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  • Open Access

    ARTICLE

    Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation

    Kenan W.D. Stern1,2, Kimberlee Gauvreau1,2, Sitaram Emani3,4, Tal Geva1,2

    Congenital Heart Disease, Vol.12, No.3, pp. 350-356, 2017, DOI:10.1111/chd.12450

    Abstract Objective: Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known.
    Design: A standardized intraoperative epicardial echocardiography protocol was developed and performed at the conclusion of Stage 1 Norwood palliation. Data pertaining to visualization of relevant anatomy, and comparison of intraoperative… More >

  • Open Access

    ARTICLE

    Practice trends over time in the care of infants with hypoplastic left heart syndrome: A report from the National Pediatric Cardiology Quality Improvement Collaborative

    Waldemar F. Carlo1, James F. Cnota2, Robert J. Dabal3, Jeffrey B. Anderson2

    Congenital Heart Disease, Vol.12, No.3, pp. 315-321, 2017, DOI:10.1111/chd.12442

    Abstract Objective: The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) was established in 2008 to improve outcomes of hypoplastic left heart syndrome (HLHS) during the interstage period. They evaluated changes in patient variables and practice variation between early and late eras.
    Design: Data including demographic, operative, discharge, and follow-up variables from the first 100 patients (6/2008–1/2010) representing 18 centers were compared with the most recent 100 patients (1/2014–11/2014) from these same centers.
    Results: Prenatal diagnosis increased from 69% to 82% (P = .05). There were no differences in gestational age or weight at Norwood. A composite of any preoperative… More >

  • Open Access

    ARTICLE

    Residents’ understanding of adult congenital heart disease

    Paul Cooper1, Morgan Hindes2, Timothy M. Maul3,4, Stephen C. Cook5

    Congenital Heart Disease, Vol.12, No.3, pp. 309-314, 2017, DOI:10.1111/chd.12441

    Abstract Objective: Medical residents are exposed to increasing numbers of adults with congenital heart disease (ACHD). While inadequate ACHD knowledge may lead to inappropriate practice, this educational deficit has not been investigated. Our aim was to analyze residents’ attitudes, perceived ability, and knowledge of ACHD medicine.
    Design, Methods, Outcome Measures: A single center, multiprogram cross-sectional study was conducted in 2015 using an electronic survey to assess 472 medical residents’ perceived knowledge and self-assessed skills related to ACHD medicine. Demographic data obtained included age, gender, level of training and program type.
    Results: The survey was completed by 25% of surveyed… More >

  • Open Access

    ARTICLE

    Neurocognitive functioning in adults with congenital heart disease

    Dawn Ilardi1,2, Kim E. Ono1,2, Rebecca McCartney3, Wendy Book4, Anthony Y. Stringer2

    Congenital Heart Disease, Vol.12, No.2, pp. 166-173, 2017, DOI:10.1111/chd.12434

    Abstract Objective: Adults with congenital heart disease (CHD) are at increased risk of psychological disorders and cognitive deficiencies due to structural/acquired neurological abnormalities and neurodevelopmental disorders as children. However, limited information is known about the neuropsychological functioning of adults with CHD. This study screened neuropsychological abilities and explored group differences related to cardiac disease severity and neurological risk factors in adults with CHD.
    Design: Participants completed brief neuropsychological testing. Information about neurobehavioral and psychological symptoms, employment, education, and disability were also collected from the patient and a family member.
    Results: Forty-eight participants with adult CHD completed neuropsychological testing. Visuospatial… More >

  • Open Access

    ARTICLE

    Appropriateness and diagnostic yield of inpatient pediatric echocardiograms

    Sean M. Lang1,2,3, Elijah Bolin1,2,3, Joshua A. Daily1,2,3, Xinyu Tang1,2,3, R. Thomas Collins II1,2,3

    Congenital Heart Disease, Vol.12, No.2, pp. 210-217, 2017, DOI:10.1111/chd.12428

    Abstract Objective: Multiple reports have shown echocardiograms for certain indications are neither costeffective nor of high diagnostic yield. Given the ease with which tests can be obtained at a tertiary academic children’s hospital, our aims were to: (1) determine the diagnostic yield of inpatient studies by in-hospital location; (2) evaluate inpatient echocardiograms to determine indications and level of appropriateness; and (3) evaluate the frequency of cardiology involvement prior to those echocardiograms.
    Design: All initial inpatient echocardiograms interpreted at our institution from February 2009 to December 2014 were reviewed retrospectively. Patient location was grouped as pediatric intensive care (PICU),… More >

  • Open Access

    ARTICLE

    Prevalence and pattern of executive dysfunction in school age children with congenital heart disease

    Jacqueline H. Sanz1,2, Madison M. Berl1,2, Anna C. Armour1, Jichuan Wang3,4, Yao I. Cheng3, Mary T. Donofrio5,6

