Pediatric Cardiac Surgery Annual最新文献

Partial Heart Transplantation - How to Change the System 部分心脏移植--如何改变系统

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2024.01.002

Douglas M. Overbey MD, MPH , Taufiek K. Rajab MD , Joseph W. Turek MD, PhD, MBA

{"title":"Partial Heart Transplantation - How to Change the System","authors":"Douglas M. Overbey MD, MPH , Taufiek K. Rajab MD , Joseph W. Turek MD, PhD, MBA","doi":"10.1053/j.pcsu.2024.01.002","DOIUrl":"10.1053/j.pcsu.2024.01.002","url":null,"abstract":"<div>Partial heart transplantation is the first clinically successful approach to deliver growing heart valve implants. To date, 13 clinical partial heart transplants have been performed. However, turning partial heart transplantation into a routine procedure that is available to all children who would benefit from growing heart valve implants poses formidable logistical challenges. Firstly, a supply for partial heart transplant donor grafts needs to be developed. This challenge is complicated by the scarcity of donor organs. Importantly, the donor pools for orthotopic heart transplants, partial heart transplants and cadaver homografts overlap. Secondly, partial heart transplants need to be allocated. Factors relevant for equitable allocation include the indication, anatomical fit, recipient clinical status and time on the wait list. Finally, partial heart transplantation will require regulation and oversight, which only recently has been undertaken by the Food and Drug Administration, which regulates human cellular and tissue-based products. Overcoming these challenges will require a change in the system. Once this is achieved, partial heart transplantation could open new horizons for children who require growing tissue implants.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 100-105"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635538","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}

引用次数: 0

Left Ventricular Outflow Tract Obstruction in Congenital Heart Disease: The Role of Cardiovascular Computed Tomography in Surgical Decision Making 先天性心脏病的左心室流出道梗阻：心血管计算机断层扫描在手术决策中的作用

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2023.12.004

B. Kelly Han MD , Edem Binka MD , Eric Griffiths MD , Reilly Hobbs MD , Aaron Eckhauser MD , Adil Husain MD , David Overman MD

{"title":"Left Ventricular Outflow Tract Obstruction in Congenital Heart Disease: The Role of Cardiovascular Computed Tomography in Surgical Decision Making","authors":"B. Kelly Han MD , Edem Binka MD , Eric Griffiths MD , Reilly Hobbs MD , Aaron Eckhauser MD , Adil Husain MD , David Overman MD","doi":"10.1053/j.pcsu.2023.12.004","DOIUrl":"10.1053/j.pcsu.2023.12.004","url":null,"abstract":"<div>Patients with many forms of congenital heart disease (CHD) and hypertrophic cardiomyopathy undergo surgical intervention to relieve left ventricular outflow tract obstruction (LVOTO). Cardiovascular Computed Tomography (CCT) defines the complex pathway from the ventricle to the outflow tract and can be visualized in 2D, 3D, and 4D (3D in motion) to help define the mechanism and physiologic significance of obstruction. Advanced cardiac visualization may aid in surgical planning to relieve obstruction in the left ventricular outflow tract, aortic or neo-aortic valve and the supravalvular space. CCT scanner technology has advanced to achieve submillimeter, isotropic spatial resolution, temporal resolution as low as 66 msec allowing high-resolution imaging even at the fast heart rates and small cardiac structures of pediatric patients ECG gating techniques allow radiation exposure to be targeted to a minimal portion of the cardiac cycle for anatomic imaging, and pulse modulation allows cine imaging with a fraction of radiation given during most of the cardiac cycle, thus reducing radiation dose. Scanning is performed in a single heartbeat or breath hold, minimizing the need for anesthesia or sedation, for which CHD patents are highest risk for an adverse event. Examples of visualization of complex left ventricular outflow tract obstruction in the subaortic, valvar and supravalvular space will be highlighted, illustrating the novel applications of CCT in this patient subset.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 11-18"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139192248","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}

引用次数: 0

Hypertrophic Cardiomyopathy: Preadolescence, Mitral Valve Disease, and Midventricular Obstruction 肥厚型心肌病：早衰、二尖瓣病变和中室阻塞

