World journal for pediatric & congenital heart surgery最新文献

{"title":"Pediatric Aortic Arch Reconstruction Using Sustained Total All-Region Perfusion (STAR): Early Experience and Postoperative Outcomes.","authors":"Douglas M Overbey, Michael Mensah-Mamfo, Seth E M Wolf, Hiba Ghandour, John A Kucera, John K Cook, Eden S Singh, Haoran Jiang, Berk Aykut, Joseph B Clark, Joseph W Turek","doi":"10.1177/21501351261480009","DOIUrl":"https://doi.org/10.1177/21501351261480009","url":null,"abstract":"<p><p>BackgroundSustained total all-region (STAR) perfusion is an emerging technique that provides continuous perfusion to the brain, lower body, and heart with mild hypothermia. We hypothesized that using STAR perfusion would result in improved postoperative outcomes.MethodsThe 4 cohorts evaluated (total n = 105) included 1) STAR perfusion for aortic arch reconstruction (Arch w/ STAR), 2) STAR perfusion for aortic arch reconstruction with subsequent cardiac arrest for ventricular septal defect/atrial septal defect (VSD/ASD) (Arch/ASD/VSD w/ STAR), 3) hypothermic circulatory arrest (HCA) with cerebral perfusion (CP) for aortic arch reconstruction (Arch w/ HCA/CP), and 4) hypothermic circulatory arrest with cerebral perfusion for aortic arch reconstruction and VSD/ASD closure (Arch/ASD/VSD w/ HCA/CP). Primary outcomes were 1-year mortality and postoperative kidney, neurologic, and cardiac dysfunction.ResultsOperative times differed between the cohorts, with Arch w/ STAR patients having the lowest operative times. Peak postoperative lactate was lower in patients who underwent Arch w/ STAR compared with Arch w/ HCA/CP. On multivariable analysis, patients in the Arch w/ HCA/CP demonstrated higher peak postoperative lactate. Postoperative creatinine was primarily predicted by baseline renal function on multivariable analysis. Arch w/ STAR and Arch/ASD/VSD w/ STAR patients had a shorter time to chest closure, and Arch/ASD/VSD w/ STAR patients produced more urine at 24 h postoperative compared with patients who underwent Arch/ASD/VSD w/ HCA/CP. There were no differences in neurologic outcomes. No mortality occurred in our STAR cohorts.ConclusionSTAR perfusion is an emerging technique that is associated with lower peak lactate levels and shorter operative times compared with patients undergoing traditional methods of aortic reconstruction.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261480009"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083540","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":"Large Pulmonary Valve Vegetation Causing Right Ventricular Outflow Tract Obstruction in an Infant: Successful Complete Excision and Valve-Preserving Surgical Management.","authors":"Naveen Deep Kaur, Rupesh Kumar, Vishwanath V Mudur, K P Gourav","doi":"10.1177/21501351261472488","DOIUrl":"https://doi.org/10.1177/21501351261472488","url":null,"abstract":"<p><p>Isolated pulmonary valve infective endocarditis is exceedingly rare in infancy. We report an 8-month-old male infant presenting with feeding diaphoresis, failure to thrive, and intermittent fever for 3 months. Echocardiography demonstrated a large mobile mass (12 × 18 mm) attached to the pulmonary valve causing severe right ventricular outflow tract obstruction with a peak gradient of 56 mmHg. Computed tomography thoracic angiography also confirmed the presence of a 16 × 11.5 mm hypodense lesion at the level of the pulmonary valve causing pulmonary arterial obstruction. Urgent surgical intervention was performed. The mass was excised completely along with the pulmonary leaflet, and pulmonary valve neocuspidization was performed using glutaraldehyde-treated autologous pericardium. Histopathology confirmed infective vegetation. The postoperative course was uneventful, and follow-up echocardiography showed no residual obstruction with trivial pulmonary regurgitation. This case highlights the importance of early diagnosis and demonstrates that valve-preserving reconstruction using autologous pericardium is a feasible and effective strategy in infants with destructive pulmonary valve endocarditis.