Ostial Atresia After Coronary Unroofing for Anomalous Aortic Origin of the Left Coronary Artery
Published: October 15, 2024.
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Sandeep Sainathan; Leonardo Mullinari; Nitya Arumugam
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
In this case report, we describe a 16-year-old patient who developed ostial atresia of the left main coronary artery after a coronary unroofing procedure for anomalous aortic origin of the left coronary artery from the right coronary sinus. This was successfully addressed with a coronary patch ostioplasty.
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Book Review: Finding the Way: A Memoir
Published: October 14, 2024.
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Carl L Backer
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
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Don’t Blame Balloon Atrial Septostomy!
Published: October 14, 2024.
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Doff B. McElhinney
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
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Anomalous Aortic Origin of a Coronary Artery: Results from a Single Surgical Team in Spain
Published: October 14, 2024.
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Laura Varela Barca; Rafael Hernández-Estefanía; Miguel Orejas Orejas; Alicia Donado Miñambres; Marta Tomás Mallebrera; Pilar Calderón Romero; Angeles Heredero Yung; Gonzalo Aldámiz-Echevarría
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
ObjectivesAnomalous aortic origin of a coronary artery is a rare congenital lesion in which a coronary artery arises from an anomalous location within the aorta. Anomalous aortic origin of a coronary artery has been associated with myocardial ischemia and it is considered the second most common cause of sudden cardiac arrest in young athletes. When surgical repair is indicated, surgical unroofing is the most commonly employed technique. Our objective is to describe the outcomes of our surgically treated patients.MethodsWe present a series of 16 adult patients who underwent surgical repair of anomalous aortic origin of a coronary artery. Patients were treated in three different institutions by the same surgeon. Surgical unroofing of the anomalous coronary artery was the surgical technique chosen in the majority of the patients. Follow-up was performed.ResultsUnroofing of an intramural anomalous coronary artery was the procedure performed in 11 patients. Three patients underwent neo-ostium creation; one patient underwent a David procedure with coronary reimplantation; and one patient was treated with coronary bypass grafting due to severe coronary atheromatous lesions. There were no perioperative deaths, and no major postoperative complications. Follow-up period was 73.8 months, the survival rate was 100%, and there were neither ischemia or heart failure reports.ConclusionsThe surgical repair of anomalous aortic origin of a coronary artery by coronary unroofing or neo-ostium creation has demonstrated excellent early and late outcomes. Late survival was excellent. The follow-up period revealed no significant morbidity or complications.
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Surgical Closure of Multiple Muscular Ventricular Septal Defects in Children Using 3D-Printed Models
Published: October 14, 2024.
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Shalom Andugala; Caroline Grant; Jennifer Powell; Supreet Marathe; Prem Venugopal; Nelson Alphonso
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
BackgroundMultiple muscular ventricular septal defects (VSDs) are often difficult to visualize and access surgically. The main challenge is identifying all defects intraoperatively, without which residual defects are inevitable. Patient-specific three-dimensional (3D) printed models can help accurately demonstrate intracardiac anatomy. We present our experience using this technology to surgically close multiple muscular VSDs .MethodsData of all patients with multiple VSDs in whom a 3D-printed model was used to aid surgical planning between September 2021 and July 2023 was collected retrospectively. Our approach involved generating a 3D model from a preoperative computerized tomography scan for each patient, which was then used to precisely identify the location of the multiple VSDs and plan surgical intervention.ResultsSix patients underwent closure of multiple VSDs using a 3D model. The mean age at surgery was 3.5 years (SD ± 2.8 years). Five (83.3%) patients had previously undergone pulmonary artery banding. The VSDs were approached through the right atrium in three (50%) and the right ventricle in three (50%) patients. Mean cardiopulmonary bypass and myocardial ischemia times were 185.2 min (SD ± 94.8 min) and 147.5 min (SD ± 86 min), respectively. There was no postoperative heart block or a hemodynamically significant residual VSD. All six patients had normal biventricular function at a median follow-up duration of 1.7 months (interquartile range: 1.2-7.4 months).Conclusion3D printing to aid closure of multiple VSDs is safe, reliable, and reproducible. We recommend adding 3D printing to surgeons’ armamentarium when faced with the challenge of closing multiple muscular VSDs in children.
