Metabolische Alkalose nach herzchirurgischen Eingriffen im Kindesalter

Effects of Tolazoline and Prostacyclin on Pulmonary Hypertension in Infants After Cardiac Surgery

Objective To evaluate the hemodynamic effects of tolazoline and prostacyclin in infants with pulmonary vasospasm after cardiac surgery. Design Prospective cohort study. Setting Pediatric ICU. Patients The cohort consisted of 42 infants and children with congenital heart disease and pulmonary hypertension who underwent corrective surgery and were monitored postoperatively using pulmonary artery catheters. Fourteen infants (2 to 12 months old) in this group required postoperative treatment with tolazoline or prostacyclin. Interventions Tolazoline was administered as a bolus of 0.5 mg/kg for treatment of persistent pulmonary hypertension or acute pulmonary hypertensive crisis. If its effective…

Transcatheter radiofrequency perforation and stent implantation for palliation of pulmonary atresia in a 3060-g infant

In a 3060-g infant with fibromuscular pulmonary atresia an open right ventricular outflow tract was created by means of interventional cardiological methods. Following two inadvertent perforations without sequelae or clinical symptoms, radiofrequency perforation and subsequent balloon dilatation were successfully performed. The implantation of a Palmaz iliac stent led to a predictable communication between the right ventricle and pulmonary artery.

Mitral and aortic regurgitation in 84 patients with mucopolysaccharidoses

In echocardiographic and necropsy studies nodular thickening of the mitral valve and, less frequently, of the aortic valve has been found in 60%-90% of patients with mucopolysaccharidoses (MPS). Little is known about the haemodynamic consequences of these morphological changes. In this study 84 unselected patients with different enzymatically proven MPS and 84 age and sex matched, healthy persons were studied prospectively by colour Doppler flow mapping. The patients' age ranged from 1 to 47 years (median 8.1 years). Mitral and aortic regurgitation were defined as a holosystolic or holodiastolic jet originating from the valve into the left atrium or the left ventricular outflow tract, respe…

Continuous monitoring of mixed venous oxygen saturation in infants after cardiac surgery

Continuous mixed venous oxygen saturation (SvO2c) was measured in 16 infants immediately after cardiac surgery. A polyurethane 4F, dual channel catheter (Opticath, Modell U440, Oximetrix) with fiberoptic filaments was introduced into the pulmonary artery during cardiothoracic surgery. The catheters were left in place for an average of 67.5 h (range 27 h -125 h) and there were no catheter-related complications. Correlation between continuous in vivo SvO2 values and in vitro values was satisfactory (r = 0.85), whereas a correlation between SvO2c and arterial oxygen saturation (SaO2) was not found (r = 0.07). The sampled arterial lactate values were inversely correlated to the simultaneously m…

Gradual angioplasty and stent implantation to treat complete superior vena cava occlusion after Mustard procedure

A 16-year-old male was admitted with complete occlusion of the superior vena cava pathway 14 years after Mustard procedure for transposition of the great arteries. From a left subclavian vein approach, the atretic vein segment was perforated using a straight guidewire, and was followed by sequential balloon dilation. Implantation of a 30 mm Palmaz-stent through a femoral vein approach resulted in a widely patent channel of the vena cava superior into the systemic venous atrium. © 1996 Wiley-Liss, Inc.

Nitric oxide and prostacyclin lower suprasystemic pulmonary hypertension after cardiopulmonary bypass

In a 3-week-old male newborn persistent suprasystemic pulmonary hypertension developed after surgical valvulotomy for a critical aortic valve stenosis. Because of a residual transvalvular pressure gradient of 35 mmHg and postoperative left as well as right ventricular dysfunction, treatment with inhaled nitric oxide (NO) and intravenously infused prostacyclin (PGI2) was attempted. Low-dose inhaled NO and low dose PGI2 corrected severe pulmonary hypertension and led to an increase in cardiac output. Treatment with NO but not PGI2 was accompanied by a rise in PaO2 and systemic blood pressure. Interruption of NO administration led to a rapid increase in pulmonary arterial pressure to suprasyst…

Reduced inotropic support after aprotinin therapy during pediatric cardiac operations

