World journal for pediatric & congenital heart surgery最新文献

{"title":"Remote Didactic Pediatric Cardiac Critical Care Education Addresses Theory-Practice Gap in Low-Resource Settings.","authors":"Samantha Druckman, Julianne P Moss, Alicia H Chaves, Peter Gaskin, Melanie L Scala, Deborah Linehan, Jamie Tumulty, Nicholas Pietris, Christian Nicolosi, Jessica R Eichner, Svetlana Streltsova-Verma, Vincent U Ohaju, Chimaobi Nwagboso, Ede Jude Ebere, Uzuoma Nwogu, Njoku Faustina Oluchi, Adrian Holloway","doi":"10.1177/21501351251322157","DOIUrl":"https://doi.org/10.1177/21501351251322157","url":null,"abstract":"<p><p>In order to bridge the theory-practice gap in pediatric cardiac critical care among clinicians in a low-resource setting, multidimensional training is crucial. In this study, we implemented a dual-methodology approach to cardiac critical care education in a low-resource setting, integrating both proactive didactic education and a subsequent peer mentor model into one comprehensive education curriculum ahead of a visiting team's mission. We theorized that this process would significantly increase both theoretical knowledge attainment and acquisition of real-world competency. Ultimately, we found that ensuring the acquisition of competence prior to working with a visiting team enhanced both theoretical and practical understanding, leading to well-rounded knowledge acquisition and increased professional comfort by members of the local team.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251322157"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675139","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":"Residual Pulmonary Valve Disease Following Repair of Tetralogy of Fallot-Is Stenosis Better Than Regurgitation?","authors":"Maria von Stumm, Gregory Heger, Julia Danner, Zahra Alalawi, Cordula Wolf, Katarzyna Gendera, Stanimir Georgiev, Peter Ewert, Jürgen Hörer, Julie Cleuziou","doi":"10.1177/21501351251321533","DOIUrl":"https://doi.org/10.1177/21501351251321533","url":null,"abstract":"<p><p>BackgroundResidual pulmonary valve disease (PVD) including pulmonary stenosis (PS), pulmonary regurgitation (PR), or both remains a known complication following repair of Tetralogy of Fallot (TOF). We sought to clarify prevalence, progression, and prognostic impact of residual PVD.MethodsWe identified consecutive patients who underwent repair of TOF at our institution between January 2004 and July 2023. Based on echocardiographic measurements following repair, residual PVD was defined: nonsevere PVD (PS < 25 mm Hg; PR<Grade3), isolated PS (PS ≥ 25 mm Hg; PR<Grade3), isolated PR (PS < 25 mm Hg; PR ≥ Grade3), and mixed PVD (PS ≥ 25 mm Hg; PR ≥ Grade3). Primary study endpoint was the composite of reoperation and catheter-based reintervention.ResultsA total of 244 patients (median age 6 months) were included. Mean follow-up time was 9 ± 5 years. At discharge, 54 patients (23%) showed nonsevere PVD, PS (n = 62, 26%), PR (n = 63, 26%), or mixed PVD (n = 61, 25%). Freedom from primary endpoint was 92 ± 2% and 88 ± 2% at 5 and 10 years, respectively for all patients with residual PVD. There was no significant difference between patients with PS and PR at 10 years (PS, 86 ± 5% vs PR, 93 ± 4%; log-rank test, <i>P</i> = .85). Multivariable analysis demonstrated a significant association between mixed PVD and the primary study endpoint.ConclusionAlthough residual PVD was frequent in patients following TOF repair, freedom from reintervention and reoperation was acceptable at midterm. Residual PS did not protect from reoperation or reintervention when compared with residual PR. The combination of PS and PR was identified as arisk factor for reoperation and reintervention<i>.</i></p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251321533"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675141","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":"Prevalence, Risk Factors, and Outcomes of Hospital-Acquired Infections in Children After Congenital Heart Surgery.","authors":"Saif Awlad Thani, Maroa Al Sawaaiya, Zakiya Al Sinani, Shadha Al Muzaini, Maha Al Aamri, Husam Al Balushi, Said Al Hanshi","doi":"10.1177/21501351251315147","DOIUrl":"https://doi.org/10.1177/21501351251315147","url":null,"abstract":"<p><p>BackgroundHospital-acquired infections (HAIs) are associated with morbidity and mortality in children following congenital cardiac surgery. Our center performs approximately 200 congenital surgeries a year, but infection rates and risk factors remain unknown. This study aims to identify HAI prevalence, risk factors, and outcomes.MethodsRetrospective cross-sectional study of children who underwent congenital cardiac surgery between 2018 and 2022. The infection risk factors were identified using univariate and multivariate analyses. Assessed outcomes are length of stay, duration of mechanical ventilation, and mortality.ResultsOut of 653 patients, 102 (15.6%) developed an infection. Independent risk factors for infection included preoperative critical care admission (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.01-7), delayed sternal closure (OR, 3.3; 95% CI, 1.37-8.0), peritoneal drain (OR, 12.7; 95% CI, 1.65-97), heterotaxy syndrome (OR, 5.6; 95% CI, 1-31), and extracorporeal membrane oxygenation (ECMO) placement in the critical care unit (OR, 10.6; 95% CI, 1.8-64.2). The pediatric critical care and hospital stays of patients with infections were significantly longer with 12.79 (12.15) days versus 4.07(5.47) days and 25.53 (16.86) days versus 10.21 (7.5) days, respectively. Infected patients had a longer mechanical ventilation duration, 169.5 (264.8) versus 28.16 (53.6) hours. Infections were associated with a higher mortality rate, with 7 (6.9%) versus 12 (2.2%).ConclusionsThe prevalence of HAIs following cardiac surgery was 15.6%. Preoperative critical care unit admission, delayed sternal closure, heterotaxy syndrome, peritoneal drain, and ECMO placement in the critical care unit were independent risk factors. Infected patients have worse outcomes. Preventive strategies are greatly needed.