World journal for pediatric & congenital heart surgery最新文献

The use of prostaglandin infusion to maintain patency of the ductus arteriosus in patients with critical coarctation of the aorta (CoA) to support systemic circulation is the standard of care. However, pulmonary overcirculation resulting from a patent ductus arteriosus in patients with critical CoA is not well described in the literature. We report two cases of critical CoA that required invasive measures to control pulmonary blood flow before surgical repair of the CoA. Both patients had signs of decreased oxygen delivery, hyperlactatemia, and systemic to pulmonary flow via the ductus arteriosus. One patient required surgical pulmonary artery banding and the second patient underwent pulmonary flow restrictor device placement for the control of pulmonary blood flow. A rapid improvement in oxygen delivery and normalization of lactate levels were observed after control of pulmonary overcirculation. Both patients underwent successful surgical repair of the coarctation A and were discharged home.

In this case report, we describe a 16-year-old patient who developed ostial atresia of the left main coronary artery after a coronary unroofing procedure for anomalous aortic origin of the left coronary artery from the right coronary sinus. This was successfully addressed with a coronary patch ostioplasty.

The retroaortic innominate vein variant usually courses asymptomatically. However, when associated with coarctation of the aorta and hypoplastic aortic arch, modifications in the surgical technique to correct the aorta should be done to avoid compression of the vein. The ascending sliding arch aortoplasty, which allows the vein to be brought anterior to the aorta, can be a good alternative, as shown in these two cases.

Background: There are very few published outcomes for the use of extended criteria donor (ECD) organs in adult congenital heart disease (ACHD) patients undergoing cardiac transplantation. We investigated outcomes with the use of ECD organs in this population. We hypothesized that ECD organs may be safely used in this population in patients who are younger and carry less vascular and renal disease than the general cardiac transplant population. Methods: United Network of Organ Sharing data from all ACHD heart transplant recipients between October 18, 2018, and September 30, 2023, was analyzed. Patients were grouped by ECD transplantation. The primary outcome of interest was one-year survival. Secondary outcomes included length of stay, posttransplant stroke, retransplantation, kidney transplantation, dialysis, pacemaker implantation, and rejection. Results: Extended criteria donor organs were utilized in 39.1% (200/512) of ACHD heart transplantation cases. There was marked regional variation in the use of ECD organs. Extended criteria donor criteria in this population were solely met by ischemic time ≥4 h in 89.5% (179/200) of cases. Transplantation with ECD donors was associated with lower survival (one-year survival 82.76% vs 90.62%). A multivariate Cox regression analysis suggested a hazard ratio of 1.96 with the use of these organs. Conclusion: Compared with organs accepted under traditional donor criteria, ECD organs appear to compromise short- and long-term survival in ACHD transplant candidates.

The combination of congenitally corrected transposition of the great arteries (ccTGA), Ebstein anomaly of the systemic atrioventricular valve, and critical systemic ventricular outflow tract obstruction is extremely rare. Management of a neonate with these lesions in cardiogenic shock is quite challenging. Tricuspid valve exclusion has been increasingly and successfully used to manage neonatal Ebstein anomaly patients. We extended this idea of tricuspid valve exclusion (modified Starnes) combined with a Norwood Stage 1 operation with a modified systemic to pulmonary artery shunt to successfully manage a neonate with ccTGA, severe systemic atrioventricular valve regurgitation, and critical ventricular outflow tract obstruction.

Left atrial (LA) myxomas are benign neoplasms that are rare in children. Their presentation is dependent on size and location. We describe a seven-year-old girl who was admitted with chest pain, upper respiratory symptoms, and persistent troponin elevation with suspected myocarditis. Workup revealed an infarction from a LA myxoma which embolized to her right coronary artery-posterior lateral branch (PLB). She underwent prompt successful surgical excision of the myxoma. We elected not to perform a coronary artery embolectomy and her infarction was managed medically. We describe this unique clinical scenario and the decision-making process leading to a successful outcome.

Background: Unrecognized intraoperative cerebral ischemia during neonatal aortic arch reconstruction may precede neurologic injury. Electroencephalogram (EEG) alpha:delta ratio (A:D) changes predict cerebral ischemia; however, if A:D differences can identify ischemia during neonatal antegrade cerebral perfusion (ACP) and aortic arch reconstruction is unknown. We hypothesized that A:D changes would precede neurologic injury. Methods: Simultaneous EEG derived left versus right: hemispheric and anterior cerebral A:Ds were retrospectively measured at baseline and every 5 min during arterial cannulation, cooling, ACP, and the rewarming phases of the operation. A paired left versus right A:D difference >25% was considered significant for ischemia, and the duration of a significant and continuous A:D difference was quantified in minutes. Neonates were divided into two groups: (1) new neurologic injury (stroke or seizure) and (2) no known neurologic injury. Results: From 72 neonates, there were no significant differences in the baseline A:Ds. Seven neonates (9.7%) developed a new neurologic injury (seizure = 3, stroke = 2, seizure and stroke = 2). Male gender and longer ACP times were significantly associated with neurologic injury. In neonates with a neurologic injury, the duration of a significant and continuous A:D difference was longer within the hemispheric and anterior regions. Multivariable analysis demonstrated that a significant and continuous anterior A:D difference (odds ratio: 1.345, 95% CI 1.058-1.712; P = .01) was independently associated with neurologic injury. Conclusions: A longer continuous anterior A:D difference > 25% was independently associated with neurologic injury. Intraoperative EEG monitoring could be considered during neonatal arch reconstruction.

Background: Multiple muscular ventricular septal defects (VSDs) are often difficult to visualize and access surgically. The main challenge is identifying all defects intraoperatively, without which residual defects are inevitable. Patient-specific three-dimensional (3D) printed models can help accurately demonstrate intracardiac anatomy. We present our experience using this technology to surgically close multiple muscular VSDs .

Methods: Data of all patients with multiple VSDs in whom a 3D-printed model was used to aid surgical planning between September 2021 and July 2023 was collected retrospectively. Our approach involved generating a 3D model from a preoperative computerized tomography scan for each patient, which was then used to precisely identify the location of the multiple VSDs and plan surgical intervention.

Results: Six patients underwent closure of multiple VSDs using a 3D model. The mean age at surgery was 3.5 years (SD ± 2.8 years). Five (83.3%) patients had previously undergone pulmonary artery banding. The VSDs were approached through the right atrium in three (50%) and the right ventricle in three (50%) patients. Mean cardiopulmonary bypass and myocardial ischemia times were 185.2 min (SD ± 94.8 min) and 147.5 min (SD ± 86 min), respectively. There was no postoperative heart block or a hemodynamically significant residual VSD. All six patients had normal biventricular function at a median follow-up duration of 1.7 months (interquartile range: 1.2-7.4 months).

Conclusion: 3D printing to aid closure of multiple VSDs is safe, reliable, and reproducible. We recommend adding 3D printing to surgeons' armamentarium when faced with the challenge of closing multiple muscular VSDs in children.