Unexpected Death After Reconstructive Surgery for Hypoplastic Left Heart Syndrome
|
|
- David Harper
- 5 years ago
- Views:
Transcription
1 Unexpected Death After Reconstructive Surgery for Hypoplastic Left Heart Syndrome William T. Mahle, MD, Thomas L. Spray, MD, J. William Gaynor, MD, and Bernard J. Clark III, MD Divisions of Cardiology and Cardiothoracic Surgery, The Cardiac Center at the Children s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Background. Although operative mortality for reconstructive surgery for hypoplastic left heart syndrome continues to improve, nonoperative mortality, especially in the first year of life, remains relatively high. A number of patients who are thought to be clinically well at hospital discharge die unexpectedly. The goal of the present study was to determine the incidence of and risk factors for unexpected death in patients with hypoplastic left heart syndrome. Methods. Retrospectively, we determined the incidence of unexpected death among 536 patients with hypoplastic left heart syndrome who were discharged to home after stage I surgical procedure. To identify potential risk factors, a nested case-control analysis was undertaken. Results. Unexpected death occurred in 22 of 536 patients (4.1%) discharged to home after stage I surgical procedure. The median age at unexpected death was 79 days (range, 25 to 227 days). Seizures preceded cardiac arrest in 2 patients, and ventricular arrhythmias were documented in 3 additional patients during attempted resuscitation. Autopsy studies were performed in 12 patients and identified residual lesions that may have contributed to death in 2 patients. In multivariate analysis documented perioperative arrhythmia and earlier year of stage I surgical procedure were associated with an increased risk for unexpected death (p 0.03 and p 0.04, respectively). There were 4 additional patients who had unexpected death after subsequent cavopulmonary operation at a median age of 1.6 years (range, 0.9 to 3.8 years). Conclusions. Unexpected death occurred in more than 4% of patients with hypoplastic left heart syndrome who were discharged to home after stage I surgical procedure and was most common in the first several months of life. Factors that may contribute to unexpected death include residual lesions, arrhythmias, and neurologic events, although in the majority of cases the cause remains largely unknown. (Ann Thorac Surg 2001;71:61 5) 2001 by The Society of Thoracic Surgeons Accepted for publication July 17, Address reprint requests to Dr Mahle, The Children s Hospital of Philadelphia, 34th & Civic Center Blvd, Philadelphia, PA 19104; mahle@ .chop.edu. The outlook for patients with hypoplastic left heart syndrome (HLHS) has improved dramatically since the introduction of reconstructive surgical procedure in the late 1970s. In recent years several centers have reported hospital survival for stage I surgical procedure of greater than 70% [1 3]. The mortality for subsequent staging operations, such as the hemi-fontan and Fontan procedures, has also decreased significantly in the last decade [4, 5]. Although considerable attention has been paid to the operative mortality, much less is known about the nonoperative mortality in this patient population. Nearly every series on reconstructive surgical procedure for HLHS published to date has reported a nonoperative mortality of greater than 5% among initial hospital survivors [1 3, 6]. A variety of factors have been implicated in these deaths including residual lesions, such as aortic arch obstruction; infectious complications; and ventricular dysfunction. In addition, a significant number of patients, many of whom appear clinically well, die unexpectedly, most commonly in the first months of life. There are many potential risk factors for unexpected death in patients with HLHS, including abnormal coronary flow patterns [7], diminished coronary reserve [8], and a high incidence of neurologic complications after stage I surgical procedure [9]. However, most published series examining reconstructive surgical procedure for HLHS have been limited by relatively small patient populations and lack of long-term follow-up. As such, it has been difficult to determine the significance of unexpected death in the HLHS population. We recently reviewed our 15-year institutional experience with more than 800 patients who have undergone reconstructive surgical procedure for HLHS [10]. Using this database, we sought to determine the incidence of and identify potential risk factors for unexpected death among patients discharged to home after stage I surgical procedure. Material and Methods Patient Population We reviewed the surgical database at our institution to identify all patients who underwent stage I surgical procedure for HLHS between January 1, 1984, and Janu by The Society of Thoracic Surgeons /01/$20.00 Published by Elsevier Science Inc PII S (00)
2 62 MAHLE ET AL Ann Thorac Surg UNEXPECTED DEATH IN HLHS 2001;71:61 5 ary 1, Hypoplastic left heart syndrome was defined as aortic atresia or stenosis, arch hypoplasia, and diminutive left ventricle. Patients with variants of HLHS such as unbalanced atrioventricular canal or double-outlet right ventricle with mitral atresia and arch hypoplasia were also included. Those subjects who underwent stage I reconstruction for lesions with single left ventricle were not included. Patient follow-up was performed between January 1, 1999, and May 1, Patient status was determined by direct patient contact or by communication with the referring cardiologist. The present study was limited to those patients who underwent stage I surgical procedure and survived to hospital discharge. Medical records and autopsy reports were reviewed to determine the circumstances of death for patients who died after hospital discharge. For the purposes of this study, unexpected death was defined as cardiovascular collapse from which the subject did not regain consciousness. Risk Factors To identify potential risk factors for unexpected death, a nested-case-control study was performed. The control group comprised 66 additional randomly selected patients with HLHS (3:1 ratio of controls to cases) who underwent stage I reconstruction and survived to hospital discharge. Patients who had unexpected death after subsequent cavopulmonary surgical procedure were not included in this analysis. Potential risk factors for unexpected death were identified from the medical records. Variables investigated included prenatal diagnosis, degree of preoperative acidosis, anatomic subtype of HLHS, type of aortopulmonary shunt, age at stage I, length of stay after stage I, the occurrence of perioperative seizures or arrhythmias, and the need for supplemental nasogastric feedings at discharge. The latter variable was included because feeding difficulties may be a marker for neurodevelopmental impairment and may put the patient at risk for an aspiration event. Ventricular systolic function was determined by two-dimensional echocardiography in a qualitative fashion (normal or depressed). Atrioventricular