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251315147"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627305","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":"The Association Between Platelet Transfusion and Acute Kidney Injury Following Fontan Surgery.","authors":"Marianne E Nellis, Asaf Mandel, Yshia Langer, Salmas Watad, Hiba Abuelhija, Yshai Salem, David Mishaly, Alain E Serraf, Uri Pollak","doi":"10.1177/21501351241313318","DOIUrl":"https://doi.org/10.1177/21501351241313318","url":null,"abstract":"<p><p><b>Objectives:</b> Previous studies have demonstrated an association between transfusion and increased organ dysfunction. We sought to determine the association between transfusion of blood components (red blood cell [RBC], plasma, platelet, and cryoprecipitate transfusions) with development of acute kidney injury (AKI) in children following the Fontan procedure. <b>Methods:</b> This is a single center, retrospective cohort study from 2009 to 2016. All children who underwent the Fontan procedure during the prescribed period who had transfusion and laboratory data available were included. <b>Results:</b> Eighty-eight children were enrolled. The median (interquartile range [IQR]) age was 4.5 (3.3-6.0) years, and median (IQR) weight was 14.8 (13.0-18.8) kg. The median (IQR) cardiopulmonary bypass (CPB) time was 62 (47-89) minutes. Following surgery, according to Kidney Disease Improving Global Outcomes criteria, 41% (36/88) had stage 1 AKI, 23% (20/88) stage 2 AKI, and 15% (13/88) stage 3 AKI. Fifty-eight percent (51/88) of children received at least one RBC transfusion, 73% (64/88) received at least one plasma transfusion, 47% (41/88) received at least one platelet transfusion, and 28% (25/88) received at least one cryoprecipitate transfusion. Children with severe AKI received more of each blood component. After adjusting for age, weight, pre-Fontan pulmonary vascular resistance, pre-Fontan dominant ventricular end-diastolic pressure, CPB time, RBC dose, plasma dose, and cryoprecipitate dose, each 1 mL/kg of platelet transfusion was associated with an increased risk in development of severe AKI (odds ratio: 1.160, 95%CI 1.006-1.339, <i>P</i> = .041). <b>Conclusions:</b> In our cohort of children undergoing the Fontan procedure, platelet transfusion was independently associated with an increased risk of severe AKI postoperatively. The risks, benefits, and alternatives to transfusion should be carefully weighed in this patient population.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351241313318"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627307","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":"Peritoneal Dialysis Catheter Placement on the Right Side of the Falciform Ligament to Prevent Obstruction by the Omentum.","authors":"F Doig, H Kheslat, Y d'Udekem, S P Namachivayam, A J Iyengar","doi":"10.1177/21501351241299762","DOIUrl":"10.1177/21501351241299762","url":null,"abstract":"<p><p>We describe a simple and reproducible technique for neonatal peritoneal dialysis catheter insertion following cardiac surgery which prevents the catheter from becoming blocked by the omentum.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"273-275"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866957","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":"Reader Comment on: Surgical Closure of Multiple Muscular Ventricular Septal Defects in Children Using 3D-Printed Models.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1177/21501351241312678","DOIUrl":"10.1177/21501351241312678","url":null,"abstract":"","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"289"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054561","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":"Staged Approach: The Role of Delayed Repair Following Complete Unifocalization of Major Aortopulmonary Collateral Arteries with Ventricular Septal Defect and Pulmonary Atresia.","authors":"Mimi X Deng, Yasmin Zahiri, Osami Honjo, David J Barron","doi":"10.1177/21501351241297710","DOIUrl":"10.1177/21501351241297710","url":null,"abstract":"<p><p>The presentation of pulmonary vasculature in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCA) is highly variable-as is the number, size and position of the MAPCAs and their relationship with the native pulmonary artery system. The priority in the management of this disease should be attaining timely and complete unifocalization, as opposed to single-stage full repair in every case. The merit of early unifocalization is that it