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261472488"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121287","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":"Sex Differences in Congenital Heart Surgery in Low and Middle Income Countries.","authors":"Anita Saxena, Kimberlee Gauvreau, Anne Betzner, Bistra Zheleva, Sandra Mattos, Laila Akbar Ladak, Kathy Jenkins","doi":"10.1177/21501351261472490","DOIUrl":"https://doi.org/10.1177/21501351261472490","url":null,"abstract":"<p><p>BackgroundCongenital heart diseases (CHD) are the most common birth defect. Previous studies found sex disparities in outcomes after cardiac surgery and in access to treatment, but little data is available for low- and middle-income countries (LMIC).MethodsData on CHD surgical admissions in children <18 years of age from 70 sites in 25 LMIC for cases between 2011 and 2020 from the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) were analyzed to explore whether risk-adjusted in-hospital mortality and major infections differed by sex overall and for six common CHD surgeries. The difference between the percentage of males and females operated on for these CHDs was compared between the IQIC and in the United States (KID 2012).FindingsOf 108,439 surgical admissions, 54.4% (59,021/108,439) were males. After adjusting for case mix, no statistically significant differences in odds ratios for mortality or infection by sex were found, although females had a lower risk of death in lower complexity and higher risk of infection in higher complexity surgeries. Six lesions analysis revealed higher odds of mortality in females for ventricular septal defect repair and higher risk of major infection for coarctation repair and the arterial switch operation compared with males. For 5 of the 6 lesions, fewer females underwent surgery in IQIC compared with the United States.InterpretationOur findings suggest that female children in LMIC have unequal access to CHD surgery compared with males with few postoperative differences in mortality or infection. Cultural and socio-economic factors such as access to timely diagnosis may be contributory.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261472490"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083651","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":"Isolated Right Aortic Arch Vascular Ring Tracheal Compression Can Significantly Increase in the Short Term.","authors":"William N Evans, Ruben J Acherman, Gary A Mayman, Dean Berthoty, Humberto Restrepo","doi":"10.1177/21501351261473229","DOIUrl":"https://doi.org/10.1177/21501351261473229","url":null,"abstract":"<p><p>ObjectiveOur principal objective was to evaluate the progression of tracheal compression over time in patients with isolated right aortic arch vascular rings (RAA VRs) who underwent serial computed tomographic (CT) scans. Our secondary objective was to characterize the outcomes of our comprehensive prenatal screening program for VRs.MethodsWe identified all infants born in Nevada with an isolated VR diagnosed prenatally or in infancy between January 2018 and December 2025.ResultsWe identified 168 children with an isolated vascular ring. Of the 168 children, 34/168 (20%) were CT-scan-confirmed double aortic arches, and 134/168 (80%) were RAA VRs, of which 104 were CT-scan-confirmed. Thirty infants only had an initial fetal echocardiogram diagnosis (12 pending CT scan, and 18 lost to follow-up). Of the 104 patients with a CT-scan-confirmed RAA VR, 88 underwent 1 preoperative CT scan, and 16 underwent 2 preoperative CT scans. Of the 16 infants with 2 scans, all with right aortic arch, aberrant left subclavian artery-left ductus arteriosus/left ligamentum (RAA ALSCA-LDA/LL) anatomy: the initial scan average tracheal compression was 29 ± 11% at a median age of 2 weeks. The subsequent average tracheal compression was 50 ± 10% (<i>P</i> = .00001) at a median time of 14.4 months from the first to the second CT scan<b>.</b>ConclusionsNevada has a high prenatal detection rate for isolated vascular rings. In addition, isolated vascular rings are not rare. Furthermore, initial neonatal CT-confirmed mild tracheal compression from a RAA ALSCA-LDA/LL can increase significantly in the short term, supporting the need for close follow-up and the potential value of infant repair.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261473229"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083599","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":"Axillary Arteriovenous Fistula for Resolution of Pulmonary Arteriovenous Malformations Following Bidirectional Superior Cavopulmonary Connections.","authors":"Ibrahim J Alibrahim, Ahmed Alomrani, Abdulraouf M Z Jijeh, Mohamed S Kabbani, Fahad Alhabshan, Omar R Tamimi, Faleh Alqahtani, Abdullah Alghamdi","doi":"10.1177/21501351261477042","DOIUrl":"https://doi.org/10.1177/21501351261477042","url":null,"abstract":"<p><p>BackgroundPulmonary arteriovenous malformations (PAVMs) are a major cause of cyanosis after bidirectional cavopulmonary connection. We evaluated the effects