World journal for pediatric & congenital heart surgery最新文献

{"title":"Understanding Early Fontan Failure in Vietnam: Incidence and Clinical Predictors.","authors":"Dac-Dai Tran, Ngoc-Thanh Le, Hai-Van T Dang, Hoang-Long Vo","doi":"10.1177/21501351241299412","DOIUrl":"10.1177/21501351241299412","url":null,"abstract":"<p><p>BackgroundWe aimed to determine the incidence of early Fontan failure (EFF) in a contemporary series of patients from Vietnam and identify risk factors for EFF.MethodsA total of 145 consecutive patients underwent the Fontan procedure at E hospital in Vietnam from August 2012 through December 2019. We analyzed predictive factors for EFF based on clinical evaluation, literature review, and our institutional database. The primary outcome assessed was EFF.ResultsThe incidence of EFF was 9.66%. In a univariate analysis of preoperative data, the anatomic diagnosis of unbalanced atrioventricular (AV) septal defect, situs inversus, AV valve regurgitation, large aortopulmonary circulation on Doppler echocardiogram, elevated pulmonary artery pressure (PAP), and elevated pulmonary vascular resistance (PVR) were significantly associated with EFF. Four intraoperative risk factors influencing EFF included pulmonary artery reconstruction, AV valve repair, bleeding, and elevated PAP. Postoperative edema was also significantly associated with EFF. A total of 22 potential independent variables were put into a model with multivariate logistic regression analysis. A final reduced model following utilizing a stepwise backward selection strategy indicated preoperative elevated PAP (odds ratio [OR]: 1.84, 95% CI: 1.12-3.00, <i>P</i> = .016), AV valve repair at Fontan (OR: 65.85, 95%CI: 1.95-2228.14, <i>P</i> = .020), and postoperative elevated PAP (OR: 1.66, 95%CI: 1.19-2.33, <i>P</i> = .004) were independent predictors for EFF.ConclusionEarly Fontan failure was relatively high in our case series and was associated with a significant mortality rate. Patients with single ventricle physiology having preoperative elevated PAP, intraoperative AV valve repair, and postoperative elevated PAP were identified as independent risk factors to predict EFF. Particularly, in the context of a developing country with limited health care resources, a comprehensive management strategy that targets the variable predictors for EFF should be incorporated with previously known risk factors to avoid EFF.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"469-477"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627294","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":"Coronary Sinus Blues: A Word of Caution When Placing the Coronary Sinus Ostium in the Left Atrium.","authors":"Clayton J Rust, Mohan M John, Joshua M Rosenblum, Glen J Iannucci, Dennis W Kim, Paul J Chai","doi":"10.1177/21501351251329927","DOIUrl":"10.1177/21501351251329927","url":null,"abstract":"<p><p>Complications related to the coronary sinus following cardiac surgery are rare and require a high index of suspicion to ensure timely diagnosis and treatment. We describe the clinical presentation and management of a patient with atrioventricular septal defect who developed coronary sinus ostial obstruction following left atrioventricular valve replacement. This manifested as a decline in ventricular function and supraventricular arrhythmias. Surgical enlargement of the coronary sinus ostium was initially successful but failed to produce a durable result.Meeting presentation: Oral presentation at the Congenital Heart Surgeons' Society Annual Meeting; October 19, 2023; Boston, MA.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"557-559"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033891","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":"Outcomes of Atrioventricular Septal Defect Repair: Two-Institutions, 10-Year Experience in Cordoba, Argentina.","authors":"Ignacio Juaneda, Lucca Pizzulli, Paula Ferrari, Rodrigo Molinas, Juan Diaz, Irma Azar, Alejandro Allub, Ernesto Juaneda, James St Louis, Alejandro Peirone, Jenkins Kathy","doi":"10.1177/21501351241305135","DOIUrl":"10.1177/21501351241305135","url":null,"abstract":"<p><p>BackgroundOutcomes following surgical repair of atrioventricular septal defect have improved over the last decades. Global mortality for repair of this defect is approximately 3.5%. We describe contemporary surgical outcomes from two institutions in Argentina.Material and MethodsA retrospective two-institution review was performed of patients operated on for atrioventricular septal defect (partial, transitional, and complete) at Hospital Privado Universitario de Cordoba and Hospital de Niños Cordoba, from January 2014 to December 2023. We analyzed demographic characteristics, operative data, mortality, and outcomes.ResultsOne hundred and ten patients were operated for atrioventricular septal defect: There were 78 patients