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Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Associated with Right Coronary Giant Aneurysm. 与右冠状巨动脉瘤相关的左冠状动脉异常起源于肺动脉。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221135767
Martin Antelo, Diego Freire, Alvaro Dendi, Gabriel Parma, Nicolas Fernandez, Dante Picarelli

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation, usually diagnosed in the infant period due to myocardial ischemia and heart failure, with the need for emergency surgery. Less commonly, it can be asymptomatic until adulthood. Coronary artery aneurysms are also rare anatomical anomalies with symptoms of acute or chronic angina or even remain completely asymptomatic. We present an unusual case of ALCAPA, associated with a giant aneurysm of the right coronary artery. Meeting presentation: American Association for Thoracic Surgery 102nd annual meeting, Boston MA, USA, May 16, 2022.

左冠状动脉起源地异常(ALCAPA)是一种罕见的先天性畸形,通常在婴儿时期因心肌缺血和心力衰竭而诊断出来,需要紧急手术治疗。不太常见的是,它可以在成年前没有症状。冠状动脉瘤也是一种罕见的解剖异常,具有急性或慢性心绞痛的症状,甚至完全没有症状。我们提出一个不寻常的病例ALCAPA,与一个巨大的动脉瘤的右冠状动脉。会议介绍:美国胸外科协会第102届年会,美国马萨诸塞州波士顿,2022年5月16日。
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引用次数: 0
Impact of Tracheal Arborization and Lung Hypoplasia in Repair of Pulmonary Artery Sling in Combination With Long-Segment Tracheal Stenosis. 气管搭桥及肺发育不全对长段气管狭窄合并肺动脉悬吊修复的影响。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221145172
Siddartha C Rudrappa, Arun Beeman, Madhavan Ramaswamy, Sachin Khambadkone, Graham Derrick, Martin Kostolny, Alistair Calder, Nagarajan Muthialu
Background: Reimplantation of the left pulmonary artery (LPA) and slide tracheoplasty has been our standard approach of care for patients with pulmonary artery sling (PAS) and tracheal stenosis. We present our experience, with emphasis on tracheal arborization and hypoplastic lungs; and their impact on long-term outcome of children with PAS and tracheal stenosis. Methods: It is a retrospective comparative study. Data were classified and analyzed based on the type of tracheobronchial arborization and normal versus hypoplastic lungs. Results: Seventy-five children operated between January 1994 and December 2019 (67 with normal lungs and 8 with lung hypoplasia/agenesis) were included. Patients with hypoplastic lungs had higher rates of preoperative ventilation (87.5%), postoperative ventilation (10 vs 8 days, P = .621), and mortality (50% vs 9%, P = .009) compared with those with normal lungs. Nineteen patients had tracheal bronchus (TB) variety and 30 patients had congenital long-segment tracheal stenosis (CLSTS) variety of tracheobronchial arborization. Endoscopic intervention was needed in 47.4% of patients with TB type and 60% with CLSTS type. CLSTS patients had higher rates of preoperative ventilation (60% vs 47.4%, P = .386), longer periods of postoperative ventilation (13 vs 6.5 days, P = .006), and ICU stay (15 vs 11 days, P = .714) compared with TB type. Conclusion: Surgical repair of PAS with tracheal stenosis has good long-term outcomes. All variations of tracheal anatomy can be managed with slide tracheoplasty. Persistence of airway problems requires intervention during follow-up as tracheal stenosis continues to be the Achilles heel.
背景:左肺动脉(LPA)再植入术和气管滑梯成形术是我们治疗肺动脉悬吊(PAS)和气管狭窄患者的标准方法。我们介绍我们的经验,重点是气管树突和肺发育不全;以及它们对PAS和气管狭窄患儿长期预后的影响。方法:回顾性比较研究。数据分类和分析基于类型的气管支气管乔枝和正常与发育不良的肺。结果:纳入1994年1月至2019年12月手术的儿童75例(肺正常67例,肺发育不全8例)。肺发育不全患者术前通气率(87.5%)、术后通气率(10天vs 8天,P = 0.621)和死亡率(50% vs 9%, P = 0.009)均高于肺正常患者。气管支气管(TB)病变19例,先天性长段气管狭窄(CLSTS)病变30例。47.4%的TB型和60%的CLSTS型患者需要内镜干预。与TB型相比,CLSTS患者术前通气率更高(60% vs 47.4%, P = .386),术后通气时间更长(13 vs 6.5天,P = .006), ICU住院时间更长(15 vs 11天,P = .714)。结论:手术修复PAS合并气管狭窄具有良好的远期疗效。气管解剖的所有变化都可以用气管滑梯成形术来处理。气道问题的持续存在需要在随访期间进行干预,因为气管狭窄仍然是阿喀琉斯之踵。
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引用次数: 1
A Single-Institutional Experience with 36 Children Smaller Than 5 Kilograms Supported with the Berlin Heart Ventricular Assist Device (VAD) over 12 Years: Comparison of Patients with Biventricular versus Functionally Univentricular Circulation. 36名体重小于5公斤的儿童12年以上使用柏林心脏辅助装置(VAD)的单一机构经验:双室与功能单室循环患者的比较
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221146150
Mark S Bleiweis, Joseph Philip, Giles J Peek, Yuriy Stukov, Gregory M Janelle, Andrew D Pitkin, Kevin J Sullivan, Connie S Nixon, Omar M Sharaf, Dan Neal, Jeffrey P Jacobs