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Clinical Assessment of the Utility of Pulsatile Over Nonpulsatile Flow for Neonatal and Pediatric Cardiopulmonary Bypass Procedures Using Multidisciplinary Translational Research at a Tertiary Care Center
Published: October 14, 2024.
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Christopher Collin Hayes; Akif Ündar
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
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Current Congenital Heart Surgery and Pediatric Perfusion Practices in Japan and Vietnam
Published: October 14, 2024.
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Hideshi Itoh; Shunji Sano; Shingo Ichiba; Nguyen The Binh; Le Ngoc Thanh
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
The declining birth rate and aging population are becoming increasingly serious social issues in Japan. In this report, we summarize the current congenital heart surgery and pediatric perfusion practices in Japan and Vietnam. In addition we report the rapid growth and development of congenital heart surgery in Vietnam made possible by medical education support provided by Japan over the past decade.
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Twenty-Seven-Year Institutional Experience With Surgery for Adults With Congenital Heart Disease
Published: October 09, 2024.
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Aeleia F. Hughes; Jeremy L. Herrmann; Mark D. Rodefeld; James E. Slaven; Mark W. Turrentine; John W. Brown
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
BackgroundGiven improved contemporary survival of adults with congenital heart disease (ACHD), we aimed to evaluate trends in ACHD surgery and outcomes at a single center over a 27-year period.MethodsSurgical databases were retrospectively queried for patients >18 years old who underwent ACHD surgery between January 1, 1994, and December 31, 2020. A total of 2,195 included patients underwent 2,425 cardiac surgical procedures within the specified time frame. Patients were grouped by era: I, 1994-2000; 2, 2001-2010; and 3, 2011-2020. Trends in primary cardiac diagnosis and surgical management were evaluated.ResultsThe median age increased across the eras. The most common primary cardiac diagnoses (n = 2,425) overall were left ventricular outflow tract anomalies (n = 2,019, 83%), atrial septal defect (n = 407, 17%), right ventricular outflow tract anomalies (n = 360, 15%), and ventricular septal defect (n = 110, 4.5%). The most commonly observed procedures overall were operations on the left ventricular outflow tract (n = 1,633, 67%), aorta (n = 675, 28%), coronary arteries (n = 449, 19%), right ventricular outflow tract (n = 323, 13%), and atrial septal defect (n = 264, 11%). Major complications occurred in 10% of cases, and 58 patients died within 30 days of their operation yielding an operative mortality of 2.4%.ConclusionTo our knowledge, this is the largest single center report on surgery for adults with congenital heart disease. Surgery for ACHD has been performed at our center with relatively low morbidity and mortality over the last few decades.
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Prospective Evaluation of Extubation Failure in Neonates and Infants After Cardiac Surgery
Published: October 03, 2024.
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Amy E. Hanson; Jeremy L. Herrmann; Samer Abu-Sultaneh; Lee D. Murphy; Christopher W. Mastropietro
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Background: Extubation failure and its associated complications are not uncommon after pediatric cardiac surgery, especially in neonates and young infants. We aimed to identify the frequency, etiologies, and clinical characteristics associated with extubation failure after cardiac surgery in neonates and young infants. Methods: We conducted a single center prospective observational study of patients ≤180 days undergoing cardiac surgery between June 2022 and May 2023 with at least one extubation attempt. Patients who failed extubation, defined as reintubation within 72 h of first extubation attempt, were compared with patients extubated successfully using χ2, Fisher exact, or Wilcoxon rank-sum tests as appropriate. Results: We prospectively enrolled 132 patients who met inclusion criteria, of which 11 (8.3%) failed extubation. Median time to reintubation was 25.5 h (range 0.4-55.8). Extubation failures occurring within 12 h (n = 4) were attributed to upper airway obstruction or apnea, whereas extubation failures occurring between 12 and 72 h (n = 7) were more likely to be due to intrinsic lung disease or cardiac dysfunction. Underlying genetic anomalies, greater weight relative to baseline at extubation, or receiving positive end expiratory pressure (PEEP) > 5 cmH2O at extubation were significantly associated with extubation failure. Conclusions: In this study of neonates and young infants recovering from cardiac surgery, etiologies of early versus later extubation failure involved different pathophysiology. We also identified weight relative to baseline and PEEP at extubation as possible modifiable targets for future investigations of extubation failure in this patient population.
