identify and intervene on those risk factors, which may be modifiable or identifiable preoperatively, such as small kidneys by renal ultrasound. © The Author(s) 2015.


PubMed | The Heart Center at Arnold Palmer Hospital for Children and University of Central Florida
Type: Case Reports | Journal: The Annals of thoracic surgery | Year: 2015

Unilateral or bilateral absence of branch pulmonaryarteries is a rare congenital heart defect. Variousreconstructive techniques have been previously described, each with its inherent limitations. Wepresent a novel technique of constructing a branch pulmonary artery that maintains potential for growth.


PubMed | Arnold Palmer Hospital for Children and The Heart Center at Arnold Palmer Hospital for Children
Type: | Journal: Case reports in cardiology | Year: 2015

We present an infant with hypoplastic left heart with persistent fever despite two courses of antibiotics and repeatedly negative blood cultures. He eventually underwent surgical extraction of two stents. The stent cultures became positive; he was treated with 4 weeks of antibiotics and the fever resolved.


O'brien M.C.,The Heart Center at Arnold Palmer Hospital for Children | Pourmoghadam K.K.,The Heart Center at Arnold Palmer Hospital for Children | Decampli W.M.,The Heart Center at Arnold Palmer Hospital for Children
Texas Heart Institute Journal | Year: 2015

Prosthetic pulmonary valve endocarditis has infrequently been described outside large cohort reviews, which have typically focused on infections of the left-sided heart valves. Hence, the pathogenesis, clinical presentation, and management principles of prosthetic pulmonary valve endocarditis have not been well differentiated from those of infected aortic and mitral valves. More patients with repaired tetralogy of Fallot are reaching adulthood and will need pulmonary valve implantation. Consequently, a focus on this infrequent but serious cardiac infection is needed, to learn what characteristics might distinguish it from infections of left-sided heart valves. We report the case of a 13-year-old girl with repaired tetralogy of Fallot who presented with fever and nonspecific symptoms. The patient initially failed to meet the Duke criteria for endocarditis but was then found to have endocarditis of her prosthetic pulmonary valve. We explanted the valve and replaced it with a pulmonary homograft, after which the patient had no infectious sequelae. In addition to presenting the patient's case, we review the literature on surgically inserted prosthetic pulmonary valves and discuss the primary management concerns when those valves become infected with endocarditis. © 2015 by the Texas Heart ® Institute, Houston


Argueta-Morales I.R.,The Heart Center at Arnold Palmer Hospital for Children | Olsen M.C.,The Heart Center at Arnold Palmer Hospital for Children | DeCampli W.M.,The Heart Center at Arnold Palmer Hospital for Children | Munro H.M.,The Heart Center at Arnold Palmer Hospital for Children | Felix D.E.,The Heart Center at Arnold Palmer Hospital for Children
Journal of Extra-Corporeal Technology | Year: 2012

Patients with heparin-induced thrombocytopenia (HIT) that require anticoagulation for cardiovascular procedures represent a challenging and high-risk group. Bivalirudin and argatroban have been successfully used as alternative anticoagulants in adult patients with HIT. There have been few experiences published involving the pediatric population and controversy exists regarding the properties and optimal dosing of these drugs. This report describes the experience of managing two pediatric patients with HIT that underwent cardiovascular procedures requiring anticoagulation. Bivalirudin was used in both cases for anticoagulation during cardiopulmonary bypass, while argatroban was used without complications during cardiac catheterization. A description of perfusion and anticoagulation protocols is included.


PubMed | The Heart Center at Arnold Palmer Hospital for Children
Type: Journal Article | Journal: World journal for pediatric & congenital heart surgery | Year: 2013

Indirect clinical evidence suggests that coronary blood flow (CBF) is altered in patients palliated with systemic-to-pulmonary artery shunts (SPSs). The addition of epinephrine may exert additional effects.A total of 11 newborn piglets underwent placement of a 3.5- to 4-mm graft between the innominate artery and the pulmonary artery. Doppler probes measured flow continuously in the aorta (aortic flow [AoF]), pulmonary artery and left coronary artery at baseline (SPS closed), SPS open, and during epinephrine administration (SPS closed and open). Each animal served as its own control. Systolic and diastolic CBF, resistance (coronary vascular resistance index [CVRI]), and myocardial oxygen supply demand ratio were calculated.Opening the SPS increased AoF and decreased systolic and diastolic pressure from baseline, with and without the presence of epinephrine. The CBF and CVRI decreased on opening the SPS in the presence of epinephrine. The decrease occurred only in diastole and was proportional to pulmonary-to-systemic flow ratio (Qp/Qs). Epinephrine infusion itself reduced CVRI with SPS closed, but there was little further decrease on opening SPS. Myocardial oxygen supply-demand ratio decreased on opening SPS at baseline and with epinephrine.This study suggests that SPS decreases CBF, especially in the presence of a higher Qp/Qs and epinephrine. The mechanism is largely due to the decrease in diastolic pressure and the inability of the coronary arteries to compensate with vasodilation.


