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Biomedical subjects

S S Higgins

Publications and source records attributed to S S Higgins.

At least 19 recordsLinked to original sources
PubMed2001

Parental role in decision making about pediatric cardiac transplantation: familial and ethical considerations.

Parents of children with complex or terminal heart conditions often face agonizing decisions about cardiac transplantation. There are differences in the level of involvement that parents prefer when making such decisions. The purpose of this study was to identify and describe parents' preferences for their roles in decisions related to cardiac transplantation. A prospective ethnographic method was used to study 24 parents of 15 children prior to their decision of accepting or rejecting the transplant option for their children. Findings revealed that the style of parent decision making ranged from a desire to make an independent, autonomous choice to a wish for an authoritarian, paternalistic choice. Nurses and physicians can best support families in this situation, showing sensitivity to the steps that parents use to make their decisions. An ethical model of decision making is proposed that includes respect for differences in beliefs and values of all persons involved in the transplantation discussion.

Adolescent↗
PubMed2000

Parental considerations for children undergoing cardiac transplantation.

There have been profound improvements in the survival of children following cardiac transplantation as surgical techniques, organ preservation, and immunosuppression have advanced. The sensitivity to individual parental differences and concerns throughout the beginning and long-term experience of pediatric cardiac transplantation must be accompanied by support from all the members of the transplant team. Quality of life for children, measured as functional status, at 3 years posttransplant is reported to be excellent. This quality of life is dependent not only on the medical and surgical success of the procedure, but also on an intact, supportive family. Further research needs to be done on quality of life issues after pediatric cardiac transplantation. Beyond the long-term medical, developmental, and psychological impact of the transplanted child, studies need to address the emotional, social, and financial impact of transplantation on the parents and the well siblings.

Adaptation, Psychological↗
PubMed1999

Prescription and administration of around the clock analgesics in postoperative pediatric cardiovascular surgery patients.

Despite an increased awareness of postoperative pain management in infants and children, they are still often undermedicated. The importance of providing maximum comfort to children following cardiac surgery is accentuated with shortened hospital stays that require early ambulation to achieve early discharge. The purposes of this study were to evaluate the administration of prescribed around the clock (ATC) pain medication and documentation of pain assessment when administering pro re nata (prn) analgesics. A descriptive design was used to study 114 consecutive patients who underwent surgery for congenital heart disease. Administration of ordered ATC medications was best in the sternotomyl > 24 months of age group and poorest in the thoracotomyl < 24 months of age group. The use of the Wong-Baker FACES Pain Rating Scale in patients who were > 36 months of age (n = 71) was 38% for predose evaluation and only 15% for postdose evaluation. Findings suggest that the postoperative pain of infants and young children demands better attention. The administration of prescribed ATC medications is imperative in providing maximal postoperative pain relief in the pediatric cardiovascular surgery patient.

Adolescent↗
PubMed1996

Factors influencing parent decision making about pediatric cardiac transplantation.

The purpose of this prospective qualitative study was to investigate factors that influenced 15 parental decision-making situations regarding pediatric heart transplantation for children with end-stage heart disease. Twenty-four parents of 15 children, ranging in age from 1 day to 16 years, who had been given the heart transplantation option were inducted into the study as a convenience sample. All 24 parents were either interviewed (n = 18) or observed at some point during the decision-making process. Data collection strategies included participant observation and in-depth interviews. Data were coded into relevant themes and then clustered into categories; concurrent coding and analysis continued until new categories were no longer found. Predominant factors identified that influenced parental decision making were (a) psychological/emotional, (b) familial, and (c) social factors, and (d) physician endorsement of a treatment option. In 10 of the 15 situations, family beliefs and values were the main parental decision-making factors. Ten families chose transplantation for their child; 5 decided against the procedure. Pediatric nurses have central roles in facilitating parent-health professional communication in complex decision making concerning treatment alternatives of children.

Adolescent↗
PubMed1996

Parental understanding of the consequences of pediatric cardiac transplantation.

