Bentall Procedure to Repair Acute Type a Aortic Dissection in Pregnant Marfan Syndrome Woman With Preservation of Pregnancy.

Background: Acute aortic dissection is the most common life-threatening disorder classically presenting with tearing chest pain radiating to the back yet can have deceiving clinical presentations.Case presentation: The patient was a 22-year-old pregnant woman (gravida 6, para 4, abortion1) at 26 weeks of gestation. She was a known case of Marfan syndrome who developed acute type A aortic dissection during pregnancy. Repair of aortic dissection was done through the Bentall procedure with a composite mechanical valved conduit while Fetal heart rate (FHR) was simultaneously monitored during surgery. Three months after surgical repair, the newborn was delivered via cesarean, and both mother and baby survived without any complications.Conclusions: In this case, we demonstrated that repair of type A aortic dissection can be done in pregnant women with preservation of fetus in the uterus through close cooperation among all members of a multi-disciplinary team.

Topical and Intravenous Tranexamic Acid in Acyanotic Children Undergoing Congenital Heart Surgery: A Randomized Clinical Trial.

INTRODUCTION: Postoperative bleeding is a common complication in congenital heart surgery. We aimed to evaluate effects of topical and intravenous tranexamic acid (TXA) administration on postoperative hemoglobin and bleeding in children with acyanotic congenital heart disease (CHD). METHODS: In this randomized clinical trial, 50 acyanotic CHD children were allocated into two groups of topical (n = 25) and infusion (n = 25). Children in the infusion group were given intravenous TXA 50 mg/kg-1 after sternotomy. Children in topical group were given 50 mg/kg-1 TXA added to 20 mL of saline intrapericardially before sternal closure. Primary endpoint of study was comparison of postoperative hemoglobin and bleeding between topical and infusion groups. A linear mixed model (LMM) was used to estimate longitudinal changes in postoperative endpoints. RESULTS: We did not observe significant differences in children's characteristics between two groups. Also, intraoperative and postoperative outcomes did not differ between two groups but children with intravenous TXA experienced significantly longer intubation time than topical children (P = 0.047). LMM analysis revealed that postoperative bleeding in topical group was lower compared to infusion group (P = 0.036). Also, age of children had a significant effect on mean changes of hemoglobin during postoperative care (ß = -0.27, P = 0.030). No children died and none had serious postoperative complications such as seizures and reoperation. CONCLUSIONS: We found that topical TXA is not superior to intravenous administration in management of blood loss. Also, no additional effect was found about topical TXA in further reducing transfusion rates and postoperative complications in acyanotic CHD children undergoing cardiac surgery.

Biventricular strain and strain rate impairment shortly after surgical repair of tetralogy of Fallot in children: A case-control study.

Background: Early biventricular dysfunction in repaired tetralogy of Fallot (TOF) children may lead to poor clinical outcomes. We aimed to assess biventricular function in TOF children before and after surgery by speckle tracking echocardiography (STE) and compare them with the controls. Methods: Twenty repaired TOF children and 20 normal children as controls were assessed by STE. Tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), biventricular strain, and strain rate were compared before and after surgery and between TOF children and controls. Results: Postoperative LVEF (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for left ventricle improved significantly compared to preoperative phase. However, postoperative left ventricular strain (p = 0.05) and strain rate (p = 0.01) in TOF children were significantly impaired compared to controls. Postoperative LVEF was correlated inversely with postoperative strain rate (r = -0.40, p = 0.04). Postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for right ventricle significantly worsened when compared with the preoperative phase. Moreover, postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.01) were significantly impaired compared to controls. Postoperative right ventricular strain rate was correlated significantly with the weight of children (r = 0.48, p = 0.02), and postoperative left ventricular strain showed significant correlations with aortic clamp time (r = 0.44, p = 0.04) and with ICU stay (r = -0.46, p = 0.04). Conclusion: Despite normal LVEF, TOF children exhibit impaired left ventricular strain and strain rate after surgery. TAPSE, strain, and strain rate for the right ventricle worsen after surgical repair. STE-driven strain can be used to detect early ventricular dysfunction and the associated prognostic implications.

