[Immediate and long-term results of the complete correction of transposition of great vessels in the child].
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Biomedical subjects
Publications and source records attributed to G Champsaur.
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Left ventricular assist devices can be successfully used in the pediatric population if currently available devices are used appropriately. To highlight their management strategies, the authors' experience with pediatric left ventricular assist devices is reviewed, with case studies documenting options for device use. A retrospective study was conducted for all patients supported at the authors' institutions. Nine pediatric patients received devices during this time, with ages ranging from 12 days to 15 years. There was considerable size differences in our patients, with weights ranging between 2.5 and 73 kg. Either the Abiomed BVS 5000 (Abiomed Cardiovascular, Inc, Danvers, MA) or the Biomedicus centrifugal pump (Bio-Medicus, Inc, Eden Prairie, MN) were used for all patients. Patients were supported for an average of 5 days (range 1-11 days). Eight patients were successfully weaned from the device, with four undergoing transplant. Four patients were discharged and are long-term survivors, and one is still recovering post transplant. Neurologic sequelae were the most common complications in these patients, with four patients having events. Pediatric ventricular assist devices are limited because of size considerations, although current devices can be successfully used for bridging to recovery or transplantation. New devices are needed to meet the flow and size characteristics for pediatric patients. Successful use of assist devices, as has been recognized in adults, is possible in pediatric patients if these requirements are met.
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The ability of magnetic resonance imaging (MRI) to detect allograft rejection was studied concomitantly in two centers. In 29 patients MR images performed on a 0.5 T imager were compared with pathologic findings obtained by transvenous right ventricular endomyocardial biopsies. Eight patients had grade 1 or 2 acute rejection, and their myocardium thickness was increased significantly compared with values obtained in normal volunteers, in normal heart allograft patients, and in patients during the resolving phase of an acute rejection episode, whereas no abnormal signal intensity was found in the myocardium of heart allograft patients with acute rejection. This finding is quite in opposition to what was found in experimental models. This could be the result of the immunosuppressive regimen of those patients including cyclosporine, whereas few experimental studies included cyclosporine treatment. For chronic rejection or fibrosis, MRI did not allow the diagnosis because the MRI appearance was close to normal. Finally, MRI appears as a complementary technique to B-mode ultrasound in detecting nonimmunologic complications such as pericardial effusions and endocavitary processes. These data suggest that MRI could be used in the future to monitor rejection, to guide the timing of endomyocardial biopsy, and to assess the response after immunosuppressive treatment.
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Two cases of right pulmonary artery to left atrium in the newborn are described. Both patients presented with refractory hypoxemia cardiomegaly, hypovascular lung fields. Moreover one patient presented with continuous murmur and localised X-ray shadow. Echocardiographic left atrium enlargement suggested diagnosis and angiography confirmed it. Spontaneous improvement in one child is due to a decrease in pulmonary vascular resistance and has allowed the patient to attain an age and a weight in which surgical ligation has been performed more safely.
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