30 results on '"Manchula Navaratnam"'
Search Results
2. ISHLT consensus statement: Perioperative management of patients with pulmonary hypertension and right heart failure undergoing surgery
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Dana P. McGlothlin, John Granton, Walter Klepetko, Maurice Beghetti, Erika B. Rosenzweig, Paul A. Corris, Evelyn Horn, Manreet K. Kanwar, Karen McRae, Antonio Roman, Ryan Tedford, Roberto Badagliacca, Sonja Bartolome, Raymond Benza, Marco Caccamo, Rebecca Cogswell, Celine Dewachter, Laura Donahoe, Elie Fadel, Harrison W. Farber, Jeffrey Feinstein, Veronica Franco, Robert Frantz, Michael Gatzoulis, Choon Hwa (Anne) Goh, Marco Guazzi, Georg Hansmann, Stuart Hastings, Paul M. Heerdt, Anna Hemnes, Antoine Herpain, Chih-Hsin Hsu, Kim Kerr, Nicholas A. Kolaitis, Jasleen Kukreja, Michael Madani, Stuart McCluskey, Michael McCulloch, Bernhard Moser, Manchula Navaratnam, Göran Rådegran, Cara Reimer, Laurent Savale, Oksana A. Shlobin, Jana Svetlichnaya, Keith Swetz, Jessica Tashjian, Thenappan Thenappan, Carmine Dario Vizza, Shawn West, Warren Zuckerman, Andreas Zuckermann, and Teresa De Marco
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Pulmonary and Respiratory Medicine ,Transplantation ,hypertension ,pulmonary ,Hypertension, Pulmonary ,risk assessment ,heart failure ,anesthesia ,congenital heart disease ,pediatric pulmonary hypertension ,consensus ,pulmonary arterial hypertension ,pulmonary hypertension ,risk factors ,Surgery ,surgery ,humans ,hypertension, pulmonary ,Cardiology and Cardiovascular Medicine - Abstract
Pulmonary hypertension (PH) is a risk factor for morbidity and mortality in patients undergoing surgery and anesthesia. This document represents the first international consensus statement for the perioperative management of patients with pulmonary hypertension and right heart failure. It includes recommendations for managing patients with PH being considered for surgery, including preoperative risk assessment, planning, intra- and postoperative monitoring and management strategies that can improve outcomes in this vulnerable population. This is a comprehensive document that includes common perioperative patient populations and surgical procedures with unique considerations.
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- 2022
3. Intraoperative epicardial echocardiography or transoesophageal echocardiography in CHD: how much does it matter?
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Katie J. Stauffer, Jerrid Brabender, Charitha D. Reddy, Elif Seda Selamet Tierney, Leo Lopez, Katsuhide Maeda, Manchula Navaratnam, and Rajesh Punn
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Pediatrics, Perinatology and Child Health ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Background:Intraoperative imaging determines the integrity of surgical repairs. Transoesophageal echocardiography represents standard care for intraoperative imaging in CHD. However, some conditions preclude its use, and epicardial echocardiography is used alternatively. Minimal literature exists on the impact of epicardial echocardiography versus transoesophageal echocardiography. We aimed to evaluate accuracy between the two modalities and hypothesised higher imaging error rates for epicardial echocardiography.Methods:We retrospectively reviewed all epicardial echocardiograms performed over 16 years and compared them to an age- and procedure-matched, randomly selected transoesophageal echocardiography cohort. We detected un- or misidentified cardiac lesions during the intraoperative imaging and evaluated patient outcomes. Data are presented as a median with a range, or a number with percentages, with comparisons by Wilcoxon two-sample test and Fisher’s exact test.Results:Totally, 413 patients comprised the epicardial echocardiography group with 295 transoesophageal echocardiography matches. Rates of imaging discrepancies, re-operation, and incision infection were similar. About 13% of epicardial echocardiography patients had imaging discrepancies versus 16% for transoesophageal (p = 0.2352), the former also had smaller body sizes (p < 0.0001) and more genetic abnormalities (33% versus 19%, p < 0.0001). Death/mechanical support occurred more frequently in epicardial echocardiography patients (16% versus 6%, p < 0.0001), while hospitalisations were longer (25 versus 19 days, p = 0.0003).Conclusions:Diagnostic accuracy was similar between patients undergoing epicardial echocardiography and transoesophageal echocardiography, while rates of death and mechanical support were increased in this inherently higher risk patient population. Epicardial echocardiography provides a reasonable alternative when transoesophageal echocardiography is not feasible.
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- 2022
4. Multidisciplinary Stroke Pathway for Children Supported With Ventricular Assist Devices
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Sarah Lee, Kathleen R. Ryan, Jenna Murray, Sharon Chen, Gerald A. Grant, Sarah Wilkins, Vamsi V. Yarlagadda, Max Wintermark, Robert Dodd, David Rosenthal, Jeffrey Teuteburg, Manchula Navaratnam, Joanne Lee, Lori C. Jordan, and Christopher S. Almond
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2022
5. Adverse Events Associated with Cardiac Catheterization in Children Supported with Ventricular Assist Devices
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Alyssa Power, Manchula Navaratnam, Jenna M. Murray, Lynn F. Peng, David N. Rosenthal, John C. Dykes, Vamsi V. Yarlagadda, Katsuhide Maeda, Christopher S. Almond, and Sharon Chen
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Heart Failure ,Biomaterials ,Cardiac Catheterization ,Treatment Outcome ,Biomedical Engineering ,Biophysics ,Humans ,Bioengineering ,Heart-Assist Devices ,General Medicine ,Child ,Respiratory Insufficiency ,Retrospective Studies - Abstract
Children on ventricular assist device (VAD) support can present several unique challenges, including small patient size, univentricular or biventricular congenital heart disease (1V- or 2V-CHD) and need for biventricular VAD (BiVAD) support. While cardiac catheterization can provide valuable information, it is an invasive procedure with inherent risks. We sought to evaluate the safety of catheterization in pediatric patients on VAD support. We performed a retrospective review of patients on VAD support who underwent catheterization at Lucile Packard Children's Hospital between January 1, 2014 and September 1, 2019. Using definitions adapted from Pedimacs, adverse events (AEs) after catheterization were identified, including arrhythmia; major bleeding or acute kidney injury within 24 hours; respiratory failure persisting at 24 hours; and stroke, pericardial effusion, device malfunction, bacteremia or death within 7 days. AEs were categorized as related or unrelated to catheterization. Sixty procedures were performed on 39 patients. Underlying diagnoses were dilated cardiomyopathy (48%), 1V-CHD (35%), 2V-CHD (8%), and other (8%). Devices were implantable continuous flow (72%), paracorporeal pulsatile (18%) and paracorporeal continuous flow (10%). Catheterizations were performed on patients in the ICU (60%), on inotropic support (42%), with deteriorating clinical status (37%) and on BiVAD support (12%). There were 9 AEs possibly related to catheterization including 6 episodes of respiratory failure, 2 major bleeding events, and 1 procedural arrhythmia. AE occurrence was associated with ICU status ( P = 0.01), BiVAD support ( P = 0.04) and procedural indication to evaluate worsening clinical status ( P = 0.04). Despite high medical acuity, catheterization can be performed with an acceptable AE profile in children on VAD support.
