World journal for pediatric & congenital heart surgery最新文献

{"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":"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":"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":"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}

{"title":"Surgical Repair of Tetralogy of Fallot With Pulmonary Atresia in Adults: Three Case Reports.","authors":"Benson Yuk Lun Chan, Tsz Him Ling","doi":"10.1177/21501351251322874","DOIUrl":"10.1177/21501351251322874","url":null,"abstract":"<p><p>We present three cases of adults who underwent late repair of tetralogy of Fallot with pulmonary atresia (ToF-PA). All three patients underwent palliative procedures at an earlier age and were not considered candidates for corrective surgery due to borderline pulmonary artery anatomy. They developed symptomatic decline with increasing dyspnea, desaturation, and decreasing exercise tolerance; thus, they were reconsidered for complete surgical repair of ToF-PA in adulthood. Improvement in symptoms and oxygen saturation were achieved in all patients. With advances in surgical techniques and cardiopulmonary bypass support, it may be worthwhile to review patients who underwent palliative procedures earlier in life but previously were thought not to be surgical candidates. The discussion for potential operative management of these patients may be possible aftercareful reassessment of pulmonary artery anatomy and ventricular function.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"553-557"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702473","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":"Prognostic Nutritional Index (PNI) As a Preoperative Screening Tool in Predicting Clinical Outcomes of Postoperative Pediatric Cardiac Surgery Patients.","authors":"Satbir Kaur, Himani Pandya, Gargee Bhatt, Deepal Prajapati, Dhruvini Patel, Aparna Sirandas, Jigisha Pujara","doi":"10.1177/21501351241293998","DOIUrl":"10.1177/21501351241293998","url":null,"abstract":"<p><p>ObjectiveThe authors sought to evaluate the role of nutritional indices such as Onodera's prognostic nutrition index (PNI), World Health Organization (WHO)-based anthropometric measurements such as weight for age (w/a), height for age, weight for height, and perioperative serum albumin levels in the determination of postoperative clinical outcomes in pediatric patients who undergo surgery for congenital cardiac defects and surgical complexity (risk-adjusted congenital heart surgery score) and its correlation with postoperative course.Material and MethodsIn this prospective observational study, 108 post-pediatric cardiac surgery patients under the age of 18 months were enrolled between January 2023 and August 2023. Through receiver operating characteristic curve analysis we have found the cutoff value for PNI is ≤66.5 and >66.5. The above mentioned parameters were analyzed for postoperative clinical outcomes such as length of intensive care unit (ICU) stay, length of hospital stay, and duration of mechanical ventilation.ResultsSignificant negative correlation was found between length of ICU stay and hospital stay with lower PNI (<i>P</i> = .019 and <.001, respectively.). Analysis of low versus high PNI groups was suggestive of a remarkable increase in mechanical ventilation time (<i>P</i> = .03), length of ICU stay (0.01), and hospital stay (<i>P</i> ≤ .001) in the low PNI group. Lower WHO-based w/a Z score was found to be significantly associated with low PNI (<66.5), after adjusting for preoperative albumin, postoperative albumin drop, and C-reactive protein (odds ratio = 1.411 per unit 0.28 increment in W/azs, <i>P</i> = .004).ConclusionPreoperative Onoderas PNI is an effective and efficient tool for predicting postoperative clinical morbidity in pediatric patients undergoing congenital heart surgery.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"493-499"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061922","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 Treatment of a Rare Case of Uhl Anomaly, Tricuspid Atresia, Absent Pulmonary Valve, Hypoplastic Right Ventricle, and Right Ventricular Coronary Artery Fistula.","authors":"Norihiko Oka, Takahiro Tomoyasu, Masahiro Kaneko, Kenta Matsui","doi":"10.1177/21501351251345787","DOIUrl":"https://doi.org/10.1177/21501351251345787","url":null,"abstract":"<p><p>We report the case of a four-month-old child with complex congenital heart disease, including tricuspid atresia, absent pulmonary valve, hypoplastic right ventricle, right ventricular coronary artery fistula, and Uhl anomaly, and to describe the challenges and management decisions involved. A Blalock-Taussig-Thomas (BTT) shunt was initially planned. However, severe ST-segment depression occurred upon oral feeding, indicating coronary insufficiency. Cardiac catheterization revealed a single coronary artery with a right ventricular coronary artery fistula, which increased the risk of myocardial ischemia with the BTT shunt. Consequently, a bidirectional Glenn (BDG) procedure with left pulmonary artery reconstruction was performed after maintaining ductal patency with prostaglandin for four months. The patient had a favorable postoperative course without ischemic events. In patients with complex congenital heart defects and coronary anomalies, the presence of a right ventricular coronary artery fistula may increase the risk of ischemia with a BTT shunt. A BDG procedure can offer a safer alternative, leading to a positive clinical outcome and avoiding ischemic complications.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351251345787"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500009","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}