Linear mixed model analysis to evaluate correlations between remdesivir adverse effects with age and gender of patients with mild Covid-19 pneumonia.

We aimed to assess longitudinal changes in clinical indexes of corona disease 2019 (Covid-19) patients with mild pulmonary infection during 5 days of remdesivir therapy and determine the effect of age and gender on remdesivir adverse effects (AE). Patients' clinical data including inflammatory markers, liver and renal function tests, and heart rate (HR) were extracted from medical records. Linear mixed model (LMM) was used to analyze longitudinal changes in patients' clinical indexes. Gender and age were inserted in LMM as covariates to find their correlation with AE and clinical indexes. Of 84 patients, 35 patients met our criteria for the study. There were significant increases in mean levels of white blood cell (WBC; p = 0.005), alanine aminotransferase (ALT; p = 0.001), aspartate aminotransferase (p = 0.001), blood urea nitrogen (BUN; p = 0.001), and creatinine (p = 0.006), whereas mean levels of erythrocyte sedimentation rate (p = 0.005), C-reactive protein (p = 0.001), alkaline phosphatase (p = 0.001), and potassium (p = 0.003) decreased significantly. Estimated glomerular filtration rate (p = 0.001) and HR (p = 0.001) showed a notable decline over the course of treatment. LMM analysis showed that mean changes in WBC (ß = 0.94, p = 0.029), creatinine (ß = 0.12, p = 0.020), and HR (ß = 6.47, p = 0.008) were greater in males than in females. Also, age of patients had a significant effect on the mean changes of WBC (ß = -0.02, p = 0.023), sodium (ß = -0.06, p = 0.010), BUN (ß = 0.23, p = 0.001), and HR (ß = -0.29, p = 0.001). Despite no renal and liver dysfunction, Covid-19 patients with mild pulmonary infection may develop some remdesivir AE and attributed side effects might be affected by gender and age of patients.

Metabolic disturbance affects postoperative cognitive function in patients undergoing cardiopulmonary bypass.

OBJECTIVES: Postoperative delirium is a common neuropsychiatric syndrome after coronary artery bypass grafting (CABG). We aimed to assess and compare clinical outcomes of CABG patients with delirium with a specific focus on the blood biochemical parameters. METHODS: This investigation was carried out on the 90 eligible patients undergoing CABG. Delirium was measured using the Neecham confusion scale and assessed patients were divided into two groups of delirium (n = 43) and non-delirium (n = 47). Preoperative variables and intraoperative and postoperative outcomes were compared. RESULTS: Delirium patients were older (p = 0.003) and had longer intubation time (p = 0.003). Non-delirium patients obtained a significantly higher Neecham confusion score (p = 0.001), and delirium patients experienced a hyperglycemic state at intraoperative (p = 0.004), intubation (p = 0.03), and extubation time (p = 0.02). Lower value of pH was seen at intubation (p = 0.03) and extubation periods (p = 0.001) in delirium group. A significant difference in base excess was observed between two groups at intubation (p = 0.04) and extubation periods (p = 0.004). Potassium level showed a significant decrease in delirium group at intubation (p = 0.01) and extubation periods (p = 0.001). Multivariate regression indicated that aging (OR = 1.08, p = 0.01), narcotic consumption (OR = 3.27, p = 0.05), DM (OR = 3.03, p=0.03), and prolonged intubation (OR = 1.18, p = 0.03) are predictors of delirium. Postoperative hyperglycemia (OR = 1.01, p = 0.002), low pH value (OR = 2.62, p = 0.02), and low potassium level (OR = 3.25, p = 0.03) are associated with development of delirium. CONCLUSIONS: Postoperative metabolic disturbance and electrolyte imbalances are closely related to the development of delirium after CABG and need to be considered more carefully. Aging, DM, and preoperative use of narcotics are strong predictors of delirium following CABG.