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2023.12.001

Elaine M. Griffeth MD, Elizabeth H. Stephens MD, PhD, Joseph A. Dearani MD

{"title":"Hypertrophic Cardiomyopathy: Preadolescence, Mitral Valve Disease, and Midventricular Obstruction","authors":"Elaine M. Griffeth MD, Elizabeth H. Stephens MD, PhD, Joseph A. Dearani MD","doi":"10.1053/j.pcsu.2023.12.001","DOIUrl":"https://doi.org/10.1053/j.pcsu.2023.12.001","url":null,"abstract":"<div>Septal myectomy is indicated in patients with obstructive hypertrophic cardiomyopathy (HCM) who have persistent symptoms despite medical therapy, intolerance of medication side effects, or severe resting or provocable gradients. Septal myectomy at high volume centers is safe, with low operative mortality (1%) and low rates of complications such as complete heart block or ventricular septal defect (3% and 0.5%, respectively). Additionally, improved survival following myectomy has been observed when compared to patients with obstructive HCM managed medically or those with nonobstructive HCM. As a longstanding, quaternary referral center for septal myectomy, our institution has built significant experience and expertise in the surgical and medical management of HCM, including atypical HCM, defined as preadolescent patients, those with mitral valve disease, and those with isolated midventricular obstruction. The most important factor of septal myectomy in achieving complete resolution of obstruction and avoiding recurrence is the apical extent of the myectomy trough, which must extend to the septum opposite the papillary muscles. If this cannot be fully achieved via a transaortic exposure, especially in preadolescents and patients with midventricular obstruction, then a transapical approach may be needed. Mitral valve repair is rarely necessary as SAM-mediated MR resolves with adequate myectomy alone, but mitral repair is performed in cases of intrinsic valvular disease. In this manuscript we provide a summary of current operative techniques and outcomes data from our institution on the management of these various categories of HCM.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 69-77"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190886","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}

引用次数: 0

Endocardial Fibroelastosis Resection: When it Works and When it Does Not 心内膜纤维瘤切除术--何时有效，何时无效

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2023.12.006

Gregor Gierlinger MD, Sitaram M. Emani MD

{"title":"Endocardial Fibroelastosis Resection: When it Works and When it Does Not","authors":"Gregor Gierlinger MD, Sitaram M. Emani MD","doi":"10.1053/j.pcsu.2023.12.006","DOIUrl":"10.1053/j.pcsu.2023.12.006","url":null,"abstract":"<div>Endocardial fibroelastosis (EFE) is a thickening of the endocardial layer by accumulation of collagen and elastic fibers. Endothelial to mesenchymal transformation is proposed to be the underlying mechanism of formation. Although EFE can occur in both right and left ventricles, this article will focus on management of left ventricular EFE. Through its fibrous, nonelastic manifestation EFE restricts the myocardium leading to diastolic and systolic ventricular dysfunction and prevents ventricular growth in neonates and infants. The presence of EFE may be a marker for underlying myocardial fibrosis as well. The extent of EFE within the left ventricular cavity can be variable ranging from patchy to confluent distribution. Similarly the depth of penetration and degree of infiltration into myocardium can be variable. The management of EFE is controversial, although resection of EFE has been reported as part of the staged ventricular recruitment therapy. Following resection, EFE recurs and infiltrates the myocardium after primary resection. Herein we review the current experience with EFE resection.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 19-24"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139188683","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}

引用次数: 0

Long-Term Outcomes of Mechanical Aortic Valve Replacement in Children 儿童主动脉瓣机械置换术的长期疗效。

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2023.12.003

Michael Z.L. Zhu MBBS , Edward Buratto MBBS, PhD, FRACS , Damien M. Wu MD , Shuta Ishigami MD, PhD , Antonia Schulz MD , Christian P. Brizard MD, MS , Igor E. Konstantinov MD, PhD, FRACS