Several reports indicate that aprotinin treatment before and during cardiopulmonary bypass (CPB) might have a protective effect on the myocardium. We evaluated the hemodynamic effects of perioperative aprotinin treatment.We conducted a randomized, double-blind, placebo-controlled trial in 34 infants (mean age, 2.5 years) who had cardiac operations. Half of the patients received high-dose aprotinin therapy. There were no significant differences between the aprotinin and placebo groups with respect to age, weight, sex, aortic cross-clamp time, and CPB time. The following data were recorded at arrival in the intensive care unit 6, 12, 24, and 48 hours after termination of CPB: heart rate, bloo…

Independent right lung high frequency and left lung conventional ventilation in the management of severe air leak during ARDS

Summary Pulmonary air leaks are one of the most common problems in patients with the adult respiratory distress syndrome, ARDS. We report what we believe to be the first case in which unilateral high-frequency ventilation combined with contralateral conventional positive pressure ventilation has been used successfully to manage severe air leak in an infant with ARDS.

Three cases of neonatal herpes simplex virus infection presenting as fulminant hepatitis

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.

Colour-flow-mapping in patients with ventricular septal defect.

Evaluation of the pulse wave arrival time as a marker for blood pressure changes in critically ill infants and children

Objective. Pulse arrival time (PAT), which is the interval between the R wave of the electrocardiogram (ECG) and the arrival of the pulse wave peripherally, has been reported to be suitable for use as an indirect measure of blood pressure change. The purpose of this study was to evaluate, in critically ill infants and children, the degree to which 1/PAT covaries with systolic, diastolic, and mean blood pressure, as well as heart rate.Methods. A laboratory device was used to calculate PAT in real time from the ECG and the plethysmographic curve of pulse oximetry used for routine monitoring. Calculated PAT and corresponding blood pressures and heart rate were stored on hard disk. A total of 1…

Verschluß einer Gaumenspalte bei einer Patientin mit Ebstein-Anomalie unter Hochfrequenzoszillationsbeatmung

Hintergrund: Es wird uber den zunachst nicht erfolgreichen Versuch der konventionellen Beatmung wahrend eines kieferchirurgischen Eingriffs bei einer Patientin mit Ebstein-Anomalie berichtet. Verminderter pulmonaler Blutflus und entsprechend verminderter linksventrikularer Auswurf fuhrten zu einer arteriellen Hypotonie mit Sauerstoffsattigungsabfall. Unter Spontanatmung normalisierte sich der kritische Zustand rasch. Operation: Der Einsatz eines Hochfrequenzoszillationsbeatmungsgerats (SensorMedics 3100A) mit gleichbleibendem mittlerem Atemwegsdruck und Vermeiden inspiratorischer Spitzendrucke ermoglichte 2 Jahre spater eine adaquate Ventilation und Oxygenierung der Patientin, so das die Op…

Hemodynamic effects of dobutamine in children with cardiovascular failure.

The effect of dobutamine, a synthetic catecholamine, was studied in 12 patients aged one day to 14 years with low cardiac output syndromes. After initial stabilization of the patients dobutamine was administered by continuous infusion in a dosage of 7.5 or 10 μg/kg/min. Heart rate, cardiac output (using thermodilution technique and/or pulse contour method), mean systemic and mean pulmonary artery pressures were determined before and after the dobutamine infusion. Systemic and pulmonary vascular resistances, cardiac index and stroke volume index were calculated. Cardiac output and cardiac index increased significantly in every patient, whereas the heart rate changed only slightly, suggesting…

Congenital pulmonary lymphangiectasia

Continuous measurement of cardiac output by the Fick principle in infants and children: comparison with the thermodilution method.

To compare a system that continuously monitors cardiac output by the Fick principle with measurements by the thermodilution technique in pediatric patients.Prospective direct comparison of the above two techniques.Pediatric intensive care unit of a university hospital.25 infants and children, aged 1 week to 17 years (median 10 months), who had undergone open heart surgery were studied. Only patients without an endotracheal tube leak and without a residual shunt were included.The system based on the Fick principle uses measurements of oxygen consumption taken by a metabolic monitor and of arterial and mixed venous oxygen saturation taken by pulse- and fiberoptic oximetry to calculate cardiac…

Toxisches Schock Syndrom

We report about a one year old girl with toxic shock syndrome (TSS), which was confirmed by a significant rise of TSST-1 titers. In addition to known manifestations of TSS, to our knowledge this is the first report about development of polyserositis in this disease. Tumor necrosis factor (TNF) was elevated at initial evaluation and fell under treatment with cortisone. This finding is in contrast to in-vitro observations. We believe that the use of cortisone in TSS warrants further investigation.