of axillary arteriovenous fistula (AAVF) creation in managing PAVMs.MethodsThis retrospective cohort study included patients who underwent AAVF creation from 2014 to 2022 with ≥6 months of follow-up. Patients underwent diagnostic cardiac catheterization to assess hemodynamic and angiographic response to AAVF. Oxygen saturation (SO₂) was recorded at 1, 2, and 6 months postoperatively, then every 3-6 months, and temporal correlations were analyzed.ResultsTwelve patients underwent AAVF creation. Nine (75%) showed improvement; 5 proceeded to total cavopulmonary connection (Fontan), and 4 remained with AAVF as final palliation. Nine patients underwent follow-up catheterization ≥6 months after AAVF, demonstrating significant improvement in pulmonary venous saturation, aortic saturation, and McGoon ratio (<i>P</i> = .013, .012, and .011, respectively). Early postoperative SO₂ at 2 months strongly correlated with later SO₂ at 6, 12, 18, and 24 months (<i>P</i> = .003, .004, .004, and .018, respectively).ConclusionsAxillary arteriovenous fistula creation was effective in treating PAVMs in 75% (9/12) of our patients and was effective as a bridge to total cavopulmonary connection (TCPC) in all patients. It may be considered an alternative to TCPC when TCPC is not feasible; however, this requires validation in a larger population with longer follow-up. Finally, mid-term SO₂ can be predicted based on the first 2 months of SO₂ post-AAVF creation, as there is excellent correlation between SO₂ at the first 2 postoperative months and SO₂ at 6, 12, 18, and 24 months.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261477042"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077217","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":"Pulmonary Artery Wall Abnormalities in an Asymptomatic Newborn Who Underwent Neonatal Absent Pulmonary Valve Syndrome Repair.","authors":"Yaroslav Ivanov, Mihnea P Dragomir, Yaroslav Mykychak, Mi-Young Cho, Simon Schallenberg, Joachim Photiadis","doi":"10.1177/21501351261480008","DOIUrl":"https://doi.org/10.1177/21501351261480008","url":null,"abstract":"","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261480008"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077225","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":"Cone Procedure for Atypical Ebstein Anomaly After Partial Atrioventricular Septal Defect Repair.","authors":"Yaroslav Ivanov, Yaroslav Mykychak, Viktoria Weixler, Sulejman Abdusalamov, Mi-Young Cho, Joachim Photiadis","doi":"10.1177/21501351261477064","DOIUrl":"https://doi.org/10.1177/21501351261477064","url":null,"abstract":"<p><p>We present a case demonstrating the successful application of the Cone procedure to treat severe right atrioventricular valve insufficiency in a patient with atypical Ebstein anomaly who had prior repair of a partial atrioventricular septal defect.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261477064"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077235","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 Proposed Clinical Algorithm for Children with Upper Respiratory Illness Undergoing Elective Cardiac Procedures Requiring Anesthesia.","authors":"Robert Ricketts, Christopher Denny, Matthew Monteleone","doi":"10.1177/21501351261484543","DOIUrl":"https://doi.org/10.1177/21501351261484543","url":null,"abstract":"<p><p>BackgroundChildren presenting for elective procedures with upper respiratory illness (URI) represent a common clinical dilemma. While several decision algorithms exist to guide perioperative management in the general pediatric surgical population, to our knowledge, no published perioperative decision frameworks specifically address children with congenital heart disease (CHD) presenting for elective procedures with URI, despite their unique physiology and perioperative risk.MethodsA review of the pediatric and congenital cardiac anesthesia literature was performed to evaluate established clinical algorithms used to guide decisions to proceed with elective cases requiring anesthesia in children with URIs. We also reviewed the literature assessing risk associated with URI symptoms in children with CHD undergoing procedures requiring anesthesia.ResultsSeveral clinical algorithms exist to help clinicians decide whether to proceed with elective procedures in children with URI symptoms. These algorithms emphasize symptom severity, comorbid pulmonary disease, and surgical factors when determining whether to proceed with anesthesia. However, no current decision algorithms address pediatric patients with heart