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- 2021
6. Comparison of combined heart‒liver vs heart-only transplantation in pediatric and young adult Fontan recipients
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Manchula Navaratnam, E. Profita, Daniel Bernstein, Seth A. Hollander, Christiane Haeffele, Sharon Chen, Rachel Bensen, K. Maeda, Sumeet S. Vaikunth, Nancy McDonald, Waldo Concepcion, and Danielle Sganga
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Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,Inotrope ,medicine.medical_specialty ,Cirrhosis ,Adolescent ,030204 cardiovascular system & hematology ,030230 surgery ,Fontan Procedure ,California ,Article ,Young Adult ,03 medical and health sciences ,Liver disease ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Interquartile range ,Humans ,Medicine ,Young adult ,Child ,Retrospective Studies ,Transplantation ,business.industry ,Incidence ,Graft Survival ,Prognosis ,medicine.disease ,Liver Transplantation ,Surgery ,Survival Rate ,Heart failure ,Cohort ,Heart Transplantation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
BACKGROUND Indications for a heart‒liver transplantation (HLT) for Fontan recipients are not well defined. We compared listing characteristics, post-operative complications, and post-transplant outcomes of Fontan recipients who underwent HLT with those of patients who underwent heart-only transplantation (HT). We hypothesized that patients who underwent HLT have increased post-operative complications but superior survival outcomes compared with patients who underwent HT. METHODS We performed a retrospective review of Fontan recipients who underwent HLT or HT at a single institution. Characteristics at the time of listing, including the extent of liver disease determined by laboratory, imaging, and biopsy data, were compared. Post-operative complications were assessed, and the Kaplan‒Meier survival method was used to compare post-transplant survival. Univariate regression analyses were performed to identify the risk factors for increased mortality and morbidity among patients who underwent HT. RESULTS A total of 47 patients (9 for HLT, 38 for HT) were included. Patients who underwent HLT were older, were more likely to be on dual inotrope therapy, and had evidence of worse liver disease. Whereas ischemic time was longer for the group who underwent HLT, post-operative complications were similar. Over a median post-transplant follow-up of 17 (interquartile range: 5–52) months, overall mortality for the cohort was 17%; only 1 patient who underwent HLT died (11%) vs 7 patients who underwent HT (18%) ( p = 0.64). Among patients who underwent HT, cirrhosis on pre-transplant imaging was associated with worse outcomes. CONCLUSIONS Despite greater inotrope need and more severe liver disease at the time of listing, Fontan recipients undergoing HLT have post-transplant outcomes comparable with those of patients undergoing HT. HLT may offer a survival benefit for Fontan recipients with liver disease.
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- 2021
7. Bridge to Transplant with Ventricular Assist Device Support in Pediatric Patients with Single Ventricle Heart Disease
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Sharon Chen, Jenna Murray, Katsuhide Maeda, John C. Dykes, Olaf Reinhartz, Manchula Navaratnam, David N. Rosenthal, Vamsi V. Yarlagadda, Christopher S. Almond, and Gail E. Wright
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Male ,medicine.medical_specialty ,Time Factors ,Heart disease ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,030204 cardiovascular system & hematology ,Univentricular Heart ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hospital discharge ,Humans ,Child ,Adverse effect ,Retrospective Studies ,Heart transplantation ,Bridge to transplant ,business.industry ,Infant ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Child, Preschool ,Ventricular assist device ,Heart Transplantation ,Female ,Heart-Assist Devices ,business - Abstract
Ventricular assist device (VAD) support for children with single ventricle (SV) heart disease remains challenging. We performed a single-center retrospective review of SV patients on VAD support and examined survival to transplant using the Kaplan-Meier method. Patients transplanted were compared with those who died on support. Between 2009 and 2017, there were 14 SV patients with 1,112 patient-days of VAD support. Stages of palliation included pre-Glenn (n = 5), Glenn (n = 5), and Fontan (n = 4). Eight patients (57%) were successfully bridged to transplant at a median 107 days. Deaths occurred early (n = 6, median 16 days) and in smaller patients (10.1 vs. 28.3 kg, P = 0.04). All Fontan patients survived to transplant, whereas only 20% of Glenn patients survived to transplant. Adverse events occurred in 79% (n = 11). Five patients met hospital discharge criteria, with two patients (one pre-Glenn, one Glenn) discharged and transplanted after 219 and 174 days of VAD support. All transplanted patients were discharged at a median 21 days posttransplant. SV patients in various stages of palliation can be successfully bridged to transplant with VAD support. With use of intracorporeal continuous-flow devices, longer-term support and hospital discharge are possible.
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- 2020
8. Intraoperative and Postoperative Hemodynamic Predictors of Acute Kidney Injury in Pediatric Heart Transplant Recipients
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Sukyung Chung, Nina B Zook, Manchula Navaratnam, Sushma Reddy, Scott M. Sutherland, Elizabeth Price, Claudia A. Algaze, Seth A. Hollander, Tristan Vella, and Jeffrey Yang
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business.industry ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Acute kidney injury ,medicine ,Hemodynamics ,Critical Care and Intensive Care Medicine ,medicine.disease ,business - Abstract
Acute kidney injury (AKI) is common after pediatric heart transplantation (HT) and is associated with inferior patient outcomes. Hemodynamic risk factors for pediatric heart transplant recipients who experience AKI are not well described. We performed a retrospective review of 99 pediatric heart transplant patients at Lucile Packard Children's Hospital Stanford from January 1, 2015, to December 31, 2019, in which clinical and demographic characteristics, intraoperative perfusion data, and hemodynamic measurements in the first 48 postoperative hours were analyzed as risk factors for severe AKI (Kidney Disease: Improving Global Outcomes [KDIGO] stage ≥ 2). Univariate analysis was conducted using Fisher's exact test, Chi-square test, and the Wilcoxon rank-sum test, as appropriate. Multivariable analysis was conducted using logistic regression. Thirty-five patients (35%) experienced severe AKI which was associated with lower intraoperative cardiac index (p = 0.001), higher hematocrit (p 12 mm Hg (odds ratio [OR] = 4.27; 95% confidence interval [CI]: 1.48–12.3, p = 0.007) and MAP
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- 2021
9. Neurosurgical intervention in children with ventricular assist devices: A single-center case series review
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Sarah Lee, Jane Yu, Kathleen R. Ryan, Chandra Ramamoorthy, Sharon Chen, Manchula Navaratnam, K. Maeda, and Jenna Murray
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hemorrhage ,Thrombosis ,Perioperative ,medicine.disease ,Neurosurgical Procedures ,Surgery ,Neurosurgical Procedure ,Transplantation ,Anesthesiology and Pain Medicine ,Ventricular assist device ,Pediatrics, Perinatology and Child Health ,Medicine ,Humans ,cardiovascular diseases ,Neurosurgery ,Heart-Assist Devices ,business ,Child ,Stroke ,External ventricular drain ,Retrospective Studies - Abstract
BACKGROUND The incidence of neurological complications related to ventricular assist devices (VAD) remains high and includes life-threatening conditions such as intracranial hemorrhage or ischemic stroke. Although no definitive management guidelines exist, operative interventions may be required for major neurological injuries. AIMS This case series describes the perioperative management of children at a single center who underwent neurosurgical procedures for major intracranial bleeds or ischemic strokes while on VAD support. METHODS A database review identified all pediatric VAD patients who underwent a neurosurgical procedure for an intracranial hemorrhage or ischemic stroke from April 2014 to January 2020. Data regarding patient characteristics, preoperative medical management, intraoperative anesthetic management, and postoperative outcomes were collected using retrospective chart review. RESULTS Ninety VADs were implanted in 78 patients. Five neurosurgical interventions were performed: four for intracranial hemorrhages and one for an ischemic stroke. All four patients with hemorrhages were receiving anticoagulation at the time of their event and the three patients on warfarin received emergent reversal with prothrombin concentrate complex and vitamin K. Three patients also received pre-procedural platelet transfusions. Two of the five procedures were emergent bedside external ventricular drain placements, and three were surgical operations. All three patients who underwent operative procedures received invasive hemodynamic monitoring and were supported with a combination of inotropes and afterload reduction. One patient required a massive blood product transfusion. The two patients who underwent external ventricular drain placement had no further surgical interventions and died from the severity of their neurological injuries. All three patients who underwent operative procedures survived to transplantation and discharge home. CONCLUSIONS Perioperative concerns for the anesthesiologist include VAD hemodynamic management, bleeding, VAD thrombosis, and prevention of secondary brain injury. A systematic, multidisciplinary approach to management is paramount to attain favorable outcomes.
