Physical Examination of Arteriovenous Fistula

Sodium abnormalities

Review article: NEJM 2015;372:55-65.

Disorders of Plasma Sodium - Causes, Consequences, and Correction.

Sterns RH.

Abstract

This review considers the causes and consequences of an abnormal plasma sodium concentration and offers a framework for correcting it.

PMID:

 

25551526

 

[PubMed - as supplied by publisher]

Acute Kidney Injury detection after heart surgery in children

JACC 2014;64:2753-62

Combining functional and tubular damage biomarkers improves diagnostic precision of acute kidney injury after cardiac surgery.

Rajit K. Basu, et al. JACC 2014;64:2753-62.

Objective: Combining two biomarkers will improve precision of acute kidney injury (AKI) diagnosis after heart surgery in children.

Methods: n=345 children after cardiopulmonary bypass (CPB). Two biomarkers: Plasma Cystatin C & uNGAL were measured 2 hr after initiation of CPB.

Conclusion: Composites of plasma Cystatin C and uNGAL are superior to serum creatinine for predicting discrete characteristics of AKI.

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Appropriate Use Criteria for Pediatric Transthoracic Echo

J Am Coll Cardiol. 2014 Nov 11;64(19):2039-60. doi: 10.1016/j.jacc.2014.08.003. Epub 2014 Sep 29.

ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 

Appropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Pediatric Cardiology

Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R.

Also, Pediatrics 2014;134:e1774

Likelihood Ratio: The AAP's Don'ts and Don'ts of Bronchiolitis, Expl...

Likelihood Ratio: The AAP's Don'ts and Don'ts of Bronchiolitis, Expl...: A lot of clinicians are confused about the new American Academy of Pediatrics guidelines on treating bronchiolitis , released just in tim...



Hilarious posting!

Rupture of sinus of Valsalva

Catheterization and Cardiovascular Interventions 2014;84:1184-89.

Li Zhong et al.

Transcatheter closure of ruptured sinus of Valsalva aneurysm.

n=22

From...To:

Non-coronary sinus to RA 11

Non-coronary sinus to RVinflow 1

Right coronary sinus to RVOT 8

Right coronary sinus to RA 2

Devices used: 

Amplatzer duct occluder 19

Amplatzer muscular VSD device 1

Outcome:

Successful in 20.

No residual shunt in 18, Small residual shunt in 2.

Complications:

Two patient needed urgent AVR because of procedure-related aortic valve regurgitation.

PDA closure: Ductal Spasm

Catheter Cardiovasc Interv. 2014 Apr 1;83(5):762-7. doi: 10.1002/ccd.25120. Epub 2013 Nov 9.

Ductal spasm during performance of transcatheter ductal occlusion.

Batlivala SP1, Glatz AC, Gillespie MJ, Dori Y, Rome JJ.

Author information

Abstract

OBJECTIVES:

Transcatheter patent ductus arteriosus (PDA) occlusion is a staple of pediatric catheterization laboratories. We present the phenomenon of significant PDA spasm to prevent failure to occlude a hemodynamically significant duct.

BACKGROUND:

Transcatheter techniques have evolved, allowing safe and effective occlusion of PDAs in younger and smaller patients. Neonatal care is evolving with increasing survival at younger gestational ages. Premature infants often have PDAs, so the proportion of formerly premature children referred for transcatheter ductal occlusion will likely rise.

METHODS:

We reviewed all transcatheter PDA occlusions performed at our institution since 2001 (N = 331). Retrospective data included: gestational age, age at catheterization, precatheterization echocardiographic parameters, PDA size (after spasm relief), device specifications, and most recent follow-up data.

RESULTS:

Seven cases were identified. Median age was 12 months, median gestational age was 28 weeks. All were born prematurely. All PDAs were restrictive and six had left-heart volume overload. All patients were examined by the interventional cardiologist and had ductal murmurs. When reauscultated (three of seven), murmurs were absent during spasm. Once spasm relieved, PDA diameters ranged from 1.5 to 8 (median 2) mm. All patients accommodated a 6-mm-or larger-Amplatzer device. No significant complications occurred and all patients were well at follow-up.

CONCLUSIONS:

Ductal spasm occurs during transcatheter occlusion and may be an unrecognized cause of procedural failure. The phenomenon seems to occur in children born prematurely, and can occur after infancy. Loss of a continuous murmur confirms the diagnosis. Care should be taken to avoid device under-sizing when spasm occurs.