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World Journal for Pediatric & Congenital Heart Surgery

Saurabh Rajpal, Alexander R Opotowsky, Anna Rutherford, Fred Wu
Recurrent ascites is a common manifestation of failing Fontan circulation. We present the hemodynamic response to large-volume paracentesis in a patient with Fontan circulation and Fontan-associated liver disease, documenting an immediate and substantial decline in systemic venous pressure and increase in cardiac output. These preliminary observations may have implications for the management of ascites in adults with Fontan circulation.
October 24, 2018: World Journal for Pediatric & Congenital Heart Surgery
Fadoua Lachhab, Rachida Amri, Loubna Mahfoudi, Said Moughil
Anomalous left coronary artery from the pulmonary artery (ALCAPA) was described by Abbott in 1908. In most cases, it is an isolated lesion, being the most common cause of myocardial ischemia in children. The associated mortality rate without intervention reaches 90% during childhood. We report the case of a 67-year-old woman, who underwent coronary angiography for investigation of atypical chest pain and was found to have ALCAPA. The patient refused surgery and has remained asymptomatic on a medical regimen...
October 18, 2018: World Journal for Pediatric & Congenital Heart Surgery
Siddharth Amboli, Yatindra U Ashtaputre, Anuradha Kamath, Channabasavaraj S Hiremath, Krishna Manohar
Partial anomalous pulmonary venous return is a congenital anomaly in which some of the pulmonary veins drain into the right atrium or one of its venous tributaries. Although excellent long-term results have been described for the classic two-patch technique repair in older patients, The Warden procedure has an important role in smaller and younger patients and those patients in whom the superior vena cava (SVC) may be small and the right-sided pulmonary veins may connect high, at or above the azygos vein. In addition to prevention of early and late sinus node dysfunction, the Warden procedure helps to avoid systemic or pulmonary venous obstruction if care is taken to ensure a tension-free Warden anastomosis...
October 18, 2018: World Journal for Pediatric & Congenital Heart Surgery
Ujjwal Kumar Chowdhury, N B Diplomate, Jhulana Kumar Jena, Suruchi Hasija, Lakshmi Kumari Sankhyan
We report two male patients aged 18 and 19 years, respectively, undergoing total pericardiectomy for chronic calcific constrictive pericarditis who developed systemic ventricular failure unresponsive to medical management following surgery. The failing circulation was successfully reestablished using intra-aortic balloon counterpulsation. Aortic counterpulsation facilitates recovery of ventricular function and appears to be a reasonable alternative in select instances of refractory cardiac failure following pericardiectomy...
October 14, 2018: World Journal for Pediatric & Congenital Heart Surgery
Carlos Domínguez-Massa, Félix Serrano-Martínez, Óscar R Blanco-Herrera, Alberto Berbel-Bonillo, Fernando Hornero-Sos, José A Montero-Argudo
Thorough study is required to decide the appropriate management of hepatic tumors in children. We present a case report of a hepatic embryonal undifferentiated sarcoma with unfavorable prognosis in a nine-year-old girl. After undergoing a detailed cancer characteristics and extension study, a two-stage surgery approach was decided. The hepatic tumor resection was the first procedure to be performed. One week later, under cardiopulmonary bypass, deep hypothermia, and circulatory arrest, thrombectomy of the inferior vena cava and right atrium was accomplished, plus thromboendarterectomy of the right pulmonary artery...
October 14, 2018: World Journal for Pediatric & Congenital Heart Surgery
Sachin Talwar, Arun Basil Mathew, Amol Bhoje, Neeti Makhija, Shiv Kumar Choudhary, Balram Airan
We report the case of a six-year-old patient who underwent an extracardiac Fontan operation including bilateral bidirectional superior cavopulmonary anastomosis and direct inferior vena cava to main pulmonary artery connection that was performed without cardiopulmonary bypass.
October 10, 2018: World Journal for Pediatric & Congenital Heart Surgery
Kuntal Roy Chowdhuri, Manoj Kumar Daga, Subhendu Mandal, Pravir Das, Amanul Hoque, Saumen Meur, Somenath Gorain, Nilanjan Dutta, Krishna Subramony Iyer
The surgical management of d-transposition of great arteries (d-TGAs) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is ever evolving and still remains a challenge because of wide anatomic variability, age of presentation, surgical options available, and their variable long-term results in different series. We describe a patient with d-TGA, VSD, and LVOTO who presented to us at 13 years of age and underwent an arterial switch operation along with neoaortic valve replacement with a mechanical prosthesis...