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Pulmonary Overcirculation Requiring Surgical and Pulmonary Flow Restrictor Device Intervention in Critical Coarctation of the Aorta—A Case Series
Published: September 27, 2024.
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Shivanand S. Medar; TK Susheel Kumar; Esther Yewoon Choi; Christine Cha; Sunil Saharan; Michael Argilla; Ralph S. Mosca; Sujata B. Chakravarti
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
The use of prostaglandin infusion to maintain patency of the ductus arteriosus in patients with critical coarctation of the aorta (CoA) to support systemic circulation is the standard of care. However, pulmonary overcirculation resulting from a patent ductus arteriosus in patients with critical CoA is not well described in the literature. We report two cases of critical CoA that required invasive measures to control pulmonary blood flow before surgical repair of the CoA. Both patients had signs of decreased oxygen delivery, hyperlactatemia, and systemic to pulmonary flow via the ductus arteriosus. One patient required surgical pulmonary artery banding and the second patient underwent pulmonary flow restrictor device placement for the control of pulmonary blood flow. A rapid improvement in oxygen delivery and normalization of lactate levels were observed after control of pulmonary overcirculation. Both patients underwent successful surgical repair of the coarctation A and were discharged home.
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The Surgical Significance of Phenotypic Variability in the Setting of Tetralogy of Fallot
Published: September 26, 2024.
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Ujjwal Kumar Chowdhury; Robert H. Anderson; Diane E. Spicer; Niraj N. Pandey; Saurabh K. Gupta; Niwin George; Maroof A. Khan; Chaitanya Chittimuri
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
The phenotypic feature of tetralogy of Fallot is anterocephalad deviation of the muscular outlet septum, or its fibrous remnant, relative to the septoparietal trabeculation, coupled with hypertrophy of septoparietal trabeculations. Although this feature permits recognition of the entity, no two cases are identical. Once diagnosed, treatment is surgical. The results of surgical treatment have improved remarkably over recent decades. The results are now sufficiently excellent, including those in the developing world, that attention is now directed toward avoidance of morbidity, while still seeking, of course to minimize any fatalities due to surgical intervention. It is perhaps surprising that attention thus far has not been directed on the potential significance of phenotypic variation relative to either mortality or morbidity subsequent to surgical correction. The only study we have found specifically addressing this variability focused on the extent of aortic override, and associated malformations, but made no mention of variability in the right ventricular margins of the interventricular communication, nor the substrates for subpulmonary obstruction. In this review, therefore, we assessed the potential significance of known morphological variability to the outcomes of surgical intervention in over 1,000 individuals undergoing correction by the same surgeon in a center of excellence in a developing country. We sought to assess whether the variations were associated with an increased risk of postoperative death, or problems of rhythm. In our hands, double outlet ventriculoarterial connection was associated with increased risk of death, while the presence of a juxta-arterial defect with perimembranous extension was associated with rhythm problems.
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Rationale and Design of the Randomized COmparison of Methods for Pulmonary Blood Flow Augmentation: Shunt Versus Stent (COMPASS) Trial: A Pediatric Heart Network Study
Published: September 23, 2024.
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Christopher J. Petit; Jennifer C. Romano; Jeffrey D. Zampi; Sara K. Pasquali; Courtney E. McCracken; Nikhil K. Chanani; Andrea S. Les; Kristin M. Burns; Allison Crosby-Thompson; Mario Stylianou; Bernet Kato; Andrew C. Glatz
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Neonates with congenital heart disease and ductal-dependent pulmonary blood flow (DD-PBF) require early intervention. Historically, this intervention was most often a surgical systemic-to-pulmonary shunt (SPS; eg, Blalock-Thomas-Taussig shunt). However, over the past two decades, an alternative to SPS has emerged in the form of transcatheter ductal artery stenting (DAS). While many reports have indicated safety and durability of the DAS approach, few studies compare outcomes between DAS and SPS. The reports that do exist are comprised primarily of small-cohort single-center reviews. Two multicenter retrospective studies suggest that DAS is associated with similar or superior survival compared with SPS. These studies offer the best evidence to-date, and yet both have important limitations. The authors describe herein the rationale and design of the COMPASS (COmparison of Methods for Pulmonary blood flow Augmentation: Shunt vs Stent [COMPASS]) Trial (NCT05268094, IDE G210212). The COMPASS Trial aims to randomize 236 neonates with DD-PBF to either DAS or SPS across approximately 27 pediatric centers in North America. The goal of this trial is to compare important clinical outcomes between DAS and SPS over the first year of life in a cohort of neonates balanced by randomization in order to assess whether one method of palliation demonstrates therapeutic superiority.
