Right ventricular failure after placement of left ventricular assist device in paediatric heart failure is associated with increased mortality. We report successful use of intravenous prostacyclin for right ventricular support and pulmonary hypertension after initiation of left ventricular assist device support. This suggests that intravenous prostacyclins may be an important therapy in right ventricular failure following ventricular assist device implantation.

Left ventricular assist device implantation is an important therapeutic option for children with end-stage heart failure. However, device-related complications such as infection may occur while the patient is supported. Device-associated infection can be life-threatening, and early detection is critical. F-fluorodeoxyglucose positron emission tomography and CT is a highly sensitive imaging modality for the detection of an inflammatory response and is useful to evaluate the response to antibiotic therapy. We present two case reports of a left ventricular assist device-associated infection detected by F-fluorodeoxyglucose positron emission tomography and CT in children.

Ventricular assist devices (VADs) are an Advanced Life Support for patients with heart failure. These patients are particularly vulnerable in the event of a disaster. A hazard vulnerability analysis (HVA) was conducted to determine areas of susceptibility for these patients. Lack of electrical power, limited access to medications and anticoagulation, dehydration, extreme temperature and weather environments, conditions which predispose to infection, and evacuation transport are all identified circumstances that place these patients at an increased risk for harm and death. Future preparations in disaster planning are needed to address and mitigate these risks.

DavisKJ, O’SheaG, BeachM. Assessment of Risks Posed to VAD Patients During Disasters. Prehosp Disaster Med. 2017;32(4):457–461.

Although nesiritide has been used in adults with left heart failure, the experience in the paediatric population is limited. We reviewed and analysed our experience with continuous nesiritide infusion as adjunct therapy in children with biventricular dysfunction due to diverse aetiologies and suffering from oliguria despite intravenous diuretics and inotropic therapies for heart-failure management.