    Congenital Heart Disease, Vol.12, No.2, pp. 202-209, 2017, DOI:10.1111/chd.12427

    Abstract Objective: Executive function, a set of cognitive skills important to social and academic outcomes, is a specific area of cognitive weakness in children with congenital heart disease (CHD). We evaluated the prevalence and profile of executive dysfunction in a heterogeneous sample of school aged children with CHD, examined whether children with executive dysfunction are receiving school services and support, and identified risk factors for executive dysfunction at school age.
    Design: Ninety-one school aged patients completed questionnaires, including the Behavior Rating Inventory of Executive Function (BRIEF) and a medical history questionnaire. An age- and gendermatched control sample was… More >

  • Open Access

    ARTICLE

    Trends, microbiology, and outcomes of infective endocarditis in children during 2000–2010 in the United States

    Shipra Gupta1, Ankit Sakhuja2, Eric McGrath1, Basim Asmar1

    Congenital Heart Disease, Vol.12, No.2, pp. 196-201, 2017, DOI:10.1111/chd.12425

    Abstract Background: We studied the incidence, trend, underlying conditions, microbiology, and outcomes of infective endocarditis (IE) in children during 11 years using Nationwide Inpatient Sample (NIS) database. This is the largest all-payer inpatient care database in the United States containing data for more than 8 million hospital stays from over 1000 hospitals.
    Methods: NIS data from 2000 to 2010 of primary discharge diagnosis of IE in children aged ≤19 years old were studied. Children with underlying congenital heart defects and acquired heart conditions were identified. Microbiological causative agents were recorded. Linear regression was used to assess trend of… More >

  • Open Access

    ARTICLE

    Ability of noninvasive criteria to predict hemodynamically significant aortic obstruction in adults with coarctation of the aorta

    Marco Astengo1,2*, Caroline Berntsson3*, Åse A. Johnsson3,4, Peter Eriksson1,2, Mikael Dellborg1,2

    Congenital Heart Disease, Vol.12, No.2, pp. 174-180, 2017, DOI:10.1111/chd.12424

    Abstract Objective: Coarctation of the aorta (CoA) is a common condition. Adult patients with newly diagnosed CoA and patients with recurring or residual CoA require evaluation of the severity of aortic obstruction. Cardiac catheterization is considered the gold standard for the evaluation of hemodynamically significant CoA. The European Society of Cardiology (ESC) Guidelines for the management of grown-up congenital heart disease (GUCH) include noninvasive criteria for identifying significant CoA. Our aim was to investigate the ability of the Class I and Class IIa ESC recommendations to identify significant CoA at cardiac catheterization.
    Design: Sixty-six adult patients with native… More >

  • Open Access

    ARTICLE

    Effect of solute temperature in the measurement of cardiac output in children using the thermodilution technique

    Shyam Sathanandam1, Pooja Kashyap1, David Zurakowski2, Lindsey Bird1, Vera McGhee3, Jeffrey Towbin1, Benjamin Rush Waller III1

    Congenital Heart Disease, Vol.12, No.2, pp. 181-187, 2017, DOI:10.1111/chd.12423

    Abstract Objectives: The primary aim of this study was to compare thermodilution (TD) cardiac index (TDCi) measured by injecting cold saline (C-TDCi) to saline at room temperature (R-TDCi). The secondary aim was to assess the change in body temperature with cold saline injections in children.
    Design: This is a prospective, case control study.
    Setting: Cardiac catheterization lab at Le Bonheur Children’s Hospital, Memphis, Tennessee.
    Patients: Eighty-six children ≤18 years of age that underwent cardiac catheterization between April 2013 and April 2015, excluding patients with admixing lesions, on inotropic support and with ejection fraction < 30%.
    Interventions: A TD catheter in the… More >

  • Open Access

    ARTICLE

    Electrocardiographic early repolarization characteristics and clinical presentations in the young: a benign finding or worrisome marker for arrhythmias

    Raya Safa, Ronald Thomas, Peter P. Karpawich

    Congenital Heart Disease, Vol.12, No.1, pp. 99-104, 2017

    Abstract Background: The early ECG repolarization QRS pattern (ERp), with J-point elevation of 0.1 mV in two contiguous inferior and/or lateral leads, can be associated with ventricular arrhythmias among adults. The significance of an ERp in the young is unknown.
    Objective: The purpose of this study was to assess the prevalence of ERp among young patients (pts), describe and correlate the characteristics with clinical presentations and any arrhythmias.
    Methods: This was a 1 y retrospective review of ECGs obtained from patients referred specifically for documented arrhythmias, possible arrhythmia-related symptoms or sports clearance. ECGs were analyzed for ERp (J-point, ascending/horizontal… More >

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