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The current range of clinical applications for cerebrospinal fluid (CSF) dynamics testing includes hydrocephalus, idiopathic intracranial hypertension, craniosynostosis, and traumatic brain injury. CSF dynamics depends on interaction between four components: CSF production, flow, absorption, and pulsations. The mathematical model of CSF pressure-volume compensation provides a theoretical basis for the differential diagnosis in hydrocephalus. Components of this model are identified in many clinical scenarios and are in use in clinical diagnostic procedures. In all pressure-volume testing techniques, parameters of model are estimated using various algorithms and various volume-adding techniques. Pulse amplitude of intracranial pressure (ICP) is synchronized with pulse amplitude of arterial pressure and the pulse amplitude of blood flow velocity in the middle cerebral artery. Pulse amplitude increases proportionally to mean CSF pressure during the infusion study. The resistance to CSF outflow demonstrates significant associations with cerebrovascular reactivity: patients with lower Rout tend to have more frequently disturbed cerebrovascular reactivity.
Rashkind balloon atrial septostomy is a common cardiac procedure aimed at improving systemic oxygenation in newborns with cyanotic congenital cardiac defects, such as transposition of the great arteries. Recent reports on the safety of this procedure were from limited series at single institutions. We analysed two complementary national databases to evaluate clinically relevant outcomes of this procedure.
Methods and results
We performed an analysis of transposition of the great artery patients nationwide using 15 years of the Nationwide In-patient Sample and three complementary years of the Kids’ Inpatient Database. Variables included gender, race, age, and co-existing diagnoses. Outcomes included mortality, length of stay, and hospital charges. Comparison between patients undergoing Rashkind procedure or not was performed using Pearson’s chi-square and Kruskal–Wallis tests. We identified 8681 patients with transposition of the great arteries, of whom 1742 (20%) underwent Rashkind procedure. Patients undergoing Rashkind procedure had lower mortality (10% versus 12%, p = 0.021), despite higher median co-morbidities and longer median length of stay. Rashkind procedure was not associated with increased risk of necrotising enterocolitis (1% versus 1%, p = 0.630), but was associated with nearly twice the risk of clinically recognised stroke (1% versus 0%, p = 0.046).
This study represents the largest national analysis of transposition of the great artery patients to date, with a subset treated with Rashkind procedure. Patients not undergoing Rashkind procedure had higher mortality. Rashkind procedure was not associated with increased risk of necrotising enterocolitis, but was associated with twice the risk of stroke.
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