We performed a prospective, randomized, placebo-controlled, double-blind trial to assess the effi... more We performed a prospective, randomized, placebo-controlled, double-blind trial to assess the efficacy of aprotinin in 61 children (median age 3.7 yr) undergoing reoperative open heart surgery (OHS). Three demographically similar groups were studied: large-dose aprotinin (ALD), small-dose aprotinin (ASD), and placebo (P). Over the first 24 postoperative hours fewer patients in the aprotinin groups received packed red cells (ALD, 53%; ASD, 89%; and P, 95%; P = 0.001), platelets (ALD, 32%; ASD, 50%; and P, 65%; P = 0.04), and fresh frozen plasma (ALD, 16%; ASD, 17%; and P, 60%; P = 0.003) than placebo patients. Most importantly, aprotinin patients had fewer exposures to banked blood components (ALD, median 1 U; and ASD, median 2 U) than P (median 6 U; P = 0.001), with no difference in overall complication rate. Use of aprotinin was associated with a savings in the patient charges for blood components, operating room time, and duration of hospitalization. In conclusion, aprotinin decreased the number of units of banked blood components used during the first 24 postoperative hours in reoperative pediatric OHS. Aprotinin thus decreases the risks associated with exposure to banked blood components and reduces hospital charges.
Journal of the American Society of Echocardiography, 1995
Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 402, May 1995, Auth... more Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 402, May 1995, Authors:Ohad Ludomirsky; Achi Ludomirsky; Thomas Lloyd; Gerald Serwer; Roger P. Vermilion; Ralph Mosca; Ed Bove. ...
Although survival of patients with the hypoplastic left heart syndrome treated by staged surgical... more Although survival of patients with the hypoplastic left heart syndrome treated by staged surgical palliation has improved, hemodynamic data after fenestrated Fontan operation and after fenestration closure have not been reported in this patient population. We sought to describe the hemodynamic status of these patients at cardiac catheterization performed for the purpose of fenestration closure and to compare these data with data from contemporary patients with other forms of univentricular heart. Hemodynamic responses to fenestration closure during cardiac catheterization were reviewed in 40 consecutive patients, including 20 with the hypoplastic left heart syndrome and 20 with other forms of univentricular heart defects. Hemodynamics before fenestration closure (arterial saturation and pressure, Fontan baffle saturation and pressure, pulmonary capillary wedge pressure, systemic arteriovenous oxygen content difference, and right-to-left shunt fraction) were nearly identical between the two groups. Significant (p < 0.05) changes after fenestration closure included increases in arterial saturation (9%), mean arterial pressure (3 mm Hg), and baffle pressure (1 mm Hg) and arteriovenous oxygen content difference (18 ml/L), with near elimination of right-to-left shunting. Cardiac output decreased by 21% and systemic oxygen transport by 13%, with no differences between the two patient groups. Mean baffle pressures were <17 mm Hg in 32 patients (80%). Hemodynamics after fenestrated Fontan operation and responses to fenestration closure in patients with the hypoplastic left heart syndrome were remarkably similar to that in patients with other univentricular heart defects.
Repair of complete atrioventricular canal early in infancy has traditionally carried greater morb... more Repair of complete atrioventricular canal early in infancy has traditionally carried greater morbidity and mortality than repair performed later. However, an individualized anatomy-based repair may give young infants outcomes that are equivalent to older patients. We retrospectively reviewed 139 patients who underwent complete atrioventricular canal repair from January 2005 to December 2012. An individualized approach was used: 2-patch repair was performed in 98 patients for large ventricular septal defects and a modified single-patch ("Australian technique") was used in 41 for "shallow" ventricular septal defects. The average age was 25.5 ± 3.9 weeks, 50% were boys, and 78% had trisomy 21. Mean follow-up was 5.1 ± 0.2 years, with 100% completeness of data. There were 3 in-hospital deaths (2.1%) and 1 late death (0.7%). A permanent pacemaker was required in 2 patients (1.4%). The rate for left atrioventricular valve reoperation was 8% at a mean of 211 ± 238 days ...
Progress in transplantation (Aliso Viejo, Calif.), 2005
Heart transplantation with ABO blood type-incompatible donors has historically been contraindicat... more Heart transplantation with ABO blood type-incompatible donors has historically been contraindicated because of the high risk of an immediate hyperacute humoral graft rejection. The immature neonatal immune system presents an immunologic window that allows for breaching the ABO barrier before the natural development of anti-ABO antibodies. Information from a small series of neonates has demonstrated similar survival rates and posttransplant outcomes compared to ABO-compatible transplantations. In the posttransplant period, particular attention is placed on the surveillance of graft-specific antibody production and monitoring for immunologic signs and symptoms of early graft vasculopathy. This article presents a case study of a neonate with congenital heart disease who underwent one of the first successful ABO-incompatible heart transplantations in the United States.