Linagliptin Protects Human SH-SY5Y Neuroblastoma Cells against Amyloid-ß Cytotoxicity via the Activation of Wnt1 and Suppression of IL-6 Release

Background: Alzheimer's disease is one of the neurodegenerative disorders typified by the aggregate of amyloid-ß (Aß) and phosphorylated tau protein. Oxidative stress and neuroinflammation, because of Aß peptides, are strongly involved in the pathophysiology of Alzheimer's disease (AD). Linagliptin shows neuroprotective properties against AD pathological processes through alleviation of neural inflammation and AMPK activation. Methods: We assessed the benefits of linagliptin pretreatment (at 10, 20, and 50 nM concentrations), against Aß1-42 toxicity (20 µM) in SH-SY5Y cells. The concentrations of secreted cytokines, such as TNF-α, IL-6, and IL-1ß, and signaling proteins, including pCREB, Wnt1, and PKCε, were quantified by ELISA. Results: We observed that Aß led to cellular inflammation, which was assessed by measuring inflammatory cytokines (TNF-α, IL-1ß, and IL-6). Moreover, Aß1-42 treatment impaired pCREB, PKCε, and Wnt1 signaling in human SH-SY5Y neuroblastoma cells. Addition of Linagliptin significantly reduced IL-6 levels in the lysates of cells, treated with Aß1-42. Furthermore, linagliptin prevented the downregulation of Wnt1 in Aß1-42-treated cells exposed. Conclusion: The current findings reveal that linagliptin alleviates Aß1-42-induced inflammation in SH-SY5Y cells, probably through the suppression of IL-6 release, and some of its benefits are mediated through the activation of the Wnt1 signaling pathway.

Case Report: Acute Intracardiac Thrombosis in Children With Coronavirus Disease 2019 (COVID-19).

We herein describe a case series of children with SARS-CoV-2 infection (COVID-19) complicated with acute intracardiac thrombosis. The diagnosis of COVID-19 was confirmed through the reverse transcription-polymerase chain reaction (RT-PCR). Transthoracic echocardiography of patients revealed large intracardiac mobile masses resected successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory state of the disease incurred by the SARS-CoV-2 virus.

Anti-aging Klotho Protects SH-SY5Y Cells Against Amyloid ß1-42 Neurotoxicity: Involvement of Wnt1/pCREB/Nrf2/HO-1 Signaling.

Alzheimer's disease (AD) is considered a prevalent neurological disorder with a neurodegenerative nature in elderly people. Oxidative stress and neuroinflammation due to amyloid ß (Aß) peptides are strongly involved in AD pathogenesis. Klotho is an anti-aging protein with multiple protective effects that its deficiency is involved in development of age-related disorders. In this study, we investigated the beneficial effect of Klotho pretreatment at different concentrations of 0.5, 1, and 2 nM against Aß1-42 toxicity at a concentration of 20 µM in human SH-SY5Y neuroblastoma cells. Our findings showed that Klotho could significantly and partially restore cell viability and decrease reactive oxygen species (known as ROS) and improve superoxide dismutase activity (SOD) in addition to reduction of caspase 3 activity and DNA fragmentation following Aß1-42 challenge. In addition, exogenous Klotho also reduced inflammatory biomarkers consisting of nuclear factor-kB (NF-kB), interleukin-1ß (IL-1ß), and tumor necrosis factor-α (TNF-α) in Aß-exposed cells. Besides, Klotho caused downregulation of Wnt1 level, upregulation of phosphorylated cyclic AMP response element binding (pCREB), and mRNA levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) with no significant alteration of epsilon isoform of protein kinase C (PKCε) after Aß toxicity. In summary, Klotho could alleviate apoptosis, oxidative stress, and inflammation in human neuroblastoma cells after Aß challenge and its beneficial effect is partially exerted through appropriate modulation of Wnt1/pCREB/Nrf2/HO-1 signaling.

Right Atrial Thrombus in a COVID-19 Child Treated Through Cardiac Surgery.

We herein report a case of large intracardiac thrombus in a child with SARS-CoV-2 infection (COVID-19). The diagnosis of COVID-19 was confirmed through HRCT and RT-PCR. Transthoracic echocardiography revealed a large thrombus in the right atrium treated successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory condition incurred by the COVID-19 virus.

