The World Society for Pediatric and Congenital Heart Surgery: 2024 Update of the World Database for Pediatric and Congenital Heart Surgery
Published: September 06, 2024.
Volume 15, Number 5
Pages 551-561
Contributors
James D. St Louis; Craig S. Collum; John K. Pennington; Taylor Broser; Rama Rudraraju; Maceo Cleggett; Jeanne Anne Love; Patricia Potter; Brian Bateson; Ignacio Juaneda; Jorge Luis Cervantes; Cheul Lee; Jeffery P. Jacobs; Erle H. Austin; James K. Kirklin
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 551-561, September 2024.
Background: The World Database for Pediatric and Congenital Heart Surgery (WDPCHS), sponsored by the World Society for Pediatric and Congenital Heart Surgery (WSPCHS), provides complex congenital heart surgery outcomes analyses for member programs. This report represents the seven-year descriptive analysis of outcomes from active members of the WDPCHS. Methods: Individual institutions submit data based on the specific procedure via a password protected platform. The data are collected, stored, and analyzed at Kirklin Solutions Inc., based in Birmingham, Alabama. This report presents a descriptive analysis of these procedures submitted from January 1, 2017, to December 31, 2023. Results: A total of 50,174 procedures were submitted with an overall mortality of 4.6%. The majority of submissions were from Asian countries. The majority of cases submitted from these countries were of STAT mortality category I and II. Repair of a ventricular septal defect (with a mortality of 0.8%) and correction of tetralogy of Fallot (2.0% mortality) were the most common procedures submitted to the database. Conclusions: The WSPCHS accomplished one of its missions in 2017 when the WDPCHS began accepting data from pediatric and congenital heart surgery programs across the globe. In doing so, it became one of the first organizations to create a platform for the exchange of knowledge and experience, regardless of the socioeconomic status of the particular program or country.
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The Fate of the Left Ventricular Outflow Tract Following Interrupted Aortic Arch Repair
Published: July 25, 2024.
Volume 15, Number 5
Pages 562-570
Contributors
Shuhua Luo; Paul H. Schoof; Edward Hickey; Conall Morgan; Nina A. Korsuize; Heynric B. Grotenhuis; Luc Mertens; Jaymie Varenbut; Mimi Xiaoming Deng; Maruti Haranal; William Border; Brian Schlosser; Glen Van Arsdell; Bahaaldin Alsoufi
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 562-570, September 2024.
Objectives: To examine the probability of left ventricular outflow tract (LVOT) reintervention following interrupted aortic arch (IAA) repair in neonates with LVOT obstruction (LVOTO) risk. Methods: This retrospective multicenter study included 150 neonates who underwent IAA repair (2003-2017); 100 of 150 (67%) had isolated IAA repair (with ventricular septal defect closure) and 50 of 150 (33%) had concomitant LVOT intervention: conal muscle resection (n = 16), Ross-Konno (n = 7), and Yasui operation (n = 27: single-stage n = 8, staged n = 19). Demographic and morphologic characteristics were reviewed. Factors associated with LVOT reoperation were explored using multivariable analysis. Results: Concomitant LVOT intervention was more likely in neonates with type B IAA, bicuspid aortic valve, aberrant right subclavian artery, smaller aortic valve annulus, and ascending aorta dimensions. On follow-up, five-year freedom from LVOT reoperation was highest following Ross-Konno (100%), 77% following Yasui (mainly for neo-aortic regurgitation), 77% following isolated IAA repair (mainly for LVOTO), and 47% following IAA repair with concomitant conal resection, P = .033. While all patients had low peak LVOT gradient at time of discharge, those who had conal resection developed higher gradients on follow-up (P = .007). Ross-Konno and Yasui procedures were associated with higher right ventricular outflow tract (RVOT) reoperation. In the cohort following isolated IAA repair, aortic sinus Z score was associated with LVOT reoperation. Conclusions: Both Yasui and Ross-Konno operations effectively mitigate late LVOTO risk. The highest risk of reintervention for LVOTO was associated with conal muscle resection while the lowest risk is associated with Ross-Konno. The RVOT reoperation risk in patients who had Ross-Konno or Yasui does not seem to affect survival.
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Autograft Reoperation Following the Ross Procedure: Evolving Strategies and Future Perspectives
Published: May 08, 2024.
Volume 15, Number 5
Pages 571-580
Contributors
Tommaso Generali; Iain McPherson; Alexandru C. Visan; Amir Mohamed; Mahmoud I. Salem; Katrijn Jansen; Louise Coats; Justyna Rybicka; David Crossland; Asif Hasan; Mohamed Nassar
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 571-580, September 2024.
