JAHA Accessed Jan 23, 2013
Review article
Wednesday, January 23, 2013
CPR Duration and Outcome in Children
Circulation 2013 - Epub on Jan 22, 2013
Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests
Renee I. Matos et al.
Background-Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric in-hospital cardiac arrests. This concept has recently been questioned.
Methods and Results - 3419 children from 328 US and Canadian sites (Get With The Guidelines-Resuscitation sites). In-hospital cardiac arrests between January 2000 and December 2009.
Patients were stratified into 5 patient illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma.
Survival to discharge was 27.9%, but only 19.0% of all cardiac arrest patients had favorable neurological outcomes.
Between 1 and 15 minutes of CPR, survival decreased linearly by 2.1% per minute, and rates of favorable neurological outcome decreased by 1.2% per minute.
Adjusted probability of survival was 41% for CPR duration of 1 to 15 minutes and 12% for >35 minutes.
Among survivors, favorable neurological outcome occurred in 70% undergoing <15 60="" and="" cpr="" minutes="" of="" undergoing="">35 minutes.
Compared with general medical patients, surgical cardiac patients had the highest adjusted odds ratios for survival and favorable neurological outcomes, 2.5 (95% confidence interval, 1.8-3.4) and 2.7 (95% confidence interval, 2.0-3.9), respectively.
Conclusions-CPR duration was independently associated with survival to hospital discharge and neurological outcome. Among survivors, neurological outcome was favorable for the majority of patients. Performing CPR for >20 minutes is not futile in some patient illness categories.
Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests
Renee I. Matos et al.
Background-Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric in-hospital cardiac arrests. This concept has recently been questioned.
Methods and Results - 3419 children from 328 US and Canadian sites (Get With The Guidelines-Resuscitation sites). In-hospital cardiac arrests between January 2000 and December 2009.
Patients were stratified into 5 patient illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma.
Survival to discharge was 27.9%, but only 19.0% of all cardiac arrest patients had favorable neurological outcomes.
Between 1 and 15 minutes of CPR, survival decreased linearly by 2.1% per minute, and rates of favorable neurological outcome decreased by 1.2% per minute.
Adjusted probability of survival was 41% for CPR duration of 1 to 15 minutes and 12% for >35 minutes.
Among survivors, favorable neurological outcome occurred in 70% undergoing <15 60="" and="" cpr="" minutes="" of="" undergoing="">35 minutes.
Compared with general medical patients, surgical cardiac patients had the highest adjusted odds ratios for survival and favorable neurological outcomes, 2.5 (95% confidence interval, 1.8-3.4) and 2.7 (95% confidence interval, 2.0-3.9), respectively.
Conclusions-CPR duration was independently associated with survival to hospital discharge and neurological outcome. Among survivors, neurological outcome was favorable for the majority of patients. Performing CPR for >20 minutes is not futile in some patient illness categories.
Outcome of Arterial Switch Operation for d-TGA
Circulation. 2013; 127: 331-339
Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries
Paul Khairy, MD, PhD et al. Boston.
Single-institution retrospective cohort study (1983-1999). n=400.
Overall, 400 patients, 154 (38.3%) with a ventricular septal defect, 238 (59.5%) with an intact septum, and 9 (2.3%) with a Taussig-Bing anomaly, were followed for a median of 18.7 years. In perioperative survivors, overall and arrhythmia-free survival rates at 25 years were 96.7±1.8% and 96.6±0.1%, respectively.
Late mortality was predominantly a result of sudden deaths and myocardial infarction.
At 25 years, 75.5±2.5% remained free from surgical or catheter-based reintervention.
Freedom from an adverse cardiovascular event was 92.9±1.9% at 25 years. Independent predictors were a single right coronary artery (hazard ratio, 4.58; 95% confidence interval, 1.32-15.90), P=0.0166) and postoperative heart failure (hazard ratio, 6.93; 95% confidence interval, 1.57-30.62; P=0.0107).
At last follow-up, the left ventricular ejection fraction was 60.3±8.9%, 97.3% had class I symptoms, and 5.2% obstructive coronary artery disease. Peak oxygen uptake was 35.1±7.6 mL/kg/min (86.1±15.1% predicted), with a chronotropic index <80 10.3="" 3.2="" 3.4="" 34.2="" 6.6="" and="" at="" in="" least="" mild="" moderate="" more="" neoaortic="" present="" pulmonary="" regurgitation="" respectively="" stenosis="" than="" were="">
Conclusions—Long-term and arrhythmia-free survival is excellent after arterial switch operation. Although sequelae include chronotropic incompetence and neoaortic, pulmonary, and coronary artery complications, most patients maintain normal systolic function and exercise capacity.
Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries
Paul Khairy, MD, PhD et al. Boston.
Single-institution retrospective cohort study (1983-1999). n=400.
Overall, 400 patients, 154 (38.3%) with a ventricular septal defect, 238 (59.5%) with an intact septum, and 9 (2.3%) with a Taussig-Bing anomaly, were followed for a median of 18.7 years. In perioperative survivors, overall and arrhythmia-free survival rates at 25 years were 96.7±1.8% and 96.6±0.1%, respectively.
Late mortality was predominantly a result of sudden deaths and myocardial infarction.
At 25 years, 75.5±2.5% remained free from surgical or catheter-based reintervention.
Freedom from an adverse cardiovascular event was 92.9±1.9% at 25 years. Independent predictors were a single right coronary artery (hazard ratio, 4.58; 95% confidence interval, 1.32-15.90), P=0.0166) and postoperative heart failure (hazard ratio, 6.93; 95% confidence interval, 1.57-30.62; P=0.0107).
At last follow-up, the left ventricular ejection fraction was 60.3±8.9%, 97.3% had class I symptoms, and 5.2% obstructive coronary artery disease. Peak oxygen uptake was 35.1±7.6 mL/kg/min (86.1±15.1% predicted), with a chronotropic index <80 10.3="" 3.2="" 3.4="" 34.2="" 6.6="" and="" at="" in="" least="" mild="" moderate="" more="" neoaortic="" present="" pulmonary="" regurgitation="" respectively="" stenosis="" than="" were="">
Conclusions—Long-term and arrhythmia-free survival is excellent after arterial switch operation. Although sequelae include chronotropic incompetence and neoaortic, pulmonary, and coronary artery complications, most patients maintain normal systolic function and exercise capacity.
Valsartan in Systemic RV
Circulation. 2013; 127: 322-330
Effect of Valsartan on Systemic Right Ventricular Function
A Double-Blind, Randomized, Placebo-Controlled Pilot Trial
Teun van der Bom, MD et al. Netherland.
Methods and Results—Multicenter, double-blind, parallel, randomized controlled trial of angiotensin II receptor blocker valsartan 160 mg twice daily compared with placebo in patients with a systemic right ventricle caused by congenitally or surgically corrected transposition of the great arteries.
The primary end point was change in right ventricular ejection fraction during 3-year follow-up, determined by MRI or CT. Secondary end points were change in right ventricular volumes and mass, peak, and quality of life. Primary analyses were performed on an intention-to-treat basis.
A total of 88 patients (valsartan, n=44; placebo, n=44) were enrolled in the trial. No serious adverse effects occurred in either group. There was no significant effect of 3-year valsartan therapy on systemic right ventricular ejection fraction (treatment effect, 1.3%; 95% confidence interval, −1.3% to 3.9%; P=0.34), maximum exercise capacity, or quality of life. There was a larger increase in right ventricular end-diastolic volume (15 mL; 95% confidence interval, 3–28 mL; P<0 .01="" 2="" 95="" and="" confidence="" g="" group.="" group="" in="" interval="" mass="" p="0.01)" placebo="" than="" the="" valsartan="">
Conclusions—There was no significant treatment effect of valsartan on right ventricular ejection fraction, exercise capacity, or quality of life. Small but significant differences between valsartan and placebo were present for change in right ventricular volumes and mass.
Effect of Valsartan on Systemic Right Ventricular Function
A Double-Blind, Randomized, Placebo-Controlled Pilot Trial
Teun van der Bom, MD et al. Netherland.
Methods and Results—Multicenter, double-blind, parallel, randomized controlled trial of angiotensin II receptor blocker valsartan 160 mg twice daily compared with placebo in patients with a systemic right ventricle caused by congenitally or surgically corrected transposition of the great arteries.
The primary end point was change in right ventricular ejection fraction during 3-year follow-up, determined by MRI or CT. Secondary end points were change in right ventricular volumes and mass, peak, and quality of life. Primary analyses were performed on an intention-to-treat basis.