Pediatric cardiac transplantation has profound medical, social, psychological and economic consequences. Parents need to understand both the medical and non-medical consequences of the transplant procedure to make a judicious decision about this treatment. The purpose of this study was to determine the parental understanding of the multiple consequences of transplantation. A prospective ethnographic method was used to study 24 parents of 15 children prior to their decision to accept or reject the transplant option for their children. Findings revealed that the medical consequences of transplantation were well addressed by the pediatric cardiac transplant team. Little attention, however, was given to the non-medical concerns of the parents. The importance of nursing interventions related to information clarification and support for parents as they make decisions about heart transplantation for their children was identified.

Adolescent↗
PubMed1995

Role of the clinical nurse coordinator in successful implementation of critical pathways in pediatric cardiovascular surgery patients.

Critical pathways reduce variations in clinical management and achieve quality patient outcomes within a defined time while reducing the average length of stay (ALOS). The critical path is a day-by-day plan that specifies the use and timing of procedures in relation to the stage in the patient's recovery. Variations from that plan are identified and aggressively approached. This article outlines the clinical nurse coordinator's role in utilizing critical pathways for the congenital heart surgery patients. Successful implementation of the pathways using the clinical nurse coordinator's role is supported by analysis of ALOS in 286 patients.

Cardiovascular Diseases↗
PubMed1994

Usefulness of magnetic resonance imaging for evaluating great-vessel anatomy after arterial switch operation for D-transposition of the great arteries.

Magnetic resonance imaging (MRI) produces high-resolution images of great-vessel anatomy in pediatric patients. In this study seven patients, aged 6 to 27 months were evaluated by using gated MRI and two-dimensional echocardiography 4 to 26 months after arterial switch operation for D-transposition of the great arteries. Measurements were taken at the right and left ventricular outflow tracts, beneath the semilunar valves, at the midaortic sinuses, at the anastomotic sites of the main pulmonary artery and the aorta, at the origin of the branch pulmonary arteries, and at the distal pulmonary arteries 1 cm beyond the bifurcation. Concordant results were obtained with both imaging techniques from all sides with the exception of the left pulmonary artery and the right pulmonary artery. With MRI, four patients had significant narrowing at the right pulmonary artery origin and six patients had narrowing at the left pulmonary artery origin. With two-dimensional echocardiogram, two patients had narrowing at the right pulmonary artery origin and four patients had narrowing at the left pulmonary artery origin. The measured pulmonary artery intraluminal diameters in these patients were consistently smaller when assessed by MRI versus two-dimensional echocardiography. To verify these results, five of seven patients underwent cardiac catheterization to provide physiologic correlation before reoperation; the MRI results were found to be significantly closer to the actual catheterization measurements. We conclude that MRI is a sensitive imaging technique for evaluation of great-vessel anatomy in patients after arterial switch operation for D-transposition of the great arteries. It is particularly useful in the evaluation of the branch pulmonary artery anatomy.

Aorta↗
PubMed1994

Postoperative evaluation of pulmonary arteries in congenital heart surgery by magnetic resonance imaging: comparison with echocardiography.

Palliative and corrective operations for the treatment of cyanotic congenital heart disease frequently involve or potentially influence the size of the pulmonary arteries. Echocardiography and magnetic resonance imaging (MRI) are two noninvasive imaging techniques currently used to assess morphologic abnormalities of the pulmonary arteries. The purpose of this study was to evaluate the role of MRI in comparison with echocardiography for defining morphologic changes of the pulmonary arteries after congenital heart surgery. The MRI scans and echocardiograms of 33 patients with surgery involving or affecting the pulmonary arteries were compared. The pulmonary outflow tract, pulmonary confluence, right and left pulmonary arteries, and surgical shunts were separately evaluated. Cineangiography and surgical reports were used to confirm findings. MRI and echocardiography were equivalent for demonstrating abnormalities of the right ventricular outflow tract, main pulmonary artery, and a variety of pulmonary shunts. MRI was superior to echocardiography in demonstrating abnormalities of the right and left pulmonary arterial branches (p < 0.001). MRI is effective for monitoring pulmonary arterial status after surgery and is superior to echocardiography for the evaluation of the right and left pulmonary arteries.

