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  • 1
    Electronic Resource
    Electronic Resource
    Hypoplastisches Linksherz Praxisorientierter Leitfaden (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 450-455 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hypoplastisches Linksherz ; Norwood-Operation ; Herztransplantation ; perioperatives Management ; Key words Hypoplastic left heart ; Norwood procedure ; heart transplantation ; perioperative management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The past decade has witnessed remarkable progress in the treatment of children born with a hypoplastic left heart. Compared with a mortality rate of more than 95% at 1 month of age before surgical intervention was possible, there is currently a survival rate of almost 60% at 5 years of age for all newborns with this condition who undergo the Norwood operation, and for newborns given heart transplantations. The current survival rate for all infants suffering from hypoplastic left heart syndrome and given heart transplantation is almost 80% at the age of 5 years. Uncertainty pertaining to the long-term outlook still exists, however. Many families and physicians continue to exercise the option of no treatment. These ethical issues will continue to be argued until the results of palliative reconstructive surgery or cardiac transplantation attain a level of success achieved for other neonatal cardiac operations.
    Notes: Zusammenfassung Während der letzten Dekade wurde ein bemerkenswerter Fortschritt in der Behandlung von Neugeborenen mit hypoplastischem Linksherz gemacht. Lag die Sterblichkeit vor der chirurgischen Behandlungsära im ersten Lebensmonat noch bei über 95%, so beträgt jetzt die aktualisierte 5 Jahres-Überlebensrate für die gestufte chirurgische Palliation, als auch für die zur Herztransplantation gelisteten Neugeborenen bei 60%. Die aktualisierte Überlebenswahrscheinlichkeit der herztransplantierten Säuglinge beträgt für die ersten 5 Jahre nahezu 80%. Es bleibt jedoch weiterhin noch eine Unsicherheit bezüglich der Langzeitergebnisse. Viele Familien und Ärzte bevorzugen daher immer noch die Option der „Nicht-Behandlung”. Diese ethisch motivierte Entscheidung wird auch noch solange bestehen bis die Ergebnisse der rekonstruktiven Chirurgie oder der Herztransplantation die Erfolgsrate anderer neonataler Herzoperationen erreicht hat.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050283
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  • 2
    Electronic Resource
    Electronic Resource
    Prospektive Behandlungs- strategie bei Neugeborenen mit hypoplastischem Linksherz Erfahrungen am Kinderherzzentrum Gießen (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 457-461 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hypoplastisches Linksherz ; Norwood-Operation ; Herztransplantation ; Behandlungsalgorithmus ; Key words Hypoplastic left heart ; Norwood operation ; Heart transplantation ; Management algorithm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Objective: Hypoplastic left heart (HLH) is a complex developmental malformation of the left ventricle, aorta, and associated valves. Survival beyond neonatal period is the exception in untreated infants. The prognosis, however, is no longer hopeless. Clinical stabilization of a neonate with HLH is appropriate until a management decision, based on appropriate parental counselling, can be made. Methods: To determine current management of hypoplastic left heart syndrome, we analysed the prospectively obtained data on the surgical procedures, and outcome for 23 neonates with this condition admitted to our institution in 1996. Results: Of the 23 patients, five were treated without surgical interventions. A Norwood I-operation was performed in eight. One infant with late surgery could not be weaned from the cardiopulmonary bypass. Another newborn died six weeks after the Norwood I procedure by hepatic failure. Heart transplantation was performed in nine patients, none patient died following transplantation. The overall survival rate of all admitted newborns with HLH was 70%. Conclusion: Our surgical strategies of staged palliative reconstruction and heart replacement by transplantation appear promising and allow an algorithm for management of HLH. These new management technologies will make inappropriate the traditional ”do nothing” approach to HLH in all but few cases.
    Notes: Zusammenfassung Fragestellung: Das hypoplastische Linksherz (HLH) ist eine komplexe Entwicklungsfehlbildung der linken Herzkammer, der Aorta und der assoziierten Herzklappen. Unbehandelt wird die Neonatalperiode nur selten überlebt. Die Prognose ist jedoch nicht länger hoffnungslos. Eine postnatale Prostaglandin-E1-Therapie ist zur Stabilisierung des Neugeborenen mit HLH in jedem Fall berechtigt, bis auf der Basis eines ausführlichen Elterngesprächs eine Entscheidung für oder gegen eine chirurgische Behandlung getroffen werden kann. Methode: Zur Beurteilung der derzeitigen Behandlungsstrategie bei Neugeborenen mit HLH analysierten wir die prospektiv erhobenen Daten von 23 im Jahr 1996 zugewiesenen Neugeborenen mit HLH. Ergebnisse: Fünf der 23 Patienten wurden nicht chirurgisch behandelt. Eine Norwood-I-Operation wurde bei 8 Kindern durchgeführt. Davon konnte ein spät postnatal operierter Säugling nicht von der Herz-Lungen-Maschine entwöhnt werden. Ein weiteres Kind starb 6 Wochen nach der Norwood-I-Operation an einem Leberversagen. Neun Kinder wurden herztransplantiert, kein Kind starb nach der Transplantation. Somit betrug die Überlebensrate aller zugewiesenen Neugeborenen 70%. Schlußfolgerungen: Unsere chirurgischen Strategien der stufenweisen Palliativrekonstruktion nach Norwood und der Herztransplantation im Säuglingsalter erlauben einen Behandlungsalgorithmus für das HLH. Die Ergebnisse der Behandlungsmöglichkeiten reduzieren die traditionelle „do nothing” Haltung für alle Neugeborenen mit HLH auf ausgewählte Patienten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050284
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Continuous measurement of cardiac output by the Fick principle in infants and children: Comparison with the thermodilution method (1996)
