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Biomedical subjects

Daniel Stromberg

Publications and source records attributed to Daniel Stromberg.

8 recordsLinked to original sources
PubMed2006

The extracardiac lateral tunnel Fontan, constructed with bovine pericardium: comparison with the extracardiac conduit Fontan.

BACKGROUND: The Fontan procedure performed with an extracardiac conduit (ECC) has gained wide acceptance as an alternative to the intracardiac lateral tunnel because it avoids placement of extensive atrial suture lines and use of prosthetic material in the systemic circulation. The extracardiac lateral tunnel (ELT) is a modification of the Fontan procedure which uses pericardium and the external surface of the atrium to create a conduit from the inferior vena cava to the pulmonary artery. This surgery theoretically avoids disruption of intra-atrial conduction by eschewing endocardial suturing while maintaining conduit growth potential and the ability to easily create a fenestration to the systemic circulation. METHODS: We retrospectively analyzed the short-term outcome of 96 consecutive patients who underwent an extracardiac Fontan procedure. An ELT using bovine pericardium was performed in 59 patients, whereas 37 patients received a traditional ECC. RESULTS: The 2 groups were similar with respect to age (P = .96), body surface area (P = .54), number of preoperative Fontan risk factors (P = .43), and ventricular morphology (P = .72). There were no significant differences in the following outcome variables between the ELT and the traditional ECC: length of hospitalization (P = .73), duration of chest tube drainage (P = .48), abnormal rhythm at time of discharge (P = .27), and mortality (P = .63). CONCLUSIONS: The ELT Fontan can be performed with a low risk of mortality and complications. The results are equivalent to the traditional ECC procedure. The theoretical advantages of the procedure suggest that it should be considered a useful modification of Fontan surgery.

Adolescent↗
PubMed2004

Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants.

BACKGROUND: In an attempt to reduce the coagulopathic and inflammatory responses seen after cardiopulmonary bypass, the use of fresh whole blood during heart operations has become the standard of care for neonates and infants at many institutions. We compared the use of fresh whole blood with the use of a combination of packed red cells and fresh-frozen plasma (reconstituted blood) for priming of the cardiopulmonary bypass circuit. METHODS: We conducted a single-center, randomized, double-blind, controlled trial involving children less than one year of age who underwent open-heart surgery. Patients were assigned to receive either fresh whole blood that had been collected not more than 48 hours previously (96 patients) or reconstituted blood (104 patients) for bypass-circuit priming. Clinical outcomes and serologic measures of systemic inflammation and myocardial injury were compared between the groups. RESULTS: The group that received reconstituted blood had a shorter stay in the intensive care unit than the group that received fresh whole blood (70.5 hours vs. 97.0 hours, P=0.04). The group that received reconstituted blood also had a smaller cumulative fluid balance at 48 hours (-6.9 ml per kilogram of body weight vs. 28.8 ml per kilogram, P=0.003). Early postoperative chest-tube output, blood-product transfusion requirements, and levels of serum mediators of inflammation and cardiac troponin I were similar in the two groups. CONCLUSIONS: The use of fresh whole blood for cardiopulmonary bypass priming has no advantage over the use of a combination of packed red cells and fresh-frozen plasma during surgery for congenital heart disease. Moreover, circuit priming with fresh whole blood is associated with an increased length of stay in the intensive care unit and increased perioperative fluid overload.

Acute-Phase Proteins↗
PubMed2004

Pediatric cardiac intensivists: are enough being trained?

OBJECTIVE: To determine both the number of cardiac intensivists being trained by member institutions of the Pediatric Cardiac Intensive Care Society and the perceived need for these professionals. DESIGN: Web-based survey of pediatric cardiac intensive care unit program directors. RESULTS: A total of 54 directors completed the survey (41% response rate). Twelve pediatric cardiac critical care fellowship positions are offered each year among the responding Pediatric Cardiac Intensive Care Society institutions in the United States and Canada-only six of the 12 positions were filled in the academic year 2002-2003. Cardiac intensivist recruitment was ongoing at 25 of the programs surveyed (46%). An additional 45 cardiac intensivists will be sought during the next 1-3 yrs and 36 during the subsequent 3- to 5-yr period. CONCLUSIONS: There is a discrepancy between the current and growing need for trained pediatric cardiac intensivists and the graduation rate of these professionals from teaching programs.

