A C Chang

Publications (11)17.71 Total impact

• Article: Captopril-Induced Pulmonary Infiltrates with Eosinophilia in an Infant with Congenital Heart Disease

  T.C. Slesnick, A.R. Mott, C.D. Fraser, A.C. Chang
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  ABSTRACT: We report a case of an infant with complex congenital heart disease who was placed on captopril for afterload reduction following cardiac surgery and subsequently developed pulmonary infiltrates with eosinophilia. The patient was readmitted with symptoms of rhinorrhea, poor feeding, and decreased activity level. She was found to have diffuse pulmonary infiltrates on chest radiograph and a marked peripheral eosinophilia without leukocytosis. After discontinuing captopril and starting systemic steroids, her symptomatology rapidly improved, and her eosinophilia and radiographic abnormalities both resolved.
  Pediatric Cardiology 04/2012; 26(5):690-693. · 1.30 Impact Factor
• Source

  Available from: rileyanesthesia.org

  Article: Mesenteric oxyhemoglobin desaturation improves with patent ductus arteriosus ligation.

  S D Meier, B K Eble, G E Stapleton, D L Morales, A C Chang, D B Andropoulos
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  ABSTRACT: Near-infrared spectroscopy was used to monitor cerebral and mesenteric regional oximetry in a preterm neonate undergoing surgical ligation of a patent ductus arteriosus. This patient initially demonstrated severe mesenteric oxyhemoglobin desaturation, which improved immediately following ductal ligation.
  Journal of Perinatology 10/2006; 26(9):562-4. · 1.80 Impact Factor
• Article: A Prospective Evaluation of Nesiritide in the Treatment of Pediatric Heart Failure

  J.L. Jefferies, S.W. Denfield, J.F. Price, W.J. Dreyer, C.J. McMahon, M.A. Grenier, J.J. Kim, V.V. Dimas, S.K. Clunie, B.S. Moffett, A.C. Chang, T.I. Wann, E.O. Smith, J.A. Towbin
  [show abstract] [hide abstract]
  ABSTRACT: This study sought to determine the potential of recombinant B-type natriuretic peptide (nesiritide) for the treatment of pediatric decompensated heart failure. Nesiritide is a widely used and effective treatment for decompensated heart failure (HF) in adults, but its safety and efficacy in pediatric patients is unclear. Outcomes of 55 separate nesiritide infusions of varying durations in 32 patients (13 males and 19 females; mean age, 8.01 years; range, 0.01–20.4) were evaluated prospectively. All patients received nesiritide in the intensive care unit. The starting dose (0.01μg/kg/min) was titrated to a maximum of 0.03μg/kg/min. All patients were monitored for clinical signs and symptoms, hemodynamics, urine output, electrolytes, oxygen requirements, and oral intake. Functional status was assessed by patients and/or their parents. All patients successfully underwent initiation and titration of nesiritide infusion. No hypotension or arrhythmias were noted during 478 cumulative days of therapy. Nesiritide was given safely with vasoactive medications. Mean urine output improved from 2.35 ± 1.71 cc/kg/hr on the day before nesiritide initiation (baseline) to 3.10 ± 1.94 cc/kg/hr on day 4 of treatment (p < 0.01). Serum creatinine decreased from 1.04 to 0.92 mg/dl (p = 0.096), mean central venous pressure from 13 to 7 mmHg (p = 0.018), and mean weight from 30.4 to 29.7 kg (p < 0.001) with therapy. Thirst, as subjectively assessed by patients old enough to respond, decreased with infusion in 31 of 42 cases (74%). Mean New York Heart Association functional class improved significantly (p < 0.001). Nesiritide infusion, alone or in combination, is a safe treatment for decompensated HF in pediatric patients. It is associated with decreased thirst and improved urine output and functional status, and it may be efficacious in the treatment of pediatric HF.
  Pediatric Cardiology 07/2006; 27(4):402-407. · 1.30 Impact Factor
• Article: Neonate With Vein of Galen Malformation and Heart Failure: Serial Changes in Plasma B-Type Natriuretic Peptide Following Endovascular Embolization