disease. Existing algorithms do not account for these patients' diverse cardiac physiologies and risks. We propose an algorithm emphasizing the severity of respiratory illness, the patient's cardiac physiology, and selective, deliberate viral testing in specific clinical circumstances.ConclusionsChildren with cardiac disease undergoing cardiac procedures with URI symptoms represent a unique population not addressed by existing decision algorithms. The proposed algorithm prioritizes clinical examination, the patient's cardiac physiology, and judicious viral testing. This algorithm may reduce postponement of cardiac procedures in this patient population while maintaining favorable clinical outcomes.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261484543"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993271","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":"Direct Innominate Artery Cannulation for Antegrade Cerebral Perfusion Across the Spectrum of Congenital Aortic Arch Reconstruction.","authors":"Héctor S Diliz Nava, Diego Rodríguez Alvirde, Alejandro Reyes Rodríguez, Alexis Palacios-Macedo Quenot","doi":"10.1177/21501351261477057","DOIUrl":"https://doi.org/10.1177/21501351261477057","url":null,"abstract":"<p><p>BackgroundAntegrade cerebral perfusion (ACP) is widely used during congenital aortic arch reconstruction; however, variability persists regarding cannulation strategies. Direct innominate artery cannulation may simplify arterial access while maintaining reliable cerebral perfusion, but reports describing its systematic use remain limited.MethodsA retrospective single-center study was performed including consecutive patients undergoing congenital aortic arch reconstruction with ACP established through direct innominate artery cannulation between December 2022 and February 2026. All procedures were performed using the same cannulation strategy by the same attending congenital cardiac surgeon. Demographic, operative, perfusion, and postoperative variables were analyzed.ResultsTwenty-five patients underwent aortic arch reconstruction using direct innominate artery cannulation for ACP. Age ranged from 6 to 971 days and weight from 2.0 to 12.7 kg. Diagnoses included coarctation complex with transverse arch hypoplasia, interrupted aortic arch, Taussig-Bing anomaly, transposition of the great arteries, recoarctation with arch hypoplasia, complete atrioventricular septal defect, and borderline left ventricle. Associated procedures included ventricular septal defect closure and arterial switch operation. Mean cardiopulmonary bypass time was 153 min, mean cross-clamp time was 67 min, and mean ACP duration was 24 min. No cannulation-related vascular injuries or conversions occurred. No structural neurologic injury was identified. One patient developed transient neurologic symptoms without sequelae. Two hospital deaths occurred, neither attributable to the cannulation technique.ConclusionsDirect innominate artery cannulation represents a safe, reproducible, and technically straightforward strategy for ACP during congenital aortic arch reconstruction. Consistent use without major modification supports its reliability across a heterogeneous spectrum of congenital arch procedures.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261477057"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993366","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":"Aortic Uncrossing With Double Arterial Cannulation Strategy for a Circumflex Aorta in an 11-Year-Old Child.","authors":"Roman Sekelyk, Maksym Delikatnyi, Vsevolod Safonov, Raad Tammo, Hanna Morkovkina, Ibrahim Yusifli, Dmytro Kozhokar, Illya Yemets","doi":"10.1177/21501351261484521","DOIUrl":"https://doi.org/10.1177/21501351261484521","url":null,"abstract":"<p><p>We report a successful aortic uncrossing procedure in an 11-year-old boy weighing 25 kg who presented with a 2-year history of persistent cough and severe dysphagia. Computed tomography (CT) confirmed a circumflex aorta. Cardiopulmonary bypass was established using double arterial cannulation (DAC) of the ascending and descending aorta. Postoperatively, symptoms resolved immediately, and the patient was discharged from the hospital uneventfully. At the 3-month follow-up, repeat CT confirmed the complete absence of tracheoesophageal compression. Aortic uncrossing using DAC is a safe strategy for managing a circumflex aorta.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"21501351261484521"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993439","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}