valve insufficiency was determined by color Doppler echocardiography, according to accepted classifications. Statistical Analysis Data are expressed as mean standard deviation or median and range, where appropriate. Survival was estimated by the Kaplan-Meier method, defined as the elapsed time from the date of birth to date of death or last known follow-up. Comparison between the two groups was performed with Fischer s exact test or 2 test for categorical variables and Wilcoxon rank-sum test for continuous variables. Multivariate analysis was performed using logistic regression. Analysis was performed with STATA 6.0 (Stata Corporation, College Station, TX). Significance was determined at p value of less than All p values are two-sided and confidence intervals are 95%. Results Patient Characteristics Between January 1, 1984, and January 1, 1999, 840 patients underwent stage I reconstruction for HLHS at our institution. The median age at stage I surgical procedure was 6 days (range, 0 to 216 days). There were 536 patients who survived to hospital discharge. The median interval from stage I surgical procedure to discharge was 14 days (range, 6 to 270 days). Complete follow-up, as of January 1, 1999, was available for 478 (89.2%) of the initial hospital survivors. Of the 58 patients who were lost to follow-up, 41 (71%) were known to be alive as of 6 months of age and 29 (50%) were known to be alive as of 1 year of age. Of the 536 patients who survived to stage I hospital discharge, 22 (4.1%) had unexpected death. The median age at death was 79 days (range, 25 to 227 days). The median interval from hospital discharge to unexpected death was 40 days (range, 1 to 208 days). There were 6 patients discharged to home who had unexpected death within 30 days of stage I surgical procedure. The hazard function for unexpected death is shown in Figure 1. In addition to the 22 unexpected deaths among the 536 initial survivors, there were 63 additional nonoperative deaths, the majority of which occurred in-hospital [10]. Unexpected death, therefore, accounted for just over one quarter of the nonoperative mortality in this series. Autopsy and Clinical Data Autopsy reports including evaluation of the heart and great vessels were available for 12 of 22 patients (54.5%) who had unexpected death. In 2 patients the autopsy demonstrated a residual cardiac lesion that may have accounted for the death. One patient had narrowing of the Blalock-Taussig shunt. A second patient had coarctation of the distal portion of the reconstructed arch to a diameter of 3 mm. Review of this patient s echocardiogram obtained before hospital discharge suggested that the distal arch reconstruction was of adequate caliber; however, complete Doppler interrogation was not performed. Both of the patients with residual lesions identified at autopsy had been evaluated by cardiologist less than 4 weeks before death and were thought to be doing well clinically. In the remaining 10 autopsy investigations, there were no residual cardiac lesions that could be linked to an unexpected death event. Microscopic analysis of the myocardium was available for 10 patients. Three had normal right ventricular histology. Necrosis was detected in 2, ischemia in 3, fibrosis in 4, and calcification in 3 subjects. Microscopic analysis of the left ventricular myocardium revealed endocardial fibroelastosis in 3 patients. There were 5 additional patients in whom the clinical history suggested other factors, which may have contributed to unexpected death. Three patients had documented ventricular arrhythmia at the time of attempted resuscitation. Two of these patients were brought to the emergency department by fire-rescue in ventricular fibrillation and could not be resuscitated. One 6-monthold patient had ventricular tachycardia and subsequent cardiovascular collapse 10 hours after routine hemody-
3 Ann Thorac Surg MAHLE ET AL 2001;71:61 5 UNEXPECTED DEATH IN HLHS 63 multivariate analysis (Table 3) documented perioperative arrhythmias and earlier year of surgical procedure were associated with an increased risk for unexpected death (p 0.03 and p 0.04, respectively). Fig 1. Hazard function for unexpected death (time 0 date of birth) in the first year of life; age in months is shown on the x-axis. namic catheterization. There were 2 additional patients who manifested tonic-clonic movements, which preceded the unexpected death, suggesting that a generalized seizure may have been the inciting event. The unexpected death events occurred at home in 20 patients. One patient died in the primary physician s office. One patient died in-hospital after a cardiac catheterization. The patient characteristics from the initial hospital admission of the 22 subjects with unexpected death and 66 control patients are shown in Tables 1 and 2. Two patients who later had unexpected death were noted to have junctional ectopic tachycardia in the postoperative period. One patient had sustained supraventricular tachycardia before stage I surgical procedure. None of these patients received antiarrhythmic pharmacotherapy other than digoxin at the time of discharge. None of the 22 patients had significant ventricular arrhythmias during the hospital stay. Risk Factor Analysis In univariate analysis none of the patient-related or procedure-related factors was significantly associated with unexpected death (Tables 1 and 2). However, in Table 1. Preoperative Data for Patients With Subsequent Unexpected Death and Control Subjects Variable Unexpected Death (n 22) Control Subjects (n 66) p Value Anatomic subtype 0.57 AA/MA 12 (55%) 26 (39%) AA/MS 3 (14%) 15 (23%) AS/MS 5 (23%) 15 (23%) Other variants 2 (9%) 10 (15%) Preoperative Prenatal diagnosis 3 (13.6%) 15 (22.7%) 0.54 Highest recorded base 7.2 (0 20) a 5.3 (0 32) a 0.84 deficit (mmol/dl) Age at admission (d) 2 (0 69) a 2 (0 84) a 0.94 Unexpected Death After Cavopulmonary Operation Of the 422 patients with HLHS who had subsequent cavopulmonary operation, 4 patients (0.9%) not included in the above analysis had unexpected death after hospital discharge. Two had unexpected death after the hemi-fontan and 2 after the Fontan procedure. Median age at unexpected death for these 4 patients was 1.6 years (range, 0.9 to 3.8 years). Three patients died suddenly at home, one died suddenly while awaiting laboratory studies in the physician s office. None were known to have had prior arrhythmias. One patient had been diagnosed with protein-losing enteropathy. In this series there were 204 patients followed to 5 years of age and 65 patients followed beyond 10 years of age. Comment The greatest risk for mortality for patients with HLHS who undergo staged reconstruction is at the time of the stage I procedure, with most of the deaths occurring within the first 48 postoperative hours [1, 10]. Those patients who are discharged to home after stage I surgical procedure, however, are still at significant risk for mortality within the first year of life. Several single institution and multi-institution studies have reported considerable early attrition among