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An Unusual Culprit: Syncope in an Adolescent With Congenital Left Main Coronary Artery Atresia
Published: September 19, 2024.
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Charlie J. Sang; Audrey Khoury; Michael Yeung; Thomas G. Caranasos; Elman G. Frantz
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
There are fewer than 100 reported cases of congenital left main coronary artery atresia. In this report, we present an adolescent male presenting with exertional syncope in the setting of this rare coronary defect, and review important diagnostic and therapeutic considerations imperative to obtain a favorable outcome.
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The Enduring Impact of Shape Following Perfect Coarctation of the Aorta Repair
Published: September 17, 2024.
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Liam Swanson; Emilie Sauvage; Malebogo Ngoepe; Silvia Schievano; Jan L. Bruse; Tain-Yen Hsia
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Objectives: Aortic arch appearances can be associated with worse cardiac function and chronic hypertension late after coarctation of the aorta (CoA) repair, even without residual obstruction. Statistical shape modeling (SSM) has identified specific 3D arch shapes linked to poorer cardiovascular outcomes. We sought a mechanistic explanation. Methods: From 53 asymptomatic patients late after CoA repair with no residual obstruction (age: 22.3 ± 5.6 years; 12-38 years after operation), eight aortic arch shapes associated with the four best and four worst cardiovascular parameters were obtained from 3D SSM. Four favorable shapes were affiliated with left ventricular (LV) ejection fraction +2 standard deviation (SD) values from the mean, and indexed LV end diastolic volume/indexed LV mass/resting systolic blood pressure that were −2SD. Four unfavorable shapes were defined by the reverse. Computational Fluid Dynamics modeling was carried out to assess differences in pressure gradient across the aortic arch and viscous energy loss (VEL) between favorable and unfavorable aortic arches. Results: In all aortic arches, the pressure gradients were clinically insignificant (<8 mm Hg). However, in the four unfavorable aortic arches, VEL were uniformly higher than those in the favorable shapes (VEL difference: 15%-32%). There was increased turbulence and more complex propagation of VEL along with the unfavorable aortic arches. Conclusions: This study reveals the variable flow dynamics that underpin the association of aortic arch shapes with worse cardiovascular outcomes late after successful CoA repair. Higher VEL persists in the unfavorable aortic arch shapes. Further understanding of the mechanism of viscous energy loss in cardiovascular maladaptation may afford mitigating strategies to monitor and modify this unrelenting liability.
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Resolution of Severe Ulcerative Colitis Secondary to Nickel Allergy Following Explantation of Amplatzer Septal Occluder Device: A Delayed Presentation
Published: September 17, 2024.
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Sujata Subramanian; Swati Iyer; Gregory Johnson; Hitesh Agrawal; Charles D. Fraser
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Nickel is a component of nitinol, an alloy used in several medical devices. Allergy to nickel may place patients at a high risk for severe hypersensitivity reactions. We report a rare case of a patient who developed severe ulcerative colitis ten years following closure of an atrial septal defect with the Amplatzer Septal Occluder device.
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Ascending Sliding Arch Aortoplasty for Coarctation of the Aorta and Hypoplastic Aortic Arch to Avoid Compression of a Retroaortic Innominate Vein
Published: September 17, 2024.
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Alexis Palacios-Macedo; Héctor Díliz-Nava; Fabiola Pérez-Juárez; Santiago Villar-Cantoral; Krystell Martínez Balderas; Jorge Silva-Estrada; Luis García-Benítez
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
The retroaortic innominate vein variant usually courses asymptomatically. However, when associated with coarctation of the aorta and hypoplastic aortic arch, modifications in the surgical technique to correct the aorta should be done to avoid compression of the vein. The ascending sliding arch aortoplasty, which allows the vein to be brought anterior to the aorta, can be a good alternative, as shown in these two cases.