Background: Pulmonary autograft failure remains a cause of reoperation following the Ross procedure. The aim of this study is to describe our evolving approach to autograft reoperations. Methods: Retrospective study of all patients who underwent a pulmonary autograft reoperation following a Ross procedure between June 1997 and July 2022. Results: Two-hundred and thirty-five Ross procedures were performed. Thirty-six patients (15%) plus one referral underwent an autograft reoperation at a median of 7.8 years (IQR 4.6-13.6). The main indication was: neoaortic root dilatation associated with mild/moderate (n = 12) or severe (n = 8) aortic regurgitation; isolated severe aortic regurgitation (n = 6); infective endocarditis (IE) (n = 8); and aortic root pseudoaneurysm with no history of IE (n = 3). The autograft was spared in 29 cases (78%): 9 patients (24%) underwent aortic valve repair or aortic root remodeling, 15 patients (40%) aortic root reimplantation, 5 patients neoaortic root stabilization with a Personalized External Aortic Root Support (PEARS) sleeve. There were no in-hospital deaths. At a median follow up of 37 months (IQR 8-105), all patients were alive, 30 (81%) were asymptomatic. Eight patients (22%) required nine further reoperations. Estimated freedom from further reoperation was 90%, 72%, and 72% at 12-, 36-, and 60-months. Conclusions: Autograft reoperations following the Ross procedure can be safely performed and do not affect overall survival in the early and mid-term. Valve-sparing autograft replacement is technically feasible but remains at risk of further interventions. Alternative strategies, such as the PEARS sleeve, are becoming increasingly available but requires validation in the long term.
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Surgical Management of Norwood Procedure for Atypical Aortic Arch
Published: May 20, 2024.
Volume 15, Number 5
Pages 581-587
Contributors
Shota Masaki; Yusuke Ando; Toshihide Nakano
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 581-587, September 2024.
Background: Postoperative restenosis of the aortic arch after the Norwood procedure is still an important complication that significantly affects surgical outcomes. The rarity of the Norwood procedure for atypical aortic morphology means appropriate arch reconstruction methods and postoperative complications are still unknown. This study aimed to assess the rate of arch reintervention and clinical outcomes after the Norwood procedure for atypical aortic arch. Methods: This retrospective single-center study was conducted between 2001 and 2022. Sixteen patients were identified, eight with a right aortic arch, five with transposition of the great arteries, one with a right aortic arch and transposition of the great arteries, and two with a large tortuous patent ductus arteriosus connected to the opposite side of the descending aorta. We selected and performed four different surgical techniques depending on each aortic arch morphology. Results: Except for one case, autologous tissue-only arch reconstruction was possible. There was one operative death and four late deaths. Overall, no patients required any surgical or catheter-based reintervention for the aortic arch. On the other hand, left pulmonary artery stenosis due to a narrow subaortic space was found in two patients. Conclusions: The Norwood procedure for atypical aortic arch was performed with good results by choosing the appropriate technique for each morphology. On the other hand, pulmonary artery stenosis is likely to occur especially in the transposition of the great arteries group. Therefore, careful surgical method selection or further improvement of the technique that allows retroaortic space should be considered.
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Comparison of Levosimendan Versus Milrinone After the Arterial Switch Operation for Infants ≤3 kg
Published: May 20, 2024.
Volume 15, Number 5
Pages 588-596
Contributors
Reena Khantwal Joshi; Raja Joshi; Neeraj Aggarwal; Mridul Agarwal; C. Rudrappa Siddartha; Jay Relan; Anil Kumar; Manoj Modi; Parul Chug
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 588-596, September 2024.
Background: Various inotropes and inodilators have been utilized to treat low cardiac output syndrome after the arterial switch operation. The use of levosimendan, a calcium sensitizer has been limited in this setting. This study compares the effects of levosimendan with milrinone in managing low cardiac output after the arterial switch operation. Methods: A retrospective, comparative study was conducted in a tertiary care hospital on patients weighing up to 3 kg undergoing the arterial switch operation between January 2017 and January 2022. Patients received a loading dose followed by continuous infusion of either levosimendan or milrinone. Echocardiographic, hemodynamic and biochemical parameters were compared. Results: Forty-three patients received levosimendan and 42 patients received milrinone as the primary test drug. Cardiac index of less than 2.2 L/min/m2 on postoperative day 1 and 2 was found in 9.3% and 2.3% of patients receiving levosimendan versus 26.2% and 11.9% in those receiving milrinone, respectively (P = .04 and .08, respectively). Early lactate-clearance and better central venous oxygen saturations were noted in the levosimendan group. Prevalence of acute kidney injury was higher in the milrinone group (50% vs 28%; P = .03). Use of peritoneal dialysis in the milrinone group versus levosimendan was 31% and 16.3%, respectively (P = .11). There was no difference in hospital mortality between the groups (milrinone, 3; levosimendan, 2, P = .62). Conclusions: Levosimendan is safe and as effective as milrinone to treat low cardiac output syndrome occurring in neonates after the arterial switch operation. In addition we found that levosimendan was renal protective when compared with milrinone.
