Interstage Home Monitoring After Newborn First-Stage Palliation for Hypoplastic Left Heart Syndrome: Family Education Strategies

2017 ◽  
Vol 37 (2) ◽  
pp. 72-88 ◽  
Author(s):  
Jo Ann Nieves ◽  
Karen Uzark ◽  
Nancy A. Rudd ◽  
Jennifer Strawn ◽  
Anne Schmelzer ◽  
...  
Keyword(s):  
Home Care ◽  
Hypoplastic Left Heart Syndrome ◽  
Single Ventricle ◽  
Early Recognition ◽  
Home Monitoring ◽  
Growth Failure ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Growth And Survival ◽  
Left Heart Syndrome

Children born with hypoplastic left heart syndrome are at high risk for serious morbidity, growth failure, and mortality during the interstage period, which is the time from discharge home after first-stage hypoplastic left heart syndrome palliation until the second-stage surgical intervention. The single-ventricle circulatory physiology is complex, fragile, and potentially unstable. Multicenter initiatives have been successfully implemented to improve outcomes and optimize growth and survival during the interstage period. A crucial focus of care is the comprehensive family training in the use of home surveillance monitoring of oxygen saturation, enteral intake, weight, and the early recognition of “red flag” symptoms indicating potential cardiopulmonary or nutritional decompensation. Beginning with admission to the intensive care unit of the newborn with hypoplastic left heart syndrome, nurses provide critical care and education to prepare the family for interstage home care. This article presents detailed nursing guidelines for educating families on the home care of their medically fragile infant with single-ventricle circulation.

scholarly journals Seasonality of Hypoplastic Left Heart Syndrome and Single Ventricle Heart in Poland in the Context of Air Pollution

2021 ◽  
Vol 10 (15) ◽  
pp. 3207
Author(s):  
Iwona Strzelecka ◽  
Małgorzata Biedrzycka ◽  
Filip Franciszek Karuga ◽  
Bartosz Szmyd ◽  
Katarzyna Batarowicz ◽  
...  
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Single Ventricle ◽  
Single Case ◽  
Winter Season ◽  
Left Heart ◽  
Target Level ◽  
Hypoplastic Left Heart ◽  
Factors Affecting ◽  
Left Heart Syndrome ◽  
Significant Factors

Hypoplastic left heart syndrome (HLHS) and single ventricle (SV) remain a significant cause of cardiac deaths occurring in the first week of life. Their pathogenesis and seasonal frequency are still unknown. Therefore, we attempt to look at the genesis of the HLHS and SV in the context of territorial distribution as well as seasonality. A total of 193 fetuses diagnosed with HLHS and 92 with SV were selected. The frequency was analyzed depending on the year, calendar month, quarter and season (fall-winter vs. spring-summer). The spatial distribution of HLHS and SV in Poland was analyzed. We observed a statistically significant overrepresentation of HLHS formation frequency in March: 27 (14.00%) in comparison to a monthly median of 15 (IQR: 13.75–16.25; p = 0.039), as well as a significantly higher frequency of HLHS in 2007−2009: 65 cases (33.68%) in comparison to the annual mean of 13.79 ± 6.36 (p < 0.001). We noted a higher frequency of SV among parous with the last menstrual period reported in the fall/winter season of 58 vs. 34 in the spring/summer season (p = 0.014). The performed analysis also revealed significant SV overrepresentation in 2008: 11 cases (12.00%) in comparison to the annual mean of 6.57 ± 2.71 (p = 0.016). Every single case of HLHS was observed when the concentration of benzo(a)pyrene and/or PM10 exceeded the acceptable/target level. Our research indicates that both the season and the level of pollution are significant factors affecting the health of parous women and their offspring. The reason why HLHS and SV develop more frequently at certain times of the year remains unclear, therefore research on this topic should be continued, as well as on the effects of PM10 and benzo(a)pyrene exposure.

