Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, case-based programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.
Patients with CCTGA are increasingly subject to CHF with advancing age; this complication is extremely common by the fourth and fifth decades. Tricuspid (systemic atrioventricular) valvular regurgitation is strongly associated with RV (anatomical right ventricle connected to aorta in CCTGA patients; systemic ventricle in CCTGA) dysfunction and CHF; whether it is causative or a secondary complication remains speculative.
Summary
Hemodynamic studies were conducted on 32 normal, full‐term newborn infants, age 29 minutes to 11 hours, to determine the effect of placental transfusion upon the pulmonary circulatory adjustments after birth. In 10 infants, clamping of the cord was accomplished within 2 to 10 seconds after the delivery (early clamping), and in the other 22 infants it was done after cessation of the umbilical arterial pulsations (late clamping).
For comparative purposes, the pulmonary arterial pressures were related to the corresponding aortic pressure in the form of a P/A mean pressure ratio, and these were correlated with age in the 2 groups of subjects. The observed pulmonary arterial pressures in the 2 groups differed significantly. During the first 9 hours, the pulmonary pressures of the late‐clamped infants were approximately 90 % that of the aortic. In contrast, those of the early‐clamped infants were as low as 70 % of the aortic pressures by the second hour, and nearly 50 % by the fourth hour.
A hypothesis is presented that the higher pulmonary arterial pressures in the late‐clamped infants is due to greater pulmonary vasoconstriction resulting from greater pulmonary capillary…venous filling…a consequence of the large blood volume following maximal placental transfusion.
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