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A Review of Pediatric Cardiovascular Risk Factors and Current Guidelines

World Journal of Cardiovascular Surgery 2018年第4期8卷 61-92页

作者： Deeksha Sarma Lawrence M. Benedict achintya moulick Randy Stevens Vicki Mahan Department of Pediatric Cardiothoracic Surgery Drexel University College of Medicine St. Christopher’s Hospital for Children Philadelphia USA

Dyslipidemia is a highly prevalent condition, and includes a collection of diseases that cause increased levels of plasma triglycerides and/or cholestrol, or decreased levels of HDL-C, with a prototypical disease being familial hypercholesterolemia. Dyslipidemic conditions promote increased atherogenesis through the oxidation of lipids by macrophages, and an increased response to injury by the vascular endothelium. This vascular damage, loss of vascular compliance, and overall hardening of arteries lead to sequellae such as cardiovascular disease, cerebrovascular events, and aneurysm formation. It has been established that certain risk factors predispose individuals to the sequellae of atherosclerosis, including smoking, diabetes, hypertension, and hyperlipidemia. However, studies show that these risk factors can be seen in children as well. This review aims to assess the effect of these risk factors and demonstrate their effects through adolescence into adulthood.

关键词： Cardiovascular Disease Familial Hypercholesterolemia Dyslipidemia Atherosclerosis

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Hemodynamic Changes and Clinical Outcomes after the Intra/Extracardiac Fenestrated Fontan Procedure

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World Journal of Cardiovascular Surgery 2018年第2期8卷 29-39页

作者： Naveen Menon Chihyang Lin Cesar I. Mesia achintya moulick Randy Stevens Vicki Mahan Drexel University College of Medicine and Department of Pediatric Cardiothoracic Surgery St. Christopher’s Hospital for Children Philadelphia PA USA

Background: The primary concern of the Fontan procedure has been atrial arrhythmias, but little attention has been given to hemodynamic changes. This study’s purpose was to examine the hemodynamics and arrhythmias of the Intra/extracardiac fenestrated Fontan, and determine any advantages/disadvantages of this newer Fontan procedure. Methods: Patients undergoing the intra/ extracardiac fenestrated Fontan procedure at this institute between December 2009 and June 2017 were included in this retrospective evaluation of preoperative and postoperative hemodynamics during cardiac catheterization. End Diastolic Pressure (EDP), Pulmonary Artery Pressure (PAP), Left Atrial Pressure (LAP), and Transpulmonary Gradient (TPG) were the hemodynamic markers of interest. Occurrence of arrhythmias was also examined preoperatively, less than 2 weeks postoperatively, and greater than 2 weeks postoperatively. Morbidities and mortalities were also evaluated. Results: Fourteen patients underwent the procedure between December 2009 and June 2017. Preoperative data was available in all of these patients. Postoperative data was partially incomplete for atrial arrhythmias and hemodynamic data. EDP rose from 9.29 ± 3.50 mmHg to 10.33 ± 3.12 mmHg. PAP rose from 12.57 ± 2.50 mmHg to 14.27 mmHg. TPG dropped from 5.00 ± 2.29 mmHg to 3.25 ± 1.67 mmHg. LAP rose from 7.57 ± 2.87 mmHg to 10.30 ± 1.95 mmHg. Atrioventricular valve (AVV) regurgitation remained the same pre and postoperatively. 8 of 13 patients developed arrhythmias at less than 2 weeks postoperatively, and 5 of 12 patients developed arrhythmias at greater than 2 weeks postoperatively. There were no morbidities or mortalities. Conclusions: We found a statistically significant change in EDP, PAP, LAP, and TPG levels. It is unclear whether this is an advantage or disadvantage. The significance of these changes is unclear in this small population of patients. Further evaluation of hemodynamics, arrhythmias, morbidities and mortalities associa

关键词： Fontan Functionally Univentricular Heart Circulatory Hemodynamics Hypoplastic Left Heart Syndrome Congenital Heart Disease (CHD)

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Innominate Artery Cannulation Access in Pediatric Patients Undergoing Redo Sternotomy

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World Journal of Cardiovascular Surgery 2016年第9期6卷 112-116页

作者： Lydia Ran John Schultz Jeeni Patel Randy Stevens achintya moulick Vicki Mahan Drexel University College of Medicine Philadelphia PA USA Department of Cardiothoracic Surgery St. Christopher’s Hospital for Children Philadelphia PA USA

Redo sternotomy in pediatric patients can be complicated due to the unsuitability of many arterial cannulation sites for the pediatric population. Innominate artery cannulation provides a safe and easily reproducible alternative and prevents many of the disadvantages seen in femoral and axillary artery cannulation. Its use in pediatric cardiac surgery has seen a rise [1]. Herein, we describe the technique for innominate artery cannulation in pediatric patients undergoing redo sternotomy and review our experience with the technique.

关键词： Reentry Sternotomy Redo Sternotomy Cannulation for Cardiopulmonary Bypass Aortic Cannulas

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Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

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World Journal of Cardiovascular Surgery 2018年第1期8卷 7-21页

作者： Vicki L. Mahan Monika Gupta Stephen Aronoff David Bruni Randy M. Stevens achintya moulick Division of Pediatric Cardiothoracic Surgery/Department of Surgery St. Christopher’s Hospital for Children/Drexel University College of Medicine Philadelphia USA Division of Critical Care/Department of Pediatrics St. Christopher’s Hospital for Children/Drexel University College of Medicine Philadelphia USA Division of Pediatric Infectious Disease/Department of Pediatrics Lewis Katz School of Medicine at Temple University Philadelphia USA Drexel University College of Medicine Philadelphia USA

Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.

关键词： Re-Entry Sternotomy Vasoactive-Ventilation-Renal Score VVR Score Recursive Partitioning Analysis Congenital Heart Disease (CHD)

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