Twenty-Seven-Year Institutional Experience With Surgery for Adults With Congenital Heart Disease
Published: October 09, 2024.
Volume 16, Number 1
Pages 11-20
Contributors
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, Volume 16, Issue 1, Page 11-20, January 2025.
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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Changes in Neonatal Intraoperative Electroencephalogram Alpha: Delta Ratios Precede Neurologic Injury
Published: September 13, 2024.
Volume 16, Number 1
Pages 21-29
Contributors
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, Volume 16, Issue 1, Page 21-29, January 2025.
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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The Enduring Impact of Shape Following Perfect Coarctation of the Aorta Repair
Published: September 17, 2024.
Volume 16, Number 1
Pages 30-36
Contributors
Liam Swanson; Emilie Sauvage; Malebogo Ngoepe; Silvia Schievano; Jan L. Bruse; Tain-Yen Hsia
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 30-36, January 2025.
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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Prospective Evaluation of Extubation Failure in Neonates and Infants After Cardiac Surgery
Published: October 03, 2024.
Volume 16, Number 1
Pages 37-45
Contributors
Amy E. Hanson; Jeremy L. Herrmann; Samer Abu-Sultaneh; Lee D. Murphy; Christopher W. Mastropietro
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 37-45, January 2025.
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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Extended Donor Criteria Outcomes in Adult Congenital Heart Disease Patients Undergoing Heart Transplantation in the United States
Published: November 22, 2024.
Volume 16, Number 1
Pages 46-51
Contributors
Luke Masha; Nael Aldweib; Nalini Colaco; Castigliano M. Bhamidipati
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 46-51, January 2025.
Background: There are very few published outcomes for the use of extended criteria donor (ECD) organs in adult congenital heart disease (ACHD) patients undergoing cardiac transplantation. We investigated outcomes with the use of ECD organs in this population. We hypothesized that ECD organs may be safely used in this population in patients who are younger and carry less vascular and renal disease than the general cardiac transplant population. Methods: United Network of Organ Sharing data from all ACHD heart transplant recipients between October 18, 2018, and September 30, 2023, was analyzed. Patients were grouped by ECD transplantation. The primary outcome of interest was one-year survival. Secondary outcomes included length of stay, posttransplant stroke, retransplantation, kidney transplantation, dialysis, pacemaker implantation, and rejection. Results: Extended criteria donor organs were utilized in 39.1% (200/512) of ACHD heart transplantation cases. There was marked regional variation in the use of ECD organs. Extended criteria donor criteria in this population were solely met by ischemic time ≥4 h in 89.5% (179/200) of cases. Transplantation with ECD donors was associated with lower survival (one-year survival 82.76% vs 90.62%). A multivariate Cox regression analysis suggested a hazard ratio of 1.96 with the use of these organs. Conclusion: Compared with organs accepted under traditional donor criteria, ECD organs appear to compromise short- and long-term survival in ACHD transplant candidates.
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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.
Volume 16, Number 1
Pages 52-56
Contributors
Shivanand S. Medar; T.K. 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, Volume 16, Issue 1, Page 52-56, January 2025.
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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Surgical Closure of Multiple Muscular Ventricular Septal Defects in Children Using 3D-Printed Models
Published: October 14, 2024.
Volume 16, Number 1
Pages 57-63
Contributors
Shalom Andugala; Caroline Grant; Jennifer Powell; Supreet Marathe; Prem Venugopal; Nelson Alphonso
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 57-63, January 2025.
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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Anomalous Aortic Origin of a Coronary Artery: Results from a Single Surgical Team in Spain
Published: October 14, 2024.
Volume 16, Number 1
Pages 64-72
Contributors
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, Volume 16, Issue 1, Page 64-72, January 2025.
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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Outcomes and Risk Factors for Morbidity and Mortality of Systemic-to-Pulmonary Shunts in a Tertiary Hospital in Thailand
Published: October 25, 2024.
Volume 16, Number 1
Pages 73-82
Contributors
Khunthorn Kadeetham; Piya Samankatiwat
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 73-82, January 2025.