Objectives: We reviewed outcomes in all 36 consecutive children <5 kg supported with the Berlin Heart pulsatile ventricular assist device (VAD) at the University of Florida, comparing those with univentricular circulation (n  =  23) to those with biventricular circulation (n  =  13).

Methods: The primary outcome was mortality. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival after VAD insertion. T-tests using estimated survival proportions and standard errors were used to compare groups at specific time points.

Results: Of all 82 patients ever supported with Berlin Heart at our institution, 49 (49/82  =  59.76%) weighed <10 kg and 36 (36/82  =  43.90%) weighed <5 kg. Of these 36 patients who weighed <5 kg, 26 (26/36  =  72.22%) were successfully bridged to transplantation. Of these 36 patients who weighed <5 kg, 13 (13/36  =  36.1%) had biventricular circulation and were supported with 12 biventricular assist devices (BiVADs) and 1 left ventricular assist device (LVAD) (Age [days]: median  =  67, range  =  17-212; Weight [kilograms]: median  =  4.1, range  =  3.1-4.9), while 23 (23/36  =  63.9%) had univentricular circulation and were supported with 23 single ventricle-ventricular assist devices (sVADs) (Age [days]: median  =  25, range  =  4-215; Weight [kilograms]: median  =  3.4, range  =  2.4-4.9). Of 13 biventricular patients who weighed <5 kg, 12 (12/23  =  92.3%) were successfully bridged to cardiac transplantation. Of 23 functionally univentricular patients who weighed <5 kg, 14 (14/23  =  60.87%) were successfully bridged to cardiac transplantation. For all 36 patients who weighed <5 kg: 1-year survival estimate after VAD insertion  =  62.7% (95% confidence interval [CI]  =  48.5%-81.2%) and 5-year survival estimate after VAD insertion  =  58.5% (95% CI  =  43.8%-78.3%). One-year survival after VAD insertion: 84.6% (95% CI  =  67.1%-99.9%) in biventricular patients and 49.7% (95% CI  =  32.3%-76.4%) in univentricular patients, P  =  0.018. Three-year survival after VAD insertion: 84.6% (95% CI  =  67.1%-99.9%) in biventricular patients and 41.4% (95% CI  =  23.6%-72.5%) in univentricular patients, P  =  0.005.

Conclusion: Pulsatile VAD facilitates bridge to transplantation in neonates and infants weighing <5 kg; however, survival after VAD insertion in these small patients is less in those with univentricular circulation in comparison to those with biventricular circulation.