Analgosedierung mit Fentanyl/Midazolam nach Korrektur angeborener Herzfehler

Abstract There is no standard therapy in the management of postoperative pain control following corrective cardiac surgery of congenital heart disease. Assessment in the preverbal age is difficult. In a randomized study we compared a combined treatment of fentanyl and midazolam, given as continuous infusion versus single dose application. A pain assessment score was used to measure the effectiveness of analgosedation in addition to recording nurseries observations. Fentanyl and midazolam are an appropriate combination for postoperative pain treatment. Continuous application is considered to be more effective concerning basic anxiety, cumulative dosage and to avoid volume overload in infants…

Assistierte Zirkulation bei einem 7 Tage alten Neugeborenen wegen Postkardiotomie-low-output-syndrom

Bei einem 7 Tage alten Saugling wurde ein nach anatomischer Korrektur einer d-Transposition der grosen Arterien aufgetretenes Postkardiotomie-low-output-Syndrom mittels assistierter Zirkulation behandelt. Unter Einsatz eines Zentrifu-galpumpensystems konnte die linksventrikulare Kreislaufunterstutzung bis zur Durchfuhrung eines erfolgreichen Entwohnungsverfahrens nach insgesamt 20 Stunden der Kreislaufassistenz aufrechterhalten werden. Zum Entlassungszeitpunkt war bei dem neurologisch unauffalligen Neugeborenen echokardiographisch eine komplette Erholung der linksventrikularen Funktion nachweisbar.

Interventionelle Behandlung von Neugeborenen mit Pulmonalatresie und intaktem Ventrikelseptum durch Eröffnung der Pulmonalklappe oder Stentimplantation in den Ductus Botalli

Die chirurgischen Moglichkeiten fur Neugeborene mit Pulmonalatresie und intaktem Ventrikelseptum bestehen in der Etablierung eines adaquaten pulmonalen Blutflusses und, wenn moglich, in der Eroffnung des rechtsventrikularen Ausflustrakts. Die Patientenauswahl fur eine pulmonale Valvulotomie mit oder ohne Anlage eines systempulmonalarteriellen Shunts hangt vom Vorliegen eines rechtsventrikularen Ausflustrakts und der Morphologie der rechten Kammer ab. In den letzten Jahren sind neue Herzkathetertechniken entwickelt worden, die eine Eroffnung und nachfolgende Ballondilatation der atretischen Klappe oder ein Stenting des Ductus arteriosus erlauben. Wir berichten uber unsere Erfahrungen mit die…

Kontinuierliche EEG-Ableitung unter submaximaler fahrradergometrischer Belastung epilepsiekranker Kinder

Dreisig epilepsiekranke Kinder wurden unter kontinuierlicher EEG-Ableitung einer fahrradergometrischen Belastung unterzogen. Patienten mit einer primar generalisierten Epilepsie (acht Kinder) zeigten keine pathologischen Veranderungen. Vier von siebzehn Kindern mit einer focalen Epilepsie und zwei von funf mit einer sekundar generalisierten Epilepsie wiesen eine Verschlechterung unter Belastung auf. Hypersynchrone Aktivitaten traten besonders bei den Kindern auf, deren letzter Anfall weniger als zwei Wochen zurucklag. Ein Krampfanfall wurde bei keinem Kind ausgelost. Die individuelle Beurteilung der Sportfahigkeit mus die Epilepsieform und die Anfallshaufigkeit berucksichtigen. Wahrend der …

Congenital mitral regurgitation caused by a perforation in the anterior leaflet: Perioperative evaluation by color-coded Doppler echocardiography

Color-coded two-dimensional (2D) echocardiography confirmed the presence of severe congenital mitral regurgitation in an 8-month-old infant. Intraoperative inspection revealed an isolated perforation in the anterior leaflet.