4 results
The family burden of paediatric heart disease during the chronic phase of illness
- Kevin Hummel, Avital Ludomirsky, Lauren Burgunder, Minmin Lu, Sarah Goldberg, Lynn Sleeper, Jeffrey Reichman, Elizabeth D. Blume
-
- Journal:
- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 28 November 2023, pp. 1-7
-
- Article
- Export citation
-
Background:
CHD is a lifelong condition with a significant burden of disease to patients and families. With increased survival, attention has shifted to longer-term outcomes, with a focus on social determinants of health. Among children with CHD, socioeconomic status is associated with disparities in outcomes. Household material hardship is a concrete measure of poverty and may serve as an intervenable measure of socioeconomic status.
Methods:A longitudinal survey study was conducted at multiple time points (at acute hospitalisation, then 12–24 months later in the chronic phase) to determine the prevalence of household material hardship among parents of children with advanced heart disease and quality of life during long-term follow-up.
Results:The analytic cohort was 160 children with a median patient age of 1 year (IQR 1,4) with 54% of patients <2 years. During acute hospitalisation, over one-third of families reported household material hardship (37%), with significantly lower household material hardship in the chronic phase at 16% (N = 9 of 52). For parents reporting household material hardship during acute hospitalisation, 50% had resolution of household material hardship by the chronic phase. Household material hardship-exposed children were significantly more likely to be publicly insured (56% versus 20%, p = 0.03) with lower quality of life than those without household material hardship (64% versus 82%, p = 0.013).
Conclusion:The burden of heart disease during the chronic phase of illness is high. Household material hardship may serve as a target to ensure equity in the care and outcomes of CHD patients and their families.
Functional state following the Fontan procedure
- Ismee A. Williams, Lynn A. Sleeper, Steven D. Colan, Minmin Lu, Elizabeth A. Stephenson, Jane W. Newburger, Welton M. Gersony, Meryl S. Cohen, James F. Cnota, Andrew M. Atz, Richard V. Williams, Renee Margossian, Andrew J. Powell, Mario P. Stylianou, Daphne T. Hsu, For the Pediatric Heart Network Investigators (see Appendix)
-
- Journal:
- Cardiology in the Young / Volume 19 / Issue 4 / August 2009
- Published online by Cambridge University Press:
- 01 August 2009, pp. 320-330
-
- Article
- Export citation
-
Background
Despite improvements in outcomes after completion of the Fontan circulation, long-term functional state varies. We sought to identify pre- and postoperative characteristics associated with overall function.
Methods and ResultsWe analyzed data from 476 survivors with the Fontan circulation enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. Mean age at creation of the Fontan circulation was 3.4 plus or minus 2.1 years, with a range from 0.7 to 17.5 years, and time since completion was 8.7 plus or minus 3.4 years, the range being from 1.1 to 17.3 years. We calculated a functional score for the survivors by averaging the percentile ranks of ventricular ejection fraction, maximal consumption of oxygen, the physical summary score for the Child Health Questionnaire, and a function of brain natriuretic peptide. The mean calculated score was 49.5 plus or minus 17.3, with a range from 3 to 87. After adjustment for time since completion of the circulation, we found that a lower score, and hence worse functional state, was associated with: right ventricular morphology (p less than 0.001), higher ventricular end-diastolic pressure (p equals 0.003) and lower saturations of oxygen (p equals 0.047) prior to completion of the Fontan circulation, lower income for the caregiver (p equals 0.003), and, in subjects without a prior superior cavopulmonary anastomosis, arrhythmias after completion of the circulation (p equals 0.003). The model explained almost one-fifth (18%) of the variation in the calculated scores. The score was not associated with surgical centre, sex, age, weight, fenestration, or the period of stay in hospital after completion of the Fontan circuit. A validation model, using 71 subjects randomly excluded from initial analysis, weakly correlated (R equals 0.17, p equals 0.16) with the score calculated from the dataset.