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Surgical Protocol for Partial Heart Transplantation in Growing Piglets
Published: May 23, 2024.
Volume 15, Number 5
Pages 597-603
Contributors
Cathlyn K. Medina; Berk Aykut; Lillian Kang; Deani McVadon; Douglas M. Overbey; Kristi L. Helke; Carolyn L. Taylor; David C. Fitzgerald; Marc Hassid; Alicia M. Braxton; Stephen G. Miller; Corey Mealer; Chak-Sum Ho; Kristin M. Whitworth; Randall S. Prather; Mary E. Moya-Mendez; Sydney Jeffs; Lauren E. Parker; Joseph W. Turek; Taufiek Konrad Rajab
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 597-603, September 2024.
Partial heart transplantation is a new approach to deliver growing heart valve implants. Partial heart transplants differ from heart transplants because only the part of the heart containing the necessary heart valve is transplanted. This allows partial heart transplants to grow, similar to the valves in heart transplants. However, the transplant biology of partial heart transplantation remains unexplored. This is a critical barrier to progress of the field. Without knowledge about the specific transplant biology of partial heart transplantation, children with partial heart transplants are empirically treated like children with heart transplants because the valves in heart transplants are known to grow. In order to progress the field, an animal model for partial heart transplantation is necessary. Here, we contribute our surgical protocol for partial heart transplantation in growing piglets. All aspects of partial heart transplantation, including the donor procedure, the recipient procedure, and recipient perioperative care are described in detail. There are important nuances in the conduct of virtually all aspects of open heart surgery that differs in piglets from humans. Our surgical protocol, which is based on our experience with 34 piglets, will allow other investigators to leverage our experience to seek fundamental knowledge about the nature of partial heart transplants. This is significant because the partial heart transplant model in piglets is complex and very resource intensive.
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Use of Hybrid Stage I to Stratify Between Single Ventricle Palliation and Biventricular Repair
Published: August 09, 2024.
Volume 15, Number 5
Pages 604-613
Contributors
Justin Smith; Jeffrey D. Zampi; Sowmya Balasubramanian; Bryan Mosher; Karen Uzark; Ray Lowery; Sunkyung Yu; Jennifer C. Romano
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 604-613, September 2024.
Background: Hybrid stage I palliation (HS1P) has been utilized for patients with single ventricle (SV) congenital heart disease (CHD). To date, reports on the use of HS1P for other indications including biventricular (BiV) CHD have been limited. Methods: We performed a single-center retrospective cohort study of patients who underwent HS1P with an anticipated physiologic outcome of BiV repair, or with an undetermined SV versus BiV outcome. Patient characteristics and outcomes from birth through definitive repair or palliation were collected and reported with descriptive statistics. Results: Nineteen patients underwent HS1P with anticipated BiV repair. Extracardiac and intracardiac risk factors (ICRF) were common. Ultimately, 13 (68%) patients underwent BiV repair, 1 (5%) underwent SV palliation, and 5 (26%) died prior to further palliation or repair. Resolution of ICRF tracked with BiV outcome (6/6, 100%), persistence of ICRF tracked with SV outcome or death (3/3, 100%). Twenty patients underwent HS1P with an undetermined outcome. Ultimately, 13 (65%) underwent BiV repair, 6 (30%) underwent SV palliation, and 1 (5%) underwent transplant. There were no deaths. Intracardiac risk factors were present in 15 of 20 patients (75%); BiV repair only occurred when all ICRF resolved (67%). Post-HS1P complications and reinterventions occurred frequently in both groups, through all phases of care. Conclusions: Hybrid stage 1 palliation can be used to defer BiV repair and to delay decision between SV palliation and BiV repair. Resolution of ICRF was associated with ultimate outcome. In this high-risk group, complications are common, and mortality especially in the marginal BiV patient is high.