the hospital survivors of stage I surgical procedure for HLHS. Bove and Lloyd [2] reported a 1-month survival of 80% and a 1-year survival of 67% for 158 consecutive patients. During this time operative mortality for the hemi-fontan was less than 3%. Table 2. Procedure-Related Data at Stage I Surgical Procedure for Patients With Subsequent Unexpected Death and Control Subjects Variable Unexpected Death (n 22) Control Subjects (n 66) p Value Age at stage I (d) 6 (1 75) a 6 (1 90) a 0.86 Aortopulmonary shunt 0.64 Central 9 (41%) 19 (29%) Modified Blalock-Taussig 13 (59%) 47 (71%) Interval stage I to 12 (7 56) a 14 (6 104) a 0.31 discharge (d) Perioperative seizure 5 (23%) 8 (12%) 0.29 Perioperative arrhythmia 3 (14%) 3 (5%) 0.16 Depressed ventricular 3 (14%) 4 (6%) 0.36 shortening AV valve insufficiency ( 2 ) 0 6 (9%) 0.33 Feeding difficulties b 2 (9%) 7 (11%) 0.84 Discharge medications Digoxin 22 (100%) 63 (95%) 0.57 Furosemide 22 (100%) 62 (94%) 0.57 a Data are shown as median (range). AA aortic atresia; AS aortic stenosis; MA mitral atresia; MS mitral stenosis. a Data are shown as median (range). feedings at discharge. AV atrioventricular. b Patients receiving nasogastric
4 64 MAHLE ET AL Ann Thorac Surg UNEXPECTED DEATH IN HLHS 2001;71:61 5 Table 3. Multivariate Analysis of Risk Factors for Unexpected Death Risk Factor Odds Ratio (95% CI) p Value Prenatal diagnosis 0.41 ( ) 0.32 Aortic atresia 0.71 ( ) 0.57 Age at admission 0.94 ( ) 0.37 Age at stage I 1.06 ( ) 0.38 Aortopulmonary shunt 2.00 ( ) 0.34 Interval stage I to discharge 1.02 ( ) 0.35 Perioperative seizure 1.07 ( ) 0.94 Perioperative arrhythmia 9.32 ( ) 0.03 Depressed ventricular 4.28 ( ) 0.15 shortening Later year of surgical 0.81 ( ) 0.04 procedure Feeding difficulties 0.86 ( ) 0.86 CI confidence interval. Ishino and colleagues [3] reported 6 late deaths among 82 patients discharged to home after stage I surgical procedure. Although the cause of these interstage deaths is not specified in all of these reports, unexpected death is one of the likely mechanisms [11]. In our analysis of 536 hospital survivors of stage I surgical procedure, unexpected death was relatively common, occurring in more than 4% of patients. This represents a significant cause of mortality in this patient population, and is higher than most other forms of repaired or palliated congenital heart lesions [12, 13]. In lesions such as aortic stenosis, transposition of the great arteries, or tetralogy of Fallot the risk of sudden death appears to either increase with time or stay the same [12, 13]. In HLHS conversely, the risk of unexpected death is greatest within the first several months of life and decreases significantly thereafter. There was an association between earlier year of stage I surgical procedure and an increased risk for unexpected death. This would agree with our report of a significant decrease in hospital mortality for stage I surgical procedure between 1984 and 1999 from 45% to less than 20% [10]. Why the incidence of unexpected death may be less in more recent years remains a matter of speculation. One could hypothesize that many of these unexpected deaths may be related to residual lesions after stage I surgical procedure. The current study includes some of the earliest experience with staged reconstruction for HLHS, during which time many technical modifications were undertaken. There were 2 patients from the earlier surgical experience who had identifiable residual lesions on autopsy. Other factors that may also be associated with a lower risk of unexpected deaths in more recent years include a trend toward shorter periods of circulatory arrest and advances in perfusion techniques. The relationship of arrhythmias to unexpected death in patients with HLHS is poorly understood. In other congenital heart lesions, such as tetralogy of Fallot, ventricular arrhythmia is thought to be one mechanism of sudden death [13]. In this series there was an association between perioperative arrhythmias and unexpected death. Interestingly, 2 patients had junctional ectopic tachycardia, which is generally considered a transient postoperative phenomenon [14]. Further studies will be needed to show a causal relationship between perioperative arrhythmias and unexpected death in this population. It must be recognized that retrospective analysis may underestimate the incidence of arrhythmias. Published data regarding the incidence of arrhythmias in patients with HLHS are limited. Cohen and associates [15] performed ambulatory electrocardiography on 149 patients with single ventricle, 57% of whom had HLHS, at a mean of years after Fontan operation and found atrial flutter in 4.1% and supraventricular tachycardia in 5.0%. The incidence of atrial arrhythmias was no different between the patients with HLHS and those with other forms of single ventricle. The incidence of ventricular tachycardia at late follow-up was 2.7% (MI Cohen, personal communication). Whether the incidence of atrial and ventricular arrhythmias is different in those patients with HLHS less than 1 year of age is not known. One factor that does distinguish patients with HLHS from other forms of single ventricle, and which may account for the increased risk of unexpected death, is myocardial perfusion. In a study of coronary flow reserve using positron emission tomography, Donnelly and colleagues [8] found that infants who had undergone stage I reconstruction had less perfusion and oxygen delivery to the systemic ventricle than infants with other forms of congenital heart disease. The pattern of coronary blood flow also appears to be abnormal in some patients with HLHS. In patients with aortic atresia who have undergone stage I reconstruction, Fogel and colleagues [7] demonstrated that coronary blood flow occurs primarily in systole. This abnormal pattern of coronary blood flow may limit endocardial perfusion. The lack of coronary blood flow during diastole presumably results from runoff into the pulmonary artery through the aortopulmonary shunt. Theoretically patients with aortic atresia, in whom coronary blood flow depends entirely on retrograde perfusion, might be at greater risk for unexpected death than those patients with aortic stenosis. Although previous studies have suggested an association between anatomic subtype and the risk for late death after stage I [16], our study found no association between unexpected death and the presence of aortic atresia. Interestingly, the data from Fogel and coworkers [7] suggest that once patients have undergone a volume-unloading operation, such as the hemi-fontan, coronary blood flow shifts primarily to diastole. If abnormal coronary blood flow is a factor in sudden death, then this might explain the significantly decreased risk of unexpected death after hemi-fontan or Fontan surgical procedure. Adverse neurologic events may also contribute to unexpected death in this population. In our series several patients were noted to have tonic-clonic movements that preceded the arrest. It is known that patients with HLHS are at risk for adverse neurologic sequelae after stage I surgical procedure and that the incidence of perioperative