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Myocardial Infarction in a Seven-Year-Old Girl With Left Atrial Myxoma
Published: September 13, 2024.
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Srujan Ganta; Danielle Strah; Natalie Ellington; Dana Mueller; John J. Nigro; Paul Grossfeld
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Left atrial (LA) myxomas are benign neoplasms that are rare in children. Their presentation is dependent on size and location. We describe a seven-year-old girl who was admitted with chest pain, upper respiratory symptoms, and persistent troponin elevation with suspected myocarditis. Workup revealed an infarction from a LA myxoma which embolized to her right coronary artery–posterior lateral branch (PLB). She underwent prompt successful surgical excision of the myxoma. We elected not to perform a coronary artery embolectomy and her infarction was managed medically. We describe this unique clinical scenario and the decision-making process leading to a successful outcome.
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Infantile Cardiac Hemangioma: A Rare Case Presentation
Published: September 13, 2024.
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Debabrata Gohain; Amarjyoti Rai Baruah; James Thiek; Evanisha Marbaniang; Sushant Agarwal; Hafizur Rahman
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Cardiac hemangiomas are rare tumors of the heart which account for less than one-twentieth of all primary cardiac tumors. They can be seen in all age groups but are mostly diagnosed in neonates and children. Although cardiac hemangiomas are benign in nature they can present with features of congestive heart failure and occasionally be life-threatening. We present such a case in a two-month-old child who underwent successful surgical excision of the mass.
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Changes in Neonatal Intraoperative Electroencephalogram Alpha: Delta Ratios Precede Neurologic Injury
Published: September 13, 2024.
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Michael F. Swartz; Justin Lansinger; Emelie-Jo Scheffler; Aubrey Duncan; Jill M. Cholette; Shuichi Yoshitake; George M. Alfieris
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Background: Unrecognized intraoperative cerebral ischemia during neonatal aortic arch reconstruction may precede neurologic injury. Electroencephalogram (EEG) alpha:delta ratio (A:D) changes predict cerebral ischemia; however, if A:D differences can identify ischemia during neonatal antegrade cerebral perfusion (ACP) and aortic arch reconstruction is unknown. We hypothesized that A:D changes would precede neurologic injury. Methods: Simultaneous EEG derived left versus right: hemispheric and anterior cerebral A:Ds were retrospectively measured at baseline and every 5 min during arterial cannulation, cooling, ACP, and the rewarming phases of the operation. A paired left versus right A:D difference >25% was considered significant for ischemia, and the duration of a significant and continuous A:D difference was quantified in minutes. Neonates were divided into two groups: (1) new neurologic injury (stroke or seizure) and (2) no known neurologic injury. Results: From 72 neonates, there were no significant differences in the baseline A:Ds. Seven neonates (9.7%) developed a new neurologic injury (seizure = 3, stroke = 2, seizure and stroke = 2). Male gender and longer ACP times were significantly associated with neurologic injury. In neonates with a neurologic injury, the duration of a significant and continuous A:D difference was longer within the hemispheric and anterior regions. Multivariable analysis demonstrated that a significant and continuous anterior A:D difference (odds ratio: 1.345, 95% CI 1.058-1.712; P = .01) was independently associated with neurologic injury. Conclusions: A longer continuous anterior A:D difference > 25% was independently associated with neurologic injury. Intraoperative EEG monitoring could be considered during neonatal arch reconstruction.
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WOW! But You Have to Ask Yourself One Question (or a Few)
Published: September 12, 2024.
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Scott M. Bradley
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
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Birth in the Operating Room for Immediate Cardiac Surgery: A Rare but Effective Strategy
Published: September 10, 2024.