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- 2021
10. Impact of a clinical pathway on acute kidney injury in patients undergoing heart transplant
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Claudia A. Algaze, Scott M. Sutherland, Seth A. Hollander, Nina B Zook, Katsuhide Maeda, Jeffrey Yang, Elizabeth P Price, Tristan D Margetson, Sarah P Samreth, Manchula Navaratnam, and David M. Kwiatkowski
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Male ,medicine.medical_specialty ,Mean arterial pressure ,Adolescent ,Hemodynamics ,Intensive Care Units, Pediatric ,Clinical pathway ,Postoperative Complications ,Internal medicine ,Medicine ,Humans ,Child ,Retrospective Studies ,Transplantation ,business.industry ,Central venous pressure ,Acute kidney injury ,Perioperative ,Acute Kidney Injury ,medicine.disease ,Blood pressure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cardiology ,Coronary care unit ,Critical Pathways ,Heart Transplantation ,Female ,business - Abstract
Background To evaluate the impact of a clinical pathway on the incidence and severity of acute kidney injury in patients undergoing heart transplant. Methods This was a 2.5-year retrospective evaluation using 3 years of historical controls within a cardiac intensive care unit in an academic children's hospital. Patients undergoing heart transplant between May 27, 2014, and April 5, 2017 (pre-pathway) and May 1, 2017, and November 30, 2019 (pathway) were included. The clinical pathway focused on supporting renal perfusion through hemodynamic management, avoiding or delaying nephrotoxic medications, and providing pharmacoprophylaxis against AKI. Results There were 57 consecutive patients included. There was an unadjusted 20% reduction in incidence of any acute kidney injury (p = .05) and a 17% reduction in Stage 2/3 acute kidney injury (p = .09). In multivariable adjusted analysis, avoidance of Stage 2/3 acute kidney injury was independently associated with the clinical pathway era (AOR -1.3 [95% CI -2.5 to -0.2]; p = .03), achieving a central venous pressure of or less than 12 mmHg (AOR -1.3 [95% CI -2.4 to -0.2]; p = .03) and mean arterial pressure above 60 mmHg (AOR -1.6 [95% CI -3.1 to -0.01]; p = .05) in the first 48 h post-transplant, and older age at transplant (AOR - 0.2 [95% CI -0.2 to -0.06]; p = .002). Conclusions This report describes a renal protection clinical pathway associated with a reduction in perioperative acute kidney injury in patients undergoing heart transplant and highlights the importance of normalizing perioperative central venous pressure and mean arterial blood pressure to support optimal renal perfusion.
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- 2021
11. Impact of Modified Anesthesia Management for Pediatric Patients With Williams Syndrome
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Alexander R. Schmidt, Manchula Navaratnam, Chandra Ramamoorthy, R. Thomas Collins, Yamini Adusumelli, Yingjie Weng, and Kirstie L. MacMillen
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Williams Syndrome ,medicine.medical_treatment ,Blood Pressure ,030204 cardiovascular system & hematology ,Anesthesia, General ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Cardiopulmonary resuscitation ,Child ,Cardiac catheterization ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Hemodynamics ,medicine.disease ,Anesthesiology and Pain Medicine ,Blood pressure ,Intravenous anesthesia ,Strictly standardized mean difference ,Anesthesia ,Child, Preschool ,Williams syndrome ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Objective This study compared the percent change in systolic blood pressure and the incidence of adverse cardiac events (ACEs; defined as cardiac arrest, cardiopulmonary resuscitation, arrhythmias, or ST-segment changes) during anesthesia induction in patients with Williams syndrome (WS) before and after implementation of a perioperative management strategy. Design Retrospective observational cohort study. Setting Single quaternary academic referral center. Participants The authors reviewed the records of all children with WS at the authors’ institution who underwent general anesthesia for cardiac catheterization, diagnostic imaging, or any type of surgery between November 2008 and August 2019. The authors identified 142 patients with WS, 48 of whom underwent 118 general anesthesia administrations. A historic group (HG) was compared with the intervention group (IG). Interventions Change in perioperative management (three-stage risk stratification: preoperative intravenous hydration, intravenous anesthesia induction, and early use of vasoactives). Measurements and Main Results The authors determined event rates within 60 minutes of anesthesia induction. Standardized mean difference (SMD) was calculated (SMD >0.2 suggests clinically meaningful difference). Sixty-seven general anesthesia encounters were recorded in the HG (mean age, 4.8 years; mean weight, 16.3 kg) and 51 in the IG (mean age, 6.0 years; mean weight, 18.2 kg). The change in systolic blood pressure was –17.5% (–30.0, –5.0) in the HG versus –9% (–18.0, 5.0) in the IG (p = 0.015; SMD = 0.419), and the incidence of ACEs was 6% in the HG and 2% in the IG (p = 0.542; SMD = 0.207). Conclusions Preoperative risk stratification, preoperative intravenous hydration, intravenous induction, and early use of continuous vasoactives resulted in greater hemodynamic stability, with a 2% incidence of ACEs.
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- 2021
12. Management of a Pediatric Patient With a Left Ventricular Assist Device and Symptomatic Acquired von Willebrand Syndrome Presenting for Orthotopic Heart Transplant
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Manchula Navaratnam, Kaitlin M. Flannery, Katsuhide Maeda, Christopher S. Almond, Paul Shuttleworth, and Komal Kamra
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medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Perioperative Care ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Acquired von Willebrand syndrome ,law ,Cardiopulmonary bypass ,Coagulopathy ,Medicine ,Humans ,Child ,Perioperative management ,business.industry ,Perioperative ,medicine.disease ,Pathophysiology ,Surgery ,Pediatric patient ,von Willebrand Diseases ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Ventricular assist device ,Heart Transplantation ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
We present the successful perioperative management of an 11-year-old patient presenting for heart transplant with a left ventricular assist device, symptomatic acquired von Willebrand syndrome, and recent preoperative intracranial hemorrhage. A brief review of the pathophysiology of acquired von Willebrand syndrome is included. As the number of pediatric patients supported with ventricular assist devices continues to increase, the management of symptomatic acquired von Willebrand syndrome during the perioperative period is an important consideration for anesthesiologists.
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- 2020
13. Pectoral nerve blocks decrease postoperative pain and opioid use after pacemaker or implantable cardioverter-defibrillator placement in children
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Jeffrey Yang, Kara S. Motonaga, Manchula Navaratnam, William R. Goodyer, Anne M. Dubin, Grant McFadyen, Scott R. Ceresnak, Anthony Trela, Debra Hanisch, Henry Chubb, and Danton S. Char
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Male ,medicine.medical_specialty ,Heart disease ,Adolescent ,Heart Diseases ,medicine.drug_class ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,medicine ,Humans ,030212 general & internal medicine ,Child ,Pain Measurement ,Retrospective Studies ,Pain, Postoperative ,Local anesthetic ,business.industry ,Opioid use ,Nerve Block ,medicine.disease ,Confidence interval ,Defibrillators, Implantable ,Analgesics, Opioid ,Opioid ,Cardiothoracic surgery ,Anesthesia ,Anesthetic ,Female ,Cardiology and Cardiovascular Medicine ,Complication ,business ,medicine.drug ,Follow-Up Studies - Abstract
Pectoral nerve blocks (PECs) can reduce intraprocedural anesthetic requirements and postoperative pain. Little is known about the utility of PECs in reducing pain and narcotic use after pacemaker (PM) or implantable cardioverter-defibrillator (ICD) placement in children.The purpose of this study was to determine whether PECs can decrease postoperative pain and opioid use after PM or ICD placement in children.A single-center retrospective review of pediatric patients undergoing transvenous PM or ICD placement between 2015 and 2020 was performed. Patients with recent cardiothoracic surgery or neurologic/developmental deficits were excluded. Demographics, procedural variables, postoperative pain, and postoperative opioid usage were compared between patients who had undergone PECs and those who had undergone conventional local anesthetic (Control).A total of 74 patients underwent PM or ICD placement; 20 patients (27%) underwent PECs. There were no differences between PECs and Control with regard to age, weight, gender, type of device placed, presence of congenital heart disease, type of anesthesia, procedural time, or complication rates. Patients who underwent PECs had lower pain scores at 1, 2, 6, 18, and 24 hours compared to Control. PECs patients had a lower mean cumulative pain score [PECs 1.5 (95% confidence interval [CI] 0.8-2.2) vs Control 3.1 (95% CI 2.7-3.5); P.001] and lower total opioid use [PECs 6.0 morphine milligram equivalent (MME)/mPECs reduce postoperative pain scores and lower total opioid usage after ICD or PM placement. PECs should be considered at the time of transvenous device placement in children.