5 Ann Thorac Surg MAHLE ET AL 2001;71:61 5 UNEXPECTED DEATH IN HLHS 65 seizures in this population can exceed 15% [9]. In this retrospective analysis postoperative seizures were noted in 5 of 22 patients (22.7%) who later had unexpected death. Although it is uncommon for generalized seizures to lead to a cardiac arrest in infants, patients with HLHS, who have shunt-dependent pulmonary blood flow, may be particularly vulnerable to changes in systemic and pulmonary vascular resistances. Alternatively, it is possible that the seizure activity noted in several patients may have been secondary to hemodynamic instability and acidosis. Late unexpected death events in our patient population were very uncommon. There were 2 patients who had sudden death after successful Fontan surgical procedure. In this series there were 204 patients followed to at least 5 years of age and 65 patients followed to at least 10 years of age. No unexpected death events occurred after 4 years of age in our study cohort. Several other large series examining long-term outcome after the Fontan procedure have suggested a small but significant risk of late sudden death thought to be related primarily to atrial arrhythmias. Mair and colleagues [17] reported 3 late sudden death events among 155 patients who had undergone the Fontan procedure. Gelatt and associates [18], however, reported 1 late unexpected death among 236 patients discharged to home after the Fontan procedure. Most reports of long-term follow-up after Fontan have focused on patients who have undergone an atriopulmonary anastomosis. It appears that the risk of unexpected death may be less in patients with a lateral tunnel-type Fontan procedure [18]. In our series more than 95% of patients who underwent Fontan surgical procedure had a lateral tunnel-type Fontan procedure [10]. Limitations The retrospective study design and the lack of autopsy studies for half of the patients may have limited our ability to identify a mechanism of death. In addition, complete follow-up data were not available for approximately 10% of the patients. Lastly, it is important to recognize that several of the unexpected deaths in this series might also be classified as operative deaths because they occurred within 30 days of stage I surgical procedure. These deaths are included in the present study to draw attention to the risk of mortality immediately after hospital discharge and to highlight the difficulty in identifying patients who might be at risk for unexpected death. Conclusion Unexpected death occurs in more than 4% of patients discharged to home after stage I surgical procedure for HLHS. The majority of these events occur within the first 3 months of life. Factors that may contribute to sudden death include residual lesions, arrhythmias, and neurologic events, although in the majority of cases the cause is unknown. Multivariate analysis demonstrated that perioperative arrhythmias and earlier year of stage I surgical procedure were risk factors for unexpected death. Continued investigations into the mechanisms of unexpected death after stage I surgical procedure and potential preventive strategies are warranted. References 1. Kern JH, Hayes CJ, Michler RE, Gersony WM, Quaegebeur JM. Survival and risk factor analysis for the Norwood procedure for hypoplastic left heart syndrome. Am J Cardiol 1997;80: Bove EL, Lloyd TR. Staged reconstruction for hypoplastic left heart syndrome. Ann Surg 1996;3: Ishino K, Stumper O, De Giovanni JJV, et al. The modified Norwood procedure for hypoplastic left heart syndrome: early to intermediate results of 120 patients with particular reference to aortic arch repair. J Thorac Cardiovasc Surg 1999;117: Forbess JM, Cook N, Serraf A, Burke RP, Mayer JE, Jonas RA. An institutional experience with second- and third-stage palliative procedures for hypoplastic left heart syndrome: the impact of the bidirectional cavopulmonary shunt. J Am Coll Cardiol 1997;29: Koutlas TC, Gaynor JW, Nicolson SC, Steven JM, Wernovsky G, Spray TL. Modified ultrafiltration reduces post-operative morbidity after cavopulmonary connection. J Thorac Cardiovasc Surg 1997;64: Jacobs ML, Blackstone EH, Bailey LL. Intermediate-term survival in neonates with aortic atresia: a multi-institutional study. J Thorac Cardiovasc Surg 1998;116: Fogel MA, Rychik J, Vetter J, Donofrio MT, Jacobs ML. Effect of volume unloading surgery on coronary flow dynamics in patients with aortic atresia. J Thorac Cardiovasc Surg 1997; 113: Donnelly JP, Raffel DM, Shulkin BL, et al. Resting coronary flow and coronary flow reserve in human infants after repair or palliation of congenital heart defects as measured by positron emission tomography. J Thorac Cardiovasc Surg 1998;115: Mahle WT, Clancy RR, Moss EM, Gerdes M, Jobes DR, Wernovsky G. Neurodevelopmental outcome and lifestyle assessment in school age and adolescent children with hypoplastic left heart syndrome. Pediatrics 2000;105; Mahle WT, Spray TL, Wernovsky G, Gaynor JW, Clark BJ. Survival after palliative surgery for hypoplastic left heart syndrome: 15-year experience from a single institution. Circulation 2000;102(Suppl 3):III Bartram U, Grunenfelder J, Van Praagh R. Causes of death after the modified Norwood procedure: a study of 122 postmortem cases. Ann Thorac Surg 1997;64: Silka MJ, Hardy BG, Menashe VD, Morris CD. A populationbased prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol 1998;32: Murphy JG, Gersh BJ, Mair DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993;329: Walsh EP; Saul JP; Sholler GF, et al. Evaluation of a staged treatment protocol for rapid automatic junctional tachycardia after operation for congenital heart disease. J Am Coll Cardiol 1997;29: Cohen MI, Wernovsky G, Vetter VL, et al. Sinus node function after a systemically staged Fontan procedure. Circulation 1998;98(Suppl 2):II Forbess JM, Cook N, Roth SJ, Serraf A, Mayer JE, Jonas RA. Ten-year institutional experience with palliative surgery for hypoplastic left heart syndrome; risk factors related to stage I mortality. Circulation 1995;92(Suppl 2):II Mair DD, Hagler DJ, Julsrud PR, Puga FJ, Schaff HV, Danielson GK. Early and late results of the modified Fontan procedure for double-inlet left ventricle: the Mayo Clinic experience. J Am Coll Cardiol 1991;18: Gelatt M, Hamilton RM, McCrindle BW, et al. Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol 1994;24:
Introduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationImpact of Mitral Stenosis and Aortic Atresia on Survival in Hypoplastic Left Heart Syndrome
ORIGINAL ARTICLES: Impact of Mitral Stenosis and Aortic Atresia on Survival in Hypoplastic Left Heart Syndrome Jenifer A. Glatz, MD, Raymond T. Fedderly, MD, Nancy S. Ghanayem, MD, and James S. Tweddell,
More informationHypoplastic left heart syndrome (HLHS) can be easily
Improved Surgical Outcome After Fetal Diagnosis of Hypoplastic Left Heart Syndrome Wayne Tworetzky, MD; Doff B. McElhinney, MD; V. Mohan Reddy, MD; Michael M. Brook, MD; Frank L. Hanley, MD; Norman H.