Cardiology↗
PubMed2002

Fenestration improves clinical outcome of the fontan procedure: a prospective, randomized study.

BACKGROUND: The Fontan procedure is the definitive operation for palliation of complex congenital heart disease with single-ventricle physiology. Fenestration of the Fontan circuit allows for shunting of deoxygenated blood to the systemic circulation. This procedure improved the clinical outcomes of patients who are at high risk for poor Fontan results. However, it is controversial whether fenestration is beneficial for standard-risk patients. METHODS AND RESULTS: This prospective, randomized trial evaluated the clinical utility of fenestration in patients with standard preoperative risk profiles for Fontan surgery. Forty-nine consecutive patients were assigned to undergo either a fenestrated (25 patients) or nonfenestrated (24 patients) Fontan procedure. The fenestrated and nonfenestrated groups were comparable with respect to age (P=0.944), body surface area (P=0.250), number of preoperative risk factors for poor outcome (P=0.681), cardiopulmonary bypass time (P=0.302), number of patients who required aortic cross-clamping (P=0.240), preoperative oxygen saturation (P=0.101), and number of patients with dominant left ventricular morphology (P=0.534). Patients in the fenestrated group had 55% less total chest tube drainage (P=0.036), 41% shorter total hospitalization (P=0.018), and 67% fewer additional procedures in the postoperative period (P=0.006) than those in the nonfenestrated group. CONCLUSIONS: Baffle fenestration performed at the time of Fontan surgery improves short-term outcome in standard-risk patients by decreasing pleural drainage, hospital length of stay, and need for additional postoperative procedures.

Child↗
PubMed2002

Myocardial inflammatory activation in children with congenital heart disease.

OBJECTIVE: In several cardiac-related diseases, there is a strong association between systemic endotoxemia, myocardial cytokine production, and cardiac failure. Because pre- and postoperative endotoxemia recently was reported in children with congenital heart disease, we sought direct evidence of myocardial inflammatory activation in a cohort of children undergoing congenital heart surgery on cardiopulmonary bypass. Inflammatory activation was prospectively defined as the presence of nuclear factor-kappaB nuclear translocation in myocardial tissue samples. DESIGN: Prospective observational study. SETTING: Tertiary care pediatric intensive care unit. PATIENTS: Fifteen children with congenital heart disease undergoing operative repair on cardiopulmonary bypass. INTERVENTIONS: All patients underwent operative repair of congenital heart disease on cardiopulmonary bypass and had plasma samples obtained for endotoxin and tumor necrosis factor-alpha, both pre- and postoperatively. Myocardial tissue samples were obtained intraoperatively, both before and during cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: Elevated plasma endotoxin concentrations were documented in all 15 patients during the study period. In 12 patients, plasma endotoxin was elevated before cardiopulmonary bypass. The median preoperative tumor necrosis factor-alpha concentration was 16.4 pg/mL, which is higher than concentrations reported in adults with New York Heart Association class III congestive heart failure. Examination of myocardial tissue samples revealed nuclear factor-kappaB nuclear translocation (predominantly p50/p65 heterodimers) in nine of 15 patients (60%). Four of these nine patients had nuclear factor-kappaB nuclear translocation before initiation of cardiopulmonary bypass, with p50/p50 homodimers present in two of the four. CONCLUSIONS: These data provide the first evidence of nuclear factor-kappaB activation in children with congenital heart disease and the first evidence of myocardial nuclear factor-kappaB translocation in human hearts before explant for transplantation. Furthermore, these data suggest that, similar to adults with advanced congestive heart failure, the myocardial inflammatory cascade may contribute to the pathophysiology of congenital heart disease in infants and children.

Active Transport, Cell Nucleus↗