Cerebral arterial gas embolism in a patient with hypoplastic left heart syndrome treated with emergent hyperbaric oxygen: case report

2020 ◽  
pp. 431-434
Author(s):  
Mark Binkly ◽  
◽  
Matthew Kelly ◽  
Kevin Hardy ◽  
◽  
...  
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Hyperbaric Oxygen ◽  
Single Ventricle ◽  
Case Reports ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Small Areas ◽  
Left Heart Syndrome

A 30-year-old female with a history of seizure disorder and hypoplastic left heart syndrome treated with a Norwood procedure in 1986 followed by a modified non-fenestrated Fontan (Left SVC to IVC to pulmonary arteries) with a known baffle leak presented to the emergency department. On day of presentation, the patient became unresponsive, with perioral cyanosis, rightward gaze and a left facial droop near the end of a platelet transfusion. An emergent non-contrast head CT revealed intracranial air in the right MCA distribution. She was taken to the hyperbaric chamber and was treated with a U.S. Navy Table 6 in a multiplace chamber with no extensions. Ten minutes into the treatment patient became more alert and spontaneously asked questions. The following day she was treated with a U.S. Navy Table 5. Patient had repeat CT of the head, which showed resolution of intracerebral gas and small areas of ischemia in right frontal lobe and right caudate. On hospital day five neurologic exam was normal, with 5/5 strength and no residual deficits. Treating the patient was a concern because patient has a single ventricle, in which the pulmonary artery is connected directly to the vena cava. There is very little data regarding the effects of hyperbaric oxygen (HBO2) therapy on single-ventricle physiology. Only two case reports of three pediatric patients treated with HBO2 for CAGE in a similar setting are known. In these cases the patients had improvements in their symptoms following HBO2. These cases and ours indicate HBO2 is feasible and indicated for CAGE in patients with cyanotic congenital heart disease.

Feeding Protocols for Neonates With Hypoplastic Left Heart Syndrome

2015 ◽  
Vol 26 (3) ◽  
pp. 215-221
Author(s):  
Erin Jenkins
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Enteral Feeding ◽  
Growth Failure ◽  
High Rate ◽  
Left Heart ◽  
Metabolic Demand ◽  
Hypoplastic Left Heart ◽  
Gastrointestinal Complications ◽  
Left Heart Syndrome ◽  
Feeding Protocol

Optimizing nutrition in neonates with hypoplastic left heart syndrome is essential, given the high rate of growth failure in this population. Infants with hypoplastic left heart syndrome are predisposed to nutritional deficiency as a result of their increased metabolic demand; however, early enteral feeding also increases the risk of serious gastrointestinal morbidity and mortality caused by poor intestinal perfusion. Consequently, providers have difficulty deciding when and how to safely feed these patients. A review of the literature found that implementation of a structured enteral feeding protocol may decrease the risk of gastrointestinal complications while also minimizing dependence on parenteral nutrition and decreasing length of hospital stay. As these studies were limited, further research is warranted to establish a best practice feeding protocol to decrease risk and optimize nutrition in this fragile population.

scholarly journals Results of heart transplantation following failed staged palliation of hypoplastic left heart syndrome and related single ventricle anomalies

2015 ◽  
Vol 48 (5) ◽  
pp. 792-799 ◽  
Author(s):  
Bahaaldin Alsoufi ◽  
Shriprasad Deshpande ◽  
Courtney McCracken ◽  
Brian Kogon ◽  
Robert Vincent ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Hypoplastic Left Heart Syndrome ◽  
Single Ventricle ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Left Heart Syndrome

Abstract 17246: Predictors for Listing for Transplant in Infants with Hypoplastic Left Heart Syndrome : an analysis of the Single Ventricle Reconstruction Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Aparna Kulkarni ◽  
Richard Neugebauer ◽  
Jacqueline M Lamour ◽  
Daphne T Hsu
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Median Time ◽  
Single Ventricle ◽  
Significant Risk ◽  
Wait List ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Time To Death ◽  
Valve Insufficiency ◽  
Left Heart Syndrome