More informationSince first successfully performed by Jatene et al, the
Long-Term Predictors of Aortic Root Dilation and Aortic Regurgitation After Arterial Switch Operation Marcy L. Schwartz, MD; Kimberlee Gauvreau, ScD; Pedro del Nido, MD; John E. Mayer, MD; Steven D. Colan,
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACHD. See Adult congenital heart disease (ACHD) Adult congenital heart disease (ACHD), 503 512 across life span prevalence of, 504 506
More informationInterstage attrition between bidirectional Glenn and Fontan palliation in children with hypoplastic left heart syndrome
Carlo et al Congenital Heart Disease Interstage attrition between bidirectional Glenn and Fontan palliation in children with hypoplastic left heart syndrome Waldemar F. Carlo, MD, a Kathleen E. Carberry,
More informationThe evolution of the Fontan procedure for single ventricle
Hemi-Fontan Procedure Thomas L. Spray, MD The evolution of the Fontan procedure for single ventricle cardiac malformations has included the development of several surgical modifications that appear to
More informationTotal Cavopulmonary Connections in Children With a Previous Norwood Procedure
Total Cavopulmonary Connections in Children With a Previous Norwood Procedure Anthony Azakie, MD, Brian W. McCrindle, MD, FRCP(C), Lee N. Benson, MD, FRCP(C), Glen S. Van Arsdell, MD, Jennifer L. Russell,
More informationPatients at Risk for Low Systemic Oxygen Delivery After the Norwood Procedure
Patients at Risk for Low Systemic Oxygen Delivery After the Norwood Procedure James S. Tweddell, MD, George M. Hoffman, MD, Raymond T. Fedderly, MD, Nancy S. Ghanayem, MD, John M. Kampine, MD, Stuart Berger,
More informationMid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum
Mid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum Kagami MIYAJI, MD, Akira FURUSE, MD, Toshiya OHTSUKA, MD, and Motoaki KAWAUCHI,
More informationRight Ventricle to Pulmonary Artery Conduit Improves Outcome After Stage I Norwood for Hypoplastic Left Heart Syndrome
Right Ventricle to Pulmonary Artery Conduit Improves Outcome After Stage I Norwood for Hypoplastic Left Heart Syndrome Christian Pizarro, MD*; Edward Malec, MD ; Kevin O. Maher, MD*; Katarzyna Januszewska,
More informationThe outlook for patients with hypoplastic left heart syndrome (HLHS) Tricuspid valve repair in hypoplastic left heart syndrome CHD
Ohye et al Surgery for Congenital Heart Disease Tricuspid valve repair in hypoplastic left heart syndrome Richard G. Ohye, MD a Carlen A. Gomez, MD b Caren S. Goldberg, MD, MS b Holly L. Graves, BA a Eric
More informationIntraoperative and Postoperative Arrhythmias: Diagnosis and Treatment
Intraoperative and Postoperative Arrhythmias: Diagnosis and Treatment Karen L. Booth, MD, Lucile Packard Children s Hospital Arrhythmias are common after congenital heart surgery [1]. Postoperative electrolyte
More informationThe incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients
The Turkish Journal of Pediatrics 2008; 50: 549-553 Original The incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients Selman Vefa Yıldırım 1, Kürşad
More information3/14/2011 MANAGEMENT OF NEWBORNS CARDIAC INTENSIVE CARE CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 WITH HEART DEFECTS
CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 MANAGEMENT OF NEWBORNS WITH HEART DEFECTS A NTHONY C. CHANG, MD, MBA, MPH M E D I C AL D I RE C T OR, HEART I N S T I T U T E C H I LDRE N
More informationStage I palliation for hypoplastic left heart syndrome in low birth weight neonates: can we justify it? q
European Journal of Cardio-thoracic Surgery 21 (2002) 716 720 www.elsevier.com/locate/ejcts Stage I palliation for hypoplastic left heart syndrome in low birth weight neonates: can we justify it? q Christian
More informationChildren with Single Ventricle Physiology: The Possibilities
Children with Single Ventricle Physiology: The Possibilities William I. Douglas, M.D. Pediatric Cardiovascular Surgery Children s Memorial Hermann Hospital The University of Texas Health Science Center
More informationcan be attributed to improvements in diagnostic
Cardiac Intensive Care Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock-Taussig shunt or right
More informationRecent technical advances and increasing experience
Pediatric Open Heart Operations Without Diagnostic Cardiac Catheterization Jean-Pierre Pfammatter, MD, Pascal A. Berdat, MD, Thierry P. Carrel, MD, and Franco P. Stocker, MD Division of Pediatric Cardiology,
More informationFirst-stage palliation for hypoplastic left heart syndrome
Comparison of Norwood Shunt Types: Do the Outcomes Differ 6 Years Later? Eric M. Graham, MD, Sinai C. Zyblewski, MD, Jacob W. Phillips, MD, Girish S. Shirali, MBBS, Scott M. Bradley, MD, Geoffery A. Forbus,
More informationCARDIOVASCULAR SURGERY
Volume 107, Number 4 April 1994 The Journal of THORACIC AND CARDIOVASCULAR SURGERY Cardiac and Pulmonary Transplantation Risk factors for graft failure associated with pulmonary hypertension after pediatric
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,
More informationAlthough the surgical management of hypoplastic left
Hypoplastic Left Heart Syndrome With Intact or Highly Restrictive Atrial Septum Outcome After Neonatal Transcatheter Atrial Septostomy Antonios P. Vlahos, MD; James E. Lock, MD; Doff B. McElhinney, MD;
More informationWhen to implant an ICD in systemic right ventricle?
When to implant an ICD in systemic right ventricle? Département de rythmologie et de stimulation cardiaque Nicolas Combes n.combes@clinique-pasteur.com Pôle de cardiologie pédiatrique et congénitale Risk
More informationJournal of the American College of Cardiology Vol. 52, No. 1, by the American College of Cardiology Foundation ISSN /08/$34.
