Recognition Of Congenital Heart Disease Research Articles

Recognition of congenital heart disease in subsequent hospital visits among children with a prenatal diagnosis

BackgroundDocumentation of congenital heart disease diagnosis is important for optimal patient care. ObjectivesWe investigated longitudinal documentation of congenital heart disease (CHD) diagnosis among children who received a prenatal diagnosis of congenital heart disease at an academic health system in the southeastern United States. MethodsPatients born at our hospital in 2014–2018 were included in a retrospective analysis if they had a prenatal diagnosis of congenital heart disease. Medical records after the birth admission were analyzed for the presence of documented congenital heart disease diagnosis using International Classification of Disease (ICD) codes and free-text notes. ResultsThirty-two children contributing 482 health system encounters met inclusion criteria.Fifty-eight encounters (12%) did not have documentation of CHD. Multivariable analysis determined that Black as compared to White (OR: 6.4; 95% CI: 1.5, 27.3) was associated with non-documentation of CHD diagnosis at a given encounter. Documentation in free-text notes only (vs. ICD codes) was more common for Hispanic and older patients, and for non-cardiology encounters compared to cardiology clinic visits. Complex vs. simple CHD was associated with increased likelihood of documentation via ICD codes. ConclusionDespite a shared electronic medical record, congenital heart disease diagnosis was not always recorded in encounters within the same health system after prenatal diagnosis of congenital heart disease. Future work should explore opportunities to improve the consistency of documenting congenital heart disease diagnosis, especially among older children and children transferring care across clinics or health systems.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Study of congenital heart diseases in neonates

Background: Congenital heart disease defined as an abnormality in cardio circulatory structure or function that is mostly present at birth; even it is discovered much later. Recognition of congenital heart disease in newborn is important as this group abnormality constitutes a significant proportion of congenital malformation that present in the neonatal life, and their early detection is important for appropriate management and good outcome. Objectives of present study were to evaluate clinical profile and outcome of various CHDs identified during neonatal period and to study effect of paracetamol used for pharmacological closure of PDA in preterm neonates.Methods: The study was conducted prospectively in NICU, Dhiraj hospital, Department of Pediatrics and Neonatology from January 2016 to June 2017 (1.5 years span). Echocardiography screening of all neonates suspected of having CHD was done. Details of all neonates having CHD diagnosed by echocardiography were noted in the prescribed Performa and their incidence, clinical profile and outcome was studied.Results: Total 69 cases of CHD diagnosed by Echocardiography in neonatal period were studied. Incidence of CHD among neonates born at Dhiraj hospital was 8.48 per 1000 live birth. Male: female ratio of all CHD cases was 1.38:1. Risk of neonate with CHD is highest (18.18%) in extremely low birth weight neonates. Incidence of CHD was 4.08% in preterm < 34 weeks, 3.47% in late preterms and 0.51% in full term neonates. 86.95% were diagnosed within first week of life. 26.09% babies had associated anomalies. Presenting problem of neonates was breathing difficulty 42 (60.87%), feeding difficulty 36 (52.17%) and cyanosis 5 (7.25%). 8 (11.59%) neonates were asymptomatic. The most common presenting sign was murmur 46 (75.71%). 56 (81.16%) had Acyanotic CHD and 13 (18.84%) had Cyanotic CHD. Amongst 56 (81.16%) Acyanotic CHD cases, commonest was PDA in 44 (78.5%), followed by VSD in 18 (32.14%), ASD in 5 (12.5%) either in isolation or in combination with other lesions. Amongst Cyanotic Congenital Heart Disease, maximum incidence was of Tricuspid Atresia (TA) in 4 (30.76%) cases; followed by TGA in 3 (23.07%). 20 preterm neonates with PDA received paracetamol for PDA closure. 9 (45.0%) responded to paracetamol while 11 (55%) did not respond. 47(68.12%) were discharged, 10(14.49%) went left against medical advice, 7(10.14%) were referred to higher centre for surgery and 5(7.25%) babies expired.Conclusions: Early recognition of congenital heart disease during neonatal life is important as its appropriate and timely management can result in good outcome.

What the pediatrician should know about congenital heart disease.

Initial recognition of congenital heart disease in the neonate as well as decisions for referral to a cardiac center for subsequent management are usually the responsibility of the pediatrician. While the malformations of the heart sometimes present obvious mamifestions in the newborn, the early diagnosis is more often elusive and the type and severity of cardiac dysfunction can be obscure, especially when only traditional methods of clinical evaluation are used.

In defence of auscultation: a glorious future?

Auscultation of the heart using a simple stethoscope continues to be a central aspect of the cardiovascular examination despite declining proficiency and availability of competing technologies such as hand-held ultrasound....

Risk-stratified postnatal care of newborns with congenital heart disease determined by fetal echocardiography.