ObjectivesA systemic-to-pulmonary shunt is the palliation of choice for many children with cyanotic congenital heart disease. However, significant morbidity and mortality related to these procedures and the postoperative course still exists. We aim to report our outcomes of systemic-to-pulmonary shunts as well as to define certain risk factors for adverse events.Materials and MethodsWe retrospectively collected data from the electronic medical records of Ramathibodi hospital from January 01, 2013, to April 30, 2024. Demographic data, operative, and postoperative details were collected and reviewed. Inclusion criteria included patients whose primary operation was a systemic-to-pulmonary shunt. Exclusion criteria were patients diagnosed with hypoplastic left heart syndrome and whose medical record data were missing significant information.ResultsThere were initially 56 patients eligible for our study. After exclusion, the total number of patients enrolled was 42. Overall the results were excellent, with only one operative mortality, no discharge mortality, and four reinterventions. Outcomes between different shunt types, shunt sizes, surgical approaches, and diagnoses were statistically similar.ConclusionsWe demonstrate that systemic-to-pulmonary shunts are a safe and reliable procedure based on our results at a tertiary hospital in Thailand. We emphasize meticulous surgical techniques as well as utilization of proper and reproducible postoperative care protocols to optimize patient outcomes.
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The Surgical Significance of Phenotypic Variability in the Setting of Tetralogy of Fallot
Published: September 26, 2024.
Volume 16, Number 1
Pages 83-95
Contributors
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, Volume 16, Issue 1, Page 83-95, January 2025.
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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Invited Commentary: Morphological Variations in Tetralogy of Fallot and Their Impact in the Surgical Approach and Postoperative Evolution
Published: November 06, 2024.
Volume 16, Number 1
Pages 96-97
Contributors
Vera D. Aiello
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 96-97, January 2025.
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Fetal Cardiac Intervention: A Comprehensive Review of Current Evidence
Published: November 08, 2024.
Volume 16, Number 1
Pages 98-106
Contributors
Henrique Provinciatto; Christiane Simioni; Alberto Borges Peixoto; Talita Micheletti; Marcelo Brandão da Silva; Carlo Benatti Pilla; Edward Araujo Júnior
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 98-106, January 2025.
Fetal cardiac intervention consists of a novel and evolving technique for the intrauterine treatment of a subset of patients with congenital heart diseases, which aims to improve hemodynamics, reduce secondary damage, and achieve better postnatal outcomes. Nevertheless, the risks and benefits of this therapy remains subject to controversy. This review describes the rationale, selection criteria, and technical features for the most frequently performed fetal cardiac interventions. In addition, we provide a comprehensive overview of the medical literature, exploring the clinical implications of each therapy.
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A Low-Cost Workflow to Generate Virtual and Physical Three-Dimensional Models of Cardiac Structures
Published: November 14, 2024.
Volume 16, Number 1
Pages 107-113
Contributors
Philippe Grieshaber; Alexander Schneller; Elizabeth Fonseca-Escalante; Mina Farag; Rebecca Krey; Angéla Czundel; Christoph Jaschinski; Matthias Karck; Matthias Gorenflo; Tsvetomir Loukanov
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 107-113, January 2025.
PurposeThree-dimensional modeling and printing (3DMP) of anatomical structures from cross-sectional imaging data can enhance the understanding of spatial relationships in complex congenital heart defects. Partially due to the substantial financial, material and personnel resources required, 3DMP is not yet universally used. Here, we describe a workflow that addresses and eliminates these drawbacks.DescriptionThe workflow utilizes the open-source software “3D Slicer” (The Slicer Community) and “Blender” (Blender Foundation) for segmentation and post-editing of datasets. This approach enables the generation of virtual or physical 3D models. The physical models are printed using a standard fused deposition modeling printer.EvaluationThe financial challenges that likely constrain the wider use of 3DMP are largely addressed by this approach. However, the workflow still requires a considerable amount of time to manually segment the imaging data.ConclusionsThree-dimensional modeling and printing might improve planning and safety of congenital cardiac surgical treatment. Furthermore, it is a useful tool for education of parents and medical professionals. This workflow increases its suitability for routine use also in regions with low economic resources.