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- 2020
14. LVOT-VTI is a Useful Indicator of Low Ventricular Function in Young Patients
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Chandra Ramamoorthy, Theresa A. Tacy, Rajesh Punn, and Manchula Navaratnam
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Cardiomyopathy, Dilated ,Male ,Cardiac function curve ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,Ventricular Dysfunction, Left ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Health Status Indicators ,Humans ,Ventricular Function ,Medicine ,Cutoff ,Ventricular outflow tract ,030212 general & internal medicine ,Child ,Stroke ,Retrospective Studies ,Echocardiography, Doppler, Pulsed ,Body surface area ,Ejection fraction ,Surrogate endpoint ,business.industry ,Infant ,Dilated cardiomyopathy ,medicine.disease ,Child, Preschool ,Heart Function Tests ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Left ventricular outflow tract velocity time integral (LVOT-VTI), a Doppler-derived measure of stroke distance, is used as a surrogate marker of cardiac function in adults. LVOT-VTI is easily obtained, independent of ventricular geometry and wall motion abnormalities. We investigated the relationship between LVOT-VTI and conventional measures of function in young patients by comparing controls to children with dilated cardiomyopathy (DCM). Sixty-two healthy and 52 DCM patients over 1 year were studied retrospectively. The average pulsed (PW) and continuous wave (CW) LVOT-VTIs from apical views were measured from three cycles. Body surface area (BSA) and Ejection fraction (EF) were obtained. We compared LVOT-VTIs between study and control groups and assessed BSA’s impact on LVOT-VTI. The entire cohort was classified into three levels of LV function which were compared. We determined LVOT-VTI cutoff values that indicated an EF
- Published
- 2017
15. Adverse Events Following Cardiac Catheterization among Infants, Children, and Young Adults on Ventricular Assist Device Support
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Alyssa Power, Manchula Navaratnam, A. A. Shui, John C. Dykes, Christopher S. Almond, Jenna Murray, David N. Rosenthal, Katsuhide Maeda, Vamsi V. Yarlagadda, Shuping Chen, and Lynn F. Peng
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,Ventricular assist device ,medicine ,Cardiology ,Surgery ,Young adult ,Cardiology and Cardiovascular Medicine ,business ,Adverse effect ,Cardiac catheterization - Published
- 2020
16. Single Ventricular Assist Device Support for the Failing Bidirectional Glenn Patient
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Katsuhide Maeda, Manchula Navaratnam, Teimour Nasirov, John C. Dykes, Jenna Murray, Olaf Reinhartz, Christopher S. Almond, Vamsi V. Yarlagadda, David N. Rosenthal, Beth D. Kaufman, Seth A. Hollander, and Sharon Chen
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,ARDS ,Surgical strategy ,medicine.medical_treatment ,Pulsatile flow ,030204 cardiovascular system & hematology ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Cause of Death ,Medicine ,Humans ,cardiovascular diseases ,Child ,Retrospective Studies ,Heart transplantation ,Heart Failure ,Postoperative Care ,business.industry ,Continuous flow ,Infant ,medicine.disease ,Surgery ,030228 respiratory system ,Respiratory failure ,medicine.vein ,Ventricular assist device ,Child, Preschool ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Given poor outcomes, strategies to improve ventricular assist devices (VADs) for single-ventricle patients with bidirectional Glenn (BDG) palliation are needed. Methods This retrospective review describes an institutional experience with VAD support for patients with BDG from April 2011 to January 2019. Surgical strategies, complications, and causes of death are described. Survival to heart transplantation for various strategies are compared. Results A total of 7 patients with BDG (weights, 5.6 to 28.8 kg; ages, 7 months to 11 years) underwent VAD implantation. Three patients underwent implantation of Berlin Heart EXCOR devices (Berlin Heart, Inc, Spring, TX), 2 had HeartWare HVADs (Medtronic, Minneapolis, MN) implanted, and 2 patients underwent implantation of paracorporeal continuous flow devices. Four patients underwent ventricular inflow cannulation, and 3 underwent atrial inflow cannulation. At the time of VAD implantation, the BDG was left intact in 3 patients, taken down in 3 patients, and created de novo in 1 patient. Over a total of 420 VAD support days, 2 patients survived to heart transplantation, 1 patient with HeartWare ventricular cannulation and intact BDG (after 174 days) and another with Berlin Heart atrial cannulation and BDG take-down (after 72 days). There were 3 deaths within 2 weeks of VAD implantation (2 from respiratory failure, 1 from infection) and 2 deaths after 30 days as a result of strokes. Conclusions The surgical strategy and postoperative management of VAD with BDG are still evolving. Successful support can be achieved with (1) both pulsatile and continuous flow pumps, (2) atrial or ventricular cannulation, and (3) with or without BDG take-down. Surgical strategy should be determined by individual patient anatomy, physiology, and condition.