目的:我们回顾了所有36个连续儿童的结局方法:主要结局是死亡率。Kaplan-Meier方法和log-rank检验用于评估VAD植入后各组长期生存的差异。使用估计生存比例和标准误差的t检验在特定时间点比较各组。结果:在我院接受过柏林心脏治疗的82例患者中,49例(49/82 = 59.76%)体重P = 0.018。插入VAD后的三年生存率:双室患者为84.6% (95% CI = 67.1% ~ 99.9%),单室患者为41.4% (95% CI = 23.6% ~ 72.5%), P = 0.005。结论:搏动性VAD有助于新生儿和体重婴儿移植的桥接
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引用次数: 0
Regionalization or Access to Care? A Joint Pediatric Heart Care Program That Achieves Both: One Program-Two Sites. 区域化还是获得医疗服务?一个联合儿科心脏护理项目,实现两个:一个项目,两个地点。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221149420
David A Katz, Shaun Mohan, Matthew Bacon, Eimear McGovern, W Jack Wallen, Geneva M Preston, Douglas Schneider, Louis Bezold, Scottie Day, Andrew N Redington, James Quintessenza, Carl L Backer

Background: Regionalization of care for children with congenital heart disease has been proposed as a method to improve outcomes. This has raised concerns about limiting access to care. We present the details of a joint pediatric heart care program (JPHCP) which utilized regionalization and actually improved access to care. Methods: In 2017, Kentucky Children's Hospital (KCH) launched the JPHCP with Cincinnati Children's Hospital Medical Center (CCHMC). This unique satellite model was the product of several years of planning, leading to a comprehensive strategy with shared personnel, conferences, and a robust transfer system; "one program-two sites." Results: Between March 2017 and the end of June 2022, 355 operations were performed at KCH under the auspices of the JPHCP. As of the most recent published Society of Thoracic Surgeons (STS) outcome report (through the end of June 2021), for all STAT categories, the JPHCP at KCH outperformed the STS overall in postoperative length of stay, and the mortality rate was lower than expected for the case mix. Of the 355 operations, there were 131 STAT 1, 148 STAT 2, 40 STAT 3, and 36 STAT 4 operations, with two operative mortalities: an adult undergoing surgery for Ebstein anomaly, and a premature infant who died from severe lung disease many months after aortopexy. Conclusions: With a select case mix, and by affiliating with a large volume congenital heart center, the creation of the JPHCP at KCH was able to achieve excellent congenital heart surgery results. Importantly, access to care was improved for those children at the more remote location utilizing this one program-two sites model.

背景:先天性心脏病患儿的区域化护理已被提出作为改善预后的一种方法。这引起了人们对限制获得医疗服务的担忧。我们提出了一项联合儿科心脏护理计划(JPHCP)的细节,该计划利用区域化并实际改善了获得护理的机会。方法:2017年,肯塔基儿童医院(KCH)与辛辛那提儿童医院医学中心(CCHMC)共同启动了JPHCP。这种独特的卫星模式是几年规划的产物,形成了一种全面的战略,包括共享人员、会议和健全的转移系统;“一个项目,两个地点。”结果:2017年3月至2022年6月底,在JPHCP主持下,在KCH进行了355例手术。根据最新发表的胸外科学会(STS)结果报告(截至2021年6月底),对于所有STAT类别,KCH的JPHCP在术后住院时间方面总体优于STS,并且病例组合的死亡率低于预期。在355例手术中,有131例为STAT 1, 148例为STAT 2, 40例为STAT 3, 36例为STAT 4,有2例手术死亡:一名成人因Ebstein异常手术,一名早产儿在主动脉切除术后数月死于严重肺部疾病。结论:通过选择病例组合,并与大容量先天性心脏中心合作,在KCH建立JPHCP能够取得良好的先天性心脏手术效果。重要的是,利用这一方案-两个地点模式,改善了偏远地区儿童获得护理的机会。
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引用次数: 1
Norwood Aneurysm: Report of a Rare Phenomenon. 诺伍德动脉瘤:一罕见现象报告。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221137288
Othman A Aljohani, Ahmad Hasan, Francesca Byrne, John Lamberti, Raghav Murthy

An 18-year-old male with complex single-ventricle physiology status post-3-stage palliation developed a large Norwood aneurysm (77 × 67 mm). The patient underwent a successful surgical reconstruction. Care providers must be aware of this rare complication and provide appropriate surveillance.

