RESUMO
A total of 466 neonates with transposition of the great arteries, all less than 15 days of age, have been entered into a 20-institution study between Jan. 1, 1985, and June 1, 1987. Seventy-three percent were less than 48 hours old when entered into the study. Two hundred twelve of these underwent an arterial switch repair, and the 1-week, 1-year, and 2 1/2-year survival rates were 82%, 79%, and 78%, respectively. The usual coronary anatomy was present in 67% of the patients. The arterial switch repair was performed in 16 of the institutions. Six among these were shown to be "low-risk" institutions, with the prevalence of the demographic and surgical variables seeming to be the same in these as in the other institutions. The 1-week, 1-year, and 2 1/2-year survival rates after the arterial switch repair in low-risk institutions for simple transposition were 96%, 91%, and 90%, respectively; for transposition with ventricular septal defect they were 84%, 83%, and 83%. Only older age at operation (over 14 days of age), in the case of simple transposition, and transposition with ventricular septal defect were risk factors for death in these six institutions. Among the patients as a whole, freedom from reoperation for pulmonary outflow obstruction at 1 week and 1 year was 99% and 89%, respectively. A previous pulmonary artery banding and, possibly, one institution were identified as risk factors for reoperation. Inferences: In low-risk institutions, the arterial switch repair can be accomplished with good early results, which suggests the possibility that the late results will be better than after the atrial switch repair. Since young age was not a risk factor for the arterial switch repair of transposition and ventricular septal defect, this type of repair for this anomaly, as well as for simple transposition, may be more advantageously performed early in life than at 2 to 3 months of age.
Assuntos
Transposição dos Grandes Vasos/cirurgia , Fatores Etários , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido , Estudos Multicêntricos como Assunto , Reoperação , Fatores de Risco , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/mortalidadeAssuntos
Cateterismo Cardíaco , Hipnóticos e Sedativos/uso terapêutico , Pré-Medicação , Anestesia Geral/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Criança , Halotano/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipnóticos e Sedativos/farmacologia , Ketamina/farmacologiaRESUMO
To determine the accuracy and reproducibility of cardiac output determination by thermodilution (COT) in children, simultaneous outputs were measured by the Fick technique (COF) (using measured oxygen consumption) and thermodilution in 26 children, ranging in age from 8 to 86 months, who were undergoing cardiac catheterization. There was excellent correlation between mean output by thermodilution and by the Fick technique: COT = 1.10 COF -- 0.2 l/minute, R = 0.91. In three-quarters of the patients with COT differed by 15% or less and in none differed by more than 25%. Serial values of thermodilution outputs were reproducible in each patient with a SD of 5.5%. Our observations indicate that COT is accurate, reproducible, and valuable in the care of critically ill infants and children.
Assuntos
Débito Cardíaco , Termodiluição , Cateterismo Cardíaco , Criança , Pré-Escolar , Humanos , Lactente , MétodosRESUMO
Infusion of prostaglandin E1 into the main pulmonary artery of an infant with interruption of the aortic arch and a closing ductus arteriosus resulted in dilation of the ductus arteriosus and improved systemic perfusion. Treatment with prostaglandin E1 is recommended for infants with interruption of the aortic arch, critical coarctation of the aorta, and other lesions in which systemic perfusion is limited by a restrictive ductus arteriosus.