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Anomalous Origin of the Right Subclavian Artery from the Right Pulmonary Artery in a Patient with d-Transposition of the Great Arteries: Diagnosis and Surgical Treatment
Published: November 04, 2024.
Volume 16, Number 1
Pages 114-116
Contributors
Roman Sekelyk; Maksym Delikatnyi; Dmytro Kozhokar; Ibrahim Yusifli; Danylo Shypov; Andrii Kurkevych; Illya Yemets
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 114-116, January 2025.
Anomalous origin of the right subclavian artery (AORSA) from the right pulmonary artery is a rare congenital anomaly usually diagnosed by computed tomography, magnetic resonance imaging, or angiography. We present a very rare case of diagnosis and surgical correction of AORSA coexisting with d-transposition of the great arteries in a newborn’s first hours of life. Due to the critical local hospital and patient conditions, additional cross-sectional imaging was not feasible. The diagnosis was suspected by clinical signs, confirmed by transthoracic echocardiogram, and the patient was urgently taken to the operating room. We discuss clinical and echocardiographic signs of this child with d-transposition of the great arteries and AORSA from the right pulmonary artery.
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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.
Volume 16, Number 1
Pages 117-119
Contributors
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, Volume 16, Issue 1, Page 117-119, January 2025.
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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Resolution of Severe Ulcerative Colitis Secondary to Nickel Allergy Following Explantation of Amplatzer Septal Occluder Device: A Delayed Presentation
Published: September 17, 2024.
Volume 16, Number 1
Pages 119-121
Contributors
Sujata Subramanian; Swati Iyer; Gregory Johnson; Hitesh Agrawal; Charles D. Fraser
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 119-121, January 2025.
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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Ostial Atresia After Coronary Unroofing for Anomalous Aortic Origin of the Left Coronary Artery
Published: October 15, 2024.
Volume 16, Number 1
Pages 121-124
Contributors
Sandeep Sainathan; Leonardo Mullinari; Nitya Arumugam
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 121-124, January 2025.
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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Infantile Cardiac Hemangioma: A Rare Case Presentation
Published: September 13, 2024.
Volume 16, Number 1
Pages 124-126
Contributors
Debabrata Gohain; Amarjyoti Rai Baruah; James Thiek; Evanisha Marbaniang; Sushant Agarwal; Hafizur Rahman
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 124-126, January 2025.
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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Myocardial Infarction in a Seven-Year-Old Girl With Left Atrial Myxoma
Published: September 13, 2024.
Volume 16, Number 1
Pages 127-129
Contributors
Srujan Ganta; Danielle Strah; Natalie Ellington; Dana Mueller; John J. Nigro; Paul Grossfeld
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 127-129, January 2025.
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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Aortic Rupture in a Pediatric Patient With Influenza
Published: November 06, 2024.
Volume 16, Number 1
Pages 130-132
Contributors
Madison A. Grasty; Nathan L’Etoile; Lindsay J. Nitsche; Moe Takeda; Brian T. Fisher; Stacy Drant; Constantine D. Mavroudis
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 130-132, January 2025.
Influenza can lead to significant morbidity and mortality in children. Aortopathy tends to occur in adults during influenza season; however, aortic pathology in children with influenza is exceedingly rare. This report describes a child who experienced an aortic rupture during an influenza infection without evidence of secondary bacterial infection or connective tissue disorder.
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Combined Norwood and Modified Left-Sided Starnes Procedures for Congenitally Corrected Transposition of the Great Arteries
Published: October 30, 2024.
Volume 16, Number 1
Pages 132-134
Contributors
Yash Vaidya; Farida Karim; Satoshi Miyairi; Pranava Sinha
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 132-134, January 2025.
