Rare cardiac tumour-nodular fasciitis.

Left ventricular tumour is a rare condition in children. The causes include vegetations, thrombus, and fibroma. 2-year-old asymptomatic female presented with an innocent heart murmur at 6 months of age. Subsequent follow-ups at 18 months of age showed left ventricular mass. Surgical pathology revealed "nodular fasciitis." This type of tumour has never been described in the heart before.

Coronary transfer for complex looping and intramural variants in the arterial switch procedure.

Achieving a safe and accurate coronary transfer in the context of the precise geometry of the realigned great arterial connections is the essence of the arterial switch operation for transposition. Because the incidence of variant coronary patterns is not low, one needs to be familiar with techniques to transfer all types of coronary patterns when performing the arterial switch operation. Both closed and open techniques for coronary transfer have been widely adopted for the arterial switch operation. We routinely use the open technique for coronary transfer combined with a liberal use of trapdoor incisions. We demonstrate that this technique, with appropriate technical modifications, serves as a template for achieving accurate coronary transfer even in the context of complex looping and intramural variants.

Two-patch transannular repair of tetralogy of Fallot with complete atrioventricular canal defect.

We demonstrate the repair in an infant of tetralogy of Fallot with complete atrioventricular canal defect using a 2-patch technique with transannular reconstruction of the right ventricular outflow tract due to a diminutive pulmonary valve annulus. This approach is reproducible and particularly valuable to surgeons who routinely use a 2-patch technique to repair an isolated complete atrioventricular canal defect.

Left Atrial Appendage Aneurysm Characterized by Multimodal Imaging.

We present a four-year-old female with an incidental finding of a congenital left atrial appendage aneurysm who underwent surgical resection with excellent results. This case highlights the importance of multimodal imaging in the diagnosis and characterization of this rare condition.

Single-stage repair of interrupted aortic arch type B with ventricular septal defect.

In this video tutorial, we present our surgical technique for single-stage complete repair of an interrupted aortic arch with ventricular septal defect. The key operative steps, which include dual cannulation, the arch repair, and the intra-cardiac repair, are clearly demonstrated.

Impact of 3D Printouts in Optimizing Surgical Results for Complex Congenital Heart Disease.

Planning corrective and palliative surgery for patients who have complex congenital heart disease often relies on the assessment of cardiac anatomy using two-dimensional noninvasive cardiac imaging modalities (echocardiography, cardiac magnetic resonance imaging, and computed tomography scan). Advances in cardiac noninvasive imaging now include the use of three-dimensional (3D) reconstruction tools that produce 3D images and 3D printouts. There is scant evidence available in the literature as to what effect the availability of 3D printouts of complex congenital heart defects has on surgical outcomes. Surgical outcomes of study subjects with a 3D cardiac printout available and their paired control subject without a 3D cardiac printout available were compared. We found a trend toward shorter surgical times in the study group who had the benefit of 3D models, but no statistical significance was found for bypass time, cross-clamp time, total time, length of stay, or respiratory support. These preliminary results support the proposal that 3D modeling be made readily available to congenital cardiac surgery teams, for use in patients with the most complex congenital heart disease.

Heart Transplant in Patient With Isolated Left Superior Vena Cava by Atrial Appendage Rotation.

Orthotopic heart transplantation in patients with an isolated persistent left superior vena cava is extremely rare, and the anastomotic connection between a right-sided donor superior vena cava and left-sided recipient superior vena cava can be challenging to perform. We present a novel technique used in an infant female, using the left atrial appendage to extend the superior vena cava anastomosis.

Single-stage repair of double outlet right ventricle with subpulmonic ventricular septal defect (Taussig-Bing anomaly).

Double outlet right ventricle with subpulmonic ventricular septal defect is a very rare form of congenital heart disease. Surgical correction involves closure of the ventricular septal defect with baffling of blood flow from the left ventricle to the pulmonic valve and arterial switch of the usually side-by-side great arteries. In this tutorial, we present our surgical technique for single-stage repair of this complex anomaly.

Managing extensive mitral valve and ventricular septal injuries secondary to penetrating trauma.

Penetrating cardiac injuries with extensive intracardiac components and minimal epicardial components are a rare presentation. A 31-year-old male presented with complex mitral valve and ventricular septal injuries with partial atrioventricular disruption but with hardly visible epicardial injuries; the patient's presentation, progression of injuries and successful management are discussed.

Safe sternal reentry in all age groups with the Rultract Resternotomy Retractor™.

In patients undergoing repeat sternotomy, the risk of injury to cardiac structures can be reduced by utilizing a technique that provides sustained visualization of structures adherent to underside of the sternum. We discuss the use of a retractor specifically designed for this purpose: the Rultract Resternotomy Retractor™.

Repair of truncus arteriosus with interrupted aortic arch (Van Praagh type A4).

Truncus arteriosus is an extremely rare and complex form of congenital heart disease. Surgical strategies vary depending on anatomic subtype.  In this tutorial, we present our surgical technique for single stage repair of a truncus arteriosus with interrupted aortic arch (Van Praagh type A4).