Journal of the American College of Cardiology Vol. 52, No. 1, 2008 2008 by the American College of Cardiology Foundation ISSN 0735-1097/08/$34.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.03.034
More informationAccuracy of the Fetal Echocardiogram in Double-outlet Right Ventricle
Blackwell Publishing IncMalden, USACHDCongenital Heart Disease 2006 The Authors; Journal compilation 2006 Blackwell Publishing, Inc.? 200723237Original ArticleFetal Echocardiogram in Double-outlet Right
More informationSURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE
SURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE Mr. W. Brawn Birmingham Children s Hospital. Aims of surgery The aim of surgery in congenital heart disease is to correct or palliate the heart
More informationImprovements in Survival and Neurodevelopmental Outcomes in Surgical Treatment of Hypoplastic Left Heart Syndrome: A Meta-Analytic Review
The Journal of ExtraCorporeal Technology Improvements in Survival and Neurodevelopmental Outcomes in Surgical Treatment of Hypoplastic Left Heart Syndrome: A Meta-Analytic Review Joseph J. Sistino, PhD,
More informationFailure of epicardial pacing leads in congenital heart disease: not uncommon and difficult to predict
DOI 10.1007/s12471-011-0158-5 ORIGINAL ARTICLE Failure of epicardial pacing leads in congenital heart disease: not uncommon and difficult to predict M. C. Post & W. Budts & A. Van de Bruaene & R. Willems
More informationAdult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016
1 Adult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Why should all echocardiographers
More informationSurvival Rates of Children with Congenital Heart Disease continue to improve.
DOROTHY RADFORD Survival Rates of Children with Congenital Heart Disease continue to improve. 1940-20% 1960-40% 1980-70% 2010->90% Percentage of children with CHD reaching age of 18 years 1938 First Patent
More informationPediatric Echocardiography Examination Content Outline
Pediatric Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 Anatomy and Physiology Normal Anatomy and Physiology 10% 2 Abnormal Pathology and Pathophysiology
More informationCYANOTIC CONGENITAL HEART DISEASES. PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU
CYANOTIC CONGENITAL HEART DISEASES PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU DEFINITION Congenital heart diseases are defined as structural and functional problems of the heart that are
More informationSurgical Repair of Ventricular Septal Defect; Contemporary Results and Risk Factors for a Complicated Course
Pediatr Cardiol (2017) 38:264 270 DOI 10.1007/s00246-016-1508-2 ORIGINAL ARTICLE Surgical Repair of Ventricular Septal Defect; Contemporary Results and Risk Factors for a Complicated Course Maartje Schipper
More informationEarly outcome after Fontan operation for univentricular
Thrombus Formation After the Fontan Operation Patrick D. Coon, RDCS, RCVT, Jack Rychik, MD, Rita T. Novello, RDCS, Pamela S. Ro, MD, J. William Gaynor, MD, and Thomas L. Spray, MD Cardiac Center at the
More informationAdult Congenital Heart Disease T S U N ` A M I!
Adult Congenital Heart Disease T S U N ` A M I! Erwin Oechslin, MD, FRCPC, FESC Director, Congenital Cardiac Centre for Adults University Health Network Peter Munk Cardiac Centre / Toronto General Hospital
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationStaged surgical management of hypoplastic left heart syndrome. A single-institution 12-year experience
Heart Online First, published on June 6, 2005 as 10.1136/hrt.2005.068684 Staged surgical management of hypoplastic left heart syndrome. A single-institution 12-year experience Simon P McGuirk 1, Massimo
More informationResearch Presentation June 23, Nimish Muni Resident Internal Medicine
Research Presentation June 23, 2009 Nimish Muni Resident Internal Medicine Research Question In adult patients with repaired Tetralogy of Fallot, how does Echocardiography compare to MRI in evaluating
More informationThe Fetal Cardiology Program
The Fetal Cardiology Program at Texas Children s Fetal Center About the program Since the 1980s, Texas Children s Fetal Cardiology Program has provided comprehensive fetal cardiac care to expecting families
More informationAlthough most patients with Ebstein s anomaly live
Management of Neonatal Ebstein s Anomaly Christopher J. Knott-Craig, MD, FACS Although most patients with Ebstein s anomaly live through infancy, those who present clinically as neonates are a distinct
More informationWhat Can the Database Tell Us About Reoperation?
AATS/STS Congenital Heart Disease Postgraduate Symposium May 5, 2013 What Can the Database Tell Us About Reoperation? Jeffrey P. Jacobs, M.D. All Children s Hospital Johns Hopkins Medicine The Congenital
More informationSurgical Results in Patients With Double Outlet Right Ventricle: A 20-Year Experience
Surgical Results in Patients With Double Outlet Right Ventricle: A 20-Year Experience John W. Brown, MD, Mark Ruzmetov, MD, Yuji Okada, MD, Palaniswamy Vijay, PhD, MPH, and Mark W. Turrentine, MD Section
More informationPEDIATRIC CARDIOLOGY. Philadelphia, Pennsylvania
JACC Vol. 17, No.5 April 1991:1143-9 1143 PEDIATRIC CARDIOLOGY Hypoplastic Left Heart Syndrome: Hemodynamic and Angiographic Assessment After Initial Reconstructive Surgery and Relevance to Modified Fontan
More informationHemodynamic assessment after palliative surgery
THERAPY AND PREVENTION CONGENITAL HEART DISEASE Hemodynamic assessment after palliative surgery for hypoplastic left heart syndrome PETER LANG, M.D., AND WILLIAM I. NORWOOD, M.D., PH.D. ABSTRACT Ten patients
More informationWhat is the Definition of Small Systemic Ventricle. Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University
What is the Definition of Small Systemic Ventricle Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University Contents Introduction Aortic valve stenosis Aortic coarctation
More informationCardiac Catheterization Cases Primary Cardiac Diagnoses Facility 12 month period from to PRIMARY DIAGNOSES (one per patient)
PRIMARY DIAGNOSES (one per patient) Septal Defects ASD (Atrial Septal Defect) PFO (Patent Foramen Ovale) ASD, Secundum ASD, Sinus venosus ASD, Coronary sinus ASD, Common atrium (single atrium) VSD (Ventricular
More informationLONG TERM OUTCOMES OF PALLIATIVE CONGENITAL HEART DISEASE
LONG TERM OUTCOMES OF PALLIATIVE CONGENITAL HEART DISEASE S Bruce Greenberg, MD, FACR, FNASCI Professor of Radiology and Pediatrics Arkansas Children's Hospital University of Arkansas for Medical Sciences
More informationIncidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institutional database. Carlos M.
Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institutional database Carlos M. Mery, MD, MPH Assistant Professor, and Pediatrics Congenital Heart Texas
More informationHybrid Stage I Palliation / Bilateral PAB
Hybrid Stage I Palliation / Bilateral PAB Jeong-Jun Park Dept. of Thoracic & Cardiovascular Surgery Asan Medical Center, University of Ulsan CASE 1 week old neonate with HLHS GA 38 weeks Birth weight 3.0Kg
More informationGlenn and Fontan Caths:
Glenn and Fontan Caths: Pre-operative evaluation and Trouble-shooting Cavo-Pulmonary Shunts Daniel H. Gruenstein, M.D. Director, Pediatric Interventional Cardiology University of Minnesota Children s Hospital,
More informationA new diagnostic algorithm for assessment of patients with single ventricle before a Fontan operation
A new diagnostic algorithm for assessment of patients with single ventricle before a Fontan operation Ashwin Prakash, MD, Muhammad A. Khan, MD, Rose Hardy, BA, Alejandro J. Torres, MD, Jonathan M. Chen,
More informationCardiac MRI in ACHD What We. ACHD Patients
Cardiac MRI in ACHD What We Have Learned to Apply to ACHD Patients Faris Al Mousily, MBChB, FAAC, FACC Consultant, Pediatric Cardiology, KFSH&RC/Jeddah Adjunct Faculty, Division of Pediatric Cardiology
More informationMajor Infection After Pediatric Cardiac Surgery: External Validation of Risk Estimation Model
Major Infection After Pediatric Cardiac Surgery: External Validation of Risk Estimation Model Andrzej Kansy, MD, PhD, Jeffrey P. Jacobs, MD, PhD, Andrzej Pastuszko, MD, PhD, Małgorzata Mirkowicz-Małek,
More informationSingle Ventricle with Mitral and Aortic Atresia
1 Bahrain Medical Bulletin, Vol. 26, No. 2, June 2004 Single Ventricle with Mitral and Aortic Atresia Vijaya V Mysorekar, MBBS, MD* Chitralekha P Dandekar, MBBS, MD** Saraswati G Rao, MBBS, MD*** We report
More information가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY
가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY PA c IVS (not only pulmonary valve disease) Edwards JE. Pathologic Alteration of the right heart. In: Konstam MA, Isner M, eds.
More informationA Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution
Original Article A Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution Ghassan Baslaim, MD, and Jill Bashore, RN Purpose: Adult patients with congenital
More informationAs early outcomes for infants and children undergoing
Neurodevelopmental Outcomes in Children After the Fontan Operation Joseph M. Forbess, MD; Karen J. Visconti, PhD; David C. Bellinger, PhD, MSc; Richard A. Jonas, MD Background Previous studies of patients
More informationDIAGNOSIS, MANAGEMENT AND OUTCOME OF HEART DISEASE IN SUDANESE PATIENTS
434 E AST AFRICAN MEDICAL JOURNAL September 2007 East African Medical Journal Vol. 84 No. 9 September 2007 DIAGNOSIS, MANAGEMENT AND OUTCOME OF CONGENITAL HEART DISEASE IN SUDANESE PATIENTS K.M.A. Sulafa,
More informationOBJECTIVES BACKGROUND METHODS RESULTS CONCLUSIONS
Journal of the American College of Cardiology Vol. 36, No. 4, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00855-X Survival
More informationManagement of Heart Failure in Adult with Congenital Heart Disease
Management of Heart Failure in Adult with Congenital Heart Disease Ahmed Krimly Interventional and ACHD consultant King Faisal Cardiac Center National Guard Jeddah Background 0.4% of adults have some form
More informationManagement of a Patient after the Bidirectional Glenn
Management of a Patient after the Bidirectional Glenn Melissa B. Jones MSN, APRN, CPNP-AC CICU Nurse Practitioner Children s National Health System Washington, DC No Disclosures Objectives qbriefly describe
More informationAdults with Congenital Heart Disease. Michael E. McConnell MD, Wendy Book MD Teresa Lyle RN NNP
Adults with Congenital Heart Disease Michael E. McConnell MD, Wendy Book MD Teresa Lyle RN NNP Outline History of CHD Statistics Specific lesions (TOF, TGA, Single ventricle) Erythrocytosis Pregnancy History
More informationT who has survived first-stage palliative surgical management
Intermediate Procedures After First-Stage Norwood Operation Facilitate Subsequent Repair Richard A. Jonas, MD Department of Cardiac Surgery, Children s Hospital, Boston, Massachusetts Actuarial analysis
More informationOutcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease TIRONE E. DAVID, MD ; SEMIN THORAC CARDIOVASC SURG 19:116-120c 2007 ELSEVIER INC. PRESENTED BY INTERN 許士盟 Mitral valve
More informationCenter Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes
ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationCongenital Heart Defects
Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass
More informationAdult Congenital Heart Disease Certification Examination Blueprint
Adult Congenital Heart Disease Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the
More informationExercise Testing Interpretation in the Congenital Heart.
Interpretation in the Congenital Heart. Stephen M. Paridon, MD Medical Director, Exercise Physiology Laboratory The Children s Hospital of Philadelphia Professor of Pediatrics The University of Pennsylvania
More informationRegional Prenatal Congenital Heart Disease Detection and Practices Jenny Ecord, APRN Ward Family Heart Center Wichita
Regional Prenatal Congenital Heart Disease Detection and Practices Jenny Ecord, APRN Ward Family Heart Center Wichita The Children's Mercy Hospital, 2014. 05/14 Objectives Review current local and regional
More informationOutline. Congenital Heart Disease. Special Considerations for Special Populations: Congenital Heart Disease
Special Considerations for Special Populations: Congenital Heart Disease Valerie Bosco, FNP, EdD Alison Knauth Meadows, MD, PhD University of California San Francisco Adult Congenital Heart Program Outline
More informationSurgical Management of TOF in Adults. Dr Flora Tsang Associate Consultant Department of Cardiothoracic Surgery Queen Mary Hospital
Surgical Management of TOF in Adults Dr Flora Tsang Associate Consultant Department of Cardiothoracic Surgery Queen Mary Hospital Tetralogy of Fallot (TOF) in Adults Most common cyanotic congenital heart
More informationArrhythmias in a Contemporary Fontan Cohort
Journal of the American College of Cardiology Vol. 56, No. 11, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.03.079
More informationShuichi Shiraishi, Masashi Takahashi, Ai Sugimoto, Masanori Tsuchida. Introduction
Original Article Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure
More informationPredictive Value of Intraoperative Diagnosis of Residual Ventricular Septal Defects by Transesophageal Echocardiography
ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS
More informationSupplemental Information
ARTICLE Supplemental Information SUPPLEMENTAL TABLE 6 Mosaic and Partial Trisomies Thirty-eight VLBW infants were identified with T13, of whom 2 had mosaic T13. T18 was reported for 128 infants, of whom
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationThe first report of the Society of Thoracic Surgeons
REPORT The Society of Thoracic Surgeons National Congenital Heart Surgery Database Report: Analysis of the First Harvest (1994 1997) Constantine Mavroudis, MD, Melanie Gevitz, BA, W. Steves Ring, MD, Charles
More informationSurvival of infants born with hypoplastic left heart syndrome (HLHS)
Surgery for Congenital Heart Disease Sano et al Right ventricle pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome Shunji Sano, MD a Kozo Ishino, MD a Masaaki Kawada, MD
More informationNIH Public Access Author Manuscript World J Pediatr Congenit Heart Surg. Author manuscript; available in PMC 2015 April 01.