患者为18岁男性,单脑室生理状况复杂,经3期姑息治疗后发现巨大的诺伍德动脉瘤(77 × 67 mm)。病人接受了成功的手术重建。护理人员必须意识到这种罕见的并发症,并提供适当的监测。
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引用次数: 0
Performance of CardioCel in Cardiac Surgery: A Systematic Review. 心脏细胞在心脏外科中的应用:系统综述。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221149416
Aditya A Patukale, Jessica Suna, Abhishek Anand, Kim S Betts, Tom R Karl, Prem Venugopal, Supreet P Marathe, Nelson Alphonso

A systematic review was performed for evaluation of the performance of CardioCel® in cardiac surgery. The review included all studies published from January 2013 to December 2020. We conclude that CardioCel is a strong, flexible tissue substitute with good handling characteristics and a low incidence of thrombosis, aneurysm formation, infection, or structural degeneration. It can be used for a variety of intracardiac and extracardiac repairs of congenital heart defects in all age groups with good durability at mid-term follow-up. However, the use of CardioCel in certain positions requires caution. Information on the long-term performance of CardioCel is lacking.

对CardioCel®在心脏外科手术中的表现进行了系统评价。该综述包括2013年1月至2020年12月发表的所有研究。我们的结论是,CardioCel是一种坚固、灵活的组织替代品,具有良好的处理特性,血栓形成、动脉瘤形成、感染或结构变性的发生率低。在中期随访中,可用于各种年龄段先天性心脏缺损的心内、心外修复,具有良好的耐久性。然而,在某些位置使用CardioCel需要谨慎。关于CardioCel的长期性能的信息是缺乏的。
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引用次数: 1
Invited Commentary: Norwood Procedure Using Regional Cerebral Perfusion at Normothermia: Are We There Yet? 特邀评论:诺伍德手术在正常体温下使用局部脑灌注:我们还在那里吗?
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351231155811
Christian Pizarro
Over the last few decades, significant advances in the field of congenital heart surgery have allowed the successful management of most forms of congenital heart disease even in the smallest patients. The two most significant challenges are the protection of the brain and the myocardium. Interventions on the aortic arch require a perturbation of the cerebral blood flow that, therefore, requires a specific protective strategy. Since the initial report by Bigelow, it was recognized that deep hypothermic circulatory arrest (DHCA) permitted a precise repair and was associated with improved surgical outcomes. This was largely due to the advantage of a “quiet and bloodless operative field” as well as organ protection from ischemia due to a significant reduction of oxygen consumption. Nevertheless, extended periods of DHCA have been associated with neurologic injury leading to adverse neurodevelopmental (ND) outcomes. The search for an optimal strategy led to the Boston Circulatory Arrest Study, which based on a subanalysis of a small subgroup of patients created the perception that low-flow hypothermic bypass was a superior strategy, when in fact the message was that each strategy had its own ND imprint. Based on this notion, when it comes to the reconstruction of the aortic arch, regional cerebral perfusion (RCP) has been widely embraced as a “superior” strategy, because it minimizes the exposure to DHCA. Nevertheless, several studies, including a large prospective randomized trial, have failed to provide such evidence.4–6 Moreover, despite the intuitive notion that antegrade or RCP is protective, Gunn and colleagues reported a 33% incidence of perioperative seizures in a cohort of patients undergoing arch reconstruction while utilizing RCP between 18 °C and 25 °C. Seizures were commonly leftsided and usually present during the period of antegrade cerebral perfusion. In addition, the reduction in left-hemispheric cerebral oxygenation reported by near-infrared spectroscopy during RCP brings into question the safety and effectiveness of this approach in its current form to ameliorate the morbidity associated with DHCA exposure. Keizman and colleagues describe their experience with patients with hypoplastic left heart syndrome comparing a strategy of arch reconstruction with antegrade cerebral perfusion at normothermia (>34 °C) versus hypothermia (<34 °C). This work is courageous and potentially promising. However, it lacks the necessary assurances that normothermic RCP is not detrimental to ND outcomes. The retrospective nature of the study and the lack of universal ND evaluation preand postintervention are serious limitations of this study. As demonstrated by the recent survey of preferences and attitudes toward perfusion techniques during neonatal arch reconstruction, there is a paucity of robust and conclusive data to inform this decision. The choice of DHCA, antegrade or RCP, or DHCA with intermittent perfusion remains largely based on personal expe
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引用次数: 0
Impact of Genetic Disorders in the Surgical Management of Congenital Heart Disease. 遗传性疾病对先天性心脏病手术治疗的影响。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221139837
Elizabeth H Stephens, Joseph A Dearani, Heidi M Connolly, Stephen J Gleich, David R Deyle, Jonathan N Johnson

