Epidemiology: Prevalence of CHD in US

Prevalence of CHD in US

Poster presented at ACC 2012: (JACC 2012;59(Supplement 1):E787.

These numbers were derived by extrapolating data from Quebec population study (Circ 2007;115:163-72) & 2010 US Census data.

(Click on the image to enlarge)

Prevalence of CHD in Europe

(Circulation 2011;123:841-9)

Prevalence in Quebec

(Circulation 2007;115:163-72)

Scoring system to determine need for LA decompression

J Heart Lung Transplant. 2003 Aug;22(8):883-8.


Scoring system to determine need for balloon atrial septostomy for restrictive interatrial communication in infants with hypoplastic left heart syndrome.

Mulla NF, Osher AP, Beeson WL, Kuhn MA, Larsen RL.

SourceDepartment of Pediatrics, Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California 92534 , USA. nmulla@ahs.llumc.edu



Abstract

BACKGROUND: Restrictive interatrial communication (IAC) causes morbidity and mortality in infants with hypoplastic left heart syndrome awaiting cardiac transplantation. We sought to create a scoring system, based on echocardiographic and clinical findings, to serve as a guide for determining the need for balloon atrial septostomy (BAS).



METHODS: We retrospectively reviewed echocardiograms of 44 infants with hypoplastic left heart syndrome. Infants were studied from the time of admission to the final end-point of transplantation, Norwood procedure, or death. Seventeen infants underwent BAS for clinical indications of oxygen saturation <80% in room air. Data collected included age at BAS, maximum velocity (V(max)), and IAC diameter throughout the clinical course. We assigned higher IAC scores to smaller IAC diameter, greater V(max) through the IAC, and lower oxygen saturation value. The minimum score was 3, and the maximum score was 9.



RESULTS: Only 10% of infants with a score <6 at presentation required BAS, whereas 67% of those with scores > or =6 required BAS. Higher IAC scores at presentation were associated with earlier need for BAS (p = 0.04).



CONCLUSIONS: The IAC scoring system can serve as a reliable clinical guide for identifying infants with hypoplastic left heart syndrome who are likely to require BAS for relief of critically restrictive IAC while awaiting cardiac transplantation.

Endocarditis Prophylaxis 2007 Guidelines are right.

New study published online Circulation 2012 supports 2007 guidelines.
Be sure to check the editorial associated with this article.

This article is reviewed in theheart.org "heartwire" as well.

Biodegradable stents are equivalent to metal stents

Link

Fenaldopam

Journal List > BMC Anesthesiol > v.8; 2008		Formats: Abstract  |  Full Text  |  PDF (230K)
	BMC Anesthesiol. 2008; 8: 6. Published online 2008 October 6. doi:  10.1186/1471-2253-8-6 PMCID: PMC2576052 Copyright © 2008 Hammer et al; licensee BioMed Central Ltd. Pharmacokinetics and pharmacodynamics of fenoldopam mesylate for blood pressure control in pediatric patients Gregory B Hammer,1 Susan T Verghese,2 David R Drover,3 Myron Yaster,4 and Joseph R Tobin5 1Departments of Anesthesia and Pediatrics, Stanford University School of Medicine, Stanford, USA 2Departments of Anesthesia and Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, USA 3Department of Anesthesia, Stanford University School of Medicine, Stanford, USA 4Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, Johns Hopkins University, Baltimore, USA 5Departments of Anesthesiology and Pediatrics, Wake Forest University School of Medicine, Winston-Salem, USA Corresponding author. Gregory B Hammer: ham@stanford.edu; Susan T Verghese: sverghes@cnmc.org; David R Drover:ddrover@stanford.edu; Myron Yaster: myaster@jhmi.edu; Joseph R Tobin: jtobin@wfubmc.edu Received April 7, 2008; Accepted October 6, 2008. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  Other Sections▼ Abstract Background Fenoldopam mesylate, a selective dopamine1-receptor agonist, is used by intravenous infusion to treat hypertension in adults. Fenoldopam is not approved by the FDA for use in children; reports describing its use in pediatrics are limited. In a multi-institutional, placebo controlled, double-blind, multi-dose trial we determined the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics and side-effect profile of fenoldopam in children. Methods Seventy seven (77) children from 3 weeks to 12 years of age scheduled for surgery in which deliberate hypotension would be induced were enrolled. Patients were randomly assigned to one of five, blinded treatment groups (placebo or fenoldopam 0.05, 0.2, 0.8, or 3.2 mcg/kg/min iv) for a 30-minute interval after stabilization of anesthesia and placement of vascular catheters. Following the 30-minute blinded interval, investigators adjusted the fenoldopam dose to achieve a target mean arterial pressure in the open-label period until deliberate hypotension was no longer indicated (e.g., muscle-layer closure). Mean arterial pressure and heart rate were continuously monitored and were the primary endpoints. Results Seventy-six children completed the trial. Fenoldopam at doses of 0.8 and 3.2 mcg/kg/min significantly reduced blood pressure (p < 0.05) during the blinded interval, and doses of 1.0–1.2 mcg/kg/min resulted in continued control of blood pressure during the open-label interval. Doses greater than 1.2 mcg/kg/min during the open-label period resulted in increasing heart rate without additional reduction in blood pressure. Fenoldopam was well-tolerated; side effects occurred in a minority of patients. The PK/PD relationship of fenoldopam in children was determined. Conclusion Fenoldopam is a rapid-acting, effective agent for intravenous control of blood pressure in children. The effective dose range is significantly higher in children undergoing anesthesia and surgery (0.8–1.2 mcg/kg/min) than as labeled for adults (0.05–0.3 mcg/kg/min). The PK and side-effect profiles for children and adults are similar

Chest Pain Assessment in Children

SCAMP - Standardized Clinical Assessment Management Plan

JAHA April 2012

Demographic variables, clinical characteristics, and cardiac testing in a historical cohort (n=406) of patients presenting to our outpatient division for initial evaluation of chest pain in the most recent pre-SCAMP calendar year (2009) to patients enrolled in the chest pain SCAMP (n=364).

Demographic variables including age at presentation, sex, and clinical characteristics were similar between groups.

Adherence to the SCAMP algorithm for echocardiography was 84%. Practice variation decreased significantly after implementation of the SCAMP (P<0.001).

The number of exercise stress tests obtained was significantly lower in the SCAMP-enrolled patients compared with the historic cohort (∼3% of patients versus 29%, respectively; P<0.001).

Similarly, there was a 66% decrease in utilization of Holter monitors and 75% decrease in the use of long-term event monitors after implementation of the chest pain SCAMP (P=0.003 and P<0.001, respectively).

The number of echocardiograms obtained was similar between groups.

Conclusions Implementation of a SCAMP for evaluation of pediatric chest pain has lead to a decrease in practice variation and resource utilization.

Fundoplication & Gastrostomy ...outcome of single ventricle

Keating JJ et al.

JTCVS 2012;143:891-895

1999=2007

n=155

32 (21%) had fundoplication &/or G-tube (24 had both. 7 had G-tube only).

65 (42%) were HLHS. 24 of 65 had Fundos &/or G-tube.

Need for fundo &/or Gtube was associated with lower transplant-free survival.