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“I'm sure Mr Humphries will let you know when he's good and ready! “The problem is, Heather, the story has got around the school that you.

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Imaging of pediatric congenital heart disease. J Thorac Imaging. Noninvasive imaging in congenital heart disease. Curr Opin Cardiol. Classic imaging signs of congenital cardiovascular abnormalities. Review Bernstein D. Laboratory evaluation.

  1. Special Needs For Children with a Congenital Heart Defect.
  2. ¿De qué tipo soy? (Autoayuda) (Spanish Edition);

Geme JW, et al, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier Saunders; Pharmaceutical management of decompensated heart failure syndrome in children: current state of the art and a new approach. Curr Treat Options Cardiovasc Med. Side effects of therapy with prostaglandin E1 in infants with critical congenital heart disease. To intubate or not to intubate? Transporting infants on prostaglandin E1. Mechanism of cyanotic spells in Tetralogy of Fallot--the missing link? Int J Cardiol. Tetralogy of Fallot management of hypercyanotic tet spells. Accessed January 15, Tetralogy of Fallot.

Review article Barata IA. Cardiac emergencies. Treatment of Tetralogy of Fallot hypoxic spell with intranasal fentanyl. Cochrane Database Syst Rev. Presentation, diagnosis, and medical management of heart failure in children: Canadian Cardiovascular Society guidelines. Can J Cardiol. Cardiac failure in children. Geneva, Switzerland: World Health Organization; The effectiveness and relative effectiveness of intravenous inotropic drugs acting through the adrenergic pathway in patients with heart failure-a meta-regression analysis.

Eur J Heart Fail. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Prospective double-blind placebo-controlled parallel group trial; patients Buck ML.

Clinical experience with spironolactone in pediatrics. Ann Pharmacother. Heart failure in children: part II: diagnosis, treatment, and future directions. Circ Heart Fail. Carvedilol as therapy in pediatric heart failure: an initial multicenter experience. Carvedilol for children and adolescents with heart failure: a randomized controlled trial.

Congenital Heart Disease: Katie's Story

Beta-blockers for congestive heart failure in children. Digitalis for treatment of congestive heart failure in patients in sinus rhythm. Repair of congenital heart disease: a primer-part 2. Repair of congenital heart disease: a primer-part 1. Cardiovascular emergencies in the pediatric patient. Anomalous origin of the coronary arteries. Pediatric cardiac emergencies: children are not small adults. J Emerg Trauma Shock. Review article Bernstein D. Abnormal positions of the heart and heterotaxy syndromes.

Geme JW, et al. Pulmonary complications of congenital heart disease. Paediatr Respir Rev. Pulmonary hypertension. As front line health care providers for children, pediatricians are entrusted with the responsibility for discovering early signs of heart diseases in this complex patient population. Especially in the newborn period, the presentation of pediatric heart disease is frequently obscure, and the consequences of these illnesses can be devastating if not caught early and managed correctly.

This comprehensive, easy to understand book is a ready guide to acquiring the proficiency and confidence necessary to decipher the wide spectrum of disease presentations. Case scenarios give life to each chapter, with key images and illustrations reinforcing notable concepts. Special attention is given to the interpretation of chest radiographs and the role of echocardiography and catheterization.

All chapters are dual authored by an academic cardiologist and a practicing general pediatrician, resulting in this book's elegant blend of medical authority, real life value, and fresh practical viewpoints. The first is an overall approach to heart diseases in children with ample discussion to diagnostic testing. The second and third sections cover the spectrum of congenital heart defects and acquired heart diseases.


The fourth section prsents issues related to office cardiology. The book concludes with an extensive drug appendix. Significant and meaningful online complements, heart sounds and murmurs are available at www. This unique book is a go-to resource for pediatricians, pediatric residents, family practitioners, medical students and nurses, conveying essential information for the diagnosis and treatment of pediatric heart diseases.

JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Medicine Pediatrics. Free Preview. Vibration, tapping, manual chest pressure, suction of the airways, coughing and postural drainage are conventional bronchial hygiene maneuvers available between the resources that can be used. Other possibilities are the technique of expiratory flow increase EFI , the active cycle of breathing, forced expiration technique as well as encouraging inspiratory exercises and non-invasive ventilation NIV [8,10,23]. It is noted that although the combined use of postural drainage and percussion is usual in clinical practice, there are still few comparative studies emphasizing that, especially in heart diseases.

Thus, there is the relevance of future research to evaluate such clearance techniques [25] that, in addition to routinely used, are geared to parents for home treatment of their children. As the guidance is an effective practice for physiotherapy, Garbossa et al.