The combination of congenitally corrected transposition of the great arteries (ccTGA), Ebstein anomaly of the systemic atrioventricular valve, and critical systemic ventricular outflow tract obstruction is extremely rare. Management of a neonate with these lesions in cardiogenic shock is quite challenging. Tricuspid valve exclusion has been increasingly and successfully used to manage neonatal Ebstein anomaly patients. We extended this idea of tricuspid valve exclusion (modified Starnes) combined with a Norwood Stage 1 operation with a modified systemic to pulmonary artery shunt to successfully manage a neonate with ccTGA, severe systemic atrioventricular valve regurgitation, and critical ventricular outflow tract obstruction.
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Correction of Hemitruncus in an Adult Patient Alleviated Pulmonary Arteriovenous Fistula in the Affected Lung
Published: November 18, 2024.
Volume 16, Number 1
Pages 134-137
Contributors
Tomohiro Nakata; Maiko Tachi; Kenji Yasuda; Junya Tanabe; Yuka Kawanami; Kazuhiro Yamazaki
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 134-137, January 2025.
We present a case of a 36 year old adult with anomalous origin of the right pulmonary artery from the aorta (hemitruncus), pulmonary hypertension, and moderate mitral regurgitation. Moreover, selective contrast echocardiogram (agitated saline injection into the right pulmonary artery) performed during preoperative cardiac catheterization demonstrated a moderate amount and prompt appearance of echo contrast in the left atrium (right pulmonary arteriovenous fistula). We successfully performed a reconstruction of the right pulmonary artery using a woven Dacron graft (12 mm in diameter). Six months postsurgery, the pulmonary arteriovenous fistula had substantially regressed, and the pulmonary arterial pressure and mitral regurgitation had both dramatically improved.
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A Rare Case of Solitary Cardiac Myofibroma in an Infant
Published: November 05, 2024.
Volume 16, Number 1
Pages 137-140
Contributors
Liwei Yu; Patrick W. O’Leary; M. Yasir Qureshi; Joseph J. Maleszewski; Elizabeth H. Stephens; Joseph A. Dearani; Rebecca K. Ameduri
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 137-140, January 2025.
Solitary myofibromas are rare, benign, mesenchymal tumors typically found in the head and neck regions. We report an exceptionally rare case of a solitary cardiac myofibroma and its short-term management and outcome. A two-month-old infant was referred due to a murmur. Echocardiography revealed a 2 × 1 cm solitary mass originating from a mitral papillary muscle, causing severe regurgitation. Magnetic resonance imaging showed the mass to be homogeneous on T1, hyperintense on T2, and hypointense on first-pass perfusion imaging with no enhancement on delayed postcontrast imaging. The mass was surgically excised partially due to its involvement with the mitral valve. Postoperative recovery was uneventful, with echocardiography four months later showing no tumor recurrence and trivial mitral regurgitation. This report provides valuable imaging and pathology examples to aid in the recognition of this rare tumor and demonstrates that successful surgical excision is possible, even with significant cardiac involvement.
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Importance of Comprehensive Reporting in Rare Pediatric Cases: Insights From a Cardiac Echinococcosis Case Report
Published: November 05, 2024.
Volume 16, Number 1
Pages 141-141
Contributors
Shifa Israr; Muhammad Usama; Muhammad Ikrama
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 141-141, January 2025.
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Response to: Importance of Comprehensive Reporting in Rare Pediatric Cases: Insights From a Cardiac Echinococcosis Case Report
Published: November 07, 2024.
Volume 16, Number 1
Pages 142-142
Contributors
Thierry Carrel
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 142-142, January 2025.
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Leaving the Ductus Open During BTT Shunt: Risk of Ductus-Associated Pulmonary Coarctation?
Published: November 07, 2024.
Volume 16, Number 1
Pages 143-143
Contributors
Safak Alpat
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 143-143, January 2025.
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Erratum to “Atrial septal defect closure: not always straightforward”
Published: October 25, 2024.
Volume 16, Number 1
Pages 144-144
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 144-144, January 2025.
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Corrigendum to “A review on the surgical management of subvalvular aneurysm”
Published: May 15, 2020.
Volume 16, Number 1
Pages 145-145
World Journal for Pediatric and Congenital Heart Surgery, Volume 16, Issue 1, Page 145-145, January 2025.