Changes in sexual function and hormone levels are commonly found in subjects addicted to narcotic... more Changes in sexual function and hormone levels are commonly found in subjects addicted to narcotics. In this study we examined 16 male and 3 female addicts who had been taking heroin (H) in the last year in doses higher than 150 mg/day. In these patients, who presented similar clinical problems, we assayed by RIA the plasma levels of heroin, testosterone, (T), dihydrotestosterone (DHT), androstenedione (A), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) for periods of 150 min, 6 h and 9 h. We found a significant reduction of T and DHT concomitant with higher plasma concentrations of heroin but no relevant changes of A, LH and FSH. T and DHT returned to the initial levels after the decrease of heroin concentration. The GnRH test effectd on a female subject allowed us to make the diagnosis of hypothalamic amenorrhea. In the same patient no circadian rhythms for T, DHT and A were detected.
Journal of Cardiovascular Magnetic Resonance, 2000
Development of a mycotic aneurysm or pseudoaneurysm after subacute bacterial endarteritis is unco... more Development of a mycotic aneurysm or pseudoaneurysm after subacute bacterial endarteritis is uncommon. Nonetheless, patients with coarctation of the aorta are more likely to develop this complication. We describe a case of a large pseudoaneurysm discovered in a child with a previously undiagnosed aorta coarctation. Successful repair was performed with the aid of partial left heart bypass and the use of an interposition graft. A high index of suspicion is necessary to accurately diagnose this rare but life-threatening entity.
To determine the efficacy of decreasing cardiopulmonary bypass (CPB) prime volume for neonates an... more To determine the efficacy of decreasing cardiopulmonary bypass (CPB) prime volume for neonates and small infants by using low prime oxygenators, small diameter polyvinyl chloride (PVC) tubing and removing the arterial line filter (ALF) in an effort to reduce intraoperative exposure to multiple units of packed red blood cells (PRBC). Two retrospective database studies comparing neonatal CPB prime volume were undertaken: Study 1--A CPB circuit consisting of a 1/8 inch arterial line, a 3/16 inch venous line and a low prime oxygenator with 172 ml total circuit prime (n=74) was compared to a circuit with a 3/16 inch arterial line, a 1/4 inch venous line and a higher prime oxygenator with a 350 ml total circuit prime (n=74). Study 2--The 172 ml circuit (n=389) was compared to a circuit that included an ALF and had a total circuit prime volume of 218 ml (n=389). Study 1--of the 74 neonates and small infants whose CPB prime volume was 350 ml, 19 were exposed to two or more intraoperative ex...
We performed a prospective, randomized, placebo-controlled, double-blind trial to assess the effi... more We performed a prospective, randomized, placebo-controlled, double-blind trial to assess the efficacy of aprotinin in 61 children (median age 3.7 yr) undergoing reoperative open heart surgery (OHS). Three demographically similar groups were studied: large-dose aprotinin (ALD), small-dose aprotinin (ASD), and placebo (P). Over the first 24 postoperative hours fewer patients in the aprotinin groups received packed red cells (ALD, 53%; ASD, 89%; and P, 95%; P = 0.001), platelets (ALD, 32%; ASD, 50%; and P, 65%; P = 0.04), and fresh frozen plasma (ALD, 16%; ASD, 17%; and P, 60%; P = 0.003) than placebo patients. Most importantly, aprotinin patients had fewer exposures to banked blood components (ALD, median 1 U; and ASD, median 2 U) than P (median 6 U; P = 0.001), with no difference in overall complication rate. Use of aprotinin was associated with a savings in the patient charges for blood components, operating room time, and duration of hospitalization. In conclusion, aprotinin decreased the number of units of banked blood components used during the first 24 postoperative hours in reoperative pediatric OHS. Aprotinin thus decreases the risks associated with exposure to banked blood components and reduces hospital charges.
Journal of the American Society of Echocardiography, 1995
Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 402, May 1995, Auth... more Journal of the American Society of Echocardiography, Volume 8, Issue 3, Pages 402, May 1995, Authors:Ohad Ludomirsky; Achi Ludomirsky; Thomas Lloyd; Gerald Serwer; Roger P. Vermilion; Ralph Mosca; Ed Bove. ...
Although survival of patients with the hypoplastic left heart syndrome treated by staged surgical... more Although survival of patients with the hypoplastic left heart syndrome treated by staged surgical palliation has improved, hemodynamic data after fenestrated Fontan operation and after fenestration closure have not been reported in this patient population. We sought to describe the hemodynamic status of these patients at cardiac catheterization performed for the purpose of fenestration closure and to compare these data with data from contemporary patients with other forms of univentricular heart. Hemodynamic responses to fenestration closure during cardiac catheterization were reviewed in 40 consecutive patients, including 20 with the hypoplastic left heart syndrome and 20 with other forms of univentricular heart defects. Hemodynamics before fenestration closure (arterial saturation and pressure, Fontan baffle saturation and pressure, pulmonary capillary wedge pressure, systemic arteriovenous oxygen content difference, and right-to-left shunt fraction) were nearly identical between the two groups. Significant (p < 0.05) changes after fenestration closure included increases in arterial saturation (9%), mean arterial pressure (3 mm Hg), and baffle pressure (1 mm Hg) and arteriovenous oxygen content difference (18 ml/L), with near elimination of right-to-left shunting. Cardiac output decreased by 21% and systemic oxygen transport by 13%, with no differences between the two patient groups. Mean baffle pressures were <17 mm Hg in 32 patients (80%). Hemodynamics after fenestrated Fontan operation and responses to fenestration closure in patients with the hypoplastic left heart syndrome were remarkably similar to that in patients with other univentricular heart defects.