with complete atrioventricular septal defect, 10 with partial atrioventricular septal defect, and 22 with transitional atrioventricular septal defect. Mean age and weight at operation were 1.17 year (range 0.04-13 years) and 7.53 kg (2.8-55 kg), respectively. For the complete atrioventricular septal defect subgroup, surgeries with the modified single patch technique had shorter cardiopulmonary bypass times when compared with the two patch technique (95.6 vs 139.7 min, respectively, <i>P</i> < .001). Hospital mortality was 4.5% (5 of 110 patients), all with complete atrioventricular septal defect operated with the double patch technique. Mean follow-up of the entire cohort was 57.4 months (1-118 months). Five patients underwent a reoperation at a mean time from the first operation of 14.4 months (6-24 months).ConclusionsAtrioventricular septal defect surgical repair was successfully achieved in different ages and anatomical subtypes in most patients. Complete atrioventricular septal defect had higher mortality when compared with other subgroups. Our review shows similar outcomes following repair of atrioventricular septal defect compared with an international aggregate in a resource-limited practice.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"509-515"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070614","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":"Routine Use of an On-Table Extubation Protocol in Pediatric Cardiac Surgery-Our Experience With Life in the Fast Lane.","authors":"Jothinath Kaushik, Raju Vijayakumar, Pavithra Ramanath, Murugesan Karthik Babu, Srinivasan Naveen, Janarthanan Maniyarasu, Michael E Nemergut, Joseph Dearani","doi":"10.1177/21501351241306032","DOIUrl":"10.1177/21501351241306032","url":null,"abstract":"<p><p>BackgroundWe undertook this study to evaluate the efficacy of an on-table extubation protocol and to assess the magnitude of benefits when implemented as a routine practice in a developing country.MethodsThis prospective observational study at a single tertiary care referral hospital was designed to determine the efficacy of an on-table extubation protocol when applied to children undergoing cardiac surgery in the developing world. The study included 226 patients who were 1 month to 18 years of age undergoing cardiac surgery (including grown-up congenital heart disease [GUCHD] patients). Patients with RACHS score ≥ 4, neonates, preoperatively ventilated children, and emergency surgeries were excluded from the study. All pediatric elective cardiac surgical patients belonging to RACHS 1, 2, and 3 categories were considered as potential candidates for on-table extubation. Trial registration: Clinical Trials Registry of India (CTRI/2020/07/026567).ResultsAmong the 226 children who underwent elective cardiac surgeries, we were able to extubate 142 patients (62.83%) in the operating room. This included 46.6% (54/116) infants, 80.8% (38/47) children less than 5 years of age, 79.3% (46/58) children between 5 years to 18 years age, and 80% (4/5) GUCHD. The duration of intensive care unit (ICU) stay, hospital stay, and hospital cost were significantly less in the on-table extubation group (23 [20, 26] hours; 102 [97, 125] hours; INR 2,09,011 [181032, 244298]) as compared with those patients extubated in the ICU within 6 hours (28 [22, 46] hours; 122 [100, 168] hours; INR 2,25,430 [162203, 273831]) and beyond 6 hours (71 [45, 121] hours; 184 [127, 243] hours; INR 2,53,541 [226838, 306871]).ConclusionsThis protocol shows a significant reduction in ICU stay, hospital stay, and total hospital cost when compared with either extubation within 6 h in the ICU or delayed extubation (beyond 6 h) in patients undergoing pediatric cardiac surgery.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"483-492"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411879","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":"Can We Better Understand the Anatomy of Channels Between the Ventricles on the Basis of Knowledge of Their Development?","authors":"Niraj N Pandey, Diane E Spicer, Ujjwal K Chowdhury, Justin T Tretter, Adrian C Crucean, Robert H Anderson","doi":"10.1177/21501351251322163","DOIUrl":"10.1177/21501351251322163","url":null,"abstract":"<p><p>Surgeons usually close the channels described as \"ventricular septal defects.\" When both arterial trunks arise from the right ventricle, however, the surgeon will be aware that it is not appropriate to close the channel most frequently described as the \"ventricular septal defect.