In our experience, adequate PDA flows in early newborns with CHD and PDA-dependent pulmonary circulation could be achieved at a much lower dose than recommended in the literature. The lower dose of PGE1 also causes much fewer complications, such as apnea, fever, and hypotension. For early newborns with CHD and PDA-dependent pulmonary circulation, treatment with a lower initial dose of PGE1 of 20 ng/kg/minute and a maintenance dose of 10 ng/kg/minute is recommended.
The diagnosis of idiopathic DCM in children is associated with a generally poor prognosis. The lack of available donors results in significant mortality for pediatric patients awaiting transplantation. Advocating organ donation to increase the size of the organ donor pool is needed to significantly reduce the mortality rate in such patients.
Background: The myocardial kinetic energy (KE) and its association with pulmonary regurgitation (PR) have yet to be investigated in repaired tetralogy of Fallot (rTOF) patients. Purpose: To evaluate the adaptation of myocardial KE in rTOF patients by tissue phase mapping (TPM). Study Type: Prospective. Population: A total of 49 rTOF patients (23 AE 5 years old; male = 32), 47 normal controls (22 AE 1 year old; male = 29). Field Strength/Sequence: 3-T/2D dark-blood three-directional velocity-encoded gradient-echo sequence. Assessment: Left and right ventricle (LV, RV) myocardial KE in radial (KE r ), circumferential (KE ø ), longitudinal (KE z ) directions. The proportions of KE in each direction to the sum of all KE (KE røz ): %KE r , %KE ø , %KE z . PR fraction. Statistical Test: Student's t test, multivariable regression. Statistical significance: P < 0.05. Results: In rTOF group, LV KE z remained normal in systole (P = 0.565) and diastole (P = 0.210), whereas diastolic LV %KE z (62% AE 14% vs. 72% AE 7%) and systolic LV %KE ø (9% AE 6% vs. 20% AE 7%) were significantly decreased. The KE r and %KE r of both ventricles significantly increased in the rTOF group (RV in diastole: 6 AE 3 vs. 3 AE 1 μJ and 54% AE 13% vs. 27% AE 7%). The rTOF group exhibited significantly higher RV/LV ratios of %KE r (systole: 1.3 AE 0.3 vs. 1.0 AE 0.3) and %KE ø (systole: 1.6 AE 0.8 vs. 1.0 AE 0.3) and significantly lower ratios of %KE z in systole (0.7 AE 0.2 vs. 1.0 AE 0.1) and diastole (0.5 AE 0.2 vs. 0.9 AE 0.1). In multivariable regression analysis, the RV peak systolic KE røz , RV systolic KE z , and LV diastolic %KE ø were independently associated with PR fraction in the rTOF group (adjusted R 2 = 0.479). Data Conclusion: In rTOF patients, the adaptation of the KE proportion occurred earlier than that of the KE amplitude, and the biventricular balance of %KE was disrupted. PR may cause differential KE adaptation in RV and LV. TPM-derived KE may be useful in investigation of myocardial adaptation in rTOF patients.
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