Single Ventricular Assist Device Care and Outcomes for Failed Stage I Palliation: A Single-Center Decade of Experience.

Single ventricular assist device (SVAD) use before and after stage I palliation (S1P) is increasing with limited data on outcomes. To address this knowledge gap, we conducted a single-center retrospective review to assess pre- and post-SVAD clinical status, complications, and outcomes. We leveraged a granular, longitudinal, local database that captures end-organ support, procedural interventions, hematologic events, laboratory data, and antithrombotic strategy.

Heart Transplantation in Children With Down Syndrome.

Background Children with Down syndrome (DS) have a high risk of cardiac disease that may prompt consideration for heart transplantation (HTx). However, transplantation in patients with DS is rarely reported. This project aimed to collect and describe waitlist and post- HTx outcomes in children with DS.

Heterogeneous outcomes of liver disease after heart transplantation for a failed Fontan procedure.

Background: Fontan-associated liver disease (FALD) uniformly affects patients with long-term Fontan physiology. The effect of isolated heart transplant (HT) on the course of FALD post-HT is not well understood.

Methods: We evaluated serial liver imaging pre- and post-HT to assess liver changes over time in a single-center retrospective analysis of Fontan HT recipients who had pre- and ≥1-year post-HT liver imaging.

Association of low center performance evaluations and pediatric heart transplant center behavior in the United States.

Background: To date, no study has evaluated the effects of low center performance evaluations (CPE) on pediatric heart transplant center behavior. We sought to assess the impact of low CPE flags on pediatric heart transplant center listing and transplant volumes and center recipient and donor characteristics.

Methods: We included centers performing at least 10 pediatric (age <18 years) transplants during the Scientific Registry of Transplant Recipients reporting period January 2009-June 2011 and evaluated consecutive biannual program specific reports until the last reporting period January 2016-June 2018.

Delayed Development of Coronary Artery Dilitation in Suspected Severe Acute Respiratory Syndrome Coronavirus 2 Multisystem Inflammatory Syndrome: More Research Needed.

Unlabelled: Although significant disease burden in the severe acute respiratory syndrome coronavirus 2 pandemic has been relatively uncommon in children, worldwide cases of a postinfectious multisystem inflammatory syndrome in children and possible atypical Kawasaki-like disease attributing to severe acute respiratory syndrome coronavirus 2 infection have arisen. Original thinking for coronavirus disease-19 disease was that an overwhelming proinflammatory response drove disease pathogenesis. Emerging reports suggest that a robust immune suppression may be more relevant and predominant.

Report from the 2018 consensus conference on immunomodulating agents in thoracic transplantation: Access, formulations, generics, therapeutic drug monitoring, and special populations.

In 2009, the International Society for Heart and Lung Transplantation recognized the importance and challenges surrounding generic drug immunosuppression. As experience with generics has expanded and comfort has increased, substantial issues have arisen since that time with other aspects of immunomodulation that have not been addressed, such as access to medicines, alternative immunosuppression formulations, additional generics, implications on therapeutic drug monitoring, and implications for special populations such as pediatrics and older adults. The aim of this consensus document is to address critically each of these concerns, expand on the challenges and barriers, and provide therapeutic considerations for practitioners who manage patients who need to undergo or have undergone cardiothoracic transplantation.

Classical 1/3 scaling of convection holds up to Ra = 10.

The global transport of heat and momentum in turbulent convection is constrained by thin thermal and viscous boundary layers at the heated and cooled boundaries of the system. This bottleneck is thought to be lifted once the boundary layers themselves become fully turbulent at very high values of the Rayleigh number [Formula: see text]-the dimensionless parameter that describes the vigor of convective turbulence. Laboratory experiments in cylindrical cells for [Formula: see text] have reported different outcomes on the putative heat transport law.

Review of the discard and/or refusal rate of offered donor hearts to pediatric waitlisted candidates.

We aimed to review current literature on the discard rate of donor hearts offered to pediatric recipients and assess geographical differences. Consequences and ways to reduce the discard rate are discussed. A systemic review on published literature on pediatric transplantation published in English since 2010 was undertaken.

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation.

The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance.

Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria.