\" In this latter setting, furthermore, there is currently no name for the area usually closed during surgery to restore septal integrity. Our previous attempts to emphasize the logical problems created by this situation have not, thus far, been met with uniform approbation. This may reflect the fact that we have not always expressed our concepts using words that are easy to understand. But we continue to believe that words are important if we are to achieve optimal understanding. In this review, therefore, we illustrate those areas that can be closed surgically to restore septal integrity, making a comparison with the defects that provide an outlet for the left ventricle, and hence cannot be closed. To assist understanding, we draw further comparison with the situation in the developing heart, when an area that is initially part of the right ventricle becomes the left ventricular outflow tract subsequent to the completion of septation. We discuss all these features in the setting of the simple perimembranous ventricular septal defect, the defects found in tetralogy of Fallot, and those found in the various forms of double outlet right ventricle. We emphasize the importance to the surgeon of knowing the boundaries around which a patch, or baffle, must be placed to restore septal integrity.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"516-525"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083118","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":"An Alternative Technique of Performing the Bidirectional Superior Cavopulmonary Connection without Cardiopulmonary Bypass.","authors":"Sachin Talwar, Sandeep Chakraborty, Niwin George, Amitabh Satsangi, Akshaya Kumar Bisoi","doi":"10.1177/21501351251327215","DOIUrl":"10.1177/21501351251327215","url":null,"abstract":"<p><p>There is an increasing trend of performing the bidirectional superior cavopulmonary anastomosis or bidirectional Glenn (BDG) without cardiopulmonary bypass (CPB). However, there are concerns of neurological dysfunction due to cerebral congestion and systemic oxygen desaturation due to clamping the superior vena cava and pulmonary artery, respectively, required for the off-pump anastomosis. In this report we present our alternative technique of performing the procedure without CPB in 13 patients. This technique may be a useful alternative in a select anatomic group of patients.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"537-542"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059164","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 10-mm Monocusp Expanded Polytetrafluoroethylene Valved Conduit for Right Ventricular Outflow Tract Reconstruction in Neonates and Young Infants.","authors":"Kwang Ho Choi, Hyungtae Kim, Jae Hong Lee, Si Chan Sung, Hyoung Doo Lee, Hoon Ko, Joung-Hee Byun, Taehong Kim","doi":"10.1177/21501351241306043","DOIUrl":"10.1177/21501351241306043","url":null,"abstract":"<p><p>BackgroundCurrently, no ideal prosthesis is available for right ventricular outflow tract (RVOT) reconstruction in neonates and young infants. Therefore, we developed a 10-mm handmade monocusp expanded polytetrafluoroethylene (ePTFE) valved conduit and report our experience.MethodsA retrospective clinical review was conducted on 11 consecutive patients who underwent RVOT reconstruction with a 10-mm handmade monocusp ePTFE valved conduit since May 2018. Six patients underwent a definitive Rastelli operation, and five underwent palliative right ventricle-to-pulmonary artery conduit formation. The median age at the time of operation was 61 (range, 6-462; interquartile range [IQR]: 229) days, and the median weight was 4.0 (range, 3.0-11.6; IQR: 4.3) kg.ResultsOne patient died early due to brain hemorrhage, and one died late due to sepsis. The follow-up duration was 38.5 ± 18.9 months. The mean peak pressure gradients across the conduit were 6.5 ± 4.4 mm Hg at discharge and 22.0 ± 11.2 mm Hg at the latest follow-up echocardiography. Regarding conduit regurgitation, all conduits showed better than moderate grading at the last follow-up or before reintervention. There were seven conduit explantations and three catheter interventions for conduit-related reasons. The explantations included a definitive Rastelli operation in three patients and conduit stenosis due to somatic growth in four patients.ConclusionOur simple 10-mm handmade monocusp ePTFE valved conduit demonstrated satisfactory clinical outcomes and is be a suitable option for RVOT reconstruction in neonates and young infants.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"530-536"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653038","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":"Surgical Repair of Double Outlet Right Ventricle Infants Guided by Three Dimensional-Computed Tomography Cardiac Modeling and Printing.","authors":"Srujan Ganta, Justin R Ryan, Michael J Lewis, John J Nigro","doi":"10.1177/21501351241305129","DOIUrl":"10.1177/21501351241305129","url":null,"abstract":"<p><p>BackgroundDouble outlet right ventricle (DORV) is a challenging congenital cardiac lesion to surgically master. We utilize computed tomography-guided-three-dimensional (3D) modeling/printing and novel in-house software to delineate anatomical relationships providing operative insight into the surgical approach. Our intent is to highlight this and showcase our technology.MethodsWe have created a repository of 3D heart reconstructions allowing for review of DORV patients. 