This is a randomized clinical trial with 51 adults divided into control and intervention groups. The levels of anxiety and pain were assessed pre- and postoperatively, and only the intervention group received guidance on surgical procedures and instructions on exercise ventilation. We observed lower anxiety scores in patients who were counseled preoperatively.

It is suggested performance of clinical trials with similar purpose and method, because in pediatric patients similar studies have not been found. There are also few prospective clinical trials to assess the pulmonary complications in children undergoing cardiac surgery, as well as the effects of physiotherapy in the preoperative and postoperative period, regarding prevention of these complications [ Likewise, few studies have evaluated the incidence of pulmonary complications after heart surgery in adults [ The study by Felcar et al. This study followed children up to 6 years old who underwent surgery for various congenital heart diseases, divided into two groups: one submitted to pre- and postoperative physiotherapy and the other group only postoperatively.

The presence of pulmonary complications, especially pneumonia, associated with other complications, such as length of hospital stay was significantly higher in the group who received preoperative physiotherapy. There are published reports that corroborate this finding and the indication for physiotherapy in pre- and postoperatively, based on reducing the length of hospital stay and stay in the ICU [].

The process of inclusion of physiotherapy during CSPR has gained space, although the effectiveness of this activity still needs clear-cut research. The patient's condition in the immediate postoperative period of cardiac surgeries CCIPO depends on three factors: 1 diagnosed heart disease, 2 presence of malformations associated with the cardiac presentation and 3 surgical procedure, which involves the duration of surgery, and anesthetic drugs used, duration of aortic occlusion and CPB, the volume of diuresis output during surgery and received blood and blood products, and perioperative complications [10,11].

Support physiotherapy starts on the child's arrival to the ICU. The professional will collaborate with the team to adjust the positioning of the patient in bed and ensure proper location of vascular access, drainage and tracheal cannula, known the risk of displacement during transport from the operating room [10,11]. Subsequently, it is recommended to perform physiotherapy assessment in CCIPO, which includes: inspection of the chest wall expansion, lung auscultation, chest X-ray analysis, interpretation of arterial blood gases associated with the assessment of the severity of clinical presentation and discussion with ICU staff, verification of ventilatory support, measurement of oxygen saturation S p O 2 monitoring and other vital signs [10,11].

In most cases, children undergoing heart surgery are transported to the ICU intubated. It is known that weaning should be a priority, rapid and the extubation should be performed as soon as possible. Usually, the first six hours, after the anesthetic effect and after careful clinical and laboratory evaluation, patients are extubated. This practice reduces the chances of pneumonia and hypertrophy of the diaphragm and increased morbidity and mortality [4].

Simplest cases, of low surgical risk may have even earlier extubation. Ventilatory support is necessary, often in cases where there is associated respiratory disease, especially pneumonia and bronchiolitis, and cardiogenic pulmonary edema, respiratory system depression by sedation, laryngeal edema, and especially in the presence of pulmonary hypertension [30 ]. With an indication of support, children are initially placed in controlled ventilation with the parameters adjusted to the respiratory rate for age and interpretation of arterial blood gases.

A successful surgery can be determined by the adequacy of ventilatory parameters and oxygen, which depend on the hemodynamics of each variety of congenital heart disease. The appropriate ventilatory management, as well as patient positioning, help to reduce the maximum intrathoracic pressure and venous stasis of trunk and upper limbs, which facilitates the drainage of blood in the lungs [4,8,16,]. Only 0.

Pediatric and Congenital Heart Disease | The Patient Guide to Heart, Lung, and Esophageal Surgery

In this research, physiotherapy maneuvers were used for chest expansion and antalgic posture correction, aiming to preserve a satisfactory pulmonary ventilation and maintain a patent airway. Because pain is a common condition, especially postoperatively, it can be avoided antalgic posture through exercises with the upper limbs associated with breathing and also one should proceed with guidelines on proper positioning in bed [10]. In addition to respiratory dysfunction of the child, other complications are described in CCIPO such as low cardiac output syndrome, characterized by sweating, signs of psychomotor agitation, cold extremities, pale lips, filiform or absent peripheral pulses, hypotension and oliguria.

The physiotherapist should be aware of these signals [11]. In this sample, four children showed dysfunction of multiple organs and systems, including hematologic dysfunction, with a mortality of The other two children who died also had a long time on CPB, corresponding to more than minutes. These findings corroborate the literature that the longer infusion tme in CPB, further trauma to the cellular elements.

