Technical Aspects and Common Pitfalls of Norwood With Modified Blalock Taussig Shunt.

The Stage 1 Norwood procedure is the first of 3 stages in the surgical palliation of hypoplastic left heart syndrome and certain other single ventricle lesions with systemic outflow obstruction. In this article, we address some technical aspects and common pitfalls of the Norwood procedure with systemic to pulmonary shunt for HLHS palliation. We report our results with the Norwood with Blalock Taussig shunt in a cohort of 44 patients over a 7-year period in 2 institutions in Argentina. The results of the Norwood procedure have improved significantly through the understanding and refinement of the surgical techniques. Procedures must be technically perfect since residual lesions are poorly tolerated. Norwood with a modified Blalock Taussig shunt can be performed with low mortality and may provide excellent long-term outcomes.

CABG With Internal Thoracic Artery in Children With Congenital Heart Defects: A Good Option When It Is the Only One.

OBJECTIVE: Coronary complications may present during or after repair of congenital heart defects. We report coronary artery bypass grafting (CABG) by internal thoracic artery (ITA) grafts to either coronary artery in children with congenital anomalies. METHODS: Four cases who underwent CABG with ITA grafts from March 2016 to March 2020 were retrospectively reviewed. RESULTS: At the time of operation, patient's ages and weight were 7 and 20 months old and 14 and 15 years old and 6.5, 10, 40, and 45 kg, respectively. Diagnosis were anomalous origin of the left coronary artery from the pulmonary artery with leftward lateral ostial origin (n = 1), neopulmonary annulus hypoplasia post arterial switch with contiguous right coronary artery (RCA) arising from the left facing sinus (n = 1), RCA stenosis after the Ross procedure (n = 1), and right coronary ostial obstruction after aortic valve replacement in truncus arteriosus (n = 1). Procedures included left ITA to left coronary ostium (n = 1), right ventricular outflow tract (RVOT) enlargement with pulmonary valve replacement with left ITA to RCA (n = 1), RVOT enlargement with pulmonary valve replacement with right ITA to RCA (n = 1), and aortic valve re-replacement, pulmonary valve replacement, and right ITA to RCA (n = 1). At last follow-up, all four patients were asymptomatic, with normal ventricular function, and all grafts were patent. CONCLUSIONS: The use of CABG in children is valuable alternative when dealing with complex coronary anatomy not suitable for classic repairs. In children, graft patency is required to be longer than 50 years; therefore, use of arterial grafts seems mandatory.

Lymphatic Decompression Concomitant With Fontan/Kreutzer Procedure: Early Experience.

OBJECTIVE: To present a strategy for identifying patients at risk of lymphatic failure in the setting of planned Fontan/Kreutzer completion, allowing a tailored surgical approach. METHODS: Since January 2017, clinical evaluation before performance of the Fontan/Kreutzer procedure included T2-weighted magnetic resonance imaging (MRI) lymphangiography. Thoracic lymphatic abnormalities were categorized using a scale of I to IV according to progression of severity. Patients with severe lymphatic abnormalities (types III and IV) underwent Fontan/Kreutzer with lymphatic decompression via connection of the left jugular-subclavian junction containing the thoracic duct to the systemic atrium (group A). RESULTS: Thirteen patients were enrolled. Magnetic resonance imaging showed type I abnormalities in four cases (30.7%), II in four (30.7%), III in two (15.3%), and IV in three (23.3%). Patients in types III and IV underwent a Fontan/Kreutzer with lymphatic decompression (group A, n = 5), while patients in types I and II underwent a fenestrated extracardiac Fontan/Kreutzer procedure without lymphatic decompression (group B, n = 8). Preoperatively, there were no differences in age, weight, ventricular dominance (right vs left), superior vena cava pressure, incidence of chylothorax after previous superior cavopulmonary anastomosis (Glenn), or need for concomitant procedures at Fontan/Kreutzer completion. There were no differences in procedural times between the groups, nor were there differences in mortalities and Fontan/Kreutzer takedowns. There were no statistically significant differences in early and late morbidity between the two groups with the exception of total volume of effusions output postoperatively. At median follow-up of 18 months (range, 4-28 months), all patients in group A are in New York Heart Association class 1 with no differences between groups in arterial oxygen saturation. CONCLUSIONS: Lymphatic decompression during Fontan/Kreutzer procedure was successfully performed in patients identified by MRI as predisposed to lymphatic failure. A larger cohort of patients and longer follow-up are required to determine the efficacy of this approach in preventing early- and long-term Fontan/Kreutzer failure.