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- 2019
17. Preoperative Laboratory Studies for Pediatric Cardiac Surgery Patients: A Multi-Institutional Perspective
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Ellen Spurrier, Edmund H. Jooste, Dheeraj Goswami, Claudia Benkwitz, Gregory J. Latham, Jamie M. Schwartz, Kelly A. Machovec, Manchula Navaratnam, Matthew R. McDaniel, Luis M. Zabala, Lisa Wise-Faberowski, David Faraoni, Nina A. Guzzetta, Nischal K. Gautam, Laura A. Downey, Stephanie E. Jones, and Erin A. Gottlieb
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medicine.medical_specialty ,Canada ,Hemostasis ,business.industry ,Perspective (graphical) ,Thoracic Surgery ,Heart ,Pediatrics ,United States ,Cardiac surgery ,Specialties, Surgical ,Anesthesiology and Pain Medicine ,Anesthesiology ,Surveys and Questionnaires ,Medicine ,Humans ,Blood Gas Analysis ,Cardiac Surgical Procedures ,Practice Patterns, Physicians' ,business ,Intensive care medicine ,Child ,Blood Chemical Analysis ,Follow-Up Studies ,Retrospective Studies - Published
- 2019
18. The use of prothrombin complex concentrate as a warfarin reversal agent in pediatric patients undergoing orthotopic heart transplantation
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Manchula Navaratnam, Victoria Y. Ding, Jin Long, Katsuhide Maeda, Glyn D. Williams, Sharon Chen, and Daniel J. Sisti
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Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Hemorrhage ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Blood product ,030225 pediatrics ,Cardiopulmonary bypass ,Medicine ,Humans ,Child ,Blood Coagulation ,Retrospective Studies ,Heart transplantation ,business.industry ,Warfarin ,Anticoagulants ,Prothrombin complex concentrate ,Blood Coagulation Factors ,Surgery ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Ventricular assist device ,Pediatrics, Perinatology and Child Health ,Heart Transplantation ,Female ,business ,Packed red blood cells ,medicine.drug - Abstract
Background Patients supported with a ventricular assist device are predisposed to severe bleeding at the time of orthotopic heart transplant due to several risk factors including anticoagulation with vitamin K antagonists. Kcentra, a four-factor prothrombin complex concentrate, has been approved by the FDA for warfarin reversal in adults prior to urgent surgery. There is a lack of published data on the preoperative use of four-factor prothrombin complex concentrates in pediatric patients undergoing cardiacsurgery. Methods This is a single-center retrospective analysis of pediatric patients with a continuous-flow ventricular assist device who underwent heart transplant, comparing patients who received Kcentra for anticoagulation reversal with a historical patient cohort who did not. Consecutive patients from January 2013 to December 2017 were analyzed. The primary outcome was volume of blood product transfusion prior to cardiopulmonary bypass initiation. Secondary outcomes include blood product transfusion after cardiopulmonary bypass intraoperatively and up to 24 hours postoperatively, chest tube output within 24 hours of surgery, time to extubation, incidence of thromboembolism, and post-transplant length ofstay. Results From 2013 to 2017, 31 patients with continuous-flow ventricular assist devices underwent heart transplant, with 27 patients included in the analysis. Fifteen patients received Kcentra compared with 12 patients who received fresh-frozen plasma for anticoagulation reversal. Compared with the control group, patients who received Kcentra had less packed red blood cells, fresh-frozen plasma, and platelets transfused prior to cardiopulmonary bypass initiation. The Kcentra group also received less packed red blood cells on bypass and less packed red blood cells after cardiopulmonary bypass termination. There were no differences in chest tube output, time to extubation, intensive care unit length of stay, or overall hospital length of stay. Neither group had thromboembolic complications detected during the first seven postoperative days. Conclusion This small retrospective study indicates that preoperative warfarin reversal with Kcentra reduces blood product exposure in pediatric patients with ventricular assist devices undergoing heart transplant.
- Published
- 2019
19. Perioperative management of pediatric en-bloc combined heart-liver transplants: a case series review
- Author
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Glyn D. Williams, Julianne M. Mendoza, Ann Ng, Manchula Navaratnam, Waldo Concepcion, Seth A. Hollander, Chandra Ramamoorthy, and Katsuhide Maeda
- Subjects
Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Time Factors ,Blood transfusion ,Adolescent ,Heart disease ,medicine.medical_treatment ,Operative Time ,030204 cardiovascular system & hematology ,030230 surgery ,Liver transplantation ,Perioperative Care ,law.invention ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,law ,Antifibrinolytic agent ,medicine ,Cardiopulmonary bypass ,Humans ,Blood Transfusion ,Child ,Retrospective Studies ,Heart transplantation ,business.industry ,Perioperative ,Length of Stay ,medicine.disease ,Liver Transplantation ,Surgery ,Transplantation ,Anesthesiology and Pain Medicine ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Heart Transplantation ,Female ,business - Abstract
SummaryBackground Combined heart and liver transplantation (CHLT) in the pediatric population involves a complex group of patients, many of whom have palliated congenital heart disease (CHD) involving single ventricle physiology. Objective The purpose of this study was to describe the perioperative management of pediatric patients undergoing CHLT at a single institution and to identify management strategies that may be used to optimize perioperative care. Methods We did a retrospective database review of all patients receiving CHLT at a children's hospital between 2006 and 2014. Information collected included preoperative characteristics, intraoperative management, blood transfusions, and postoperative morbidity and mortality. Results Five pediatric CHLTs were performed over an 8-year period. All patients had a history of complex CHD with multiple sternotomies, three of whom had failing Fontan physiology. Patient age ranged from 7 to 23 years and weight from 29.5 to 68.5 kg. All CHLTs were performed using an en-bloc technique where both the donor heart and liver were implanted together on cardiopulmonary bypass (CPB). The median operating room time was 14.25 h, median CPB time was 3.58 h, and median donor ischemia time was 4.13 h. Patients separated from CPB on dopamine, epinephrine, and milrinone infusions and two required inhaled nitric oxide. All patients received a massive intraoperative blood transfusion post CPB with amounts ranging from one to three times the patient's estimated blood volume. The patient who required the most transfusions was in decompensated heart and liver failure preoperatively. Four of the five patients received an antifibrinolytic agent as well as a procoagulant (prothrombin complex concentrate or recombinant activated Factor VII) to assist with hemostasis. There were no 30-day thromboembolic events detected. Postoperatively the median length of mechanical ventilation, ICU stay and stay to hospital discharge was 4, 8, and 37 days, respectively. All patients are alive and free from allograft rejection at this time. Conclusion Combined heart and liver transplantation in the pediatric population involves a complex group of patients with unique perioperative challenges. Successful management starts with thorough preoperative planning and communication and involves strategies to deal with massive intraoperative hemorrhage and coagulopathy in addition to protecting and supporting the transplanted heart and liver and meticulous surgical technique. An integrated multidisciplinary team approach is the cornerstone for successful outcomes.
- Published
- 2016
20. Bilateral automatized intermittent bolus erector spinae plane analgesic blocks for sternotomy in a cardiac patient who underwent cardiopulmonary bypass: A new era of Cardiac Regional Anesthesia
- Author
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Gail Boltz, Manchula Navaratnam, Katsuhide Maeda, Thomas J Caruso, and Ban C. H. Tsui
- Subjects
business.industry ,Analgesic ,Treatment outcome ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Postoperative diagnosis ,law ,Regional anesthesia ,Anesthesia ,Intermittent bolus ,Cardiopulmonary bypass ,Medicine ,030212 general & internal medicine ,Ultrasonography ,business - Published
- 2018
21. Bilateral continuous erector spinae plane blocks for sternotomy in a pediatric cardiac patient
- Author
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Manchula Navaratnam, J. Wong, R. J. Ramamurthi, Ban C. H. Tsui, Katsuhide Maeda, and Gail Boltz
- Subjects
Tachycardia ,medicine.medical_specialty ,Plane (geometry) ,business.industry ,medicine.medical_treatment ,Treatment outcome ,Lumbar vertebrae ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Postoperative diagnosis ,medicine.anatomical_structure ,030202 anesthesiology ,Anesthesia ,medicine ,Nerve block ,030212 general & internal medicine ,Ultrasonography ,medicine.symptom ,business ,Paraspinal Muscle - Published
- 2018
22. Cover Image
- Author
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Manchula Navaratnam, Katsuhide Maeda, and Seth A. Hollander
- Subjects
Anesthesiology and Pain Medicine ,Pediatrics, Perinatology and Child Health - Published
- 2019
23. Surgical Reconstruction of Tracheal Stenosis in Conjunction With Congenital Heart Defects
- Author
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Ryan R. Davies, Frank L. Hanley, Richard D. Mainwaring, Michael Shillingford, V. Mohan Reddy, Peter J. Koltai, and Manchula Navaratnam
- Subjects
Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine ,Humans ,Child ,Retrospective Studies ,Tracheal obstruction ,business.industry ,Congenital tracheal stenosis ,Infant, Newborn ,Infant ,Retrospective cohort study ,Plastic Surgery Procedures ,respiratory system ,Airway obstruction ,medicine.disease ,Surgery ,Tracheal Stenosis ,Airway Obstruction ,Trachea ,medicine.anatomical_structure ,Ventricle ,Child, Preschool ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Airway - Abstract
Background Surgical reconstruction is the primary method of treating airway obstruction in children. Tracheal stenosis is frequently associated with congenital heart defects, which may further complicate the overall management strategy. The purpose of this study was to review our experience with surgical reconstruction of airway obstruction in conjunction with congenital heart defects. Methods This was a retrospective review of our surgical experience with tracheal stenosis from February 2003 to August 2011. Twenty-seven patients were identified in our database. Six patients had isolated, congenital tracheal stenosis, and 21 had tracheal stenosis in association with congenital heart defects. There were two identifiable subgroups. Thirteen patients had airway stenoses identified concurrently with congenital heart defects and underwent combined repair. The second group comprised 8 patients who had previous correction of their congenital heart defects and experienced delayed presentation of tracheal (n = 6) or bronchial (n = 2) obstruction. Results The median age at surgery was 9 months. There were 2 postoperative deaths, both in children with single ventricle. The median duration of follow-up for the entire cohort of 25 surviving patients was 4 years. None of the patients have required reoperations on the trachea; 5 have had minor reinterventions. Conclusions The data demonstrate that tracheal obstruction is frequently found in conjunction with congenital heart defects. Nearly one third of our patients had delayed presentation of airway obstruction that was identified subsequent to previous congenital heart defect repair. Tracheal reconstructive techniques were effective regardless of the cause of the airway obstruction.