Adolescent↗
PubMed1994

Long-term follow-up of the postoperative patient with congenital heart disease. General concerns.

There are an estimated 400,000 adults with postoperative congenital heart disease (CHD) in the United States. The majority of these patients require long-term follow-up for management of persistent problems. These problems are related to electrophysiologic sequelae, myocardial changes, ventricular failure, prosthetic materials, and infective endocarditis. The goal for adults with postoperative CHD is to achieve not only long-term survival, but the best possible quality of life.

Adult↗
PubMed1994

Common congenital heart defects. Long-term follow-up.

Dramatic advances in the diagnosis and treatment of patients with congenital heart disease (CHD) have profoundly increased their survival rate. More than 500,000 patients in the United States with functionally significant congenital cardiac defects have reached adulthood. The focus of this article is to present an overview of the long-term surgical outcomes of the following common congenital heart defects: atrial septal defect, pulmonary stenosis, ventricular septal defect, coarctation of the aorta, aortic stenosis, tetralogy of Fallot, and transposition of the great arteries.

Adult↗
PubMed1991

Nuclear magnetic resonance imaging of the palliative operation for hypoplastic left heart syndrome.

Electrocardiographic-gated nuclear magnetic resonance (NMR) imaging has been shown to be effective for the evaluation of congenital heart disease, particularly in supracardiac regions. This study evaluated the postoperative status after a stage I palliative operation (Norwood procedure) for hypoplastic left heart syndrome. The NMR images from three patients were compared with those of angiography and depicted all components of the reconstructed supracardiac and intracardiac anatomy after this operation. Nonobstructive anastomosis of the main pulmonary artery to the proximal aorta was clearly demonstrated in each patient. The caliber of the central or branch pulmonary artery, patency and caliber of the systemic to pulmonary artery shunt and the size of the atrial communication were also depicted in each patient and these findings corresponded with angiographic results. The results suggest that NMR imaging is effective for assessing the results of initial palliative surgery for hypoplastic left heart syndrome, which seems to be important for managing patients before subsequent definitive surgery.

Anastomosis, Surgical↗
PubMed1990

Evaluation of complex congenital ventricular anomalies with magnetic resonance imaging.

Complex ventricular anomalies are frequently associated with abnormalities of thoracic and abdominal situs, arterioventricular connection, and venous connection. The definition of all components of these anomalies is difficult to accomplish with imaging techniques. This study compared the effectiveness of electrocardiographic (ECG) gated spin-echo magnetic resonance imaging (MRI) with cardiac angiography for the evaluation of all components of central cardiovascular anatomy in patients with the clinical diagnosis of single or common ventricle or complete atrioventricular (AV) septal (canal) defect. MRI studies and angiograms of 29 patients were evaluated independently. A sequential approach was used to define cardiac anatomy assessing nine anatomic features in each patient. MRI provided 261 observations and angiography provided 209 observations. In the mutual 209 observations, only 17 discrepancies were found. Comparison of MRI and angiography in individual cases showed that MRI was as effective as angiography in the depiction of ventricular anomalies, including determination of morphology and evaluation of the size of the ventricles, the orientation of the ventricular septum relative to the AV valves, as well as the origins and spatial relationships of the great arteries. MRI was more informative for the determination of thoracic and abdominal situs and systemic and pulmonary venoatrial connections, but was not as effective for the evaluation of semilunar valves. Thus MRI provides complete evaluation of central cardiovascular anatomy and is effective in the anatomic assessment of most components of complex ventricular anomalies.

Adolescent↗
PubMed1990

Evaluation of surgical procedures for cyanotic congenital heart disease by using MR imaging.