October 10, 2018: World Journal for Pediatric & Congenital Heart Surgery
Emily N Lawson, Michael D Seckeler
Young children with congenital heart disease are undergoing an increasing number of catheter-based interventions. These procedures can lead to obstruction of large central veins, making future interventions more challenging or even impossible. We present a young child with a chronically occluded inferior vena cava (IVC) secondary to prior catheterization-based interventions for congenital heart disease. The IVC was recanalized with serial angioplasty and stent placement with continued patency for over two years...
October 8, 2018: World Journal for Pediatric & Congenital Heart Surgery
Raghav Murthy, Nicole L Herrick, Howaida El-Said, Paul Grossfeld, John Moore, John J Lamberti
Ehlers-Danlos syndrome vascular type IV is characterized by translucent skin, easy bruising, and fragility of arteries. A full-term female infant presented at four weeks of age with a diagnosis of d-transposition of the great arteries with restrictive atrial septal defect. She successfully underwent emergent balloon atrial septostomy and placement of patent ductus arteriosus (PDA) stent. She required restenting of the PDA and pulmonary artery banding prior to arterial switch procedure. At 16 months of age, the patient successfully underwent arterial switch procedure without complication...
October 8, 2018: World Journal for Pediatric & Congenital Heart Surgery
Jeremy Steele, Lourdes Prieto, David Majdalany, Robert Stewart, Hani Najm, Malek El Yaman
Systemic venous anomalies can occur in isolation or in association with other congenital heart disease. A left superior vena cava draining to a roofed coronary sinus represents the most common venous variant and is usually inconsequential. Embryologic or acquired disruptions in systemic veins can be problematic due to shunting and/or venous obstruction. In this case series, we report four systemic venous anomalies in patients with atrial and ventricular situs solitus. Each case demonstrates how clinically significant right to left shunts can occur from a systemic vein to the left atrium...
September 16, 2018: World Journal for Pediatric & Congenital Heart Surgery
Adam M Lubert, Timothy B Cotts, Peter K Henke
A 24-year-old woman with a history of coarctation repair by subclavian flap aortoplasty presented at 15 weeks' gestation with transient episodes of vision loss. She was diagnosed with subclavian steal syndrome and underwent left carotid artery to subclavian artery bypass at 17 weeks' gestation. She has had no recurrence of symptoms at ten months of postoperative follow-up. Despite the anatomic substrate for subclavian steal in patients with this type of surgical repair, neurologic symptoms are uncommon. It is possible that the pregnancy-induced fall in systemic vascular resistance triggered symptoms in this previously asymptomatic patient...
September 10, 2018: World Journal for Pediatric & Congenital Heart Surgery
Sethuraman Swaminathan, Arpit Agarwal, Juan C Infante, Eliot Rosenkranz
Tetralogy of Fallot with absent pulmonary valve syndrome is a rare form of congenital heart disease. Among the different variations with this rare anomaly is nonconfluent pulmonary artery branches with anomalous origin of the left pulmonary artery from the ductus arteriosus. The authors present one such case which was diagnosed prenatally to have tetralogy of Fallot with absent pulmonary valve and identified postnatally to have nonconfluent pulmonary artery branches in addition. We discuss the conundrum of respiratory management in this patient pre- and postoperatively due to a unique ventilation perfusion mismatch problem, which varies between the two lungs...
August 27, 2018: World Journal for Pediatric & Congenital Heart Surgery
Reid C Chamberlain, Kevin D Hill, Gregory A Fleming
Obstructed total anomalous pulmonary venous connection (TAPVC) involves anomalous drainage of all pulmonary veins to a location other than the left atrium and typically causes significant respiratory symptoms requiring urgent surgical repair. Premature infants born with obstructed TAPVC are often not considered to be suitable surgical candidates due to their size and therefore pose a significant treatment dilemma. Catheter-based interventions provide a temporizing option for infants with obstructed TAPVC, allowing for hemodynamic stabilization and growth until surgical intervention is feasible...