The Association Between Circulating Klotho and Dipeptidyl Peptidase-4 Activity and Inflammatory Cytokines in Elderly Patients With Alzheimer Disease.

INTRODUCTION: Klotho and Dipeptidyl Peptidase-4 (DPP4) are two proteins that modulate inflammatory pathways. We investigated the association between circulating klotho and DPP4 activity and their relationship with inflammatory cytokines, miR-29a, and miR-195 in Alzheimer Disease (AD). METHODS: This study was conducted on 16 AD patients and 16 healthy age-matched controls. Plasma levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß, interleukin-6 (IL-6), klotho, and DPP4 were measured by enzyme-linked immunosorbent assay. Plasma expression of miR-29a and miR-195 were also measured and compared by a real-time polymerase chain reaction. RESULTS: There was a significant increase in TNF-α (p=0.006), IL-1ß (p=0.012), and IL-6 (p=0.012) levels in the AD subjects compared with controls. Also, we found a decrease in plasma levels of klotho and an increase in plasma levels of DPP4 in the AD group that was not significant compared with the controls. Lower expression of miR-29a (P=0.009) and higher expression of miR-195 (P=0.003) were observed in the AD group that was significant than controls. Further analysis showed a negative correlation between klotho and plasma levels of IL-6 (r=-0.58, p=0.01). Also, there was a positive correlation between plasma DPP4 activity and TNF-α levels (r=0.50, P=0.04) and IL-1ß (r=0.62, P=0.01). Likewise, plasma klotho concentration showed a negative correlation with the age of AD subjects (r=-0.56, P=0.02). CONCLUSION: TNF-α, IL-1ß, and IL-6 are involved in AD pathophysiology, and dysregulation of DPP4 and klotho may be associated with the inflammatory response of AD. Down-regulation of miR-29a and up-regulation of miR-195 indicated the role of miRNAs in the AD process.

Comparative Outcomes of Primary Arterial Switch Operation for Transposition of Great Arteries within the First Month of Life.

Background: The optimal surgical plan to correct the simple transposition of the great arteries (TGA) is the arterial switch operation (ASO). This study aimed to assess the outcomes of ASO in infants with simple TGA with a special focus on the time of surgery. Methods: This retrospective study enrolled 105 infants with simple TGA who underwent ASO and categorized them into 3 groups based on the time of repair: first week of life: Group A; second week of life: Group B; and third week of life: Group C. The endpoints, comprised of an assessment of pre- and postoperative outcomes, complications, and survival, were compared between the groups. Results: The mean age of the infants was 10.50±6.26 days, and 61 (58.1%) cases were male. The mean number of days on dopamine was 1.85±0.12 in Group A, 2.48±0.03 in Group B, and 2.67±0.08 in Group C (P<0.001). The mean number of days on epinephrine was 1.25±0.07 in Group B and 1.27±0.08 in Group C (P<0.001). The mean number of days on the ventilator was 3.52±0.20 in Group A, 4.56±0.24 in Group B, and 5.06±0.21 in Group C (P<0.001). The mean number of days of ICU stay was 6.69±0.21 in Group A, 8.46±0.57 in Group B, and 9.70±0.64 in Group C (P<0.001). The infants in Group A had a greater survival rate (97.0%) than those in Group B (94.1%) and Group C (78.4%) (P=0.042). Conclusion: ASO in infants with simple TGA can be done within the first week of life with satisfactory outcomes and survival.

Early mobilization reduces delirium after coronary artery bypass graft surgery.

BACKGROUND: Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting. METHODS: This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46: a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed. RESULTS: Patients in the control group used cigarettes (31.1% vs. 11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h, p = 0.020), and fewer blood components infused (15.6% vs. 33.3%, p = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively, p = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10, p = 0.001). Multivariable analysis showed significant associations between Neecham score and age (p = 0.022), ejection fraction (p = 0.015), myocardial infarction (p = 0.016), systolic pressure (p = 0.009), and diastolic pressure (p = 0.008). CONCLUSIONS: Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.

Klotho Ameliorates Cellular Inflammation via Suppression of Cytokine Release and Upregulation of miR-29a in the PBMCs of Diagnosed Alzheimer's Disease Patients.