  L.H. Tan, B.A. Johnson, M.E. Mawad, A.C. Chang
  [show abstract] [hide abstract]
  ABSTRACT: We report a neonate with vein of Galen malformation (VGM) who developed congestive heart failure (CHF) early after birth. Serial changes in plasma B-type natriuretic peptide (BNP) following an endovascular embolization procedure for VGM were mirrored in his clinical CHF status. The plasma BNP level markedly increased to 1800 pg/ml (normal, <100 pg/ml) in accordance with the severity of CHF. It rapidly decreased to 356 pg/ml during the first week after endovascular embolization for VGM. In the following 3 weeks there was an unexpected upward trend in plasma BNP despite echocardiography revealing normal biventricular function. After additional evaluation and treatment for CHF, BNP decreased again and the patient’s clinical status concurrently improved. The patient was discharged with a normal BNP level. Monitoring serial plasma BNP provides valuable information regarding the need for additional evaluation or treatment of newborns with CHF and may be used to document improvement.
  Pediatric Cardiology 03/2006; 27(2):276-278. · 1.30 Impact Factor
• Article: Left Ventricular Noncompaction Cardiomyopathy in Association with Trisomy 13

  C.J. McMahon, A.C. Chang, R.H. Pignatelli, W.C. Miller-Hance, B.K. Eble, J.A. Towbin, S.W. Denfield
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  ABSTRACT: In recent years, left ventricular noncompaction (LVNC) has been recognized as a distinct form of cardiomyopathy with its own clinical presentation and natural history. More than 100 cases of LVNC have been described in children. Although LVNC has been described in association with metabolic disorders such as Fabry's disease or genetic disorders such as Roifman's syndrome, this case represents the first report of LVNC in a child with trisomy 13.
  Pediatric Cardiology 07/2005; 26(4):477-479. · 1.30 Impact Factor
• Article: Altered dystrophin expression in the right atrium of a patient after Fontan procedure with atrial flutter.

  C J McMahon, M Vatta, C D Fraser, J A Towbin, A C Chang
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  ABSTRACT: Underlying mechanisms in the development of atrial flutter or intra-atrial re-entry tachycardia in patients with structural cardiac abnormalities remain poorly defined. The right atrial myocardium from two patients with congenital heart disease was evaluated, of whom one presented with severe right atrial dilation and arrhythmia and the other with a normal right atrium, to assess whether increased right atrial pressure and volume overload give rise to sarcolemmal alteration. N-terminus dystrophin staining in the atrium from the patient who had undergone a Fontan procedure showed a normally distributed but significantly reduced staining signal compared with the second patient. This is the first report that patients with severe right atrial dilation and atrial flutter have marked reduction in atrial dystrophin expression.
  Heart (British Cardiac Society) 01/2005; 90(12):e65. · 4.22 Impact Factor
• Article: Captopril-induced pulmonary infiltrates with eosinophilia in an infant with congenital heart disease.

  T C Slesnick, A R Mott, C D Fraser, A C Chang
  [show abstract] [hide abstract]
  ABSTRACT: We report a case of an infant with complex congenital heart disease who was placed on captopril for afterload reduction following cardiac surgery and subsequently developed pulmonary infiltrates with eosinophilia. The patient was readmitted with symptoms of rhinorrhea, poor feeding, and decreased activity level. She was found to have diffuse pulmonary infiltrates on chest radiograph and a marked peripheral eosinophilia without leukocytosis. After discontinuing captopril and starting systemic steroids, her symptomatology rapidly improved, and her eosinophilia and radiographic abnormalities both resolved.
  Pediatric Cardiology 26(5):690-3. · 1.30 Impact Factor
• Article: Left ventricular noncompaction cardiomyopathy in association with trisomy 13.

  C J McMahon, A C Chang, R H Pignatelli, W C Miller-Hance, B K Eble, J A Towbin, S W Denfield
  [show abstract] [hide abstract]
  ABSTRACT: In recent years, left ventricular noncompaction (LVNC) has been recognized as a distinct form of cardiomyopathy with its own clinical presentation and natural history. More than 100 cases of LVNC have been described in children. Although LVNC has been described in association with metabolic disorders such as Fabry's disease or genetic disorders such as Roifman's syndrome, this case represents the first report of LVNC in a child with trisomy 13.
  Pediatric Cardiology 26(4):477-9. · 1.30 Impact Factor
• Article: Vasodilatory shock after surgery for aortic valve endocarditis: use of low-dose vasopressin.

