DORV-Adequacy of distance between TV and PV for an intracardiac baffle vs. Rastelli

Figures from Aldo Castaneda's book.

Separation between TV and PV should at least the diameter of AoV. Otherwise, SubAS within the baffle will result either at surgery or later.

(DORV-"Normally-related" Great Arteries)

Procainamide

 Procainamide:

(Lexicomp, 21^st ed. 2014-2015)

 

SVT:

(May use for stable, monomorphic VT and pre-excited A fib).

Newborn:

IV-Loading dose 5-10 mg over 60 min.

Infusion: 20 – 80 mcg/kg/min.

(Lower dose for preterm and renal impairment).

Infants/Children/Adults:

Loading dose 10-2 mg/kg over 30-60 min.

Infusion: 20-80 mcg/kg/min.

 

Monitoring:

EKG (PR interval, QTc prolongations), BP, CBC/diff.

Drug level: 6-12 hrs. after starting infusion.

Therapeutic range:

Procainamide level 4-10 mcg/ml. (> 10-12 mcg/ml is toxic)

Proc + NAPA level = 10-30 mcg/ml.

Side effects:

- PR, QTc prolongation, Paradoxical increase in ventricular rate in Afib.

- Agranulocytosis

- ANA positive

- Others.

Flecainide Dose (Lexicomp, accessed on 3/4/2026)

Newborn:

Initial: 2 mg/kg/day in 2 divided doses.

Usual effective dose: 3.35 ± 1.3 mg/kg/day.

 

Children:

Initial: 1-3 mg/kg/day (or) 50 – 100 mg/m2/day in 3 divided doses.

Max: 8 mg/kg/day (or) 200 mg/m2/day.

Usual effective dose: 4 mg/kg/day (or) 140 mg/m2/day.

 

Adults:

Initial: 50 mg q12 or 100 mg qd.

Increase dose Q4 days, Max. 300 mg/day for SVT & 400 mg/day for VT.

Pill-in-pocket for A fib: 200 mg (< 70 kg) & 300 mg (> 70 kg). Patient should be on AV nodal blocking agent (Beta-blocker or Calcium-channel blocker) while on this plan. Inpatient trial should be done prior to discharge to check its efficacy.

 

Monitor: 

EKG, Serum trough level. LFT, CBC/diff.

Serum trough level – Check 3 days after starting or changing medication.

Therapeutic level: 0.2 – 1.0 mcg/ml.

In children, response is noted at 0.2 – 0.5 mcg/ml range.

Side effects:

- PR prolongation, QRS widening, paradoxical increase in ventricular rate in A fib.

- Leukopenia, thrombocytopenia

- LFT

- Paraesthesia, blurred vision

- Urticaria

Kawasaki Disease Management (2024 Guidelines)

(Click on the image to enlarge)

 

Bronchopulmonary dysplasia with Pulmonary Hypertension - Cardiac Catheterization

 

Pulmonary Hypertension Medications for Children

 

Pulmonary Hypertension Clinical Classification

 

Pulmonary Embolism - Systemic Thrombolysis - Adult

 

Pulmonary embolism in Children

(Click on the image to enlarge)

 

Atrial fibrillation - HRS guideline - Acute Rate Control

(Click on the image to enlarge)