Combined Rastelli and Bentall Procedures for Pulmonary Atresia With Ventricular Septal Defect and a Large Aortopulmonary Collateral Artery and Ascending Aorta Aneurysm.

We report a challenging case of a 32-year-old patient in New York Heart Association (NYHA) class IV with pulmonary atresia, ventricular septal defect, a left aortopulmonary collateral artery, a right modified Blalock-Taussing shunt, and a gigantic aneurysm of the ascending aorta with severe aortic valve insufficiency. A combined Rastelli and Bentall procedure was performed by a joint adult and pediatric cardiovascular surgery team. One year after the operation, the patient is in NYHA class I, working full time.

Insuficiencia tricuspídea causada por traumatismo no penetrante de tórax en adolescente de 14 años / Insuficiência tricúspide causada por traumatismo nåo penetrante de tórax em um adolescente de 14 anos / Tricuspid valve regurgitation due to thoracic blunt trauma in a 14 year old adolescent

La insuficiencia tricuspídea como consecuencia de un traumatismo no penetrante de tórax es poco frecuente. Presentamos el caso de una paciente de 14 años con diagnóstico pre quirúrgicode insuficiencia tricuspídea por displasia valvular y de ventrículo derecho en el cual, durante la cirugía, se evidencia la desinserción de la valva anterior tricuspídea sin displasia. Debido a lascaracterísticas de la lesión valvular, se sospecha que su etiología podía ser de origen traumático. Interrogando a la familia, recuerdan un accidente que ocurrió 7 años atrás, en el que la paciente sufrió un fuerte traumatismo no penetrante de tórax...

A insuficiência tricúspide como consequência de um traumatismo não penetrante de tórax é pouco frequente. Apresentamos o caso de uma paciente de 14 anos com diagnóstico pré cirúrgicode insuficiência tricúspide por displasia valvar e de ventrículo direito no qual, durante a cirurgia, evidenciou-se a desinserção da valva anterior tricúspide sem displasia. Devido às característicasda lesão valvar, suspeita-se que sua etiologia pudesse ser de origem traumática. Durante uma entrevista com a familia, foi relatado um acidente ocorrido 7 anos antes, onde a paciente sofreu um forte traumatismo não penetrante de tórax...

Tricuspid insufficiency as a consequence of blunt thoracic trauma is uncommon. We present the case of a 14 year-old patient with preoperative diagnosis of tricuspid insufficiency due to valvularand right ventricle dysplasia where, during the surgery, there is evidence of desinsertion of the anterior leaflet of the tricuspid valve without dysplasia. Because of the characteristics of the valvular injury, its etiology is suspected to be of traumatic origin. The family, when inquired, remembers an accident that occurred 7 years ago, when the patient suffered a blunt thoracic trauma...

Aortopulmonary fistula after an arterial switch operation.

Aortopulmonary fistula has been documented in adult patients with acute aortic dissection, atherosclerotic disease, and other comorbidities. However, until now we believe this was not previously reported as a complication after the arterial switch operation in a patient with transposition of the great arteries. We report the case of a 3-month-old boy who underwent an arterial switch operation as a neonate. After balloon dilation to relieve a postoperative supravalvular pulmonary stenosis, he presented with severe congestive heart failure due to an undiagnosed but previously present fistula between the ascending aorta and the main pulmonary artery. He underwent successful surgical repair and recovered uneventfully.