secures the pulmonary vascular bed by (a) avoiding loss of lung segments from progressive stenosis/atresia of MAPCA origins, (b) preventing lung injury from high pressure/flow in areas fed by large, unobstructed MAPCAs, and (c) restoring central continuity of the pulmonary vasculature. Furthermore, there are a small but important group of patients with poorly developed vessels (about 10%-15% of the population) and/or diminutive native pulmonary artery vasculature that require initial shunt procedures to promote rehabilitation and growth of vessels before unifocalization can be attempted. During unifocalization, patients not suitable for single stage repair can be identified by intraoperative flow studies and can be successfully managed with staged strategies that provide time for growth and reinterventions on the pulmonary vasculature. Over 85% of patients can achieve unifocalization. Deferring closure of the VSD to a subsequent procedure is safe and these cases have similar survival to primary repair. Some patients (15%-20%) may never achieve VSD closure with this strategy but can still maintain a good quality of life with a restrictive right ventricular to pulmonary artery conduit and open VSD.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"208-217"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974122","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":"Single-Stage Midline Unifocalization Is Associated With Excellent Outcomes in Infants of All Ages.","authors":"Elisabeth Martin, Michael Ma, Yulin Zhang, Ritu Asija, Jennifer Shek, Chandra Ramamoorthy, Frank L Hanley, Doff B McElhinney","doi":"10.1177/21501351241293708","DOIUrl":"10.1177/21501351241293708","url":null,"abstract":"<p><p>ObjectiveTetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries are a complex congenital heart defect. For years, our program has recommended early single-stage midline unifocalization at three to six months of age. However, many patients are referred beyond six months. Thus, we sought to evaluate surgical outcomes according to age at repair.MethodsWe performed a retrospective review of patients who underwent unifocalization from age 3 to 12 months. These patients had not undergone prior surgery at our institution or elsewhere and were also not protocoled into early surgery. Patients were divided in the following groups: 3.0 to 4.9 (n = 61), 5.0 to 5.9 (n = 56), 6.0 to 7.9 (n = 56), and 8.0 to 11.9 (n = 47) months. Competing risk regression analyses were performed.ResultsWe included 220 patients from 2001 to 2020. Baseline characteristics were not significantly different among the four groups. Overall, single-stage complete repair with bilateral unifocalization, ventricular septal defect closure, atrial septal defect closure, and right ventricular-pulmonary artery (PA) conduit placement was achieved at the index operation in 174 (79%) patients and did not differ across age groups. Early mortality was 4% (n = 9). At one year, 91% (200/220) of the entire cohort was fully septated. Comparing with group 1, group 4 was significantly less likely to undergo any PA reinterventions [hazard ratio (HR) 0.44, 95% CI 0.21-0.92, <i>P</i> = .028] or surgical PA reinterventions [HR 0.12, 95% CI 0.02-0.95, <i>P</i> = .044] following complete repair.ConclusionsGiven the excellent outcomes across all ages, surgical timing for single-stage unifocalization should be dictated by clinical and anatomic details, with potential advantage in select clinically appropriate older infants who appear to be at a lower probability of PA reinterventions following full septation.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"218-226"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061923","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":"Infracardiac Total Anomalous Pulmonary Venous Connection With Meandering Intrapulmonary Vertical Vein Masquerading as a Scimitar Vein.","authors":"Damandeep Singh, Niraj Nirmal Pandey, Aprateem Mukherjee, Ankur Handa, Lamk Kadiyani, Vatsal Vora, Pradeep Ramakrishnan, Sanjeev Kumar","doi":"10.1177/21501351241305128","DOIUrl":"10.1177/21501351241305128","url":null,"abstract":"","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"276-278"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469862","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":"The Anatomy and Embryology of Tetralogy of Fallot With Pulmonary Atresia.","authors":"Vera D Aiello","doi":"10.1177/21501351241269904","DOIUrl":"10.1177/21501351241269904","url":null,"abstract":"<p><p>In this review, we approach the main morphologic and developmental aspects of the congenital cardiovascular malformation known as tetralogy of Fallot with pulmonary atresia. It is recognized that pulmonary atresia associated with a deficient ventricular septation can occur in several situations. However, the tetralogy presentation in particular, with frequent but not invariable concomitance of systemic-to-pulmonary collateral arteries supplying the lungs entirely or in part, poses surgical challenges. The variations in the morphology of such collateral arteries and the intracardiac anatomy are discussed.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"177-182"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142268","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}