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Advanced medical and surgical treatment of heart failure and management of patients following heart transplantation is an emerging area. Treatment options at various levels are becoming available in an increasing number of countries. This rapidly evolving field involves a complex multi-disciplinary approach with a number of complementary medical and surgical strategies, including pharmacotherapy, structural cardiac interventions, electrophysiological optimisation, mechanical circulatory support, and heart transplantation. Furthermore, the importance of psycho-social support and care of patients and their families cannot be overstated. The aforementioned challenges and dynamics of new developments require guidance for core and advanced medical training in heart failure and transplantation. The Association for European Paediatric and Congenital Cardiology working group “pulmonary hypertension, heart failure and transplantation” has produced this document as an expert consensus statement; however, all recommendations must be considered and applied in the context of the local and national infrastructure and legal regulations.
We compare reactions in the prices and trading patterns of common stocks and closed-end funds (CEFs), securities with substantially different investor clienteles, to the Sept. 11, 2001 terrorist attacks. When the market reopened 6 days later, retail investors sold and there were sharp price declines, even in assets with net institutional buying. In the subsequent 2 weeks, price reversals were substantially security specific and thus not simply due to improved systematic sentiment. Consistent with microstructure theory, comparisons between CEFs and common stocks show the speed of these reversals depended significantly on the relative quality and availability of information about fundamental values.
This chapter discusses the physiological changes of brain death, the management of complex patients, the organization of the recovery, and new technologies that may allow increased number of organs available for transplantation. Most lethal brain injuries follow a common pathway whereby a patient suffers brainstem death secondary to sudden or gradual increases in intracranial pressure (ICP). Hemodynamic instability seen after brain death is also consequent to loading conditions imposed on the heart. The physiological changes of brain death have direct and indirect effects on lung function. Traumatic brain injury accounts for one third of all trauma related deaths. Early assessment of renal and liver quality is performed in cases of donor death secondary to trauma, exclusion of liver injury. It has been shown that treatment of ex vivo human lungs with an adenoviral vector encoding for interleukin (IL)-10 decreased inflammatory cytokine expression and led to significant improvements in graft function.
Isomerism of the left atrial appendages is often associated with cyanosis due to intracardiac structural abnormalities such as common atrium and/or anomalous pulmonary or systemic venous connections. We report two cases of children with cyanosis and left isomerism but no other lesions within the heart. In these cases, multiple small pulmonary arteriovenous malformations were found bilaterally, resulting in intrapulmonary right-to-left shunting and systemic desaturation.
The role of familial disease in childhood dilated cardiomyopathy is unknown. A novel mutation in the cardiac Troponin C gene has been identified recently in a family with dilated cardiomyopathy. Here we present a subsequent case of dilated cardiomyopathy occurring in a child from the same family, and emphasise the implications for future screening and counselling.
Purpose: Although intravascular ultrasound (IVUS) in children has been reported it is not widely used due to concerns over safety. Detailed analyses of measurements outlined by the ACC consensus statement on IVUS have not been reported in children. We report our safety and analysis data to date. Procedures: IVUS of the left anterior descending was performed with mechanised pullback concurrently with surveillance coronary angiography. Procedure and fluoroscopy screening times were compared with a second group of patients who experienced coronary angiography alone. Analysis was performed to measure vessel and lumen area, vessel and lumen diameters and intimal thickness for serial slices at fixed intervals from a distal identification point. Mean atheroma burden, mean maximum intimal thickness (MIT) and overall maximal intimal thickness were determined for each study. Results: Twenty-seven procedures were analysed. Table 1 shows patient demographics and information relating to IVUS analysis. Details of procedure and fluoroscopy time for both IVUS and coronary angiography groups are presented in Table 2. No complications were encountered. Routine coronary angiography was normal in all but one patient. Conclusions: We have demonstrated the safety of IVUS for coronary surveillance in children. When compared to coronary angiography alone procedure time and screening time are increased but we feel this is outweighed by the increased sensitivity of IVUS. Fifty-two percent of children have an IMT > 0.5 mm despite normal angiography. Such detailed analysis would appear central to future research into paediatric coronary disease.
Surgical treatment of hypoplastic left heart syndrome has generated substantial interest and attention amongst cardiac surgeons since the initial reports from Norwood and his colleagues in 1980.1,2 Initial efforts at most programmes were to create reproducible results, and mortality rates remained high at several institutions throughout the 1980s and 1990s. A recent multi-institutional review demonstrates that the hospital mortality still remains high in numerous centers at the current time.3 Nevertheless, several advances over recent years have led to improved outcomes, and in the best centers, hospital survival now approaches 90%. Survival in successful centers is claimed to relate to the ability of the team to help the patient balance the systemic and pulmonary flows of blood. This ability to balance flow has been enhanced, over recent years, by numerous contributions, including decreasing the size of shunt ordinarily used,4 the use of alpha blockade,5 the rapid deployment of extracorporeal membrane oxygenation,6–8 and various forms of ventilatory manipulation.