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Comparison of Blalock-Taussig-Thomas Shunts With Patent Ductus Arteriosus Ligated Versus Left Open
Published: July 23, 2024.
Volume 15, Number 5
Pages 614-620
Contributors
Mandy W. Nasworthy; Mark Roeser; Deborah Frank; Jeffrey Vergales
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 614-620, September 2024.
Background: The optimal approach to patent ductus arteriosus management during systemic-to-pulmonary artery shunt placement is currently unknown. The purpose of this study is to examine the outcomes of variable strategies for patent ductus arteriosus management during Blalock-Taussig-Thomas shunt surgery. Methods: A retrospective cohort study of infants who underwent shunt placement was performed, comparing those who had the ductus ligated with those who had the ductus left open. Indicators of low cardiac output syndrome, development of necrotizing enterocolitis, and secondary outcomes such as resuscitation events were examined. Results: Thirty-six infants were included all of whom had their shunt placed via median sternotomy. Twenty infants had their ductus ligated at the time of the shunt, and they were compared with 16 infants whose ductus was left open. There was no statistical difference in preoperative baseline characteristics, including corrected gestational age, age in days, weight, mechanical ventilation, vasoactive use, heterotaxy, and gastrointestinal anomalies. There was also no statistical difference in postoperative indicators of low cardiac output, including urine production, total fluids given, renal injury, maximum lactate, and vasoactive-inotropic score. Three patients had postoperative renal injury, and all were in the ligated duct group. There was also no statistical difference in any secondary outcomes, including the development of necrotizing eneterocolitis, resuscitation events, reinterventions, length of intubation, total length of stay, and mortality. Conclusions: This study provides evidence that variable management of the ductus during shunt placement does not significantly impact outcomes. Leaving the ductus open allows for a potential rescue source of pulmonary blood flow and does not appear to increase the risk of postoperative low cardiac output.
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Pediatric Quadricuspid Aortic Valve: Morphology, Characteristics, Clinical Outcomes, and Literature Review
Published: July 25, 2024.
Volume 15, Number 5
Pages 621-627
Contributors
Jordan Holthe; Rabia Javed; Frank Cetta; Elizabeth H. Stephens; Jonathan N. Johnson; Donald J. Hagler; Talha Niaz
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 621-627, September 2024.
Background: Quadricuspid aortic valve (QAV) is an exceedingly rare congenital heart defect (CHD) which has not been well-defined in a pediatric population. Methods: The Mayo Clinic echocardiography database was retrospectively analyzed to identify patients ≤18 years diagnosed with QAV from January 1990 to December 2023. Patients with truncus arteriosus were excluded. All images were independently reviewed to define morphology of the QAV by using the Hurwitz and Roberts classification. Results: Fourteen patients with QAV were identified with a median age at time of diagnosis being 10.5 years (interquartile range [IQR] 6-14 years). Male-to-female ratio was 3:1. Associated CHDs were present in 50% (n = 7) patients. The most common morphological subtypes of QAV were Type D in 43% (n = 6) and Type B in 29% (n = 4). Aortic regurgitation was the most frequently associated valvular abnormality affecting 86% (n = 12) cases, with greater than moderate regurgitation in only two patients. Aortic valve stenosis was observed in 14% (n = 2) patients. Ascending aortic dilatation was present in 21% (3/14) of the cohort, but only 14% (1/7) of isolated QAV patients. At a mean follow up of 11 ± 6.6 years and a median follow-up age of 22 years (IQR 14-27 years), survival was 100% with no primary interventions on the aortic valve or aorta. However, four patients required surgical interventions for associated CHDs. Conclusion: Among children with QAV, almost half of the patients had additional CHD. Aortic regurgitation was the predominant hemodynamic abnormality. Long-term survival was excellent with minimal progression during childhood and adolescence.
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Scimitar Syndrome in a Pediatric Cohort
Published: May 22, 2024.
Volume 15, Number 5
Pages 628-635
Contributors
Laia Brunet-Garcia; Flavio Zuccarino; Fredy Hermógenes Prada Martínez; Juan Manuel Carretero Bellon
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 628-635, September 2024.
