PubMed Health⌕ Search

Biomedical subjects

Clifford L Cua

Publications and source records attributed to Clifford L Cua.

8 recordsLinked to original sources
PubMed2006

Changes in tissue Doppler characteristics in a patient with pulmonary atresia and intact ventricular septum.

Tissue Doppler measurements of the right and left lateral ventricular walls were made before and after perforation of the pulmonary valve using radiofrequency energy in a patient with pulmonary atresia and intact ventricular septum. The ratio of peak tissue velocity during rapid ventricular filling to atrial contraction increased for both atrioventricular valves after perforation of the pulmonary valve, and the patient was able to be weaned off prostaglandins without further intervention. Such measurements made using tissue Doppler may aid in the management of patients with pulmonary atresia and intact ventricular septum by predicting improvements in right ventricular relaxation.

Abnormalities, Multiple↗
PubMed2006

Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock-Taussig shunt or right ventricle to pulmonary artery conduit.

OBJECTIVE: Previous publications using nonconcurrent series of patients indicate improved survival for patients with hypoplastic left heart syndrome (HLHS) undergoing stage I palliation with a right ventricle to pulmonary artery conduit (NW-RVPA) vs. a modified Blalock-Taussig shunt (NW-BT). We compared postoperative outcomes in a concurrent series of patients with HLHS undergoing an NW-BT procedure vs. NW-RVPA procedure. DESIGN: Perioperative data from 66 consecutive patients who underwent NW-BT (n = 37) or NW-RVPA (n = 29) procedures were retrospectively analyzed. SETTING: Cardiac intensive care unit in a tertiary pediatric hospital. PATIENTS: Charts were reviewed for all patients with the diagnosis of HLHS undergoing the NW-BT or NW-RVPA procedure between January 2002 and December 2003. RESULTS: Cardiopulmonary bypass time was longer in the NW-BT group than in the NW-RVPA group (152.5 +/- 52.0 vs. 134.5 +/- 36.1 mins; p = .04). Postoperative diastolic pressures were higher and the Pao2 to Fio2 ratio profiles were lower for the NW-RVPA group over the first 72 hrs. Time to sternal closure (2 [1-6] vs. 4 [2-41] days; p = .01), duration of mechanical ventilation (113 [49-386] vs. 136 [84-764] hrs; p = .01), time to establish enteral feeds (4 [2-8] vs. 5 [3-22] days; p = .01), length of intensive care unit stay (11 [7-55] vs. 15 [8-90] days; p = .04), and length of hospital stay (16 [11-67] vs. 27 [12-126] days; p = .01) were shorter in the NW-RVPA group. Postoperative mortality was not significantly different between the NW-RVPA group (7%) and NW-BT group (11%). CONCLUSION: At an experienced institution with low stage I palliation mortality for HLHS, there were no differences in early morbidity and mortality between the NW-RVPA and NW-BT procedures. The primary advantage of the NW-RVPA procedure may be faster recovery following surgery and earlier discharge from the hospital.

Analysis of Variance↗
PubMed2006

Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient.

OBJECTIVE: Hyperglycemia in critical care populations has been shown to be a risk factor for increased morbidity and mortality. Minimal data exist in postoperative pediatric cardiac patients. The goal of this study was to determine whether hyperglycemia in the postoperative period was associated with increased morbidity or mortality. DESIGN: Retrospective chart review. SETTING: Tertiary care, free-standing pediatric medical center with a dedicated cardiac intensive care unit. PATIENTS: We included 184 patients <1 yr of age who underwent cardiac surgery requiring cardiopulmonary bypass from October 2002 to August 2004. Patients with a weight <2 kg, a preoperative diagnosis of diabetes, preoperative extracorporeal membrane oxygenation support, solid organ transplant recipients, and preoperative renal or liver insufficiency were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Age was 4.3 +/- 3.2 months and weight was 4.9 +/- 1.7 kg at surgery. Duration of hyperglycemia was significantly longer in patients with renal insufficiency (p = .029), liver insufficiency (p = .006), infection (p < .002), central nervous system event (p = .038), extracorporeal membrane oxygenation use (p < .001), and death (p < .002). Duration of hyperglycemia was also significantly associated with increased intensive care (p < .001) and hospital (p < .001) stay and longer ventilator use (p < .001). Peak glucose levels were significantly different in patients with renal insufficiency (p < .001), infection (p = .002), central nervous system event (p = .01), and mortality (p < .001). CONCLUSIONS: Hyperglycemia in the postoperative period was associated with increased morbidity and mortality in postoperative pediatric cardiac patient. Strict glycemic control may improve outcomes in this patient population.

Cardiac Surgical Procedures↗
PubMed2005

Improved interstage mortality with the modified Norwood procedure: a meta-analysis.