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Spencer J. Hogue; Amir Mehdizadeh-Shrifi; Kevin Kulshrestha; James F. Cnota; Allison Divanovic; Marco Ricci; Awais Ashfaq; David G. Lehenbauer; David S. Cooper; David L. S. Morales
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
Background: With significant advancements in fetal cardiac imaging, patients with complex congenital heart disease (CHD) carrying a high risk for postnatal demise are now being diagnosed earlier. We sought to assess an interdisciplinary strategy for delivering these children in an operating room (OR) adjacent to a cardiac OR for immediate surgery or stabilization. Methods: All children prenatally diagnosed with CHD at risk for immediate postnatal hemodynamic instability and cardiogenic shock who were delivered in the operating room (OR) between 2012 and 2023 in which the senior author was consulted were included. Results: Eight patients were identified. Six (75%) patients were operated on day-of-life zero, all requiring obstructed total anomalous pulmonary venous return (TAPVR) repair. Of these six patients, 2 (33%) required a simultaneous Norwood procedure, 2 (33%) required pulmonary artery unifocalization and modified Blalock-Taussig-Thomas shunt, and 2 (33%) patients had repair of obstructed mixed TAPVR. The remaining 2 patients potentially planned for immediate surgery had nonimmune hydrops fetalis and went into cardiogenic shock at 12 and 72 hours postnatally, requiring a novel Norwood procedure with left-ventricular exclusion for severe aortic/mitral valve insufficiency. The median ventilation and inpatient durations were 19 [IQR: 11-26] days and 41 [IQR: 32-128] days, respectively. Three(38%) patients required one or more in-hospital reoperations. Subsequent staged procedures included Glenn (n = 5), Fontan (n = 3), biventricular repair (n = 2), ventricular assist device placement (n = 1), and heart transplant (n = 1). Median follow-up was 5.7 [IQR:1.3-7.8] years. The five-year postoperative survival was 88% (n = 7/8). Conclusion: While children with these diagnoses have historically had poor survival, the strategy of birth in the OR adjacent to a cardiac OR where emergent surgery is planned is a potentially promising strategy with excellent clinical outcomes. However, this is a high-resource strategy whose feasibility in any program requires thoughtful assessment.
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Short-Term Results With Ozaki Valved Conduit—A Simple Solution for Patients Needing Right Ventricle to Pulmonary Artery Conduit in a Low-Resource Setting
Published: September 10, 2024.
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Vijayakumar Raju; Christopher W. Baird; Naveen Srinivasan; Divya Kadavanoor Sasikumar; Rajalakshmi Moorthy; Koushik Jothinath; Sreja Gangadharan; Kalyanasundaram Muthu Swamy; Aparna Vijaya Raghavan; Mani Ram Krishna; Pavithra Ram Nath
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
BackgroundThe repair of certain types of complex congenital cardiac defects may require a right ventricle-pulmonary artery (RV-PA) conduit. Using the Ozaki Aortic valve neocuspidization (AVNeo)technique, a valved RV-PA conduit was constructed with an Ozaki valve inside a Dacron graft. This study aims to evaluate the short-term outcome of the Ozaki valved RV-PA conduit.Material/MethodA total of 22 patients received the Ozaki valved RV-PA conduit from November 2019 until December 2023. The median age was 12 years (interquartile range [IQR], 5.5-21), median body weight was 35 kg (IQR, 15.8-48.5). The conduit was used in 16 patients (72.7%) under 18 years of age. Indications for conduit placement included: anatomic repair of corrected transposition of the great arteries, ventricular septal defect/pulmonary stenosis, conduit replacement, pulmonary atresia with associated anomalies, pulmonary artery aneurysm with dysplastic pulmonary valve, tetralogy of Fallot with coronary artery crossing the right ventricular outflow tract, bioprosthetic pulmonary valve regurgitation, and rheumatic heart disease. Native pericardium was used for the Ozaki valve in 12 patients and bovine pericardium for 10 patients. Conduit sizes ranged from 18 mm to 30 mm.ResultThe median intensive care unit stay was 4 (IQR, 2-6) days and the median hospital stay was 9 (IQR, 5.5-13.5) days. There were two perioperative mortalities (9.1%) both unrelated to the conduit. The median follow-up was 12.3 (IQR, 4.43-21.2) months. There was no infective endocarditis of the conduit. The median peak gradient across the conduit was 22 mm Hg (range 0-44 mm), and all were competent with trivial regurgitation on follow up.ConclusionCreation of an Ozaki valved conduit is an attractive option due to low cost, reproducibility, and excellent hemodynamics. Longer-term studies are needed to confirm the durability.