Background: Scimitar syndrome is a rare form of congenital heart disease (CHD) characterized by anomalous pulmonary venous drainage of the right lung to the inferior vena cava. We describe the presentation, diagnosis, therapeutic management and long-term follow-up of 10 pediatric patients with Scimitar Syndrome. Methods: We performed a retrospective observational study of all pediatric patients from our institution with scimitar syndrome (March 1996-July 2023). Patients underwent systematic evaluation including medical and family history, chest x-ray, 12-lead electrocardiogram, echocardiogram, angiography and/or computed tomography; or magnetic resonance angiography. Results: Ten patients with scimitar syndrome were included. The median age at diagnosis was 10.4 [0.1-150.2] months and the median follow-up time was 7.7 [1.3-15.3] years. Eight patients presented with aortopulmonary collateral arteries which were embolized. Two patients had dual connections to the inferior vena cava and left atrium; embolization of the inferior vena cava connection was only feasible in one of them. No patients underwent surgery of the scimitar vein. Three patients had surgical correction of CHDs. There were no deaths related to scimitar syndrome during follow-up. Conclusions: All patients with scimitar syndrome need prompt cardiovascular evaluation and follow-up. Our study demonstrates that a conservative approach with aortopulmonary collateral artery embolization, scimitar vein embolization when dual drainage to the left atrium is identified, along with correction of concomitant CHDs might have good results in patients with scimitar syndrome in order to postpone surgical correction of the anomalous pulmonary venous return to an older age when clinically or hemodynamically indicated. Further studies with longer-term follow-up and a larger sample size are needed to more effectively determine treatment strategy.
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Pediatric Monitoring Technologies and Congenital Heart Disease: A Systematic Review
Published: May 29, 2024.
Volume 15, Number 5
Pages 636-643
Contributors
Summer S. Duffy; Sharon Lee; Danielle Gottlieb Sen
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 636-643, September 2024.
Outpatient monitoring of infants with congenital heart disease has been shown to significantly reduce rates of mortality in the single ventricle population. Despite the accelerating development of miniaturized biosensors and electronics, and a growing market demand for at-home monitoring devices, the application of these technologies to infants and children is significantly delayed compared with the development of devices for adults. This article aims to review the current landscape of available monitoring technologies and devices for pediatric patients to describe the gap between technologies and clinical needs with the goal of progressing development of clinically and scientifically validated pediatric monitoring devices.
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Chylothorax in Infants and Children After Congenital Heart Surgery: Approach and Review
Published: May 06, 2024.
Volume 15, Number 5
Pages 644-652
Contributors
Anil Kumar; Sristy Agarwal; Reena Khantwal Joshi; Arun Gupta; Siddhartha C. Rudrappa; Neeraj Aggarwal; Raja Joshi
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 644-652, September 2024.
Chylothorax in infants after surgery for congenital heart disease is associated with significant morbidity and mortality. Numerous management modalities applied alone or in various combinations have been utilized but definitive guidelines have not yet been established. We present two infants who developed refractory chylothorax after congenital heart surgery. We also reviewed evidence for the use of available treatment modalities. In our experience, the use of lymphangiography followed by pleurodesis by povidone-iodine was safe and our impression was that it may have played a decisive role in controlling the lymph leak.
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Neonatal Diagnosis of Berry Syndrome: Interrupted Aortic Arch, Aortopulmonary Window, Intact Ventricular Septum, and Ascending Aortic Origin of the Right Pulmonary Artery
Published: July 23, 2024.
Volume 15, Number 5
Pages 653-655
Contributors
Nina Morgan; Arun Chandran
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 653-655, September 2024.
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Truncus Arteriosus With Cardiac Type of Total Anomalous Pulmonary Venous Connection
Published: July 23, 2024.
Volume 15, Number 5
Pages 656-657
Contributors
Neeraj Kumar; Niraj Nirmal Pandey; Sivasubramanian Ramakrishnan; Priya Jagia
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 656-657, September 2024.
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Heart Transplantation for Ebstein Anomaly due to Late Surgical Presentation
Published: May 02, 2024.
Volume 15, Number 5
Pages 658-660
Contributors
Tomas Leng; Joseph A. Dearani; Elizabeth H. Stephens; Jonathan N. Johnson
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 658-660, September 2024.
Ebstein anomaly is a myopathy of the right ventricle characterized by failure of tricuspid valve delamination with accompanying tricuspid regurgitation. Its rarity, considerable anatomic variability, and frequent absence of symptoms can make the timing of surgery challenging. Contemporary tricuspid repair techniques can be performed with low mortality and bidirectional cavopulmonary anastomosis reduces the risk of operation when right ventricular function is poor. Here, we present a patient who presented late for surgery, failed high-risk conventional surgery and required heart transplantation.