Advances in fetal echocardiography have improved recognition of congenital heart disease (CHD). Imaging protocols have been developed that predict delivery room (DR) risk and anticipated postnatal level of care (LOC). The aim of this study was to determine the utility of fetal echocardiography in the perinatal management of CHD. A retrospective analysis of fetal and postnatal records was conducted. The anticipated LOC was assigned by fetal echocardiography (LOC 1, nursery consult/outpatient follow-up; LOC 2, stable in DR with transfer to cardiac hospital; LOC 3 or 4, DR instability/urgent intervention needed). Prenatal diagnoses and LOC assignment were compared with postnatal diagnoses, treatment, and short-term outcomes. From 2004 to 2012, 8,101 fetuses were evaluated; 7,405 were normal. Of 696 with CHD, 101 terminated, 40 died in utero, and 37 received palliative care. LOC was assigned in the remaining 518. Of 219 LOC 1, 195 (89%) had postnatal follow-up. Only two required transfer for intervention (LOC 1 sensitivity, 0.9; LOC 1 positive predictive value, 0.99). Of 260 assigned LOC 2, 229 (88%) had follow-up. Of these, 200 (87%) were transferred for surgery or intervention. The median time to admission was 195min. Twenty-two patients (10%) assigned LOC 2 did not require intervention; however, seven (all with D-transposition of the great arteries) required catheter intervention before surgery. Hospital survival was 86% (LOC 2 sensitivity, 0.97; LOC 2 positive predictive value, 0.87). All LOC 3 and 4 patients had follow-up. Thirty-four (87%) needed urgent intervention, with 100% DR and 87% hospital survival (LOC 3 and 4 sensitivity, 0.83; LOC 3 and 4 positive predictive value, 0.87). Fetal echocardiography enables accurate postnatal risk stratification in CHD, with the exception of D-transposition of the great arteries. LOC 1 assignment facilitated outpatient follow-up; LOC 2 assignment facilitated transfer for intervention. LOC 3 and 4 patients underwent stabilizing intervention or surgery with good short-term outcomes. Given the inability to predict need for intervention in D-transposition of the great arteries, all such patients should be assigned as LOC 3 or 4. Fetal echocardiography with LOC assignment should be used in the planning of postnatal care in CHD.

Heart Disease in Childhood: From Malformed Hearts to the Silent Impact of Unhealthy Lifestyles

Early recognition of congenital heart disease, coupled with the growth and sophistication of diagnostic, medical, and surgical interventions at early ages, has resulted in significantly improved outcomes. However, the cardiovascular impact of the epidemic of childhood obesity and its related disorders now looms as an even greater threat to the health of children.

Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm Into the Left Ventricle: A Retrograde Approach

Aneurysms of sinuses of Valsalva (ASOV) are thin-walled saccular or tubular outpouchings of the aortic sinuses, which can be either congenital or acquired. They can rupture into heart chambers, the pulmonary artery, or the pericardial space (Perloff, Clinical recognition of congenital heart disease, [8]). This report presents a rare case of a patient with treated infective endocarditis who had a patent ductus arteriosus (PDA), a coronary cameral fistula, and a ruptured ASOV (RASOV) into the left ventricle (LV). Successful transcatheter closure of the ruptured ASOV and the other two lesions was performed using three Amplatzer duct occluders (AGA Medical Corporation, Golden Valley, MN, USA).

Uncommon Variant of Ebstein Anomaly With Tricuspid Stenosis

A 27-year-old previously healthy woman with no prior history of exercise limitations, shortness of breath, cyanosis, or arrhythmia became short of breath 10 months after her second successful pregnancy. Her shortness of breath was at rest accompanied by progressive edema, ascites, and later anasarca. An ECG revealed normal sinus rhythm with right atrial enlargement (Figure 1A), and chest x-ray revealed normal lung parenchyma with mildly enlarged cardiac silhouette (Figure 1B). A transthoracic echocardiogram demonstrated reduced left ventricular size with an ejection fraction estimated at 50%, severe right atrial enlargement, and severe right ventricular enlargement with dysfunction and was suspicious for severe displacement of the tricuspid valve leaflets toward the right ventricular apex, suggestive of Ebstein anomaly (EA) (Figure 2). She responded to intravenous diuresis with improvement in her right-sided heart failure. In light of her dilated, poorly functioning right ventricle, she was started on Coumadin. Repeat transthoracic echocardiogram 2 months later demonstrated displacement of the tricuspid valve into …

Cardiovascular Magnetic Resonance of Isolated Left Ventricular Apical Hypoplasia

A 37-year-old white peripartum female was admitted to intensive care with pulmonary edema. She had no past medical history of note. Left bundle-branch block, P mitrale, and left-axis deviation were identified on her ECG, and cardiomegaly on her chest x-ray (Figures 1 and 2⇓). She was referred for cardiovascular magnetic resonance (CMR) after diagnostic coronary angiography revealed normal coronary arteries. Figure 1. ECG showing P mitrale, left-axis deviation, and left bundle-branch block. Figure 2. Chest x-ray showing …

Delayed recognition of congenital heart disease

Objective: The aim of this prospective study was to evaluate the proportion of children with delayed recognition of congenital heart disease (CHD). Methods: Of the 744 children with CHD primarily...