ECG-gated MR imaging has been shown to be effective for the diagnosis of congenital heart disease. In this study, we assessed its role in the postoperative evaluation of surgical procedures in patients with complex congenital heart disease. MR images of 26 patients with Rastelli (five), Fontan (three), Senning (three), Damus (one), Jatene (eight), Waterston (four), and Potts (two) procedures were evaluated retrospectively. The accuracy of MR imaging was compared with that of angiography in 20 patients. The surgical anastomoses were identified in all patients. Patency, atresia, or hypoplasia of central pulmonary arteries and postoperative complications (focal stenoses of pulmonary arteries, thrombosed conduit, peri-conduit abscess) were shown. Narrowing of the right ventricular outflow tract and focal compression of the proximal pulmonary arteries were recognized as specific complications of the Jatene procedure. MR imaging appears to be effective in the postoperative evaluation of surgical procedures used for congenital heart disease. It should be considered as an alternative to repeated catheterization and angiography for the postoperative examination of children with complex congenital heart disease.

Adolescent↗
PubMed1989

Magnetic resonance imaging of congenital heart disease: sensitivity and specificity using receiver operating characteristic curve analysis.

MRI has shown promise for the evaluation of various congenital heart lesions. The current study was designed to assess the sensitivity and specificity of the technique for the evaluation of all major anatomic elements of the heart affected in simple and complex congenital heart disease. MR images of 51 patients (31 males and 20 females, ages 3 to 69 years) with a total of 110 congenital heart lesions were reviewed by a panel of two cardiac radiologists and one pediatric cardiologist, who assessed the cardiac pathoanatomy without knowledge of clinical details and assigned a confidence level to each diagnosis. The true diagnosis was established independently by the findings of angiocardiography and catheterization as well as by surgery, where applicable. ROC curves were generated from the responses, and the sensitivity at a specificity level of 90% was determined. MRI was shown to have a high sensitivity in evaluating great vessel relationships (100%), thoracic aorta abnormalities (94%), ASDs (91%) and VSDs (100%), visceroatrial situs (100%), and loop (100%). Three of five anomalies of the pulmonary and systemic veins were diagnosed by MRI. Right ventricular outflow obstructions (95%) were detected with a much higher sensitivity than lesions of the other valves (aortic valve 52%, mitral valve 62%, tricuspid valve 76%). Spin-echo MRI is a sensitive and specific method for the noninvasive assessment of congenital heart disease, with limitations in the evaluation of some valvular anomalies.

Adolescent↗
PubMed1986

Coarctation of the aorta: MR imaging.

Thirteen patients, aged 3-31 years, with coarctation of the thoracic aorta were examined by magnetic resonance (MR) imaging (total of 14 studies). Eight studies were performed preoperatively and six postoperatively. Catheterization data were available on 12 patients for verification of MR imaging findings. Electrocardiographically gated sagittal and left anterior oblique images best depicted the coarctations; however, involvement of arch vessels was best evaluated on transaxial images. MR imaging readily identified all coarctations but one, their site and extent, and involvement of the arch vessels. In addition, MR images depicted poststenotic dilatation and dilated collateral vessels. In patients studied postoperatively, restenosis could be evaluated, and complications such as postoperative aneurysm and perianastomotic hematoma were identified. MR imaging provides excellent anatomic detail of coarctation of the aorta, potentially obviating the need for angiography.

Adolescent↗
PubMed1985

Renal function in children after large dose contrast medium angiocardiography.

Serum creatinine and routine urinalysis were obtained and glomerular filtration rate estimated in 56 consecutive and hemodynamically stable children with congenital heart disease undergoing cardiac catheterization and angiocardiography, a day prior to, 1 and 7 days following the procedure. None had a history of renal disease. The patients were divided into 2 groups: Group I, 32 patients who received less than 3 ml/Kg of Renagrafin 60 and Group II, 24 patients who received greater than 3 ml/Kg. Despite a slight rise of creatinine on the first day, there were no statistically significant changes in serum creatinine or glomerular filtration rate for either group following the procedure. Occult blood was present in the urine of 2 in Group I and 1 in Group II prior to cardiac catheterization; this resolved in all cases after the procedure. Three patients in Group I and 1 in Group II developed transient trace proteinuria following the angiographic procedure. It is concluded that in children with congenital heart disease and normal kidney function, substantial doses of standard contrast medium administered during angiocardiography do not produce any apparent impairment of renal function.

Adolescent↗