BACKGROUND: Modification of the Norwood procedure has been reported to improve immediate postoperative mortality compared with the classic Norwood. Interstage mortality has not been shown to be improved with the modified Norwood probably because of the small number of patients from each institution. The goal of this study was to determine if meta-analysis would provide sufficient data to prove statistical difference in interstage mortality for the modified Norwood procedure. METHODS: PubMed was searched using six different terms individually for articles from January 2003 to October 2004. Manuscripts that compared the classic to modified Norwood were reviewed. Mantel-Haenszel analysis was used to evaluate the relationship between treatment method and mortality stratified across hospitals. The Breslow-Day procedure tested homogeneity of odds ratio across hospitals. Separate analyses were performed for inpatient and interstage periods. RESULTS: A total of 4,545 citations was screened. Five manuscripts met the criteria. Seventy-two patients undergoing classic Norwood and 84 patients undergoing modified Norwood survived to initial hospital discharge. The Breslow-Day statistic supported homogeneity of odds ratios for survival across hospitals (chi2 = 2.09, df = 4, p = 0.72). Odds of interstage death was 11.6 times greater (2.2 to 62.1, 95% CI) for the classic Norwood compared with the modified Norwood procedure. This difference was statistically significant by the Mantel-Haenszel chi2 (11.0, p = 0.001). The Breslow-Day statistic supported homogeneity of the odds ratios across hospitals (chi2 = 3.1, df = 4, p = 0.53). CONCLUSIONS: The modified Norwood procedure has a significantly lower interstage mortality compared with the classic Norwood procedure. A large randomized study is needed to determine whether these results remain consistent.

Cardiac Surgical Procedures↗
PubMed2005

A comparison of the Vasotrac with invasive arterial blood pressure monitoring in children after pediatric cardiac surgery.

The Vasotrac is a device that provides near-continuous and noninvasive arterial blood pressure monitoring and may be an alternative to direct intraarterial measurement. It has been evaluated in adult patients, but minimal information is available for pediatric patients. We evaluated agreement between measurements of arterial blood pressure and heart rate obtained from the Vasotrac versus an arterial catheter in a pediatric population. Children undergoing corrective cardiac surgery were enrolled. Simultaneous arterial blood pressure measurements were obtained postoperatively from the Vasotrac unit and an arterial catheter. Bland-Altman plots were constructed to assess agreement. Paired correlation analysis, bias, and precision calculations were performed. Sixteen patients, mean age 10.1 +/- 2.3 yr and weight 34.6 +/- 11.9 kg, were enrolled. Four-thousand-one- hundred- two paired measurements were obtained. Arterial blood pressures measured noninvasively correlated with catheter measurements with Pearson r values of 0.90, 0.80, and 0.91 for systolic, diastolic, and mean arterial blood pressures, respectively (all P < 0.001). There was excellent agreement between arterial blood pressure measurement methods. Absolute mean differences based on mixed-model regression with 95% confidence intervals were 4.0 mm Hg (3.0-5.0 mm Hg), 4.3 mm Hg (3.1-5.5 mm Hg), and 3.5 mm Hg (2.5-4.0 mm Hg) for systolic blood pressure, diastolic blood pressure, and mean blood pressure, respectively. Arterial blood pressure measurements obtained from the Vasotrac agreed well with invasive arterial monitoring in pediatric patients.

Adolescent↗
PubMed2004

Persistent electrical and morphological atrial abnormalities after early closure of atrial septal defect.

Atrial arrhythmias are associated with enlarged atrial chambers and an increased duration of the P wave. Repair of atrial defects within the oval fossa is expected to normalize atrial size. Few studies, however, have evaluated electrical and morphological atrial features after repair. Our study was performed to determine if atrial abnormalities exist after surgical closure of such atrial septal defects, and whether early closure improves outcome. We recruited patients who had undergone surgical closure of a defect within the oval fossa, so-called "secundum" atrial septal defects. Electrocardiograms, signal averaged electrocardiograms, and echocardiograms were performed. Two-tailed test and Pearson correlation was utilized for statistical analysis. The population consisted of 20 patients and 27 controls, with the mean age of the patient being 11.25 +/- 5.10 years, their age at surgery 6.55 +/- 5.10 years, and the time since surgery 4.70 +/- 2.61 years. The size of the right (23.88 +/- 6.35 ml/m2 versus 18.84 +/- 4.43 ml/m2) and left (21.91 +/- 12.47 ml/m2 versus 17.72 +/- 4.83 ml/m2) atrium were significantly larger in the patients. The duration of the P wave (108 +/- 16 ms versus 96 +/- 8 ms) and the duration of the PR interval (155 +/- 18 ms versus 138 +/- 23 ms) were longer. No correlation existed between age or interval since surgery with atrial sizes or measurements of the signal averaged electrocardiogram. We conclude that, despite surgical repair, abnormalities exist in patients with an atrial septal defect. Early surgery does not appear to prevent the atrial abnormalities.

Age Factors↗
PubMed2004

Cerebral saturations trend with mixed venous saturations in patients undergoing extracorporeal life support.

Cerebral saturation (SCO2) monitors are noninvasive tools that continuously measure saturations in the cerebral cortex, a predominately venous bed. The purpose of this study was to see if a trend existed between measurements of SCO2 and mixed venous saturation values (SVO2) for patients on extracorporeal life support (ECLS). Six patients required ECLS for cardiac failure after congenital cardiac surgery, and one patient required ECLS for pulmonary failure. Patients were divided into two groups, those without systemic/pulmonary venous mixing (n = 3, Group I) and those with mixing due to an intraatrial shunt or left ventricular vent (n = 4, Group II). The age of patients was 0.4 +/- 0.5 years (mean +/- SD), weight was 5.2 +/- 2.3 kg, and time on ECLS was 8.3 +/- 4.8 days. No significant abnormalities were seen on head imaging. A total of 786 paired data points were collected. Mean values were different; however, there was a significant trend between SCO2 and SVO2 for the entire sample (R2 = 0.66, p < 0.001). Cerebral saturation trends follow mixed venous trends and, therefore, may be helpful in combination with other physical and laboratory findings in the care of the critically ill child.

Catheterization, Central Venous↗