Background: Infants with Hypoplastic Left Heart Syndrome (HLHS) following the Norwood procedure have the worst survival among infant heart transplant (HT) recipients. The Single Ventricle Reconstruction (SVR) trial collected vital status and HT data in 920 eligible patients (pts) and prospective preoperative, operative and post-operative data in 554 randomized pts. This trial provides a unique opportunity to evaluate predictors of the need for HT in HLHS infants. Methods: The public use SVR database was used to analyze factors associated with listing for HT and mortality on the wait list and in HT pts. Pts listed for HT were compared with those who survived without listing. Results: Among 920 eligible pts, 41 were listed for HT and follow up data was available in 33/554 pts. 25 pts underwent HT. The median age at listing was 135 days (6 [[Unable to Display Character: &#8211;]] 713 days). All pts listed were status 1A, except for 2 at status 7 and 1 at status 2. Mean RV fractional area change at birth was significantly lower in the listed group (29±8% vs.35±9, p<0.05). ECMO/ CPR, and need for pacemaker were also more common in listed pts compared to the unlisted group. Gestational age, anatomic diagnosis of aortic atresia, AV valve insufficiency and the number of catheterization interventions were not risk factors for HT listing. The median time from listing to HT was 47 days (2 - 340 days). ECMO or VAD support was used in 10 pts prior to HT. Wait list mortality was 29% with a median time to death of 134 days (10 [[Unable to Display Character: &#8211;]] 707 days). Causes of death on the wait list included cardiac (8 pts), renal (1 pt), surgical (1 pt) and other (2pts). Mortality after HT was 36% with a median time to death of 197 days (48-658 days). Overall mortality after listing, including after HT, was 51%; younger age at listing was associated with increased mortality (292 vs 149 days, p<0.04). Conclusion: HT as a rescue procedure for HLHS in the first year of life carries a significant risk of mortality.

Provider perspective on the role of palliative care in hypoplastic left heart syndrome

2020 ◽  
Vol 30 (3) ◽  
pp. 377-382
Author(s):  
Sarah Lowenstein ◽  
Robert Macauley ◽  
Kathleen Perko ◽  
Christina Ronai
Keyword(s):  
Palliative Care ◽  
Hypoplastic Left Heart Syndrome ◽  
Online Survey ◽  
Single Ventricle ◽  
Postnatal Period ◽  
Support Network ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Provider Perspectives ◽  
Left Heart Syndrome

AbstractObjective:Hypoplastic left heart syndrome is a single ventricle defect. While staged surgical palliative treatments have revolutionised care, patients with hypoplastic left heart syndrome continue to have significant morbidity and mortality. In 2017, the National Pediatric Cardiology Quality Improvement Collaborative recommended all single ventricle patients to receive a prenatal palliative care consult. This study aimed to elucidate provider perspectives on the implementation of prenatal palliative care consults for families expecting a child with hypoplastic left heart syndrome.Methods:An online survey was administered to obstetric and paediatric providers of relevant disciplines to assess their experience with palliative care involvement in hypoplastic left heart syndrome cases.Results:Nearly, all physicians (97%) and most registered nurses (79%) agreed that the initial palliative care consult for patients with hypoplastic left heart syndrome should occur during the prenatal period. Respondents also indicated that prenatal palliative care consults should also be offered in a variety of other CHD conditions. Participants believed positive aspects of this new referral protocol included an expanded support network for families, decreased family stress during the postnatal period, increased patient education about what to expect during the postnatal period, and continuity of care.Conclusion:Multidisciplinary healthcare professionals believe that prenatal palliative care consults provide a variety of benefits for patients and families with hypoplastic left heart syndrome. Additional, multi-centre research is necessary to evaluate whether prenatal palliative care consults should become standard of care for families expecting a child with a single ventricle defect.

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