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While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis.
Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to end-diastolic pressure using Spearman’s test.
Median age at echocardiogram was 4.6 (range 2.5–7.4) months. Median ventricular end-diastolic pressure was 7 (range 3–19) mmHg. Median time difference between the echocardiogram and catheterisation was 0 days (range −35 to 59 days). Examining the entire cohort of 155 patients, no echocardiographic diastolic function variable correlated with ventricular end-diastolic pressure. When the analysis was limited to the 86 patients who had similar sedation for both studies, the systolic:diastolic duration ratio had a significant but weak negative correlation with end-diastolic pressure (r = −0.3, p = 0.004). The remaining echocardiographic variables did not correlate with ventricular end-diastolic pressure.
In this cohort of infants with single ventricle physiology prior to superior cavopulmonary anastomosis, most conventional echocardiographic measures of diastolic function did not correlate with ventricular end-diastolic pressure at cardiac catheterisation. These limitations should be factored into the interpretation of quantitative echo data in this patient population.
In this book Steven Levine explores the relation between objectivity and experience from a pragmatic point of view. Like many new pragmatists he aims to rehabilitate objectivity in the wake of Richard Rorty's rejection of the concept. But he challenges the idea, put forward by pragmatists like Robert Brandom, that objectivity is best rehabilitated in communicative-theoretic terms - namely, in terms that can be cashed out by capacities that agents gain through linguistic communication. Levine proposes instead that objectivity is best understood in experiential-theoretic terms. He explains how, in order to meet the aims of the new pragmatists, we need to do more than see objectivity as a norm of rationality embedded in our social-linguistic practices; we also need to see it as emergent from our experiential interaction with the world. Innovative and carefully argued, this book redeems and re-actualizes for contemporary philosophy a key insight developed by the classical pragmatists.
Neurologic conditions are among the more common concurrent medical conditions encountered during pregnancy. Table 44.1 shows the prevalence of several such neurologic diseases. Despite their cumulative prevalence, the relative rarity of many of these conditions limits the actual clinical experience of both the managing obstetrician and the neurologist. In addition, the individual practitioner is further hampered by the limited amount of pregnancy-specific information available. The frequent overlap of symptoms associated with common pregnancy complaints, the sometimes disabling and lethal consequences of the disease, and the fetal effects of the maternal disease and/or treatment make the diagnosis and management of neurologic disease during pregnancy an often-daunting task.