  E Lechner, H A Dickerson, C D Fraser, A C Chang
  [show abstract] [hide abstract]
  ABSTRACT: This is the case report of a 13-year-old male who developed vasopressor-resistant hypotension after cardiac surgery for endocarditis. As norepinephrine resulted in aggravation of the preexisting ventricular arrhythmia, vasopressin was used to maintain blood pressure. The vasopressin continuous infusion was started at 0.00002 units/kg/min and titrated up to 0.0003 U/kg/min. This low dose led to resolution of hypotension without causing side effects. As the appropriate indication and dose of vasopressin is not established, the cautious use of vasopressin in children is recommended.
  Pediatric Cardiology 25(5):558-61. · 1.30 Impact Factor
• Article: A prospective evaluation of nesiritide in the treatment of pediatric heart failure.

  J L Jefferies, S W Denfield, J F Price, W J Dreyer, C J McMahon, M A Grenier, J J Kim, V V Dimas, S K Clunie, B S Moffett, A C Chang, T I Wann, E O Smith, J A Towbin
  [show abstract] [hide abstract]
  ABSTRACT: This study sought to determine the potential of recombinant B-type natriuretic peptide (nesiritide) for the treatment of pediatric decompensated heart failure. Nesiritide is a widely used and effective treatment for decompensated heart failure (HF) in adults, but its safety and efficacy in pediatric patients is unclear. Outcomes of 55 separate nesiritide infusions of varying durations in 32 patients (13 males and 19 females; mean age, 8.01 years; range, 0.01-20.4) were evaluated prospectively. All patients received nesiritide in the intensive care unit. The starting dose (0.01 microg/kg/min) was titrated to a maximum of 0.03 microg/kg/min. All patients were monitored for clinical signs and symptoms, hemodynamics, urine output, electrolytes, oxygen requirements, and oral intake. Functional status was assessed by patients and/or their parents. All patients successfully underwent initiation and titration of nesiritide infusion. No hypotension or arrhythmias were noted during 478 cumulative days of therapy. Nesiritide was given safely with vasoactive medications. Mean urine output improved from 2.35 +/- 1.71 cc/kg/hr on the day before nesiritide initiation (baseline) to 3.10 +/- 1.94 cc/kg/hr on day 4 of treatment (p < 0.01). Serum creatinine decreased from 1.04 to 0.92 mg/dl (p = 0.096), mean central venous pressure from 13 to 7 mmHg (p = 0.018), and mean weight from 30.4 to 29.7 kg (p < 0.001) with therapy. Thirst, as subjectively assessed by patients old enough to respond, decreased with infusion in 31 of 42 cases (74%). Mean New York Heart Association functional class improved significantly (p < 0.001). Nesiritide infusion, alone or in combination, is a safe treatment for decompensated HF in pediatric patients. It is associated with decreased thirst and improved urine output and functional status, and it may be efficacious in the treatment of pediatric HF.
  Pediatric Cardiology 27(4):402-7. · 1.30 Impact Factor
• Article: Neonate with vein of Galen malformation and heart failure: serial changes in plasma B-type natriuretic peptide following endovascular embolization.

  L H Tan, B A Johnson, M E Mawad, A C Chang
  [show abstract] [hide abstract]
  ABSTRACT: We report a neonate with vein of Galen malformation (VGM) who developed congestive heart failure (CHF) early after birth. Serial changes in plasma B-type natriuretic peptide (BNP) following an endovascular embolization procedure for VGM were mirrored in his clinical CHF status. The plasma BNP level markedly increased to 1800 pg/ml (normal, <100 pg/ml) in accordance with the severity of CHF. It rapidly decreased to 356 pg/ml during the first week after endovascular embolization for VGM. In the following 3 weeks there was an unexpected upward trend in plasma BNP despite echocardiography revealing normal biventricular function. After additional evaluation and treatment for CHF, BNP decreased again and the patient's clinical status concurrently improved. The patient was discharged with a normal BNP level. Monitoring serial plasma BNP provides valuable information regarding the need for additional evaluation or treatment of newborns with CHF and may be used to document improvement.
  Pediatric Cardiology 27(2):276-8. · 1.30 Impact Factor