    Springer
    Intensive care medicine 22 (1996), S. 467-471 
    Details
    ISSN: 1432-1238
    Keywords: Fick principle ; Thermodilution ; Cardiac output ; Infants ; Cardiac surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To compare a system that continuously monitors cardiac output by the Fick principle with measurements by the thermodilution technique in pediatric patients. Design Prospective direct comparison of the above two techniques. Setting Pediatric intensive care unit of a university hospital. Patients 25 infants and children, aged 1 week to 17 years (median 10 months), who had undergone open heart surgery were studied. Only patients without an endotracheal tube leak and without a residual shunt were included. Methods The system based on the Fick principle uses measurements of oxygen consumption taken by a metabolic monitor and of arterial and mixed venous oxygen saturation taken by pulse- and fiberoptic oximetry to calculate cardiac output every 20 s. Interventions In every patient one pair of measurements was taken. Continuous Fick and thermodilution cardiac output measurements were performed simultaneously, with the examiners remaining ignorant of the results of the other method. Results Cardiac output measurements ranged from 0.21 to 4.55 l/min. A good correlation coefficient was found:r 2=0.98;P〈0.001; SEE=0.14 l/min. The bias is absolute values and in percent of average cardiac output was −0.05 l/min or −4.4% with a precision of 0.32 l/ min or 21.3% at 2 SD, respectively. The difference was most marked in a neonate with low cardiac output. Conclusion Continuous measurement of cardiac output by the Fick principle offers a convenient method for the hemodynamic monitoring of unstable infants and children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712169
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Continuous measurement of cardiac output by the Fick principle in infants and children: comparison with the thermodilution method (1996)
    Springer
    Intensive care medicine 22 (1996), S. 467-471 
    Details
    ISSN: 1432-1238
    Keywords: Key words Fick principle ; Thermodilution ; Cardiac output ; Infants ; Cardiac surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Objective:To compare a system that continuously monitors cardiac output by the Fick principle with measurements by the thermodilution technique in pediatric patients. Design: Prospective direct comparison of the above two techniques. Setting: Pediatric intensive care unit of a university hospital. Patients: 25 infants and children, aged 1 week to 17 years (median 10 months), who had undergone open heart surgery were studied. Only patients without an endotracheal tube leak and without a residual shunt were included. Methods: The system based on the Fick principle uses measurements of oxygen consumption taken by a metabolic monitor and of arterial and mixed venous oxygen saturation taken by pulse- and fiberoptic oximetry to calculate cardiac output every 20 s. Interventions: In every patient one pair of measurements was taken. Continuous Fick and thermodilution cardiac output measurements were performed simultaneously, with the examiners remaining ignorant of the results of the other method. Results: Cardiac output measurements ranged from 0.21 to 4.55 l/min. A good correlation coefficient was found: r 2=0.98; P〈0.001; SEE=0.14 l/min. The bias is absolute values and in percent of average cardiac output was −0.05 l/min or −4.4% with a precision of 0.32 l/min or 21.3% at 2 SD, respectively. The difference was most marked in a neonate with low cardiac output. Conclusion: Continuous measurement of cardiac output by the Fick principle offers a convenient method for the hemodynamic monitoring of unstable infants and children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712169
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    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Continuous monitoring of mixed venous oxygen saturation in infants after cardiac surgery (1989)
    Springer
    Intensive care medicine 15 (1989), S. 228-232 
    Details
    ISSN: 1432-1238
    Keywords: Infants ; Continuous SvO2 ; Cardiac surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Continuous mixed venous oxygen saturation SvO2c was measured in 16 infants immediately after cardiac surgery. A polyurethane 4F, dual channel catheter (Opticath, Modell U440, Oximetrix) with fiberoptic filaments was introduced into the pulmonary artery during cardiothoracic surgery. The catheters were left in place for an average of 67.5 h (range 27 h – 125 h) and there were no catheter-related complications. Correlation between continuous in vivo SvO2 values and in vitro values was satisfactory (r=0.85), whereas a correlation between SvO2c and arterial oxygen saturation (SaO2) was not found (r=0.07). The sampled arterial lactate values were inversely correlated to the simultaneously measured SvO2c, but the corelation coefficient was only r=-0.4. There was an inverse correlation between SvO2c and arteriovenous oxygen content difference (Ca−vDO2c) (r=-0.82), and a marked inverse correlation to the calculated oxygen utilization ratio (r=-0.97). Therefore SvO2c continuously reflects the overall balance between oxygen consumption and delivery, but the use of SvO2 as a predictor of blood lactate levels is unreliable. A further purpose of the present study was to demonstrate the clinical applications and to show the usefulness of SvO2c-monitoring; particularly as a surveillance and early warning system, as a guide for assessing therapy and its relevance in interpreting other monitored parameters. In our opinion continuous SvO2 measurement is a reliable and valuable indicator of cardiopulmonary function in the immediate post-operative period, even in infants with complicated repair of cardiac malformations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00271056
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    Paper (German National Licenses)
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