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  • It should be noted that the six patients who bled excessively, all showed alterations in at least one of the tests performed preoperatively, as follows: count prothrombin time, changed partial thromboplastin time and platelet count, in addition to be patients with the highest infusion time [31]. The thrombocytopenia and qualitative platelet changes are considered the main causes of bleeding in the CCPO. There is evidence that children with a disorder of hemostasis in CCPR more likely to have bleeding when undergoing surgery with CPB [31].

    The function of the respiratory system is undoubtedly affected during and after cardiac surgery, mainly due to the pain. The change of mechanical ventilation from the surgical incision, a situation found after sternotomy and the own anatomy and physiology resulting from the procedure, lead to decreased lung compliance in CCPO.

    In this situation, we recognize the importance of physiotherapy to restore function and prevent respiratory complications [32]. The sternotomy is perhaps one of the factors that are most associated with the loss of lung function in CCPO. Some authors attribute the pulmonary and hypoventilation due to pain along the sternum to reduce the movement of the chest wall and abdomen post-sternotomy [33].

    There are few studies assessing the impairment of lung function after cardiac surgery in children. In addition to the sternotomy, thoracotomy is the other commonly used incision in cardiac surgery. Access by lateral thoracotomy, performed in surgeries such as IAC, IVC and TGA, for example, presents specific features and affects the lung function, which requires specific care.

    This incision should be preferred because it is less invasive, resulting in better cosmetic results, minimizes chances of heart damage and postoperative pulmonary complications. Moreover, it preserves the integrity of the chest cavity to provide good exposure of the operative area without an incision is performed as large as the sternotomy.

    A Pediatrician's Guide

    For these factors, lower infection rates, lower rates of bleeding and early postoperative are attributed to thoracotomy. It is considered that, in children, this approach does not impact or change in the development of the chest, the pectoral muscle and breast tissue, maintaining the continuity and integrity of the bony part of the chest.

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    It would be a surgical option to prevent the installation of the deformity called pigeon breast []. Also due to the incision, the pain complaints during the postoperative are common. Researchers assessed the location and intensity of pain in adult patients undergoing cardiac surgery by sternotomy performed during the hospitalization period, and the influence of type of incision in lung function. There was significant impairment of lung function of individuals and, despite the findings, the pain did not correlate significantly with individual characteristics and the surgical procedure [39].

    There were no similar studies involving children, which would be relevant and valid for a better management of the physiotherapist during the postoperative in pediatrics. Because of the pain and changes in the biomechanics of breathing muscles after surgery, patients adopt apical and surface breath.

    This leads to decrease in vital capacity and functional residual capacity, which leads to retention of secretions and atelectasis, which agreed that the ventilatory impairment is a loss of pulmonary function of greater impact [7,40,41]. It is directly associated with the type of surgical incision and the degree of cardiopulmonary compromise in the perioperative period and in the CCPO. Its incidence is attributed to the use of anesthetics, narcotic drugs and stop ventilation during CPB.

    It is also associated with other factors, such as pain, hypersecretion before surgery, decreased ciliary function, limiting the inspiratory effort, ineffective cough reflex and other events that promote the accumulation of pulmonary secretions [ Atelectasis is attributed to the CCPO as a result of the cephalic displacement of the diaphragm caused by anesthetic drugs, compression of the lungs by mediastinal structures, inadequate intubation, inactivity of the lungs during CPB and inflammatory reactions caused by this and the surgical pleural management [ The procedures of physiotherapy to reverse atelectasis involve changes in position, PEEP and other therapies [ Another resource introduced by Silva et al.

    Inhalation of this solution immediately before and after physiotherapy for three days in a child, caused crises of productive cough and sputum induction, with subsequent complete resolution of atelectasis in the CCPO. To prevent atelectasis and other complications during the CCPO, the physiotherapist guides the patient on the proper positioning in bed, ways to avoid antalgic postures, and exercises with upper limbs associated with breathing and active cycle of breathing [8. Breathing exercises improve breathing efficiency, increase the diameter of the airways and contribute to dislodge secretions.

    They also prevent alveolar collapse, and facilitate lung expansion and clearance of the peripheral airways [12]. After the extubation, physiotherapy may be indicated several times a day for a few days to promote bronchial clearance. In infants, during the CCPO, just a small amount of mucus may block much of the lung. In this situation, a therapeutic alternative in the management of the child is the application of bronchial hygiene techniques, such as tapping and gentle vibrations, with the child in the lateral position.

    Indicated for the aspiration, the physiotherapist must be alert to any change in the presentation and the patient's condition [5]. In the episodes of child's coughing, the physiotherapist should help for fixing and support on the site of surgical incision, which can be performed using hands or a soft baffle doll , since the support of the rib cage provides the security needed to carry the child to cough effectively. The professional may need to trigger a cough, applying gentle pressure in the trachea [5].