ConclusionsRight ventricular morphology, higher ventricular end-diastolic pressure and lower saturations of oxygen prior to completion of the Fontan circuit, lower income for the provider of care, and arrhythmias after creation of the circuit, are all associated with a worse functional state. Unmeasured factors also influence outcomes.
High-temperature tensile properties of in situ-synthesized titanium matrix composites with strong dependence on strain rates
- Lv Xiao, Weijie Lu, Jining Qin, Di Zhang, Minmin Wang, Feng Zhu, Bo Ji
-
- Journal:
- Journal of Materials Research / Volume 23 / Issue 11 / November 2008
- Published online by Cambridge University Press:
- 31 January 2011, pp. 3066-3074
- Print publication:
- November 2008
-
- Article
- Export citation
-
High-temperature titanium matrix composites reinforced with hybrid reinforcements are synthesized by common casting and hot working technologies. Tensile properties are tested at different temperatures and strain rates. Ultimate strengths of the composites are significantly enhanced under all conditions and decrease when the strain rate is lower. Equicohesive temperature of the matrix is around 873 K at the strain rate 10−3s−1 and well below 873 K at 10−5s−1. At higher temperature or lower strain rate, interfacial debonding is more drastic and reduces the strengths of composites. The materials are embrittled under creep-rupture conditions. Strict reinforcement morphology is required for more complex service conditions at high temperatures in metal matrix composites.
Functional state of patients with heterotaxy syndrome following the Fontan operation
- Andrew M. Atz, Meryl S. Cohen, Lynn A. Sleeper, Brian W. McCrindle, Minmin Lu, Ashwin Prakash, Roger E. Breitbart, Richard V. Williams, Charlie J. Sang, Gil Wernovsky, for the Investigators of the Pediatric Heart Network
-
- Journal:
- Cardiology in the Young / Volume 17 / Issue S4 / September 2007
- Published online by Cambridge University Press:
- 26 November 2007, pp. 44-53
-
- Article
- Export citation
-
Background
Children born with heterotaxy syndromes have poorer outcomes compared with children born with comparable cardiac lesions requiring similar surgical palliation. Heterotaxy has been reported as a separate risk factor for mortality and increased morbidity in a series of Fontan operations reported from single centres. Little is known, however, about the functional state of surviving patients with heterotaxy following a Fontan operation.
MethodsIn the multicentric cross-sectional study carried out by the Pediatric Heart Network of 546 survivors of the Fontan procedure, the patients, aged from 6 to 18 years, underwent evaluation by echocardiography, exercise testing, electrocardiography, magnetic resonance imaging, and functional health status questionnaires compiled by the patients and their parents. Heterotaxy was identified in 42 patients (8%). Medical and patient characteristics were compared between those with heterotaxy and the remaining 504 patients who did not have heterotaxy.
ResultsPatients with heterotaxy had their Fontan procedure performed at a later age, with a median of 3.9 years versus 2.8 years (p = 0.001) and had volume-unloading surgery performed later, at a median age of 1.4 versus 0.9 years (p = 0.008). These patients had significantly different ventricular and atrioventricular valvar morphology, as well as a higher incidence of systemic and pulmonary venous abnormalities. They had a higher incidence of prior surgery to the pulmonary veins, at 21 versus 0.4%. The type of Fontan procedure was different, but no difference was detected in length of stay in hospital, or the number of postoperative complications. Sinus rhythm was less common, at 44 versus 71%, (p = 0.002), and history of atrial arrhythmias more common, at 19 versus 8%, (p = 0.018) in those with heterotaxy. Echocardiography revealed a greater degree atrioventricular valvar regurgitation, lower indexed stroke volume, and greater Tei index. Exercise performance, levels of brain natriuretic peptide in the serum, and summary and domain scores from health status questionnaires, were not different from those not having heterotaxy.
ConclusionsThe study illustrates a profile of characteristics, medical history, functional health state, and markers of ventricular performance in patients with heterotaxy after the Fontan procedure. Despite obvious anatomic differences, and some differences in echocardiography and heart rhythm, there were no important differences in exercise performance or functional health state between these patients and other survivors of the Fontan procedure.