The congenital heart surgeon frequently encounters patients with various genetic disorders requiring surgical intervention. Although the specifics of the genetics for these patients and their families lie in the purview of specialists in genetics, the surgeon is well-served to be familiar with aspects of specific syndromes that impact surgical management and perioperative care. This aids in counseling families in expectations for the hospital course and recovery as well as can impact intraoperative and surgical management. This review article summarizes key characteristics for the congenital heart surgeon to be familiar with for common genetic disorders as they help coordinate care.

先天性心脏外科医生经常遇到需要手术干预的各种遗传疾病患者。虽然这些患者及其家庭的遗传学细节属于遗传学专家的范围,但外科医生应该熟悉影响手术管理和围手术期护理的特定综合征的各个方面。这有助于咨询家庭对住院过程和康复的期望,以及可以影响术中和手术管理。这篇综述文章总结了先天性心脏外科医生熟悉的常见遗传疾病的关键特征,因为它们有助于协调护理。
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引用次数: 0
A Multidisciplinary Surgical Approach to Mediastinal Masses in Children. 儿童纵隔肿块的多学科手术方法。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 Epub Date: 2023-02-19 DOI: 10.1177/21501351221133753
Vanessa M Miller, Mitchell Disharoon, Luz A Padilla, Elizabeth A Beierle, Robert J Dabal

The aim of this study is to demonstrate the safety and advantages of a multidisciplinary approach to surgical resection of mediastinal masses in children. Eight patients underwent resection of a mediastinal mass by a team involving both a pediatric general surgeon and pediatric cardiothoracic surgeon. One patient required rapid initiation of cardiopulmonary bypass to complete the tumor resection and repair an aortic injury that occurred when removing adherent tumor from the structure. Perioperative outcomes were excellent for all patients. This series shows that a multidisciplinary surgical approach can be potentially life saving.

本研究的目的是证明采用多学科方法对儿童纵隔肿块进行手术切除的安全性和优势。八名患者接受了由小儿普外科医生和小儿心胸外科医生组成的团队进行的纵隔肿块切除术。其中一名患者需要快速启动心肺旁路术,以完成肿瘤切除,并修复在切除粘连肿瘤时造成的主动脉损伤。所有患者的围手术期效果都非常好。该系列手术表明,多学科手术方法有可能挽救患者的生命。
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引用次数: 0
Biventricular Repair for Aortic Atresia, Ventricular Septal Defect, and Type C Interrupted Aortic Arch. 主动脉闭锁、室间隔缺损和C型主动脉弓中断的双室修复。
IF 0.9 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1177/21501351221145162
Yi-Chia Wang, Heng-Wen Chou, Yih-Sharng Chen, Shu-Chien Huang

Interrupted aortic arch is a rare congenital heart defect. Among patients with interrupted aortic arch, an interruption between the innominate artery and left common carotid artery (type C) is the rarest. Herein, we report the case of a neonate with aortic atresia, ventricular septal defect, type C interrupted aortic arch, and aberrant right subclavian artery who underwent Norwood stage I operation and staged biventricular repair. Due to aortic atresia, coronary artery perfusion was retrograde from the right common carotid artery. The surgical technique and special considerations for cardiopulmonary bypass are presented.

主动脉弓中断是一种罕见的先天性心脏缺陷。在主动脉弓中断的患者中,无名动脉和左颈总动脉(C型)之间的中断是最罕见的。在此,我们报告一例新生儿主动脉闭锁,室间隔缺损,C型主动脉弓中断,右锁骨下动脉异常,接受诺伍德I期手术和分阶段双心室修复。由于主动脉闭锁,冠状动脉灌注从右颈总动脉逆行。本文介绍了体外循环的手术技术和特殊注意事项。
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引用次数: 0
期刊
World Journal for Pediatric and Congenital Heart Surgery
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