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Organ procurement coordinators must treat various cardiac dysrhythmias (arrhythmias), including rhythm disturbances that may cause or follow a cardiac arrest, in about 15% to 50% of donors. Treatment decisions should be based on the particular dysrhythmia and its effect on donor blood pressure. Medications selected should be effective but short act...
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Ectopic atrial tachycardia (EAT) is one of the most common arrhythmias causing ventricular dysfunction in children. In most case of EAT, no identifiable etiology is found. While viral myocarditis is often thought to be the cause of EAT in some patients, there is little evidence of the association. The authors report a reversible myocardial dysfunct...
Our goal was to analyse the utility of intracardiac echocardiography (ICE) for navigation and ablation of atrial tachycardias (ATs) after surgical correction of congenital heart disease (CHD).
Catheter ablation of ATs was performed in seven patients (one woman, mean age 21 +/- 6 years) after correction of complex CHD: d-transposition of the great a...
Sudden cardiac arrest in pediatric patients is a rare occurrence. Supraventricular tachycardia without the presence of ventricular preexcitation in pediatric patients with a structurally normal heart is generally considered benign. Previous literature in adults reported a subset of patients in whom SVT was suspected to be the primary trigger of sud...
Ectopic atrial tachycardia (EAT) is a relatively common type of supraventricular tachycardia in the pediatric population, and it can be resistant to antiarrhythmic drugs and lead to tachycardia-induced cardiomyopathy (TIC) if not properly managed. The purpose of this study was to determine the predictors of the response to pharmacological therapy i...
Although atrial-tachycardia remodelling is a significant atrial fibrillation (AF) promoting factor, little information is available about how atrial-tachycardia rate determines remodelling effects. This study assessed the effects of atrial tachypacing (ATP) over a range of clinically relevant rates on atrial electrophysiology and AF.
Chronically in...
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Solid organ transplantation was one of the great advances in medicine in the 20th century. Indications and demand for transplantation have, however, led to a chronic shortage of transplantable organs. Although donation rates have increased over the past decade, many patients die while waiting for a transplant [1]. In September 2009, there were 103,000 patients awaiting transplantation in the United States [2]. The development of artificial organs continues, but in the short to medium term the medical community will continue to rely on organs retrieved from recently-deceased patients. The majority of organs are procured from patients who have suffered a devastating neurologic injury and have progressed to brainstem death. In recent years, programs have been developed to allow organ donation after cardiac death, though such donors account for less than 10 % of all organs transplanted. Unfortunately, many individuals who satisfy criteria for becoming organ donors fail to donate, mainly because of lack of consent [3]. In others, a suboptimal number of organs are recovered. The greatest discrepancy between supply and demand exists for lungs and only 7–22 % of multiple-organ donors are deemed suitable to become lung donors. ‘Non-conversion’ occurs for two main reasons: In 10–20 % of cases, the patient succumbs to somatic death (i.e., cardiac arrest) after brainstem death but before organs can be retrieved [4]; in other cases, organs are deemed unsuitable for donation because of their condition. ‘Optimization’ of such organs has been the focus of initiatives by organ procurement organizations. The Organ Donation and Transplantation Breakthrough Collaborative, the latest initiative of the United States Health Resources and Service Administration, seeks to meet the goals of 3.75 organs transplanted per donor and a 75 % conversion rate for all potential organ donors.
The most common indications for lung transplantation are severe chronic obstructive pulmonary disease, pulmonary fibrosis and primary pulmonary hypertension. Simultaneous lung and heart transplantations are usually performed in patients with Eisenmenger syndrome. What is better - unilateral or bilateral lung transplantation - remains an open question. Because of the lack of suitable donors and better results, the unilateral procedure is preferred in many centers. On the other hand, bilateral transplant patients have better tolerance to stress, present less severe forms of the bronchiolitis obliterans syndrome, and have increased respiratory reserve, compared to patients after unilateral transplantation. Patients with end-stage lung disease are at significant risk of hypoxia and dynamic hyperinflation during mechanical ventilation, particularly during one-lung ventilation. After intravenous induction, a double-lumen endotracheal tube is inserted, and anaesthesia is maintained with volatile agents or propofol, with epidural analgesia providing a useful adjunct. Nitrous oxide should be avoided. Particular attention to avoiding or reducing the impact of increases in pulmonary vascular resistance and right heart failure are important and may necessitate cardiopulmonary bypass. Minimizing the administration of intravenous fluids without compromising end organ perfusion may avoid or reduce postoperative respiratory insufficiency, and frusemide is routinely used. In approximately 10-20% of cases pulmonary hypertension is observed in the immediate postoperative period. It is managed by nitric oxide inhalation and/or prostacyclin infusion. Cardiopulmonary bypass is used mostly in cases of primary pulmonary hypertension.