Repair of complete atrioventricular canal early in infancy has traditionally carried greater morb... more Repair of complete atrioventricular canal early in infancy has traditionally carried greater morbidity and mortality than repair performed later. However, an individualized anatomy-based repair may give young infants outcomes that are equivalent to older patients. We retrospectively reviewed 139 patients who underwent complete atrioventricular canal repair from January 2005 to December 2012. An individualized approach was used: 2-patch repair was performed in 98 patients for large ventricular septal defects and a modified single-patch ("Australian technique") was used in 41 for "shallow" ventricular septal defects. The average age was 25.5 ± 3.9 weeks, 50% were boys, and 78% had trisomy 21. Mean follow-up was 5.1 ± 0.2 years, with 100% completeness of data. There were 3 in-hospital deaths (2.1%) and 1 late death (0.7%). A permanent pacemaker was required in 2 patients (1.4%). The rate for left atrioventricular valve reoperation was 8% at a mean of 211 ± 238 days ...
Progress in transplantation (Aliso Viejo, Calif.), 2005
Heart transplantation with ABO blood type-incompatible donors has historically been contraindicat... more Heart transplantation with ABO blood type-incompatible donors has historically been contraindicated because of the high risk of an immediate hyperacute humoral graft rejection. The immature neonatal immune system presents an immunologic window that allows for breaching the ABO barrier before the natural development of anti-ABO antibodies. Information from a small series of neonates has demonstrated similar survival rates and posttransplant outcomes compared to ABO-compatible transplantations. In the posttransplant period, particular attention is placed on the surveillance of graft-specific antibody production and monitoring for immunologic signs and symptoms of early graft vasculopathy. This article presents a case study of a neonate with congenital heart disease who underwent one of the first successful ABO-incompatible heart transplantations in the United States.
Changes in sexual function and hormone levels are commonly found in subjects addicted to narcotic... more Changes in sexual function and hormone levels are commonly found in subjects addicted to narcotics. In this study we examined 16 male and 3 female addicts who had been taking heroin (H) in the last year in doses higher than 150 mg/day. In these patients, who presented similar clinical problems, we assayed by RIA the plasma levels of heroin, testosterone, (T), dihydrotestosterone (DHT), androstenedione (A), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) for periods of 150 min, 6 h and 9 h. We found a significant reduction of T and DHT concomitant with higher plasma concentrations of heroin but no relevant changes of A, LH and FSH. T and DHT returned to the initial levels after the decrease of heroin concentration. The GnRH test effectd on a female subject allowed us to make the diagnosis of hypothalamic amenorrhea. In the same patient no circadian rhythms for T, DHT and A were detected.
Journal of Cardiovascular Magnetic Resonance, 2000
Development of a mycotic aneurysm or pseudoaneurysm after subacute bacterial endarteritis is unco... more Development of a mycotic aneurysm or pseudoaneurysm after subacute bacterial endarteritis is uncommon. Nonetheless, patients with coarctation of the aorta are more likely to develop this complication. We describe a case of a large pseudoaneurysm discovered in a child with a previously undiagnosed aorta coarctation. Successful repair was performed with the aid of partial left heart bypass and the use of an interposition graft. A high index of suspicion is necessary to accurately diagnose this rare but life-threatening entity.
To determine the efficacy of decreasing cardiopulmonary bypass (CPB) prime volume for neonates an... more To determine the efficacy of decreasing cardiopulmonary bypass (CPB) prime volume for neonates and small infants by using low prime oxygenators, small diameter polyvinyl chloride (PVC) tubing and removing the arterial line filter (ALF) in an effort to reduce intraoperative exposure to multiple units of packed red blood cells (PRBC). Two retrospective database studies comparing neonatal CPB prime volume were undertaken: Study 1--A CPB circuit consisting of a 1/8 inch arterial line, a 3/16 inch venous line and a low prime oxygenator with 172 ml total circuit prime (n=74) was compared to a circuit with a 3/16 inch arterial line, a 1/4 inch venous line and a higher prime oxygenator with a 350 ml total circuit prime (n=74). Study 2--The 172 ml circuit (n=389) was compared to a circuit that included an ALF and had a total circuit prime volume of 218 ml (n=389). Study 1--of the 74 neonates and small infants whose CPB prime volume was 350 ml, 19 were exposed to two or more intraoperative ex...
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