摘要:

Postoperative arrhythmia is a major cause of morbidity and mortality after cardiac surgery for congenital heart disease. Rhythm disturbances that may be well tolerated in a normal heart often cause hemodynamic instability when they occur in the immediate postoperative period. In the face of pre-existing myocardial dysfunction resulting from preoperative pressure or volume overload, patients with congenital heart conditions are especially vulnerable to rhythm disturbances after cardiac surgery. Cardiopulmonary bypass, intraoperative injury to the conduction system and myocardium, postoperative metabolic abnormalities, electrolyte disturbances, and increased adrenergic tone in response to the stress of the surgery or inotropic agents are also known factors associated with increased risk of arrhythmia in the immediate postoperative period. Surgically related arrhythmia can also present in the late postoperative period, particularly in association with surgical incision sites and surgically induced hemodynamic abnormalities. Early and late postoperative arrhythmias are important risk factors for morbidity and mortality after surgical treatment of many forms of congenital heart disease. This review describes the incidence of the most common forms of arrhythmia and recent advances in their diagnosis and treatment.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A trend toward use of less invasive, nonsurgical approaches to the treatment of congenital heart disease has developed. Although transcatheter valve replacements and ventricular septal defect closures have already been performed in children, many other techniques and devices are being developed for the palliation of children with a single ventricle. Several groups have already established catheter-based procedures for the creation of Fontan communications, and others have performed nonsurgical pulmonary artery banding. Additionally, fetal catheter-based interventions are being developed for the treatment of severe congenital heart diseasein utero.Because this trend toward catheter-mediated treatment is certain to continue, care must be taken to regulate safely the introduction of novel techniques and devices into clinical use in pediatric cardiology.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Cardiomyocyte injury in pediatric patients has a vast number of causes, which are often distinct from the causes of adult heart failure. However, the management of pediatric heart failure and heart transplantation has generally been inferred from adult studies. New therapies show great promise for the neurohormonal regulation of heart failure and the ability to control immunosuppression after heart transplantation. Large, randomized, multicenter, controlled clinical trials are needed to determine the efficacy of these therapies in this population. This article reviews the current recommendations and evidence-based medicine, where available, for the medical management of myopathic dysfunction and transplantation in pediatric patients.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Care for children with congenital heart disease requires specialized services and various healthcare resources. The purpose of this article is to provide an updated overview of healthcare resources for infants and children with heart disease. In 2001, there were 1609 certified pediatric cardiologists in the United States. The ratio was approximately 45,000 children younger than 18 years per pediatric cardiologist. It is estimated that more than 19,000 cardiac surgeries are performed in children younger than 18 years in the United States each year. This article also reviews the effect of patient characteristics on access to healthcare and use of pediatric cardiac services, and discusses issues related to optimal use of these resources and the development of an organized approach toward service management by regionalization. The authors believe that improved access to high-quality facilities and providers coupled with thoughtful changes in the healthcare delivery system represent an excellent opportunity for optimizing outcomes for children with heart disease.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Mitral valve repair as a proportion of all mitral valve procedures continues to become more prominent in this country. As the procedures are performed more frequently and concomitantly surgeons become more comfortable performing these repairs, risks and benefits (compared with mitral valve replacement) have become better defined. The patient population and valve morphology that are most favorable for the repair approach have also been better defined, and new techniques (including minimally invasive approaches) have been reported. A prominent question remains: what to do about ischemic mitral regurgitation.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The diagnosis of infective endocarditis has been notoriously difficult. Over the last decade, the modified Duke criteria have assumed an increasingly important role in the early detection of this often occult disease. Echocardiography has assumed increasing importance. Transesophageal echocardiography is recognized as more sensitive and specific than transthoracic echocardiography at detecting vegetations less than 10 mm in diameter. Vegetations greater than 10 mm in diameter are thought to be at increased risk of embolizing. Combined medical and surgical medical management result in the lowest mortality for those patients with hemodynamic compromise.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Chronic thromboembolic pulmonary hypertension is associated with right ventricular dilatation, high right-sided filling pressures, and functional tricuspid regurgitation. The tricuspid regurgitation resulting from this disease has been postulated to be caused by tricuspid annular dilatation with displacement of the papillary muscles. Pulmonary endarterectomy is an operation that corrects the pulmonary hypertension resulting from chronic thromboemboli. As a result of this operation, most patients show significant improvement in tricuspid valve function. Thus, pulmonary endarterectomy is one of the few cardiac operations in which surgery remote to a valve restores valve function. This review analyzes the factors responsible for changes in tricuspid valve regurgitation after pulmonary endarterectomy and provides a strategy to predict the small subset of patients who will not show improvement in tricuspid valve function after this operation.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Aortic valve replacement for aortic stenosis represents a tremendous achievement in the management of cardiac disease. However, despite 4 decades of use, the ideal substitute for the diseased aortic valve is still not agreed upon. Stentless aortic valves represent the optimum in hemodynamic performance. This article reviews the current thinking in stentless aortic valve surgery.

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:2003

数据来源: OVID