Lutembacher’s Syndrome with Small Atrial Septal Defect Diagnosed by Transthoracic and Transesophageal Echocardiography that Underwent Mitral Valve Replacement

Lutembacher's syndrome is a rare clinical combination of congenital ostium secundum atrial septal defect associated with acquired mitral valve stenosis (usually rheumatic). This unusual cardiac entity is difficult to diagnose clinically because each lesion alters the hemodynamics and clinical characteristics of the other. The resulting clinical manifestations depend chiefly on the size of the defect, the severity of the mitral stenosis, and the compliance of the right ventricle. We present a classic case of Lutembacher's syndrome and illustrate the pitfalls and advantages of echocardiography in the correct diagnosis of the syndrome.

The Clinical Recognition of Congenital Heart Disease

ABSTRACT Dr Perloffs The Clinical Recognition of Congenital Heart Disease, now in its fourth edition, continues to occupy a unique place among pediatric cardiology textbooks. It addresses the key question, How do I make a diagnosis? and is thus a critical source of information for the pediatrician and the pediatric cardiologist alike. Even for the seasoned cardiologist, the depth of clinical information, clarity of writing, and superb photographs are a source of knowledge and satisfaction. Whereas other texts spend time with embryologic hypotheses or arguments on nomenclature, Dr Perloff reminds us that the jugular venous and carotid pulses are still part of the clinical evaluation and that the phonocardiogram (!) contains useful information. His aim is a text accessible to those with less than expert knowledge of congenital heart disease, which, if we are truly honest, includes all of us.The diagnosis of congenital heart disease is uniquely suitable to a logical,

Understanding Pediatric Heart Sounds

ABSTRACT This 230-page softcover book, by Steven Lehrer, MD, is a comprehensive review of the literature related to heart sounds. The author writes simply and clearly. The book is almost an abbreviated text of pediatric cardiology and could be titled Cardiovascular Assessment and Diagnosis. Much of the material has been previously covered in such books as Pediatric Cardiology for Practitioners, by M. K. Park, and two books by J. K. Perloff, The Clinical Recognition of Congenital Heart Disease and Physical Examination of the Heart and Circulation.The figures and tables are almost exclusively reproduced with acknowledgment from previous publications. Although little new information is included, the manner in which the author presents the material is outstanding and goes much beyond the understanding of pediatric heart sounds. The references at the end of each chapter are extensive and excellent for the student who desires to pursue the subjects in great detail.

Congenital heart disease, heritable cardiovascular disease, and pregnancy

P ROFOUND CHANGES in the population of women with heart disease and pregnancy occurred in the Western world during the 20th century as the incidence of rheumatic heart disease decreased and the recognition of congenital heart disease increased. A new population at risk resulted from the increased survival of women with congenital heart disease. Recognition of this new population resulted from more precise diagnoses and the use of surgical and medical therapy. Increased awareness of the wide range of heritable cardiovascular disease resulted primarily from phenotypic family studies; however, modern diagnostic and genetic techniques give promise for more objective methods of diagnosis and for genetic counseling. Advances in obstetrics and anesthesia have decreased the direct risks of pregnancy in these patient groups and widened the range of clinical experiences. Prospective fetal studies demonstrated higher incidence figures for congenital cardiac defects in the offspring of parents with congenital heart disease than previously appreciated. Limited understanding of the pathogenesis of most congenital and heritable cardiovascular defects has stimulated extensive research in cardiac morphogenesis and embryogenesis. The incorporation of developing genetic, biochemical, and molecular techniques into the diagnostic evaluation and long-term study of these overlapping patient groups and their offspring give promise of further understanding of normal and abnormal embryogenesis and of placing genetic counseling on a firm, scientific basis.

Clinical Recognition of Congenital Heart Disease

Clinical Recognition of Congenital Heart Disease

The Clinical Recognition of Congenital Heart Disease.3d ed

<b>The Clinical Recognition of Congenital Heart Disease.</b>3d ed

Clinical Recognition of Congenital Heart Disease.

Clinical Recognition of Congenital Heart Disease.

The Clinical Recognition of Congenital Heart Disease

The Clinical Recognition of Congenital Heart Disease

Successful tricuspid valvulectomy without replacement for endocarditis during pregnancy

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