{"title":"Long-Term Outcomes of Mechanical Aortic Valve Replacement in Children","authors":"Michael Z.L. Zhu MBBS , Edward Buratto MBBS, PhD, FRACS , Damien M. Wu MD , Shuta Ishigami MD, PhD , Antonia Schulz MD , Christian P. Brizard MD, MS , Igor E. Konstantinov MD, PhD, FRACS","doi":"10.1053/j.pcsu.2023.12.003","DOIUrl":"10.1053/j.pcsu.2023.12.003","url":null,"abstract":"<div>When the options of aortic valve repair or the Ross procedure are not feasible or have been exhausted, mechanical aortic valve replacement (AVR) may provide a reliable and structurally durable alternative, but with the limitations of long-term anticoagulation, thrombosis risk and lack of valve growth potential. In this article, we review the longitudinal outcomes of mechanical AVR in children in our institution and compare them to those recently reported by others. From 1978 to 2020, 62 patients underwent mechanical AVR at a median age of 12.4 years (interquartile range (IQR): 8.6-16.8 years). The most common underlying diagnoses were: conotruncal anomalies (40%, 25/62), congenital aortic stenosis (16%, 10/62), rheumatic valve disease (16%, 10/62), connective tissue disease (8.1%, 5/62) and infective endocarditis (6.5%, 4/62). Thirty-two patients (52%, 32/62) had at least 1 prior aortic valve surgery prior to mechanical AVR. Early death was 3.2% (2/62). Median follow-up was 14.4 years (IQR: 8.4-28.2 years). Kaplan-Meier survival was 96.8%, 91.9%, 86.3%, and 81.9% at 1, 5, 10, and 20 years. On competing risk analysis, the proportion of patients alive without aortic valve reoperation at 1, 5, 10, and 20 years was 95.2%, 87.0%, 75.5% and 55.4%, respectively, while the proportion of patients that had aortic valve reoperation (with death as a competing event) at 1, 5, 10, and 20 years was 1.6%, 4.9%, 12.8%, and 28.5%, respectively. In conclusion, when the options of aortic valve repair or the Ross procedure are not feasible in children, mechanical AVR is an alternative, yet the long-term rates of mortality and need for aortic valve reoperation are of concern.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 52-60"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189085","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}

引用次数: 0

How-I-Do-It: Aortic Annular Enlargement - Are the Nicks and Manouguian Obsolete? 我是怎么做的主动脉瓣环扩大--Nicks 和 Manouguian 已经过时了吗？

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2023.12.005

Kenneth R. Hassler DO, Katelyn Monaghan BS, China Green BS, Bo Yang MD, PhD

{"title":"How-I-Do-It: Aortic Annular Enlargement - Are the Nicks and Manouguian Obsolete?","authors":"Kenneth R. Hassler DO, Katelyn Monaghan BS, China Green BS, Bo Yang MD, PhD","doi":"10.1053/j.pcsu.2023.12.005","DOIUrl":"10.1053/j.pcsu.2023.12.005","url":null,"abstract":"<div>The Y-incision aortic annular enlargement (AAE), first performed in August 2020, offers a safe and more effective alternative for management of a small aortic annulus/root without need for violation of the left ventricular outflow tract, mitral valve geometry, or left/right atria in both first-time aortic valve replacement (AVR) and reoperative AVR. In the first consecutive 119 patients with Y-incision AAE, the median age was 65 (59, 71), 67% female, 28% had previous cardiac surgery, and 2 cases had endocarditis. The preoperative mean gradient was 36 (30, 47), and the native aortic valve area was 0.9 (0.7, 1.0). After aortic annular enlargement, the median prosthesis size was 29 (27, 29) with 63% of patients having a size 29 or the largest sized valve. The median increment of annulus enlargement was 3 (3, 4) valve sizes. Postoperative complications included 1 operative mortality, 1 stroke exacerbation, and 2 pacemaker implantations (including one case of endocarditis with Gerbode fistula). There was no renal failure requiring permanent dialysis, mediastinitis, or reoperation for bleeding. Postoperative computed tomography aortogram showed the aortic root was enlarged from 27 (24, 30) to 40 (37, 42) mm without aortic pseudoaneurysm. The postoperative mean gradient was 6 (5, 9) mm Hg and valve area was 2.2 (1.8, 2.6) cm2 at 24 months. Mitral and tricuspid valve functions were significantly improved. This report describes the Y-incision technique with the most up-to-date modifications and short-term outcomes.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 25-36"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191669","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}

引用次数: 0

Late Pulmonary Autograft Dilation: Can We Make a Good Operation Great? The Tailored Approach 肺自体移植晚期扩张：我们能让好手术变得更好吗？量身定制的方法

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2024.01.004

Ismail El-Hamamsy MD , Luca A. Vricella MD

引用次数: 0

Reconstruction of Fibrous Skeleton of the Heart for Double-Valve Replacement in A Pediatric Patient - Modified Commando Procedure 为一名儿科患者重建心脏纤维骨架以进行双瓣膜置换术--改良突击队程序

