World Journal for Pediatric and Congenital Heart Surgery最新文献

{"title":"Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Associated with Right Coronary Giant Aneurysm.","authors":"Martin Antelo,&nbsp;Diego Freire,&nbsp;Alvaro Dendi,&nbsp;Gabriel Parma,&nbsp;Nicolas Fernandez,&nbsp;Dante Picarelli","doi":"10.1177/21501351221135767","DOIUrl":"https://doi.org/10.1177/21501351221135767","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Tracheal Arborization and Lung Hypoplasia in Repair of Pulmonary Artery Sling in Combination With Long-Segment Tracheal Stenosis.","authors":"Siddartha C Rudrappa,&nbsp;Arun Beeman,&nbsp;Madhavan Ramaswamy,&nbsp;Sachin Khambadkone,&nbsp;Graham Derrick,&nbsp;Martin Kostolny,&nbsp;Alistair Calder,&nbsp;Nagarajan Muthialu","doi":"10.1177/21501351221145172","DOIUrl":"https://doi.org/10.1177/21501351221145172","url":null,"abstract":"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.","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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.","authors":"Mark S Bleiweis,&nbsp;Joseph Philip,&nbsp;Giles J Peek,&nbsp;Yuriy Stukov,&nbsp;Gregory M Janelle,&nbsp;Andrew D Pitkin,&nbsp;Kevin J Sullivan,&nbsp;Connie S Nixon,&nbsp;Omar M Sharaf,&nbsp;Dan Neal,&nbsp;Jeffrey P Jacobs","doi":"10.1177/21501351221146150","DOIUrl":"https://doi.org/10.1177/21501351221146150","url":null,"abstract":"<p><strong>Objectives: </strong>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).</p><p><strong>Methods: </strong>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. <i>T</i>-tests using estimated survival proportions and standard errors were used to compare groups at specific time points.</p><p><strong>Results: </strong>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, <i>P</i>  =  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, <i>P</i>  =  0.005.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9694625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regionalization or Access to Care? A Joint Pediatric Heart Care Program That Achieves Both: One Program-Two Sites.","authors":"David A Katz,&nbsp;Shaun Mohan,&nbsp;Matthew Bacon,&nbsp;Eimear McGovern,&nbsp;W Jack Wallen,&nbsp;Geneva M Preston,&nbsp;Douglas Schneider,&nbsp;Louis Bezold,&nbsp;Scottie Day,&nbsp;Andrew N Redington,&nbsp;James Quintessenza,&nbsp;Carl L Backer","doi":"10.1177/21501351221149420","DOIUrl":"https://doi.org/10.1177/21501351221149420","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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.\" <b>Results:</b> 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. <b>Conclusions:</b> 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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9694646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Norwood Aneurysm: Report of a Rare Phenomenon.","authors":"Othman A Aljohani,&nbsp;Ahmad Hasan,&nbsp;Francesca Byrne,&nbsp;John Lamberti,&nbsp;Raghav Murthy","doi":"10.1177/21501351221137288","DOIUrl":"https://doi.org/10.1177/21501351221137288","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9329669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of CardioCel in Cardiac Surgery: A Systematic Review.","authors":"Aditya A Patukale,&nbsp;Jessica Suna,&nbsp;Abhishek Anand,&nbsp;Kim S Betts,&nbsp;Tom R Karl,&nbsp;Prem Venugopal,&nbsp;Supreet P Marathe,&nbsp;Nelson Alphonso","doi":"10.1177/21501351221149416","DOIUrl":"https://doi.org/10.1177/21501351221149416","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9318244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Norwood Procedure Using Regional Cerebral Perfusion at Normothermia: Are We There Yet?","authors":"Christian Pizarro","doi":"10.1177/21501351231155811","DOIUrl":"https://doi.org/10.1177/21501351231155811","url":null,"abstract":"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","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9380597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Genetic Disorders in the Surgical Management of Congenital Heart Disease.","authors":"Elizabeth H Stephens,&nbsp;Joseph A Dearani,&nbsp;Heidi M Connolly,&nbsp;Stephen J Gleich,&nbsp;David R Deyle,&nbsp;Jonathan N Johnson","doi":"10.1177/21501351221139837","DOIUrl":"https://doi.org/10.1177/21501351221139837","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multidisciplinary Surgical Approach to Mediastinal Masses in Children.","authors":"Vanessa M Miller, Mitchell Disharoon, Luz A Padilla, Elizabeth A Beierle, Robert J Dabal","doi":"10.1177/21501351221133753","DOIUrl":"10.1177/21501351221133753","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biventricular Repair for Aortic Atresia, Ventricular Septal Defect, and Type C Interrupted Aortic Arch.","authors":"Yi-Chia Wang,&nbsp;Heng-Wen Chou,&nbsp;Yih-Sharng Chen,&nbsp;Shu-Chien Huang","doi":"10.1177/21501351221145162","DOIUrl":"https://doi.org/10.1177/21501351221145162","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9318241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}