- Published
- 2012
24. Anesthesia for Transplantation
- Author
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Dean B. Andropoulos, Manchula Navaratnam, Stephen A. Stayer, and Glynn Williams
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Immunosuppression ,medicine.disease ,Transplant rejection ,Surgery ,Transplantation ,Calcineurin ,Renal transplant ,Anesthesia ,Small bowel transplant ,Heart–lung transplant ,medicine ,business ,Solid organ transplantation - Published
- 2011
25. Pediatric pacemakers and ICDs: how to optimize perioperative care
- Author
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Manchula Navaratnam and Anne M. Dubin
- Subjects
medicine.medical_specialty ,Heart disease ,business.industry ,Adult population ,medicine.disease ,Multidisciplinary team ,Emergency situations ,Preoperative care ,Anesthesiology and Pain Medicine ,Pediatrics, Perinatology and Child Health ,Perioperative care ,medicine ,Lead failure ,Medical emergency ,Intensive care medicine ,business ,Noncardiac surgery - Abstract
An increasing number of pediatric patients with permanent pacemakers and implantable cardioverter defibrillators (ICDs) require cardiac and noncardiac surgery. It is critical that the anesthesiologist caring for these patients understands the management of the device and the underlying heart disease. Children with these devices are more vulnerable to lead failure and inappropriate shocks compared with the adult population. Preoperative assessment and appropriate reprogramming of the device, in addition to minimizing sources of electromagnetic interference, are keystones in the perioperative care of these patients. Prior consultation with qualified programmers is recommended to enable timely optimization of the device. Magnets may be used in emergency situations but it is important to appreciate the limitations of magnet use on different models of pacemakers and ICDs. Safe and successful perioperative care is dependent upon a well-organized and coordinated multidisciplinary team approach.
- Published
- 2011
26. Pediatric pacemakers and ICDs: how to optimize perioperative care
- Author
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Manchula, Navaratnam and Anne, Dubin
- Subjects
Postoperative Care ,Pacemaker, Artificial ,Intraoperative Care ,Infant, Newborn ,Infant ,Perioperative Care ,Defibrillators, Implantable ,Prosthesis Implantation ,Magnetics ,Electromagnetic Fields ,Child, Preschool ,Preoperative Care ,Humans ,Cardiac Surgical Procedures ,Child - Abstract
An increasing number of pediatric patients with permanent pacemakers and implantable cardioverter defibrillators (ICDs) require cardiac and noncardiac surgery. It is critical that the anesthesiologist caring for these patients understands the management of the device and the underlying heart disease. Children with these devices are more vulnerable to lead failure and inappropriate shocks compared with the adult population. Preoperative assessment and appropriate reprogramming of the device, in addition to minimizing sources of electromagnetic interference, are keystones in the perioperative care of these patients. Prior consultation with qualified programmers is recommended to enable timely optimization of the device. Magnets may be used in emergency situations but it is important to appreciate the limitations of magnet use on different models of pacemakers and ICDs. Safe and successful perioperative care is dependent upon a well-organized and coordinated multidisciplinary team approach.
- Published
- 2011
27. Truncus Arteriosus
- Author
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Manchula Navaratnam and Chandra Ramamoorthy
- Published
- 2011
28. Contributors
- Author
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Sanjib Adhikary, Jorge Aguilar, Charles Ahere, Moustafa Ahmed, Jane C. Ahn, Shamsuddin Akhtar, David B. Albert, Nasrin N. Aldawoodi, John T. Algren, Gracie Almeida-Chen, David Amar, Zirka H. Anastasian, Stephen Aniskevich, Solomon Aronson, Harendra Arora, Amit Asopa, Joshua H. Atkins, John G. Augoustides, Mohammad Fareed Azam, Catherine R. Bachman, Douglas R. Bacon, Andrew D. Badley, Emily Baird, Alethia Baldwin, Ryan Ball, Amir Baluch, David Bandola, Shawn Banks, Paul G. Barash, Kathleen E. Barrett, Shawn T. Beaman, Jonathan C. Beathe, Christopher D. Beatie, W. Scott Beattie, Perry S. Bechtle, G. Richard Benzinger, Lauren Berkow, Jeffrey M. Berman, Wendy K. Bernstein, Arnold J. Berry, Frederic Berry, Ulrike Berth, Walter Bethune, Sumita Bhambhani, Shobana Bharadwaj, Neil Bhatt, Frederic T. Billings, Wendy B. Binstock, David J. Birnbach, Michael Bishop, Stephanie Black, Mary A. Blanchette, James M. Blum, Krishna Boddu, Lara Bonasera, Richard L. Boortz-Marx, Cecil O. Borel, Gregory H. Botz, Charles D. Boucek, William Bradford, Jason C. Brainard, Michelle Braunfeld, Ferne R. Braveman, Caridad Bravo-Fernandez, Peter H. Breen, Marjorie Brennan, Tricia Brentjens, Megan A. Brockel, Jay B. Brodsky, Todd A. Bromberg, Adam J. Broussard, Chris Broussard, Carmen Labrie-Brown, Robert H. Brown, Charles S. Brudney, Sorin J. Brull, Claude Brunson, Trent Bryson, Jacob M. Buchowski, Stefan Budac, Zachary D. Bush, John Butterworth, Lisbeysi Calo, Christopher Canlas, Ayana Cannon, Shawn M. Cantie, Lisa Caplan, Marco Caruso, Davide Cattano, Charles B. Cauldwell, Laura Cavallone, Maurizio Cereda, Thomas M. Chalifoux, Susan Chan, Theodore G. Cheek, Alexander Chen, Samuel A. Cherry, Albert T. Cheung, Grace L. Chien, Peter T. Choi, Christopher Ciarallo, Franklyn Cladis, Anthony J. Clapcich, Richard B. Clark, Mindy Cohen, Neal H. Cohen, Robert I. Cohen, Stephan J. Cohn, Aisling Conran, Richard I. Cook, Randall F. Coombs, David M. Corda, Daniel Cormican, Darren Cousin, Vincent S. Cowell, Lyndsey Cox, Paula A. Craigo, Richard C. Cross, Roy F. Cucchiara, William H. Daily, Gaurang Dalal, Priti Dalal, Michael Danekas, Ahmed M. Darwish, Ribal Darwish, Suanne M. Daves, Kathleen Davis, Peter J. Davis, Bracken J. De Witt, Ellise Delphin, Seema Deshpande, Dawn P. Desiderio, Tricia Desvarieux, Laura