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2024.01.006

Arif Selcuk MD, Yves d'Udekem MD, PhD, Sofia Hanabergh MS, Mahmut Ozturk MD, Aybala Tongut MD, Can Yerebakan MD, PhD, Manan Desai MD

{"title":"Reconstruction of Fibrous Skeleton of the Heart for Double-Valve Replacement in A Pediatric Patient - Modified Commando Procedure","authors":"Arif Selcuk MD, Yves d'Udekem MD, PhD, Sofia Hanabergh MS, Mahmut Ozturk MD, Aybala Tongut MD, Can Yerebakan MD, PhD, Manan Desai MD","doi":"10.1053/j.pcsu.2024.01.006","DOIUrl":"10.1053/j.pcsu.2024.01.006","url":null,"abstract":"<div>The so-called Commando procedure, initially described by David and colleagues, consists in the reconstruction of the mitro-aortic fibrous lamina by a patch that enlarges both annuli. Its use has been described to upsize the aortic and mitral annulus for double valve replacement in adolescents. We describe a modified technique of this reconstruction of the fibrous skeleton of the heart, combined with Konno procedure to further enlarge the aortic annulus. In modified Commando procedure, following the reconstruction of aortomitral continuity with a bovine pericardium CardioCel patch (Admedus Regen Pty Ltd, Perth, WA, Australia), an aortic valved conduit that was made on the bench in order to have bottom skirt that enabled the suturing of the composite conduit far inside the left ventricle outflow tract. Coronary buttons were implanted at the supra-commissural level. The advantages of this modified Commando procedure are (1) the creation of a new aortic annulus when the integrity of this annulus has been compromised, (2) the upsizing of both annuli to any possible size of aortic and mitral prostheses, and (3) the relief of any residual left ventricular outflow tract obstruction.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 61-62"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639014","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}

引用次数: 0

From Surgical to Total Transcatheter Stage I Palliation: Exploring Evidence and Perspectives 从外科手术到全经导管 I 期姑息治疗：探索证据和观点。

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2023.12.002

Rodrigo Zea-Vera MD , Francesca Sperotto MD, PhD , Pirooz Eghtesady MD, PhD , Nicola Maschietto MD, PhD

{"title":"From Surgical to Total Transcatheter Stage I Palliation: Exploring Evidence and Perspectives","authors":"Rodrigo Zea-Vera MD , Francesca Sperotto MD, PhD , Pirooz Eghtesady MD, PhD , Nicola Maschietto MD, PhD","doi":"10.1053/j.pcsu.2023.12.002","DOIUrl":"10.1053/j.pcsu.2023.12.002","url":null,"abstract":"<div>Neonates with single ventricle physiology and ductal-dependent systemic circulation, such as those with hypoplastic left heart syndrome, undergo palliation in the first days of life. Over the past decades, variations on the traditional Stage 1 palliation, also known as Norwood operation, have emerged. These include the hybrid palliation and the total transcatheter approach. Here, we review the current evidence and data on different Stage 1 approaches, with a focus on their advantages, challenges, and future perspectives. Overall, although controversy remains regarding the superiority or inferiority of one approach to another, outcomes after the Norwood and the hybrid palliation have improved over time. However, both procedures still represent high-risk approaches that entail exposure to sternotomy, surgery, and potential cardiopulmonary bypass. The total transcatheter Stage 1 palliation spares patients the surgical and cardiopulmonary bypass insults and has proven to be an effective strategy to bridge even high-risk infants to a later palliative surgery, complete repair, or transplant. As the most recently proposed approach, data are still limited but promising. Future studies will be needed to better define the advantages, challenges, outcomes, and overall potential of this novel approach.</div>","PeriodicalId":38774,"journal":{"name":"Pediatric Cardiac Surgery Annual","volume":"27 ","pages":"Pages 3-10"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196279","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}

引用次数: 0

Editors’ Introduction 编辑导言

Pediatric Cardiac Surgery Annual Pub Date : 2024-01-01 DOI: 10.1053/j.pcsu.2024.01.009

Meena Nathan MD, MPH, FRCS , Stephanie M. Fuller MD, MS

引用次数: 0