Surgical Repair of Common Arterial Trunk With Ventriculoarterial Septal Defect and Dual Orifice Truncal Valve
Published: June 11, 2024.
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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, Ahead of Print.
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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Standardization of the Norwood Procedure Improves Outcomes in a Medium-Sized Volume Center
Published: June 10, 2024.
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Contributors
W. Hampton Gray; Robert A. Sorabella; Ashely B. Moellinger; Hayden Zaccagni; Luz A. Padilla; Borasino Santiago; Melissa Sindelar; Robert J. Dabal
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
The Norwood operation has become common practice to palliate patients with hypoplastic left heart structures. Surgical technique and postoperative care have improved; yet, there remains significant attrition prior to stage II palliation. The objective of this study is to report outcomes before and after standardizing our approach to the Norwood operation. Patients who underwent the Norwood operation at Children’s of Alabama were identified, those who underwent hybrid palliation operations were excluded. Pre- (2015-2020) and post- (2020-January 2023) standardization groups were compared and outcomes analyzed. Ninety-one patients were included (pre-standardization 44 (48.3%) and 47 (51.7%) post-standardization). There were no differences in baseline and intraoperative characteristics at Norwood between the pre- and post-standardization groups. Compared with pre-standardization, post-standardization was associated with decreased time to extubation (OR 0.87, 95%CI 0.79-0.96), inotrope duration (OR 0.92, 95%CI 0.86-0.98) and hospital length of stay (OR 0.98, 95%CI 0.96-0.99). There was a trend toward decreased cardiac arrest, reintervention rates, and interstage mortality for the post-standardization group. A standardized approach to complex neonatal cardiac operations such as the Norwood procedure may improve morbidity and decrease hospital resource utilization. We recommend establishing protocols at an institutional level to optimize outcomes in such high-risk patient populations.
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Pediatric Monitoring Technologies and Congenital Heart Disease: A Systematic Review
Published: May 29, 2024.
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Contributors
Summer S. Duffy; Sharon Lee; Danielle Gottlieb Sen
World Journal for Pediatric and Congenital Heart Surgery, Ahead of Print.
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.