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Invited Commentary: Ebstein Anomaly: Insights on Isolated Atrial Septal Defect Device Closure
Published: July 23, 2024.
Volume 15, Number 5
Pages 661-662
Contributors
Luciana Da Fonseca Da Silva; Mario Castro Medina; Melita Viegas
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 661-662, September 2024.
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Advanced Imaging Guidance for Ductus Venosus Stenting in Obstructed Total Anomalous Pulmonary Venous Return
Published: May 16, 2024.
Volume 15, Number 5
Pages 664-667
Contributors
Ernesto Mejia; Gareth J. Morgan; Matthew Stone; Michael J. Shorofsky; James Jaggers; Jenny E. Zablah
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 664-667, September 2024.
Obstructed infracardiac total anomalous pulmonary venous return is nearly always a surgical emergency in which infants present in severe cardiopulmonary distress. Ductal venosus stenting can provide a temporizing option for premature, low birth weight infants with high risk for surgical complications. In challenging anatomic cases, virtual reality, 3D-printed models, and fusion image guidance can aid in procedural planning and provide support for successful intervention.
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Surgical Repair of Common Arterial Trunk With Ventriculoarterial Septal Defect and Dual Orifice Truncal Valve
Published: June 11, 2024.
Volume 15, Number 5
Pages 667-672
Contributors
Hamood Al Kindi; Abdullah Mohsen; Pranav Kandachar; Abdullah Al Balushi; Alaa M. Mohamed; Madan Maddali; Justin T. Tretter; Robert H. Anderson
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 667-672, September 2024.
We present a case of a rare example of a ventriculo-arterial septal defect found in a patient with a common arterial trunk, with balanced aortic and pulmonary components, but with separate valvar orifices within the common truncal valve. We managed the lesion using a two-patch approach. Performing a palliative procedure to relieve the elevated right ventricular pressure aided in the preservation of the pulmonary component of the common valve. We validated the success of the technique using postoperative computerized tomography and four-dimensional flow magnetic resonance imaging.
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A Rare Variant of Aorto-Atrial Fistula; Left Sinus of Valsalva Fistula to Superior Vena Cava and Right Atrium in a Neonate
Published: August 20, 2024.
Volume 15, Number 5
Pages 672-674
Contributors
Naveen Srinivasan
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 672-674, September 2024.
Aorta-atrial fistula (AAF) is defined as the communication of blood flow between the aorta and the atrium. Most of the fistula occurs between the ascending aorta and the right atrium. Aorta-atrial fistula occurs mostly due to acquired causes. Congenital causes remain a minority. We report a very rare variant of AAF in a two-day-old neonate in whom the fistula was arising from the left sinus of Valsalva of the aortic root and draining into the superior vena cava and the right atrium. The child underwent successful surgical ligation of the fistula on a beating heart and is doing well on a two-year follow-up.
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Pediatric Cardiac Myxoma: A Rare Cause of Stroke in a Six-Year-Old Child
Published: May 16, 2024.
Volume 15, Number 5
Pages 675-677
Contributors
Nada Alguizzani; Maryam Alomair; Shaaban Halawa; Mohammed Aljughiman
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 675-677, September 2024.
This is a case report of a six-year-old child who presented with signs and symptoms of a stroke, which led to the detection of a left atrial myxoma. The myxoma was successfully removed four days after the stroke (one day after hospital transfer) and the child had nearly complete neurologic recovery.
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Atrial Septal Defect Stent Compression During Resuscitation of an Infant With Hypoplastic Left Heart Syndrome
Published: July 23, 2024.
Volume 15, Number 5
Pages 677-678
Contributors
Chawki Elzein; Emily Pena; Narutoshi Hibino; Dhaval Patel; Luca Vricella
World Journal for Pediatric and Congenital Heart Surgery, Volume 15, Issue 5, Page 677-678, September 2024.
A newborn with hypoplastic left heart syndrome underwent a Norwood procedure with a Sano shunt. A month later, he had an atrial septal defect (ASD) stent placed due to ASD size and flow restriction. Three weeks later, he had sudden bradycardia and cardiac arrest in the intensive care unit. He was resuscitated and cannulated for extracorporeal membrane oxygenation (ECMO) through a right neck approach. An attempt to wean him from ECMO a week later failed due to hypoxia. Echocardiography showed ASD flow restriction and a chest x-ray showed flattening of the left atrial side of the ASD stent from chest compression resulting in a restrictive ASD. The patient underwent surgical removal of the ASD stent with ASD enlargement and was successfully weaned from ECMO after surgery.