Transition metal oxide nanoparticles as surfaces for surface-assisted laser desorption/ionization mass spectrometry of asphaltenes.

We report the first use of NiO, Fe3O4, TiO2, and Co3O4 nanoparticles as surfaces for surface-assisted laser desorption/ionization (SALDI) mass spectrometry of asphaltenes. Higher signal-to-noise ratios (S/Ns) for asphaltene species were observed using NiO and Fe3O4 nanoparticles for SALDI as compared to LDI, where both surfaces consistently provided 2- to 3-fold improved S/Ns. The new SALDI detection method showed reliable adsorption data measuring supernatant solutions after 24 hour asphaltene adsorption on NiO, Fe3O4, and Co3O4. These results indicated that NiO has a higher adsorption affinity than Fe3O4 and Co3O4 for asphaltene molecules, corroborating reported asphaltene adsorption on metal oxide nanoparticles.

A novel technique of single patch repair of right partial anomalous pulmonary venous return to the superior vena cava by right atrial edge rotation.

In patients with partial anomalous pulmonary venous return of the right superior pulmonary veins to the superior vena cava, surgical repair generally consists of either intraatrial baffle with or without caval enlargement, or superior caval transection and cavoatrial anastomosis to the right atrial appendage. We discuss here a novel technique of superior caval enlargement without need for patch material or reimplantation.

Predictors of reintervention after repair of interrupted aortic arch with ventricular septal defect.

BACKGROUND: Left ventricular outflow tract obstruction after neonatal repair of interrupted aortic arch with ventricular septal defect may warrant reintervention. We sought to identify clinical and preoperative echocardiographic predictors of reintervention for postoperative left ventricular outflow tract obstruction. METHODS: Retrospective data were collected on neonates with interrupted aortic arch with ventricular septal defect who underwent single-stage repair from 1995 to 2009. Univariate and multivariate analyses were performed to identify predictors of reintervention. RESULTS: Seventy patients underwent repair, with 16 patients requiring reintervention: 8 underwent surgical reintervention, 5 underwent percutaneous reintervention, and 3 underwent both. The median time to reintervention was 1.2 years (range, 0.2 to 7.7). All surgical reoperations involved subaortic resection, and all percutaneous reinterventions included balloon aortic valve dilation. Several preoperative echocardiographic measurements were significant by univariate analysis; however, smaller preoperative aortic root size was an independent predictor (p = 0.02) by multivariate analysis. Patients with an aortic root size less than 6.5 mm were at greater risk for reintervention compared with patients with a root size greater than 6.5 mm (reintervention rate 44% and 12%, respectively; p < 0.001). Postoperative left ventricular outflow tract gradient by echocardiogram before discharge was significantly higher in the reintervention group. CONCLUSIONS: Preoperative aortic root size predicts reintervention for postoperative left ventricular outflow tract obstruction after single-stage repair of interrupted aortic arch with ventricular septal defect. Patients with elevated left ventricular outflow tract gradients at discharge are at higher risk of having progressive obstruction and require closer follow-up to ensure early identification and management.

Double-barrel right ventricular outflow: tetralogy of Fallot annulus preservation technique.

In patients with tetralogy of Fallot (TOF) repair and a borderline pulmonary valve annulus (PVA) size, surgical repair often necessitates a transannular incision and subsequent placement of a patch with or without a monocusp or, alternatively, a right ventricle-to-pulmonary artery conduit. We discuss here a technique in which the pulmonary valve annulus can be safely preserved, with infrequent postoperative issues as well as the potential for less incidence of right ventricular outflow intervention in the long term.

Update on the Amplatzer duct occluder: a 10-year experience in Asia.

Few data exist regarding the efficacy and safety of the Amplatzer ductal occluder (ADO) type 1 device in the Asian region. This retrospective study, conducted between August 2001 and April 2011, attempted device placement for 231 patients (165 females and 66 males) with a median age of 7.4 years (range, 3 months to 64 years) and an average weight of 19.4 kg (range, 4.1-81.0 kg). Among the patients in this study, 66 (28.6%) had pulmonary hypertension, ten (4.3%) had trisomy 21, and eight (3.5%) had other congenital cardiac anomalies. The mean narrowest patent ductus arteriosus (PDA) diameter was 4.2 mm (range, 1.3-10 mm), and the ampulla size was 9.6 mm (range, 4-20 mm). Successful implantation was achieved for 229 patients (99.1%). Complete angiographic occlusion was achieved for 201 patients (87.8%) at the end the procedure. Follow-up data were available for 129 patients (66%). At the follow-up assessment, complete echocardiographic occlusion was seen in 128 patients (99.2%) after 1 month and in 100% of the patients after 6 months. The significant morbidities involved one device embolization and one dislodgment, for which surgical retrieval was performed. No mortalities occurred during the study period, and no late clinical adverse events occurred during the follow-up period. Occlusion of the PDA using ADO is safe, effective, and applicable for a wide range of PDA sizes including large PDAs in small symptomatic infants and in adults. Good outcomes can be attributed to experience of the operators, proper patient selection, and appropriate device size selection.