Paediatric cardiac surgery in a peripheral European region: is a joint programme a safe alternative to regionalisation?

BACKGROUND: In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands. METHODS: An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated. RESULTS: In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients). CONCLUSIONS: A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.

Drenaje venoso pulmonar anómalo parcial izquierdo. Patrón anatómico atípico y corrección quirúrgica / Left partial anomalous pulmonary venous connection. Atypical anatomic pattern and surgical correction

Se presenta un caso de drenaje venoso pulmonar anómalo parcial izquierdo en una adolescente de 14 años. Se describen los hallazgos clínicos, el ecocardiograma y el cateterismo cardíaco, la indicación quirúrgica y la anatomía atípica hallada intraoperatoriamente (un colector “lejano” a la aurícula izquierda), lo mismo que las maniobras quirúrgicas empleadas en su corrección, y su evolución posterior

We had an interesting case on our hands, in particular that of a 14 year old girl with an unusual form of left partial anomalous pulmonary venous connection. We'd like to show our clinical, echocardiograms and cardiac catheterization results and findings. The patient didn’t have a normal anatomical pattern (a colector far from the left atrial appendage), and we would also like to comment on our postoperative follow up. Because of the unusual anatomy of the lesion and the long distances between the colector and the left atrial appendage, it was necesary to restructure the colector we also had to design a colector flap for the atrial appendage