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Volume 10 - January 2000

Contents

Page 1 of 9

Meeting Report

The European Paediatric Cardiac Code

  • Report of the Coding Committee of the Association for European Paediatric Cardiology

  • Rodney C. G. Franklin, Robert H. Anderson, Otto Daniëls, Martin Elliott, Marc H. M. L. Gewillig, Renzo Ghisla, Otto N. Krogmann, Herbert E. Ulmer, Franco P. Stocker
  • Published online by Cambridge University Press:
    19 August 2008, pp. 1-7

  • For many years, paediatric cardiologists and paediatric cardiac surgeons have felt the need for a common diagnostic and therapeutic coding system with which to classify patients of all ages with congenital and acquired heart disease. This desire has been highlighted by the recent, and ongoing, enquiry into the outcome of paediatric cardiac surgery at the unit in Bristol, in the United Kingdom, and the resulting obligation to provide national and international comparisons of surgical results between centres caring for these patients. In order to incorporate effective clinical governance and best practice into our speciality, a method is required to gather accurate and validated data on the diagnosis, therapy and outcome of patients with heart disease from prenatal life through to adulthood. This would facilitate comparisons between individual units which fully take into account the mix of cases involved, and thus attempt to focus on the relevant and genuine factors underlying the differing outcomes in terms of both mortality and morbidity. For this to be achieved, it is essential to have a comprehensive system of coding and classification, using mutually exclusive and unambivalent terms. The system must be both easy to use, and fulfil the needs and expectations of widely different cultures of practice. Although many centres have developed their own system of internal audit, with their own coding system, and some co-operation has taken place between centres nationally and across international boundaries within Europe by the European Congenital Heart Surgeons Federation (see below), a cohesive, and comprehensive system suitable for setting standards has yet to emerge. Historically, this has partly been due to the lack of recognition by governments of the importance of such a process, with underfunding of initiatives aimed at addressing these issues, both technologically and in terms of human resources.

From the Executive Editor

  • ‘Cardiology in the Young’ goes online

  • Edward J. Baker
  • Published online by Cambridge University Press:
    19 August 2008, pp. 177-178
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Other

From the Executive Editor

  • From the Executive Editor

  • Edward Baker
  • Published online by Cambridge University Press:
    19 August 2008, pp. 549-550
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From the Editor-in-Chief

  • Arrogance born of indifference?

  • Robert H. Anderson
  • Published online by Cambridge University Press:
    19 August 2008, pp. 297-298
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Other

Edgar Mannheimer Lecture

Meeting Report

From the Executive Editor

  • From the Executive Editor

  • Edward Baker
  • Published online by Cambridge University Press:
    19 August 2008, p. 433
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Other

Short List of Codes

From the Editor and Publisher

  • From the Editor and Publisher

  • Edward Baker
  • Published online by Cambridge University Press:
    19 August 2008, pp. 81-82
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  • From the Editor and Publisher

  • Robert H. Anderson
  • Published online by Cambridge University Press:
    19 August 2008, pp. 1-2
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Editorial Comment

  • Atrial structure in the presence of visceral heterotaxy

  • Robert H. Anderson
  • Published online by Cambridge University Press:
    19 August 2008, pp. 299-302
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From the Editor-in-Chief

  • The issue of retention of organs – an informed view from Bristol parents

  • Maria Shortis
  • Published online by Cambridge University Press:
    19 August 2008, pp. 434-437
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Original Articles

  • New insight into left ventricular function in tricuspid atresia after total cavopulmonary connection: a three-dimensional echocardiographic study

  • Philippe Acar, Zakhia Saliba, Daniel Sidi, Jean Kachaner
  • Published online by Cambridge University Press:
    19 August 2008, pp. 83-89
  • Background

    In patients with tricuspid atresia palliated by construction of a total cavopulmonary connection, both pulmonary and systemic circulations depend on the performance of the dominant left ventricle. When estimating the volume of such ventricles using cross-sectional echocardiography, it is necessary to make assumptions concerning the geometry of the ventricular shape. This is avoided by three-dimensional echocardiography, which provides direct volumetric data. Our purpose was to apply this new method to quantify left ventricular volumes and function in patients with tricuspid atresia after construction of a total cavopulmonary connection.

    Methods

    We studied ten patients (median age: 8 years) with tricuspid atresia who had undergone a total cavopulmonary connection, comparing them with 10 normal children matched for age, sex and size. The three-dimensional echocardiography was performed with electrocardio graphic and respiratory gating. A new transthoracic integrated probe designed for small children was used with a rotational scanning increment of 3°. The 60 slices obtained from the ventricular cavity were stored and formatted in a commercial system (TomTec®). End-diastolic and end-systolic volumes, stroke volume and ejection fraction were calculated after manual tracing of the endocardial surfaces. The volumes were indexed to the body surface area.

    Results

    As seen in the reconstructions, the dominant left ventricle in tricuspid atresia had a spherical shape, whereas the normal left ventricle is oblong. The left ventricular volumes and function in tricuspid atresia were 54±4 ml/m2 (end-diastolic volume), 28±3 ml/m2 (end-systolic volume), 26±7 ml/m2 (stroke volume) and 48±6% (ejection fraction). These volumes were not different from those obtained in the controls (p = NS). The left ventricular stroke volume and ejection fraction in 10 patients with tricuspid atresia were lower than those calculated for the controls (p < 0.05).

    Conclusions

    Three-dimensional echocardiography provides a quantitative insight into the pathophysiologic function of the dominant left ventricle in tricuspid atresia after construction of a total cavopulmonary connection.

Editorial Comments

  • Self-efficacy: understanding a psychological concept which can improve the quality of health care

  • Freda V. Gardner
  • Published online by Cambridge University Press:
    19 August 2008, pp. 557-559
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