K. Diaz, Christian Diez, Sanjay Dixit, Meenakshi Dogra, Karen B. Domino, Kathryn Dorhauer, Todd Dorman, Don D. Doussan, James Duke, Ann C. Duncan, Frank W. Dupont, Andrew Dziewit, L. Jane Easdown, R. Blaine Easley, Thomas J. Ebert, David M. Eckmann, Talmage D. Egan, Seth Eisdorfer, Nabil M. Elkassabany, Ryan P. Ellender, Logan S. Emory, Monique Espinosa, Lucinda L. Everett, Nauder Faraday, James J. Fehr, James M. Feld, Lynn A. Fenton, Laura H. Ferguson, Matthew Fiegel, Aaron M. Fields, Gordon N. Finlayson, Alan Finley, Gregory W. Fischer, Gary Fiskum, Molly Fitzpatrick, Russell Flatto, Lee A. Fleisher, Ronda Flower, Annette G. Folgueras, Patrick J. Forte, Joseph F. Foss, Charles J. Fox, William R. Furman, Robert Gaiser, David R. Gambling, Scott Gardiner, Matthew L. Garvey, Abraham C. Gaupp, Steven Gayer, Jeremy M. Geiduschek, Frank Gencorelli, Eric Gewirtz, Ghaleb A. Ghani, Charles P. Gibbs, Jeremy L. Gibson, Lori Gilbert, Kevin J. Gingrich, Gregory Ginsburg, Christopher Giordano, Christine E. Goepfert, Hernando Gomez, Santiago Gomez, Alanna E. Goodman, Stephanie R. Goodman, Alexandru Gottlieb, Ori Gottlieb, Allan Gottschalk, Basavana Gouda Goudra, Harry J. Gould, Nikolaus Gravenstein, Megan Graybill, William J. Greeley, Patrick Guffey, Ala Sami Haddadin, John G. Hagen, Karim Abdel Hakim, Michael Hall, N. James Halliday, Raafat S. Hannallah, Jeremy Hansen, C. William Hanson, Charles B. Hantler, Andrew P. Harris, Jonathan Hastie, Henry A. Hawney, Stephen O. Heard, James E. Heavner, James G. Hecker, Elizabeth A. Hein, Eugenie Heitmiller, Mark Helfaer, Lori B. Heller, Andrew Hemphill, Adrian Hendrickse, Frederick A. Hensley, Ian A. Herrick, Douglas Hester, Eric J. Heyer, Michael S. Higgins, Roberta Hines, Charles W. Hogue, Kenneth J. Holroyd, Natalie F. Holt, Simon J. Howell, Faisal Huda, Keith E. Hude, Hayden R. Hughes, James M. Hunter, Brad J. Hymel, James W. Ibinson, Karen E. Iles, Robert M. Insoft, Shiroh Isono, Yulia Ivashkov, Bozena R. Jachna, Anna Jankowska, Norah Janosy, Arun L. Jayaraman, Nathalia Jimenez, Judy G. Johnson, Lyndia Jones, Edmund H. Jooste, Zeev N. Kain, Maudy Kalangie, Philip L. Kalarickal, Ihab Kamel, Mia Kang, Ivan Kangrga, Ravish Kapoor, Helen W. Karl, Christopher Karsanac, Swaminathan Karthik, Jeffrey A. Katz, Alan Kaye, Adam M. Kaye, A. Murat Kaynar, Nancy B. Kenepp, Miklos D. Kertai, Mary A. Keyes, Sarah Khan, Swapnil Khoche, David Y. Kim, Jerry H. Kim, Kimberly M. King, Jeffrey Kirsch, Matthew A. Klopman, Paul R. Knight, Donald D. Koblin, W. Andrew Kofke, Vincent J. Kopp, Joseph R. Koveleskie, Courtney Kowalczyk, Valeriy V. Kozmenko, Kaylyn Krummen, Sapna R. Kudchadkar, Nathan Kudrick, Adrienne Kung, C. Dean Kurth, Robert Kyle, J. Lance LaFleur, Jason G. Lai, Kirk Lalwani, William L. Lanier, Dawn M. Larson, Richard M. Layman, Chris C. Lee, Mark J. Lema, W. Casey Lenox, Jacqueline M. Leung, Roy C. Levitt, Jerrold H. Levy, J. Lance Lichtor, Charles Lin, Sharon L. Lin, Karen S. Lindeman, Lesley Lirette, Ronald S. Litman, Qianjin Liu, Renyu Liu, Wen-Shin Liu, Justin Lockman, Stanley L. Loftness, Martin J. London, Philip D. Lumb, M. Concetta Lupa, Anne Marie Lynn, Devi Mahendran, Jeffrey Mako, Anuj Malhotra, Vinod Malhotra, Andrew M. Malinow, Mark G. Mandabach, Dennis T. Mangano, Sobia Mansoor, Inna Maranets, Jonathan B. Mark, Sinisa Markovic, H. Michael Marsh, Choendal Martin, Nicole D. Martin, Douglas Martz, Veronica A. Matei, Letha Mathews, Lynne G. Maxwell, Philip McArdle, John P. McCarren, Brenda C. McClain, Brian McClure, William A. McDade, Kathryn E. McGoldrick, Brian J. McGrath, Gregory L. McHugh, David McIlroy, Jason McKeown, Thomas M. McLoughlin, R. Yan McRae, William L. Meadow, Sameer Menda, William T. Merritt, David G. Metro, Berend Mets, Hosni Mikhaeil, David W. Miller, Jessica Miller, Mohammed Minhaj, Marek A. Mirski, Nanhi Mitter, Alexander J.C. Mittnacht, Raj K. Modak, Pierre Moine, Constance L. Monitto, Richard C. Month, Richard E. Moon, Laurel E. Moore, Roger A. Moore, Thomas A. Moore, Debra E. Morrison, Jonathan Moss, John R. Moyers, Jesse J. Muir, Adam J. Munson-Young, Stanley Muravchick, John M. Murkin, Peter Nagele, Peter A. Nagi, Daniel A. Nahrwold, Michael L. Nahrwold, Madhavi Naik, Manchula Navaratnam, Stephan P. Nebbia, Priscilla Nelson, Thai T. Nguyen, Viet Nguyen, Stavroula Nikolaidis, Zoulfira Nisnevitch, Dolores B. Njoku, Mary J. Njoku, Edward J. Norris, Omonele O. Nwokolo, Daniel Nyhan, William T. O'Byrne, Edward A. Ochroch, Andrew Oken, Nathan Orgain, Nancy E. Oriol, Pedro Orozco, Andreas M. Ostermeier, Andranik Ovassapian, Mehmet S. Ozcan, Ira Padnos, Sheela S. Pai, Nirvik Pal, Dhamodaran Palaniappan, Susan K. Palmer, Howard D. Palte, Wei Pan, Oliver Panzer, Sibi Pappachan, Anthony Passannante, Dennis A. Patel, Dilipkumar K. Patel, Kirit M. Patel, Samir Patel, Shalin Patel, Sanup Pathak, Minda L. Patt, Ronald W. Pauldine, Olga Pawelek, Tim Pawelek, Kiarash Paydar, Ronald G. Pearl, Christine Peeters-Asdourian, Padmavathi R. Perela, Charise T. Petrovitch, Patricia H. Petrozza, Dennis Phillips, Mark C. Phillips, Christine Piefer, Edgar J. Pierre, S. William Pinson, Evan G. Pivalizza, Raymond M. Planinsic, Don Poldermans, Joel M. Pomerantz, Jason E. Pope, Wanda M. Popescu, Vivian H. Porche, Jahan Porhomayon, Dmitry Portnoy, Corinne K. Postle, Paul J. Primeaux, Donald S. Prough, Ferenc Puskas, Carlos A. Puyo, Forrest Quiggle, Mary Rabb, Bronwyn R. Rae, Muhammad B. Rafique, Jesse M. Raiten, Arvind Rajagopal, Srinivasan Rajagopal, Gaurav Rajpal, Chandra Ramamoorthy, Ira J. Rampil, James G. Ramsay, James A. Ramsey, Vidya N. Rao, Joana Ratsiu, Selina Read, Ronjeet Reddy, Leila L. Reduque, David L. Reich, Karene Ricketts, Cameron Ricks, Bernhard Riedel, Jyotsna Rimal, Joseph Rinehart, James M. Riopelle, Stacey A. Rizza, Amy C. Robertson, Stephen Robinson, Peter Rock, Yillam F. Rodriguez-Blanco, Michael F. Roizen, Daniel M. Roke, Ryan Romeo, Joseph Rosa, David A. Rosen, Kathleen Rosen, Stanley H. Rosenbaum, Andrew D. Rosenberg, Andrew L. Rosenberg, Henry Rosenberg, Meg A. Rosenblatt, Steven Roth, Brian