A total of 88 patients (valsartan, n=44; placebo, n=44) were enrolled in the trial. No serious adverse effects occurred in either group. There was no significant effect of 3-year valsartan therapy on systemic right ventricular ejection fraction (treatment effect, 1.3%; 95% confidence interval, −1.3% to 3.9%; P=0.34), maximum exercise capacity, or quality of life. There was a larger increase in right ventricular end-diastolic volume (15 mL; 95% confidence interval, 3–28 mL; P<0 .01="" 2="" 95="" and="" confidence="" g="" group.="" group="" in="" interval="" mass="" p="0.01)" placebo="" than="" the="" valsartan="">
Conclusions—There was no significant treatment effect of valsartan on right ventricular ejection fraction, exercise capacity, or quality of life. Small but significant differences between valsartan and placebo were present for change in right ventricular volumes and mass.
Saturday, December 15, 2012
IVC Development - Alexander Barry's hypothesis
Clin Anat. 2010 Apr;23(3):297-303. doi: 10.1002/ca.20930.
Fetal development of the retrohepatic inferior vena cava and accessory hepatic veins: Re-evaluation of the Alexander Barry's hypothesis.
Jin ZW, Cho BH, Murakami G, Fujimiya M, Kimura W, Yu HC.
Dept. of Surgery, Chonbuk National University Medical School, Jeonju, South Korea.
Abstract
The retrohepatic inferior vena cava (IVC) is commonly considered to originate from the right vitelline or omphalomesenteric vein. In contrast, Alexander Barry hypothesized that one of the hepatic veins grows to merge with the subcardinal vein and develops into the retrohepatic IVC. We re-examined fetal development of the retrohepatic IVC and other related veins using serial histological sections of 20 human fetuses between 6 and 16 weeks of gestation. At 6-7 weeks, when a basic configuration of the portal-hepatic vein systems had just been established, one of hepatic veins (i.e., the posterocaudal vein in the present study) had grown caudally to reach the posterocaudal surface of the liver, and notably, extended into the primitive right adrenal gland (five of the eight early-staged fetuses). Because the inferior right hepatic vein (IRHV) and retrohepatic IVC appeared at the same developmental stage, it is likely that any peripheral remnants of the posterocaudal vein would continue to function as primary drainage territory for the IRHV. The caudate vein developed rapidly in accordance with marked caudal and leftward extension of Spiegel's lobe at 12-16 weeks. Thin accessory hepatic veins developed later than the caudate vein and IRHV. The present results supported Barry's hypothesis.
Fetal development of the retrohepatic inferior vena cava and accessory hepatic veins: Re-evaluation of the Alexander Barry's hypothesis.
Jin ZW, Cho BH, Murakami G, Fujimiya M, Kimura W, Yu HC.
Dept. of Surgery, Chonbuk National University Medical School, Jeonju, South Korea.
Abstract
The retrohepatic inferior vena cava (IVC) is commonly considered to originate from the right vitelline or omphalomesenteric vein. In contrast, Alexander Barry hypothesized that one of the hepatic veins grows to merge with the subcardinal vein and develops into the retrohepatic IVC. We re-examined fetal development of the retrohepatic IVC and other related veins using serial histological sections of 20 human fetuses between 6 and 16 weeks of gestation. At 6-7 weeks, when a basic configuration of the portal-hepatic vein systems had just been established, one of hepatic veins (i.e., the posterocaudal vein in the present study) had grown caudally to reach the posterocaudal surface of the liver, and notably, extended into the primitive right adrenal gland (five of the eight early-staged fetuses). Because the inferior right hepatic vein (IRHV) and retrohepatic IVC appeared at the same developmental stage, it is likely that any peripheral remnants of the posterocaudal vein would continue to function as primary drainage territory for the IRHV. The caudate vein developed rapidly in accordance with marked caudal and leftward extension of Spiegel's lobe at 12-16 weeks. Thin accessory hepatic veins developed later than the caudate vein and IRHV. The present results supported Barry's hypothesis.
Tuesday, December 4, 2012
Angiotensin Receptor Blocker for Marfan Syndrome
NEJM 2008;358:2787-95
(Click on image to enlarge)
18 pediatric patients were treated (17 received Lorsartan, 1 received Ibesartan).
Age range:1 -16 yrs (median age 6.5 yrs)
Duration of study: Median 6 yrs (~4 yrs before starting ARB & ~ 2 yrs after starting ARB)
Dose:
Losartan - started at 0.6 mg/kg/day x 3 wks. Then, gradually increased to 1.4 mg/kg/day.
Ibesartan - started at 1.4 mg/kg/day. Then, gradually increased to 2.0 mg/kg/day.
Check BUN, Creatinine, Electrolytes after 3 months.
Monday, November 19, 2012
Subscribe to:
Posts (Atom)