August 22, 2018: World Journal for Pediatric & Congenital Heart Surgery
Michael Gritti, Anne Ferris, Amee Shah, Emile Bacha, David Kalfa
Medical management of infective endocarditis in the pediatric population has an associated in-hospital mortality rate of up to 25%. In the past, infective endocarditis of the mitral valve was surgically managed with a valve replacement. Now, there is a shift toward repair. However, for complex lesions in pediatric patients, many institutions are still hesitant to perform a mitral valve repair. We describe the cases of three children with destructive mitral valve endocarditis and risk factors for higher perioperative mortality and morbidity who were successfully treated with a complex mitral valve repair with "splint" patch plasty of the posteromedial commissure...
August 21, 2018: World Journal for Pediatric & Congenital Heart Surgery
John S Kim, Jon Kaufman, Sonali S Patel, Marilyn Manco-Johnson, Jorge Di Paola, Eduardo M da Cruz
BACKGROUND: Ketorolac is used for pediatric analgesia after surgery despite its known platelet inhibition via the arachidonic acid (AA) pathway. The degree of platelet inhibitory effect after cardiac surgery is not well characterized. Thromboelastography with platelet mapping (TEG-PM) is emerging as a frequently used test to evaluate platelet inhibition via the AA pathway. METHODS: Post hoc analysis of a data set collected in a prospective observational cohort study evaluating platelet inhibition in children after congenital heart surgery with cardiopulmonary bypass (CPB)...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
Christin Huff, Christopher W Mastropietro, Christine Riley, Jonathan Byrnes, David M Kwiatkowski, Misty Ellis, Jennifer Schuette, Lindsey Justice
As the acuity and complexity of pediatric patients with congenital cardiac disease have increased, there are many noncardiac issues that may be present in these patients. These noncardiac problems may affect clinical outcomes in the cardiac intensive care unit and must be recognized and managed. The Pediatric Cardiac Intensive Care Society sought to provide an expert review of some of the most common challenges of the respiratory, gastrointestinal, hematological, renal, and endocrine systems in pediatric cardiac patients...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
Bahaaldin Alsoufi, Courtney McCracken, Lazaros K Kochilas, Martha Clabby, Kirk Kanter
BACKGROUND: Several advances have led to improved hospital survival following neonatal palliation (NP) of single ventricle (SV) anomalies. Nonetheless, a number of patients continue to suffer from interstage mortality (ISM) prior to subsequent Glenn. We aim to study patients' characteristics and anatomic, surgical, and clinical details associated with ISM. METHODS: A total of 453 SV neonates survived to hospital discharge following NP. Competing risk analysis modeled events after NP (Glenn, transplantation, or death) and examined variables associated with ISM...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
David Blitzer, Jeremy L Herrmann, John W Brown
BACKGROUND: Mitral valve replacement (MVR) with a pulmonary autograft (Ross II) may be a useful technique for pediatric and young adult patients who wish to avoid anticoagulation. Our aim was to evaluate the long-term outcomes of the Ross II procedure at our institution. METHODS: Patients undergoing the Ross II procedure between June 2002 and April 2008 were included. Preoperative diagnoses included rheumatic disease (n = 5), congenital mitral valve (MV) pathology (partial atrioventricular canal defect [n = 2], complete atrioventricular canal defect [n = 1], Shone's complex [n = 1]), and myocarditis (n = 1)...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
Néstor F Sandoval, Catalina Vargas Acevedo, Juan Bernardo Umaña, Ivonne Pineda, Albert Guerrero, Carlos Obando, Juan P Umaña, Jaime Camacho
BACKGROUND: The approach to coarctation of the aorta with hypoplastic aortic arch is controversial. We evaluated the outcomes in patients with coarctation of the aorta with or without hypoplastic aortic arch operated through a posterior left lateral thoracotomy. METHODS: A retrospective cohort of patients with aortic coarctation, who underwent repair between January 2009 and October 2017, was analyzed. Preoperative, postoperative, and echocardiographic characteristics were reviewed...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
Jürgen Hörer
Surgical techniques for correction of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction have been introduced into clinical practice nearly five decades ago. However, the optimal surgical strategy is still controversial. The reasons for the diverse approaches to this malformation are discussed in this commentary.
November 2018: World Journal for Pediatric & Congenital Heart Surgery
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