Rothman, Justin L. Rountree, Matthew J. Rowan, Marc Rozner, Ryan Rubin, Stephen M. Rupp, W. John Russell, Thomas A. Russo, Alecia L. Sabartinelli, Tetsuro Sakai, Orlando J. Salinas, Paul L. Samm, Jibin Samuel, Tor Sandven, Ted J. Sanford, Joshua W. Sappenfield, Ponnusamy Saravanan, Subramanian Sathishkumar, R. Alexander Schlichter, Eric Schnell, David L. Schreibman, Armin Schubert, Peter Schulman, Todd A. Schultz, Alan Jay Schwartz, Jamie McElrath Schwartz, Jeffrey J. Schwartz, Benjamin K. Scott, Joseph L. Seltzer, Tamas Seres, Daniel I. Sessler, Navil F. Sethna, Amar Setty, Paul W. Shabaz, Pranav Shah, Saroj Mukesh Shah, Milad Sharifpour, Joanne Shay, Jay Shepherd, Jeffrey S. Shiffrin, Marina Shindell, Daniel Siker, Richard Silverman, Brett A. Simon, Nina Singh, Ashish C. Sinha, Robert N. Sladen, Kieran A. Slevin, Tod B. Sloan, Kathleen Smith, Timothy E. Smith, Victoria Smoot, Denis Snegovskikh, Betsy Ellen Soifer, Molly Solorzano, James M. Sonner, Aris Sophocles, James A. Sparrow, Joan Spiegel, Bruce D. Spiess, Ramprasad Sripada, Stanley W. Stead, Joshua D. Stearns, Kelly Stees, Clinton Steffey, Christopher Stemland, John Stene, Christopher T. Stephens, Tracey L. Stierer, O. Jameson Stokes, Bryant W. Stolp, David F. Stowe, Ted Strickland, Suzanne Strom, Erin A. Sullivan, Michele Sumler, Dajin Sun, Lena Sun, Esther Sung, Veronica C. Swanson, Judit Szolnoki, Joe Talarico, Gee Mei Tan, Darryl T. Tang, Paul Tarasi, René Tempelhoff, John E. Tetzlaff, Alisa C. Thorne, Arlyne Thung, Vasanti Tilak, Kate Tobin, Joseph R. Tobin, Michael J. Tobin, R. David Todd, Matthew Tomlinson, Thomas J. Toung, Lien B. Tran, Minh Chau Joe Tran, Kevin K. Tremper, Sanyo Tsai, George S. Tseng, Kenneth J. Tuman, Avery Tung, Cynthia Tung, Rebecca Twersky, Mark Twite, John A. Ulatowski, Michael Urban, Manuel C. Vallejo, Andrea Vannucci, Albert J. Varon, Anasuya Vasudevan, Susheela Viswanathan, Alexander A. Vitin, Wolfgang Voelckel, Ann Walia, Russell T. Wall, Terrence Wallace, Shu-Ming Wang, David C. Warltier, Lucy Waskell, Scott Watkins, Denise Wedel, Stuart J. Weiss, Charles Weissman, Nathaen Weitzel, Gregory Weller, Gina Whitney, Robert A. Whittington, Danny Wilkerson, Nancy C. Wilkes, Michael Williams, Jimmy Windsor, Bernard Wittels, Gregory A. Wolff, Andrew K. Wong, Stacie N. Woods, A.J. Wright, Zheng Xie, Christopher C. Young, Ian Yuan, Francine S. Yudkowitz, James R. Zaidan, Paul Zanaboni, Warren M. Zapol, Angela Zimmerman, and Maurice S. Zwass
- Published
- 2011
29. Chapter 9 Day case, general, ENT, orthopaedic, neurosurgery, and maxillofacial surgery
- Author
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Manchula Navaratnam
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Neurosurgery ,business ,Surgery - Published
- 2007
30. Myocardial ischemia is more important than the effects of cardiopulmonary bypass on myocardial water handling and postoperative dysfunction: A pediatric animal model
- Author
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Jonathan R. Egan, Neil E. Street, Oliver Biecker, Carol G. Au, Andrew D. Cole, David S. Winlaw, Carla Zazulak, Kathryn N. North, Manchula Navaratnam, Avetis Aharonyan, David Baines, Tanya L. Butler, and Yee Mun Tan
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Cardiac output ,medicine.medical_specialty ,Heart disease ,Ischemia ,Myocardial Ischemia ,Hemodynamics ,Apoptosis ,030204 cardiovascular system & hematology ,Models, Biological ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,law ,Internal medicine ,Edema ,Tachycardia ,Cardiopulmonary bypass ,medicine ,Animals ,RNA, Messenger ,Cardiac Output ,030304 developmental biology ,0303 health sciences ,Water transport ,Cardiopulmonary Bypass ,Sheep ,Aquaporin 1 ,business.industry ,Myocardium ,Water ,medicine.disease ,3. Good health ,Oxygen ,Anesthesia ,Cardiology ,Lactates ,Female ,Surgery ,medicine.symptom ,Hypotension ,business ,Cardiology and Cardiovascular Medicine ,Capillary Leak Syndrome - Abstract
ObjectivesLow cardiac output state is the principal cause of morbidity after surgical intervention for congenital heart disease. Myocardial ischemia–reperfusion injury, apoptosis, capillary leak syndrome, and myocardial edema are associated factors. We established a clinically relevant model to examine relationships between myocardial ischemia, edema, and cardiac dysfunction and to assess the role of the water transport proteins aquaporins.MethodsSixteen lambs were studied. Seven were control animals not undergoing cardiopulmonary bypass, and 9 underwent bypass. Six had 90 minutes of aortic crossclamping with blood cardioplegia and moderate hypothermia. The remaining 3 underwent cardiopulmonary bypass without aortic crossclamping. Hemodynamic and biochemical data were recorded, and myocardial edema, apoptotic markers, and aquaporin expression were determined after death.ResultsThe group undergoing cardiopulmonary bypass with aortic crossclamping had a low cardiac output state, with early postoperative tachycardia, hypotension, increased serum lactate levels, and impaired tissue oxygen delivery (P < .05) compared with the group undergoing cardiopulmonary bypass without aortic crossclamping. The lambs undergoing cardiopulmonary bypass with aortic crossclamping had increased myocardial water (P < .05) compared with those not undergoing cardiopulmonary bypass and a 2-fold increase in aquaporin 1 mRNA expression (P < .05) compared with those not undergoing cardiopulmonary bypass and those undergoing cardiopulmonary bypass without aortic crossclamping.ConclusionsA temporal association between hemodynamic dysfunction, myocardial edema, and increased aquaporin 1 expression was demonstrated. Cardiopulmonary bypass without ischemia was associated with minimal edema, negligible myocardial dysfunction, and static aquaporin expression. Ischemic reperfusion injury is the main cause of myocardial edema and myocardial dysfunction, but a causal relationship between edema and dysfunction remains to be proved.
- Published
- 2008
- Full Text
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