Alzheimer's disease (AD) is the most common neurodegenerative disorder characterized by neural inflammation and oxidative stress. In the current study, the protective effects of klotho and linagliptin treatment on human peripheral blood mononuclear cells (PBMCs) of AD patients and healthy controls (HCs) are assessed through measurement of inflammatory cytokines, signaling proteins, and miRNA expression. Sixteen diagnosed AD patients and sixteen HCs were enrolled in the study. Blood samples were obtained and PBMCs were isolated. PBMCs were treated with klotho at different concentrations (0.5, 1, and 2 nM) and linagliptin (50 µM). The concentration of interleukin-1ß (IL-1ß), interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), epsilon isoform of protein kinase C (PKCε), phosphorylated cyclic AMP response element binding (pCREB), and Wnt1 were measured by ELISA. The expression of miR-29a and miR-195 was detected by real-time PCR. The results showed that klotho significantly reduced IL-1ß, IL-6, and TNF-α levels in both groups of the experiment. Linagliptin also remarkably reduced TNF-α levels in the AD group. Moreover, klotho caused the downregulation of Wnt1 in the PBMCs of both groups and the upregulation of the pCREB in HCs. Meanwhile, klotho induced miR-29a expression in the PBMCs of HCs, while miR-29a expression was induced in the AD group by klotho and linagliptin. The current findings revealed that klotho alleviates inflammation in human PBMCs, probably through the suppression of inflammatory cytokines and the upregulation of miR-29a, and part of its beneficial effect is mediated through appropriate modulation of the Wnt1/pCREB signaling cascade. In addition, linagliptin exerts protective effects by reducing TNF-α and inducing miR-29a expression in PBMCs.

Surgical repair of Tetralogy of Fallot following primary palliation: Right ventricular outflow track stenting versus modified Blalock-Taussig shunt.

BACKGROUND: Tetralogy of Fallot (TOF) is a cyanotic disease requiring early intervention. We assessed the effect of right ventricular outflow tract (RVOT) stenting versus modified Blalock-Taussig shunt (mBTS) on outcomes of surgical repair of TOF. METHODS: Fifteen palliated TOF infants underwent complete repair surgery. RVOT stenting was performed in seven infants and mBTS was done in eight infants. Data on sequential patients who underwent surgery were collected and reviewed retrospectively. RESULTS: Stenting group were significantly younger (1.62±0.34 vs 2.80±0.52, p=0.001), had lower body weight (3.28±0.48 vs 5.03±0.67, p=0.001) and lesser body surface area (0.20±0.01 vs 0.26±0.20, p=0.001) than the mBTS group at palliation. Mean right pulmonary artery (RPA) diameter in stenting group at palliation was 2.9±0.54mm (z-score -3.08±0.97) and increased at surgery to 4.6±0.49mm (z-score -0.79±0.66) (p=0.001). The mean left pulmonary artery (LPA) diameter was 2.5±0.42mm (z-score -3.3±0.86), which increased to 3.3±0.40mm (z-score -2.2±0.74) at surgery (p=0.005). The mean RPA diameter in mBTS group at palliation was 3.2±0.32mm (z-score -2.9±0.70) and increased at surgery to 4.3±0.55mm (z-score -1.1±0.94) (p=0.001). The mean LPA diameter was 2.8±0.26mm (z-score -3.3±0.62), which increased to 3.2±0.24mm (z-score -2.4±0.52) at surgery (p=0.032). Repeat echocardiography showed significant increase in McGoon ratio and Nakata index in both groups (p=0.001). No significant differences were seen between the two groups regarding surgical procedure and postoperative complications. CONCLUSION: RVOT stenting is a safe and effective approach instead of mBTS in hazardous TOF infants with hypercyanotic spell, small PAs and complex anatomies.

S-allyl cysteine improves clinical and neuropathological features of experimental autoimmune encephalomyelitis in C57BL/6 mice.

