Pre-explant LDH concentrations significantly correlated with findings on manufacture-performed pump analysis. These data validate LDH surveillance as an important clinical tool for identification of pump thrombus.

IntroductionWe hypothesized that patients with complex regional pain syndrome (CRPS) would describe a more negative pain phenotype including higher pain severity, more neuropathic pain descriptors, more centralized pain symptoms, poorer physical function, and more affective distress when compared with patients with neuropathic pain of the extremities not meeting CRPS criteria.Materials and methodsThis was a retrospective cross-sectional study conducted at a tertiary pain center. The sample included 212 patients who met Budapest Criteria for CRPS and 175 patients with neuropathic pain of the extremities who did not meet criteria. All patients completed a packet of questionnaires before their initial visit containing validated outcome measures assessing pain severity, pain interference, physical functioning, depression, anxiety, and catastrophizing.ResultsPatients with CRPS reported higher physical disability (p=0.022) and more neuropathic pain symptoms (p=0.002) than patients not meeting CRPS criteria, but the groups did not otherwise differ significantly. There were no significant differences in pain severity or affective distress, despite power analyses suggesting the ability to detect small to medium effect sizes (d=0.29; w=0.14). Subanalyses of differences in neuropathic pain symptoms revealed that patients with CRPS, compared with patients not meeting CRPS criteria, were more likely to report pain with light touch (p=0.003), sudden pain attacks (p=0.003), pain with cold or heat (p=0.002), sensation of numbness (p=0.042), and pain with slight pressure (p=0.018).DiscussionCounter to our hypothesis, the present study suggests that patients with CRPS do not have a worse clinical phenotype compared with patients not meeting CRPS criteria, with the exception of higher physical disability and more neuropathic pain symptoms. This corresponds to recent evidence that patients with CRPS are similar to other patient populations with chronic pain.

Background Intra-atrial reentry tachycardia (IART) following the Fontan operation had an early reported incidence of 10–35% during early and intermediate follow-up and posed substantial management challenges. Methods and Results To reduce the incidence of IART following the Fontan procedure, we performed a randomized, double blind study to evaluate the impact of an incision in the right atrium joining the lateral tunnel suture line and the tricuspid valve annulus. Between March 1998 and September 2003, 134 subjects (median age 1.8 years; range 1.3–5.2 years; 91 males) were randomly assigned to receive the incision. All 134 patients had a form of single ventricle pathologic anatomy. The clinical course, electrocardiograms and Holters were available for review in 114 subjects at a median 8.2 yrs (range 0.9–11.9 yrs) follow-up. There were 2 late deaths, neither subject had IART. The combined incidence of sustained IART was 3.5% (4/114). There was no difference in the occurrence of sustained IART between those subjects receiving the incision and those who did not (2 in each group) during follow-up. No patients of either group experienced short-term complications Conclusions Despite the fact that the primary outcome of this trial was not reached, the most significant finding was that with current management, the incidence of IART is considerably lower than the early retrospective, observational studies suggested.