PubMed | The Heart Center at Arnold Palmer Hospital for Children
Type: Comparative Study | Journal: The Annals of thoracic surgery | Year: 2013

An optimal selective cerebral perfusion protocol in pediatric cardiac surgery is unknown. Phentolamine is frequently used in pediatric cardiopulmonary bypass. We sought to determine the effects of continuous phentolamine infusion during selective cerebral perfusion.Twenty-seven neonatal piglets (3.38 0.32 kg) were randomly assigned to 3 groups; sham (n= 7, anesthesia alone, no surgery or bypass), control (n= 10, saline infusion), or experimental (n= 10, phentolamine infusion 0.1 mg/kg per hour). Animals underwent 90 minutes of selective cerebral perfusion. Cerebral vascular resistance index (CVRI) and metabolic rate of oxygen (CMRO2) were determined every 15 minutes. Standardized sections of hippocampus, basal ganglia, and neo-cortex were obtained. Tissue samples were stained for caspase-3 and analyzed for positive apoptotic cell count. Data were analyzed with repeated measures and one-way analysis of variance.The CVRI tended to increase over time in the control group and decrease over time in the experimental group, but difference was not statically significant (0.46 0.24 vs 0.39 0.10 mm Hg min kg(2/3)/mL, p= 0.15). Mean CMRO2 was higher in the control group compared with the experimental group (0.90 0.27 vs 0.59 0.12 mLO2/min kg(2/3), p= 0.005) and decreased over time in both groups. The percentage of caspase-3 positive cells was significantly different among regions (hippocampus= 16.9 8.8; basal ganglia= 14.6 7.5; neocortex= 10.8 6.3; p < 0.0001) but not significantly different among sham (11.8% 2.68%), control (14.4% 2.24%), and experimental (15.5% 2.24%) groups.A continuous infusion of phentolamine during selective cerebral perfusion significantly decreases CMRO2 and tends to decrease CVRI when compared with control. At the dose studied and at the time of tissue sampling, phentolamine does not appear to decrease apoptosis during or early after selective cerebral perfusion.


PubMed | The Heart Center at Arnold Palmer Hospital for Children
Type: Journal Article | Journal: Cardiology in the young | Year: 2015

Protocols for the placement of temporary pacing wires vary among institutions. Our current protocol is to selectively place temporary pacing wires in those patients who develop haemodynamically significant intra-operative arrhythmia. We wished to identify how effective our current protocol is at identifying who will develop post-operative arrhythmia and need temporary pacing wires.The charts of 880 patients over 8 years who underwent cardiopulmonary bypass were reviewed to find patients who developed intra-operative arrhythmia, had temporary pacing wires placed, and whether or not they developed post-operative arrhythmia and required utilisation of the pacing wires.A total of 87 (9.9%) out of 880 patients who required cardiopulmonary bypass over 8 years had intra-operative arrhythmia and had temporary pacing wires placed. Of these, 59 (67.8%) had post-operative arrhythmia and utilised the pacing wires, whereas 28 (32.2%) did not have post-operative arrhythmia or utilise the pacing wires. In all, seven patients who did not have intra-operative arrhythmia or temporary pacing wires placed developed post-operative arrhythmia.Intra-operative arrhythmia is predictive of post-operative arrhythmia (70.2%) and our protocol is a sensitive means of identifying those who will develop post-operative arrhythmia (89.3%).


PubMed | The Heart Center at Arnold Palmer Hospital for Children
Type: Case Reports | Journal: The journal of extra-corporeal technology | Year: 2012

Patients with heparin-induced thrombocytopenia (HIT) that require anticoagulation for cardiovascular procedures represent a challenging and high-risk group. Bivalirudin and argatroban have been successfully used as alternative anticoagulants in adult patients with HIT. There have been few experiences published involving the pediatric population and controversy exists regarding the properties and optimal dosing of these drugs. This report describes the experience of managing two pediatric patients with HIT that underwent cardiovascular procedures requiring anticoagulation. Bivalirudin was used in both cases for anticoagulation during cardiopulmonary bypass, while argatroban was used without complications during cardiac catheterization. A description of perfusion and anticoagulation protocols is included.

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