Objective: Different definitions have been used for screening for rheumatic heart disease (RHD). This led to the development of the 2012 evidence-based World Heart Federation (WHF) echocardiographic criteria. The objective of this study is to determine the intra-rater and inter-rater reliability and agreement in differentiating no RHD from mild RHD using the WHF echocardiographic criteria.

Variability in donor selection among pediatric heart transplant providers: Results from an international survey.

There is considerable variability in donor acceptance practices among adult heart transplant providers; however, pediatric data are lacking. The aim of this study was to assess donor acceptance practices among pediatric heart transplant professionals. The authors generated a survey to investigate clinicians' donor acceptance practices.

Community study to uncover the full spectrum of rheumatic heart disease in Uganda.

Objective: Estimates of the prevalence of rheumatic heart disease (RHD) in many endemic countries are limited to samples of children attending schools, which generate an incomplete picture of disease burden in communities. The present study conducted household-based RHD screening in a representative community in Gulu district, Uganda.

Methods: Members of households identified through a two-stage cluster-sampling approach between the ages of 5 years and 50 years were invited to undergo limited cardiac testing with a handheld echocardiogram to assess for the presence of RHD.

Turbulent superstructures in Rayleigh-Bénard convection.

Turbulent Rayleigh-Bénard convection displays a large-scale order in the form of rolls and cells on lengths larger than the layer height once the fluctuations of temperature and velocity are removed. These turbulent superstructures are reminiscent of the patterns close to the onset of convection. Here we report numerical simulations of turbulent convection in fluids at different Prandtl number ranging from 0.

Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes.

Background: Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited.

Methods: We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post-heart transplantation.

Extreme dissipation event due to plume collision in a turbulent convection cell.

An extreme dissipation event in the bulk of a closed three-dimensional turbulent convection cell is found to be correlated with a strong reduction of the large-scale circulation flow in the system that happens at the same time as a plume emission event from the bottom plate. The reduction in the large-scale circulation opens the possibility for a nearly frontal collision of down- and upwelling plumes and the generation of a high-amplitude thermal dissipation layer in the bulk. This collision is locally connected to a subsequent high-amplitude energy dissipation event in the form of a strong shear layer.

Hybrid Exclusion of HeartMate ІІ Left Ventricular Assist Device After Bridge to Recovery.

We present a hybrid technique of left ventricular assist device exclusion after bridge to recovery in a pediatric patient, using percutaneous occlusion of the outflow graft and surgical excision of driveline. This technique has the advantage of avoiding chest reentry and cardiopulmonary bypass.

Using a Low-Risk Population to Estimate the Specificity of the World Heart Federation Criteria for the Diagnosis of Rheumatic Heart Disease.

Background: The 2012 World Heart Federation (WHF) criteria set the minimum standards for echocardiographic diagnosis of rheumatic heart disease (RHD) in a high-risk population without history of acute rheumatic fever. The high sensitivity of the 2012 WHF criteria is well accepted, but the specificity cannot be directly assessed without a confirmatory test. The objective of this study was to estimate the false-positive rate of the WHF criteria through their application in a population at very low risk for RHD.

Handheld echocardiographic screening for rheumatic heart disease by non-experts.

Objectives: Handheld echocardiography (HAND) has good sensitivity and specificity for rheumatic heart disease (RHD) when performed by cardiologists. However, physician shortages in RHD-endemic areas demand less-skilled users to make RHD screening practical. We examine nurse performance and interpretation of HAND using a simplified approach for RHD screening.

Enhanced enstrophy generation for turbulent convection in low-Prandtl-number fluids.

Turbulent convection is often present in liquids with a kinematic viscosity much smaller than the diffusivity of the temperature. Here we reveal why these convection flows obey a much stronger level of fluid turbulence than those in which kinematic viscosity and thermal diffusivity are the same; i.e.

Simplified rheumatic heart disease screening criteria for handheld echocardiography.

Background: Using 2012 World Heart Federation criteria, standard portable echocardiography (STAND) reveals a high burden of rheumatic heart disease (RHD) in resource-poor settings, but widespread screening is limited by cost and physician availability. Handheld echocardiography (HAND) may decrease costs, but World Heart Federation criteria are complicated for rapid field screening, particularly for nonphysician screeners. The aim of this study was to determine the best simplified screening strategy for RHD detection using HAND.