World journal for pediatric & congenital heart surgery最新文献

Fetal cardiac intervention consists of a novel and evolving technique for the intrauterine treatment of a subset of patients with congenital heart diseases, which aims to improve hemodynamics, reduce secondary damage, and achieve better postnatal outcomes. Nevertheless, the risks and benefits of this therapy remains subject to controversy. This review describes the rationale, selection criteria, and technical features for the most frequently performed fetal cardiac interventions. In addition, we provide a comprehensive overview of the medical literature, exploring the clinical implications of each therapy.

Objectives: A systemic-to-pulmonary shunt is the palliation of choice for many children with cyanotic congenital heart disease. However, significant morbidity and mortality related to these procedures and the postoperative course still exists. We aim to report our outcomes of systemic-to-pulmonary shunts as well as to define certain risk factors for adverse events.

Materials and methods: We retrospectively collected data from the electronic medical records of Ramathibodi hospital from January 01, 2013, to April 30, 2024. Demographic data, operative, and postoperative details were collected and reviewed. Inclusion criteria included patients whose primary operation was a systemic-to-pulmonary shunt. Exclusion criteria were patients diagnosed with hypoplastic left heart syndrome and whose medical record data were missing significant information.

Results: There were initially 56 patients eligible for our study. After exclusion, the total number of patients enrolled was 42. Overall the results were excellent, with only one operative mortality, no discharge mortality, and four reinterventions. Outcomes between different shunt types, shunt sizes, surgical approaches, and diagnoses were statistically similar.

Conclusions: We demonstrate that systemic-to-pulmonary shunts are a safe and reliable procedure based on our results at a tertiary hospital in Thailand. We emphasize meticulous surgical techniques as well as utilization of proper and reproducible postoperative care protocols to optimize patient outcomes.

Cardiac hemangiomas are rare tumors of the heart which account for less than one-twentieth of all primary cardiac tumors. They can be seen in all age groups but are mostly diagnosed in neonates and children. Although cardiac hemangiomas are benign in nature they can present with features of congestive heart failure and occasionally be life-threatening. We present such a case in a two-month-old child who underwent successful surgical excision of the mass.

Anomalous origin of the right subclavian artery (AORSA) from the right pulmonary artery is a rare congenital anomaly usually diagnosed by computed tomography, magnetic resonance imaging, or angiography. We present a very rare case of diagnosis and surgical correction of AORSA coexisting with d-transposition of the great arteries in a newborn's first hours of life. Due to the critical local hospital and patient conditions, additional cross-sectional imaging was not feasible. The diagnosis was suspected by clinical signs, confirmed by transthoracic echocardiogram, and the patient was urgently taken to the operating room. We discuss clinical and echocardiographic signs of this child with d-transposition of the great arteries and AORSA from the right pulmonary artery.

Objectives: Anomalous aortic origin of a coronary artery is a rare congenital lesion in which a coronary artery arises from an anomalous location within the aorta. Anomalous aortic origin of a coronary artery has been associated with myocardial ischemia and it is considered the second most common cause of sudden cardiac arrest in young athletes. When surgical repair is indicated, surgical unroofing is the most commonly employed technique. Our objective is to describe the outcomes of our surgically treated patients.

Methods: We present a series of 16 adult patients who underwent surgical repair of anomalous aortic origin of a coronary artery. Patients were treated in three different institutions by the same surgeon. Surgical unroofing of the anomalous coronary artery was the surgical technique chosen in the majority of the patients. Follow-up was performed.

Results: Unroofing of an intramural anomalous coronary artery was the procedure performed in 11 patients. Three patients underwent neo-ostium creation; one patient underwent a David procedure with coronary reimplantation; and one patient was treated with coronary bypass grafting due to severe coronary atheromatous lesions. There were no perioperative deaths, and no major postoperative complications. Follow-up period was 73.8 months, the survival rate was 100%, and there were neither ischemia or heart failure reports.

Conclusions: The surgical repair of anomalous aortic origin of a coronary artery by coronary unroofing or neo-ostium creation has demonstrated excellent early and late outcomes. Late survival was excellent. The follow-up period revealed no significant morbidity or complications.