3D intraoperative software anatomical manipulation and physical 3D prints were used to gain insight into DORV anatomy with the assistance of an on-site 3D Lab. The software used (Arc 3D Model Viewer) was designed in-house by our 3D Lab, tested and refined through ongoing use by our cardiothoracic surgery team. It allows for the subtraction and addition of anatomical structures and rotation in all axes. Clinicians can pan into the heart and determine specific anatomical boundaries and relationships.ResultsFrom 2010 to 2023, our program operated on 71 patients with DORV and our 3D lab has reconstructed 29 3D-hearts. Reconstructions were analyzed using Arc 3D Model Viewer. 3D reconstructions were viewed in our care conferences and intraoperatively allowing for discussion and determination of the optimal operative approach. Overall survival for DORV patients was 96% (68/71) with two mortalities in patients who did not receive 3D reconstructions.Conclusion3D reconstruction has allowed decision-making to be moved out of the operating room into the preoperative planning phase. 3D reconstruction is now standard for all DORV patients in our surgical service. We hope to demonstrate this technology with our newly developed Arc 3D Model Viewer and summarize our clinical results.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"500-508"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019348","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":"Long-Term Outcomes After Pulmonary Valve Repair for Regurgitation Secondary to Prior Intervention.","authors":"Daniel Kyrillos Ragheb, Yulin Zhang, Ayush Jaggi, Shiraz A Maskatia, Gregory T Adamson, George K Lui, Elisabeth Martin, Michael Ma, Frank L Hanley, Doff B McElhinney","doi":"10.1177/21501351241305134","DOIUrl":"10.1177/21501351241305134","url":null,"abstract":"<p><p>PurposePulmonary valve (PV) regurgitation (PR) secondary to prior repair of congenital heart disease commonly necessitates intervention, typically with PV replacement (PVR). However, prosthetic valves are susceptible to degeneration and ultimately require reintervention. Pulmonary valve repair (PVr) can correct PR while retaining native tissue, but long-term durability is unknown.MethodsAll patients who underwent PVr from 2010 to 2018 for PR resulting from prior PV intervention were included. A control cohort included patients who underwent PVR during the same period for the same indications. Time-related outcomes including freedom from right ventricular outflow tract reintervention, moderate or greater PR, and a maximum Doppler gradient ≥36 mm Hg were compared. Approved as IRB-65340.ResultsThe study included 33 and 151 patients who underwent PVr and PVR, respectively, 72% (132/184) with tetralogy of Fallot. Patients were followed for a median of 9.0 years (6.4-11.5) and 7.7 years (5.4-9.9), respectively (<i>P</i> = .041). Estimated freedom from reintervention 5 and 10 years after discharge was 97% (80-100) and 89% (69-96) after PVr and 96% (92-99) and 79% (67-87) after PVR. On Cox regression analysis adjusted for age or weight at the time of surgery, and on multivariable Cox regression, PVr was associated with significantly longer freedom from reintervention and valve dysfunction than PVR.ConclusionsPulmonary valve repair was associated with longer freedom from valve dysfunction and reintervention than PVR, particularly in pediatric patients. Lifetime management should be considered at original repair, with an effort to maintain native tissue for potential future PVr.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"452-461"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470114","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":"Twenty-Two-Year Follow-Up After Mitral Valve Replacement With Pulmonary Autograft: A Case Report.","authors":"Aeleia F Hughes, John W Brown","doi":"10.1177/21501351251319792","DOIUrl":"10.1177/21501351251319792","url":null,"abstract":"<p><p>Experience with the Ross II operation both in developed countries and in patients without a rheumatic disease process has remained low. Our center has previously published the largest experience with the Ross II procedure in North America, and now reports the case with which we have had the longest follow-up. To our knowledge, this is the only reported follow-up of a pulmonary autograft in the mitral position that has functioned well without reintervention for over two decades.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"526-527"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506740","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}