NIH Public Access Author Manuscript Published in final edited form as: World J Pediatr Congenit Heart Surg. 2014 April ; 5(2): 272 282. doi:10.1177/2150135113519455. Linking the Congenital Heart Surgery
More informationExtracardiac vs Intra-atrial Lateral Tunnel Fontan: Extracardiac is Better. No it s not: (They both have problems)
Extracardiac vs Intra-atrial Lateral Tunnel Fontan: Extracardiac is Better No it s not: (They both have problems) Why is it difficult to analyze outcomes after the Fontan procedure? Wide range of patient
More informationECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT
ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT Karen Stout, MD, FACC Divisions of Cardiology University of Washington Medical Center Seattle Children s Hospital NO DISCLOSURES
More informationHeart Transplantation in Patients with Superior Vena Cava to Pulmonary Artery Anastomosis: A Single-Institution Experience
Korean J Thorac Cardiovasc Surg 2018;51:167-171 ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online) CLINICAL RESEARCH https://doi.org/10.5090/kjtcs.2018.51.3.167 Heart Transplantation in Patients with Superior
More informationPattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS
Pattern of Congenital Heart Disease A Hospital-Based Study *Sadiq Mohammed Al-Hamash MBChB, FICMS ABSTRACT Background: The congenital heart disease occurs in 0,8% of live births and they have a wide spectrum
More informationSeptember 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical)
September 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical) Advances in cardiac surgery have created a new population of adult patients with repaired congenital heart
More informationClinical Policy: Holter Monitors Reference Number: CP.MP.113
Clinical Policy: Reference Number: CP.MP.113 Effective Date: 05/18 Last Review Date: 04/18 Coding Implications Revision Log Description Ambulatory electrocardiogram (ECG) monitoring provides a view of
More informationScreening for Critical Congenital Heart Disease
Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most
More informationMitral Valve Disease, When to Intervene
Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages
More informationAtrioventricular valve repair in patients with functional single ventricle
CONGENITAL HEART DISEASE Atrioventricular valve repair in patients with functional single ventricle Tomohiro Nakata, MD, a Yoshifumi Fujimoto, MD, b Keiichi Hirose, MD, PhD, b Yuko Tosaka, MD, PhD, b Yujiro
More informationATRIAL SEPTAL DEFECTS
ORIGINAL STUDY Long-term follow-up of children after repair of atrial septal defects JAMES MANDELIK, MD; DOUGLAS S. MOODIE, MD; RICHARD STERBA, MD; DANIEL MURPHY, MD; ELIOT ROSENKRANZ, MD; SHARON MEDENDORP,
More informationDeok Young Choi, Gil Hospital, Gachon University NEONATES WITH EBSTEIN S ANOMALY: PROBLEMS AND SOLUTION
Deok Young Choi, Gil Hospital, Gachon University NEONATES WITH EBSTEIN S ANOMALY: PROBLEMS AND SOLUTION Carpentier classification Chauvaud S, Carpentier A. Multimedia Manual of Cardiothoracic Surgery 2007
More informationManagement of 239 Patients with Hypoplastic Left Heart Syndrome and Related Malformations from 1993 to 2007
Management of 239 Patients with Hypoplastic Left Heart Syndrome and Related Malformations from 1993 to 2007 Jeffrey P. Jacobs, MD, Sean M. O Brien, PhD, Paul J. Chai, MD, Victor O. Morell, MD, Harald L.
More informationEchocardiography of Congenital Heart Disease
Echocardiography of Congenital Heart Disease Sunday, April 15 Tuesday, April 17, 2018 Ruth and Tristram Colket, Jr. Translational Research Building on the Raymond G. Perelman Campus Learn more: chop.cloud-cme.com
More informationCase Report. Stent Placement in a Neonate with Sano Modification of the Norwood using Semi-Elective Extracorporeal Membrane Oxygenation.
Stent Placement in a Neonate with Sano Modification of the Norwood using Semi-Elective Extracorporeal Membrane Oxygenation Mustafa Gulgun and Michael Slack Associated Profesor Children National Medical
More informationRevista Anestesiología Mexicana de C CONFERENCIAS MAGISTRALES Vol. 33. Supl. 1, Abril-Junio 2010 pp S270-S274 Deep hypothermic circulatory arrest and the effects on the brain James A DiNardo, MD, FAAP*
More informationCardiac Dysrhythmias and Sports
Sudden unexpected death during athletic participation is the overriding consideration in advising individuals with dysrhythmias about participation in sports. The incidence of sudden death is 1 to 2 per
More informationNew approach to interstage care for palliated high-risk patients with congenital heart disease
Dobrolet et al Congenital Heart Disease New approach to interstage care for palliated high-risk patients with congenital heart disease Nancy C. Dobrolet, MD, Jo Ann Nieves, MSN, CPN, ARNP, PNP-BC, Elizabeth
More informationLEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT
LEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT 10-13 March 2017 Ritz Carlton, Riyadh, Saudi Arabia Zohair AlHalees, MD Consultant, Cardiac Surgery Heart Centre LEFT VENTRICULAR
More informationCardiac arrhythmias following the creation of an atrial septal defect in patients with transposition
Thorax (1973), 28, 147. Cardiac arrhythmias following the creation of an atrial septal defect in patients with transposition of the great arteries R. J. MOENE, J. P. ROOS, and A. EYGELAAR Departments of
More information