Multiple sclerosis (MS) is a deleterious autoimmune and demyelinating disorder of the central nervous system with debilitating sensory and motor complications. There is still no definite cure for it and the main focus for its treatment mostly pivots around subsiding its severity and recurrence. Experimental autoimmune encephalomyelitis (EAE) is an established animal model of MS. S-allyl cysteine (SAC) is the active and main constituent of aged garlic extract with anti-inflammatory and neuroprotective property. This study was conducted to evaluate its possible protective effect in EAE model of MS. SAC was administered p.o. at a dose of 50 mg/kg/day to female C57BL/6 mice immunized with myelin oligodendrocytic glycoprotein (MOG35-55). Results showed that SAC is capable to alleviate clinical signs and severity of the disease and improved lumbar spinal cord tissue level of tumor necrosis factor α (TNFa), interleukin 17 (IL-17), activity-dependent neuroprotector homeobox (ADNP), microtubule-associated proteins 1A/1 B light chain 3A (MAP1LC3A), and matrix metalloproteinase 9 (MMP-9). In addition, SAC attenuated inflammatory cell infiltration, axonal demyelination, and axonal loss in lumbar spinal cord in EAE group, as demonstrated by H & E, Luxol fast blue (LFB), and Bielschowsky silver staining, respectively. Taken together, SAC could mitigate severity of MOG35-55-induced EAE as a valid model of MS via amelioration of pathogenic molecular mechanisms responsible for neuroinflammation and axonal damage.

The role of preoperative sildenafil therapy in controlling of postoperative pulmonary hypertension in children with ventricular septal defects.

Introduction: Most of the ventricular septal defects (VSD) are complicated with pulmonary arterial hypertension (PAH) which is the major cause of pulmonary hypertensive crisis and right ventricular failure. Methods: We reviewed clinical outcomes of 63 infants who underwent cardiac surgery and were divided into three groups. Control group (n=20) did not received sildenafil while group A (n = 22) received drug (0.3 mg/kg) before and after surgery. Group B (n=21) received drug at the initiation of surgery. Demographic data, preoperative and postoperative variables were compared among the patients. Results: Patients in the group A had lower preoperative pulmonary arterial pressure (PAP) compared to other groups (P < 0.001). Also, patients in control group had longer cardiopulmonary bypass time (P < 0.05). Postoperative PAP in patients of group A and B decreased significantly compared to control group (P < 0.001). Also, pre- and postoperative PVR (pulmonary vascular resistance) showed a significant decrease in group A compared with control and group B (P < 0.001). The intubation time in patients of the control group was significantly more prolonged compared with patients of group A and B (P < 0.001). Moreover, the length of ICU stay was significantly longer in patients of control group compared with group A and B (P < 0.001). Conclusion: Preoperative sildenafil therapy seems to be effective and safe to prevent postoperative PAH and pulmonary hypertensive crisis in children with ventricular septal defects and has a positive impact on postoperative care.

Repair of aortic coarctation in infancy: A 10-year clinical experience.

BACKGROUND: Coarctation of the aorta is a congenital narrowing of the upper descending aorta. The approximate incidence is 4% in live-born children with congenital heart disease. This study aimed to describe the surgical outcome and survival of patients undergoing congenital aortic coarctation repair via subclavian flap aortoplasty (group 1) or resection with end-to-end anastomosis (group 2). METHODS: We retrospectively reviewed the clinical outcomes of 105 infants who underwent repair of aortic coarctation between 2000 and December 2012. Fifty patients (group 1) underwent subclavian flap aortoplasty and 55 (group 2) underwent resection with end-to-end anastomosis. Procedure details and early results were collected by retrospective review of hospital and clinic data. RESULTS: The mean age of patients in group 1 was 6.73 ± 1.1 vs. 6.76 ± 1.2 months in group 2, and the mean weight was 6.01 ± 1.3 vs. 5.9 ± 1.0 kg, respectively. There were no significant differences among the intra- and postoperative variables in the 2 groups. Six patients in group 1 had a peak systolic gradient >20 mm Hg. The recurrence rate in group 1 was 12% vs. 1.8% in group 2 (p < 0.05). Overall mortality was 2.8%. Survival in group 1 was 96% vs. 98.2% in group 2. CONCLUSION: Repair of aortic coarctation in infancy by resection with end-to-end anastomosis can be performed with a low mortality rate and a low incidence of recoarctation, and it provides the optimal prognosis for coarctation in infancy.