Objectives: Aortic arch appearances can be associated with worse cardiac function and chronic hypertension late after coarctation of the aorta (CoA) repair, even without residual obstruction. Statistical shape modeling (SSM) has identified specific 3D arch shapes linked to poorer cardiovascular outcomes. We sought a mechanistic explanation. Methods: From 53 asymptomatic patients late after CoA repair with no residual obstruction (age: 22.3 ± 5.6 years; 12-38 years after operation), eight aortic arch shapes associated with the four best and four worst cardiovascular parameters were obtained from 3D SSM. Four favorable shapes were affiliated with left ventricular (LV) ejection fraction +2 standard deviation (SD) values from the mean, and indexed LV end diastolic volume/indexed LV mass/resting systolic blood pressure that were -2SD. Four unfavorable shapes were defined by the reverse. Computational Fluid Dynamics modeling was carried out to assess differences in pressure gradient across the aortic arch and viscous energy loss (VEL) between favorable and unfavorable aortic arches. Results: In all aortic arches, the pressure gradients were clinically insignificant (<8 mm Hg). However, in the four unfavorable aortic arches, VEL were uniformly higher than those in the favorable shapes (VEL difference: 15%-32%). There was increased turbulence and more complex propagation of VEL along with the unfavorable aortic arches. Conclusions: This study reveals the variable flow dynamics that underpin the association of aortic arch shapes with worse cardiovascular outcomes late after successful CoA repair. Higher VEL persists in the unfavorable aortic arch shapes. Further understanding of the mechanism of viscous energy loss in cardiovascular maladaptation may afford mitigating strategies to monitor and modify this unrelenting liability.

Background: Given improved contemporary survival of adults with congenital heart disease (ACHD), we aimed to evaluate trends in ACHD surgery and outcomes at a single center over a 27-year period.

Methods: Surgical databases were retrospectively queried for patients >18 years old who underwent ACHD surgery between January 1, 1994, and December 31, 2020. A total of 2,195 included patients underwent 2,425 cardiac surgical procedures within the specified time frame. Patients were grouped by era: I, 1994-2000; 2, 2001-2010; and 3, 2011-2020. Trends in primary cardiac diagnosis and surgical management were evaluated.

Results: The median age increased across the eras. The most common primary cardiac diagnoses (n = 2,425) overall were left ventricular outflow tract anomalies (n = 2,019, 83%), atrial septal defect (n = 407, 17%), right ventricular outflow tract anomalies (n = 360, 15%), and ventricular septal defect (n = 110, 4.5%). The most commonly observed procedures overall were operations on the left ventricular outflow tract (n = 1,633, 67%), aorta (n = 675, 28%), coronary arteries (n = 449, 19%), right ventricular outflow tract (n = 323, 13%), and atrial septal defect (n = 264, 11%). Major complications occurred in 10% of cases, and 58 patients died within 30 days of their operation yielding an operative mortality of 2.4%.

Conclusion: To our knowledge, this is the largest single center report on surgery for adults with congenital heart disease. Surgery for ACHD has been performed at our center with relatively low morbidity and mortality over the last few decades.

Purpose: Three-dimensional modeling and printing (3DMP) of anatomical structures from cross-sectional imaging data can enhance the understanding of spatial relationships in complex congenital heart defects. Partially due to the substantial financial, material and personnel resources required, 3DMP is not yet universally used. Here, we describe a workflow that addresses and eliminates these drawbacks.

Description: The workflow utilizes the open-source software "3D Slicer" (The Slicer Community) and "Blender" (Blender Foundation) for segmentation and post-editing of datasets. This approach enables the generation of virtual or physical 3D models. The physical models are printed using a standard fused deposition modeling printer.

Evaluation: The financial challenges that likely constrain the wider use of 3DMP are largely addressed by this approach. However, the workflow still requires a considerable amount of time to manually segment the imaging data.

Conclusions: Three-dimensional modeling and printing might improve planning and safety of congenital cardiac surgical treatment. Furthermore, it is a useful tool for education of parents and medical professionals. This workflow increases its suitability for routine use also in regions with low economic resources.

Background: Extubation failure and its associated complications are not uncommon after pediatric cardiac surgery, especially in neonates and young infants. We aimed to identify the frequency, etiologies, and clinical characteristics associated with extubation failure after cardiac surgery in neonates and young infants. Methods: We conducted a single center prospective observational study of patients ≤180 days undergoing cardiac surgery between June 2022 and May 2023 with at least one extubation attempt. Patients who failed extubation, defined as reintubation within 72 h of first extubation attempt, were compared with patients extubated successfully using χ², Fisher exact, or Wilcoxon rank-sum tests as appropriate. Results: We prospectively enrolled 132 patients who met inclusion criteria, of which 11 (8.3%) failed extubation. Median time to reintubation was 25.5 h (range 0.4-55.8). Extubation failures occurring within 12 h (n = 4) were attributed to upper airway obstruction or apnea, whereas extubation failures occurring between 12 and 72 h (n = 7) were more likely to be due to intrinsic lung disease or cardiac dysfunction. Underlying genetic anomalies, greater weight relative to baseline at extubation, or receiving positive end expiratory pressure (PEEP) > 5 cmH₂O at extubation were significantly associated with extubation failure. Conclusions: In this study of neonates and young infants recovering from cardiac surgery, etiologies of early versus later extubation failure involved different pathophysiology. We also identified weight relative to baseline and PEEP at extubation as possible modifiable targets for future investigations of extubation failure in this patient population.