摘要:

Neurodevelopmental outcome of children with congenital heart disease includes a wide spectrum of developmental disorders from language and learning disabilities to mental retardation, delayed development, and cerebral palsy. Numerous studies of cardiopulmonary bypass show that this procedure alone does not affect IQ, but length of circulatory arrest and pH management are associated with decreased IQ. Described here is a behavioral phenotype of children with cardiac disease with a low normal IQ and perceptual-motor delays who are temperamentally more difficult. Further investigation of the vulnerability of specific cardiac lesions, mode of treatment, and the behavioral phenotype of children with congenital heart disease along with the influences of family functioning, socioeconomic status, and chronic medical care is warranted.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Sick sinus syndrome, the significant clinical manifestation of progressive sinus node dysfunction, is the most frequent indication for the implantation of permanent pacing systems in the United States. Revolutionary advances in pacemaker hardware and programmability now allow a careful tailoring of device, mode, and program for the individual patient and underlying electrophysiologic abnormalities. Evidence indicates that appropriate mode selection in this group of patients not only ameliorates symptoms but may decrease the incidence of complications and help maintain an acceptable quality of life. Most available data is retrospective and uncontrolled, therefore controversy remains regarding mode recommendations. More conclusive data may be produced by clinical trials currently in progress. This article reviews the latest innovations and recommendations regarding permanent pacing for sick sinus syndrome.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Episodes of sustained atrial fibrillation have long been effectively treated with external, transthoracic defibrillation. Despite concomitant, postcardioversion therapy with antiarrhythmic agents, patients will frequently have additional episodes of atrial fibrillation requiring either repeat external cardioversion or treatment with either pharmacologic or additional nonpharmacologic therapies. The limited long-term efficacy of different treatment regimens has resulted in the development and evaluation of newer, nonpharmacologic therapeutic options including the implantable atrial defibrillator. The feasibility of an implantable atrial defibrillator has been supported by recent advances in the areas of implantable ventricular defibrillators, including device size and transvenous lead systems. The concept is also supported by the demonstration in recent studies that transvenous, internal cardioversion of atrial fibrillation is possible using low energy shocks. Preliminary data suggest that low-energy atrial defibrillation shocks synchronized to an R wave with a relatively long coupling interval does not result in potentially lethal ventricular arrhythmias. Patient tolerance, and therefore acceptance of therapy, is presently a topic of significant concern and evaluation. Although present data suggest that the concept of an implantable atrial defibrillator is a potential treatment option for recurrent, persistent atrial fibrillation, significant clinical evaluation is required to define the patient population and overall clinical use of this type of device, either as a stand-alone therapy or in combination with other pharmacologic and nonpharmacologic therapies.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Atrial fibrillation, the most common of all sustained cardiac arrhythmias, can be cured using extensive surgical atriotomies. Experimental studies using linear radiofrequency catheter ablation lesions suggest the relative safety and high efficacy of these procedures. However animal models may not be relevant to human pathology because of the small size of atria, different pathophysiologic substrates, and the lack of data pertaining to spontaneous initiation of atrial fibrillation. Preliminary human studies show a higher success rate when linear ablations are performed in the left atrium than in the right atrium and that arrhythmogenic foci play a significant role in atrial fibrillation. However the procedures are prolonged, and it is difficult with current technology to achieve a linear conduction block consistently. The challenge remains to optimize this as yet investigational technique and transform it into a routine procedure.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Pharmacologic treatment continues to be the mainstay of therapy in patients with atrial fibrillation (AF). Over the past few years, considerable progress has been made in establishing the role of antiarrhythmic drug therapy for restoration and subsequent maintenance of sinus rhythm as well as for the control of ventricular rate in permanent AF. For pharmacologic cardioversion, intravenous or oral administration of class IC drugs is associated with success rates of 60% to 80% depending mainly on the duration of the arrhythmia. In persistent AF of longer than 1 week's duration, electrical cardioversion is recommended because this method is more effective and safer than drug therapy. For maintenance of sinus rhythm following successful cardioversion, class I drugs continue to be used often. However, there is increasing awareness of their proarrhythmic risk, particularly in the case of quinidine. Sotalol, a class III agent with β-receptor antagonism, is as effective as quinidine but better tolerated. In patients with so-called refractory AF, amiodarone has been proven to be effective in approximately 60% to 70% of treatment attempts. For control of ventricular rate, digoxin, β-blockers, and calcium-channel antagonists are widely used. In these patients, chronic anticoagulation with warfarin aiming at international normalized ratios between 2.0 and 3.5 has been documented to significantly reduce thromboembolic risk.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Patients with sustained ventricular tachyarrhythmias in the absence of a reversible cause require long-term therapy. Six approaches may have value in this setting, including individualized drug therapy selected by the invasive approach, individualized drug therapy selected by the noninvasive approach, β-blocking therapy, amiodarone, transcatheter or electrosurgical ablation, and the implantable cardioverter defibrillator. Data supporting the four pharmacologic approaches and data comparing these approaches to one another and to the implantable cardioverter defibrillator are reviewed. Support for primary therapy with a β-blocker is the weakest. Nevertheless, a role for concomitant β-blockade is established. Comparisons of the invasive and noninvasive approaches suggest that, in drug-naive patients, the invasive approach is effective but the noninvasive approach is not, whereas in drug-resistant patients, neither approach is adequate. Data suggesting that amiodarone is more effective than individualized drug therapy is not compelling but is widely accepted. Given these uncertainties, many authorities have embraced the implantable cardioverter defibrillator as the therapy of choice.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Progress has been made in the treatment of children born with hypoplastic left heart syndrome. From a mortality of more than 95% at 1 month of age in an era prior to surgical intervention, an actuarial survival of 58% at 5 years of age for staged surgical palliation is now being achieved. The short-term results with cardiac transplantation also appear to be excellent. Efforts are being directed at identifying potential risk factors, and fetal ultrasonography is capable of monitoring the progression of this malformation in utero. Refinements in surgical technique and postoperative care have been achieved, reducing the overall risk of the Norwood operation and sudden hemody-namic instability in the intensive care unit. Practice patterns and perceptions of outcome vary widely. Presently there is no unanimity of opinion that surgical therapy should be offered to all patients, and comfort care continues to be a family option.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

There have been multiple modifications for surgical palliation of functional single ventricle since the initial report by Fontan and Baudet in 1971. A modified Fontan procedure has been offered to patients with a variety of complex cyanotic heart disease at younger ages, and has resulted in decreased mortality. Reducing morbidity continues to be a challenge. These issues are multiple and include effusions, arrhythmia, ventricular function, exercise ability, progressive cyanosis from pulmonary arteriovenous malformations, systemic to hepatic venovenous malformations or atrial level shunting, thromboembolism, and protein-losing enteropathy. This article reviews clinical contributions published in the past year.

ISSN:0268-4705    

出版商:OVID    

年代:1997

数据来源: OVID