Repair of Tetralogy of Fallot in Infancy via the Atrioventricular Approach.

BACKGROUND: Tetralogy of Fallot (TOF) is a well-recognized congenital heart disease. Despite improvements in the outcomes of surgical repair, the optimal timing of surgery and type of surgical management of patients with TOF remains controversial. The purpose of this study was to assess outcomes following the repair of TOF in infants depending on the surgical procedure used. METHODS: This study involved the retrospective review of 120 patients who underwent TOF repair between 2010 and 2013. Patients were divided into three groups depending on the surgical procedure that they underwent. Corrective surgery was done via the transventricular approach (n=40), the transatrial approach (n=40), or a combined atrioventricular approach (n=40). Demographic data and the outcomes of the surgical procedures were compared among the groups. RESULTS: In the atrioventricular group, the incidence of the following complications was found to be significantly lower than in the other groups: complete heart block (p=0.034), right ventricular failure (p=0.027) and mediastinal bleeding (p=0.007). Patients in the atrioventricular group had a better postoperative right ventricular ejection fraction (p=0.001). No statistically significant differences were observed among the three surgical groups in the occurrence of tachycardia, renal failure, and tricuspid incompetence. The one-year survival rates in the three groups were 95%, 90%, and 97.5%, respectively (p=0.395). CONCLUSION: Combined atrioventricular repair of TOF in infancy can be safely performed, with acceptable surgical risk, a low incidence of reoperation, good ventricular function outcomes, and an excellent survival rate.

The Effect of Pulmonary Valve Replacement (PVR) Surgery on Hemodynamics of Patients Who Underwent Repair of Tetralogy of Fallot (TOF).

INTRODUCTION: Pulmonary insufficiency (PI) frequently develops in patients who underwent repair of tetralogy of fallot (TOF). The aim of present study was to assess the effect of pulmonary valve replacement (PVR) on hemodynamics of patients who underwent repair of TOF. METHODS: This retrospective cohort carried out between July 2010 and October 2012 among consecutive PVRs of 19 patients who underwent TOF surgery. The PVRs was performed using bioprosthetic (n=17) and mechanical (n=2) valves. Our data was collected during follow up visits within 6 to 12 month after PVR. RESULTS: Our results show that PVR significantly decreased right ventricular end-diastolic volume (180.89±13.78 vs. 107.21±12.02 ml/m(2), P < .01), right ventricular end-systolic volume (105.42±15.98 vs. 58.15±11.67 ml/m(2), P < .01), RV mass (47.78±6.20 vs. 30.68±8.95 g/m(2), P < .01), and PI (48.21±1.43% vs. 12.68±5.60%, P < .01). Moreover, left ventricular end-diastolic volume significantly increased (78.05±17.21 vs. 90.78±14.82 ml/m(2), P < .01) after PVR. The other hemodynamics indexes did not change, significantly. CONCLUSION: Despite the controversies about efficacy of PVR after repair of TOF, the remarkable improvement of hemodynamic is a supportive rationale for performing PVR surgery in TOF patients.

Evaluation of sternal closure with absorbable polydioxanone sutures in children.

INTRODUCTION: Sternal dehiscence, sternal wound infection and mediastinitis are troublesome complications following median sternotomy which are major causes of morbidity and mortality of patients. Synthetic polydioxanone absorbable suture seems effective in prevention of these complications in children undergoing open heart surgery. METHODS: During 2 years period, 620 patients who underwent median sternotomy were studied. The efficacy of absorbable polydioxanone suture was tested on patients using figure-of-eight suture technique. The patients' age ranged from newborn to 15 years old. All surgical interventions were performed according to a standard protocol. RESULTS: No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Two patients experienced sternal dehiscence (0.32%). Follow-up period of patients were established between 1 to 132 months after open heart surgery. CONCLUSION: Sternal closure with the polydioxanone suture in combination with figure-of-eight technique is a safe and suitable method in children with good clinical results.