Innominate Artery Pseudoaneurysm Requiring Cartilage Tracheal Repair in a Child.

Mycotic aneurysms are rare but potentially catastrophic. We report a case of an innominate artery pseudoaneurysm in a 4-year-old patient that caused a tracheoinnominate fistula requiring tracheoplasty with a costal cartilage graft and a homograft iliac artery replacement of the diseased innominate artery, with a successful outcome.

Word of caution: Severe aortic valve injury linked to retrograde closure of perimembranous ventricular septal defects.

Retrograde device closure of perimembranous ventricular septal defects (pmVSDs) is an interesting procedure with several technical advantages and encouraging follow-up results. Nevertheless, aortic valve injuries may occur and require sufficient attention. Herein, we report the first two cases of severe aortic regurgitation that we have linked to the retrograde pmVSD closure with the KONAR-MF™ VSD occluder. We detail the technical aspects, comprehensively discuss procedural errors and conclude with important learning points.

The ordeal of left atrioventricular valve replacement in children under 1 year of age.

OBJECTIVES: This study reviews the outcomes of children under 1 year of age who had left atrioventricular valve (LAVV) replacement (LAVVR) in one centre and explores the benefits of an innovative approach for LAVVR in very small patients. METHODS: Thirteen consecutive patients operated for LAVV replacement between 1997 and 2016 were reviewed retrospectively. Indication for surgery was regurgitation in 7, stenosis in 5 and both stenosis and regurgitation in 1. Nine patients (69%) had previous LAVV repair. Median age at surgery was 126 days (39-327 days). In the primary surgery, 7 mechanical valves and 1 mitral homograft were implanted. Five inverted semilunar valve conduits were implanted consisting of a Contegra valve in 4 and a pulmonary homograft in 1. RESULTS: Hospital mortality was 31% (4 of 13). Two patients required postoperative extracorporeal membrane oxygenation. Six patients developed complete atrioventricular block, with 2 survivors requiring a pacemaker. Late mortality was 31% (4 of 13). Two of the 4 patients who received an inverted Contegra conduit died. Median follow-up of the 5 survivors was 4 years (2-16 years). Four patients had 10 further replacements consisting of 6 redo conventional mechanical valves replacement, 3 supra-annular valve implantation, and 1 modified Ross II. The 5 inverted semilunar valve conduits implanted lasted for 1, 5, 6, 22 and 37 months. CONCLUSIONS: LAVVR below 1 year of age is associated with a considerable operative and late mortality. LAVVR with an inverted conduit bearing semilunar valves may be an alternative strategy for patients with the smallest annuli.

Long-term outcomes of complete vascular ring division in children: a 36-year experience from a single institution.

Objectives: Complete vascular rings are rare and cause tracheoesophageal compression. Following surgical division, some patients have persisting tracheomalacia. We aim to assess the long-term outcomes of complete vascular ring division. Methods: All patients (n = 132) who underwent surgical division of a complete vascular ring between 1978 and 2014 were identified from the hospital database and retrospectively reviewed. Results: Complete vascular rings consisted of a double aortic arch (n = 80), right aortic arch with an aberrant subclavian artery and left ligamentum arteriosum (n = 50), right aortic arch with mirror image branching and left ligamentum arteriosum (n = 1), and a left aortic arch with right descending aorta and right ligamentum arteriosum (n = 1). Kommerell's diverticulum was identified in 10 patients. Preoperative tracheomalacia was identified via bronchoscopy in 25 patients. Concomitant tracheal reconstruction was not performed in any patient. Kommerell's diverticulum was resected in 1 patient. The hospital mortality rate was 1.5% (2/132). There were no late deaths. The overall survival rate was 98.3 ± 1.2% (95% CI: 93.4, 99.6) at 20 years. Postoperatively, persistent tracheal compression was reported in 3 patients, and tracheomalacia in 16 patients. The rate of freedom from reoperation was 88.6 ± 4.0% (95% CI: 77.9, 94.3) at 20 years. No patient required tracheal surgery during the follow-up period. Follow-up was 92% (121/132) complete, with a median follow-up of 11.4 years (range 44 days to 36 years). At the last follow-up, 7 patients had mild tracheomalacia. Conclusions: Outcomes of division of a complete vascular ring are excellent. Tracheomalacia often improves following division of the vascular ring. Respiratory symptoms following complete vascular ring division are uncommon.

Successful Operation for Thoracoabdominal Aortic Aneurysm in a 5-Year-Old Boy With Tuberous Sclerosis.

The association of abdominal aortic aneurysm (AAA) and tuberous sclerosis (TS) is rare. A 5-year-old boy was diagnosed with a 7-cm calcified thoracoabdominal aortic aneurysm (TAAA), and the clinical evaluation revealed TS. The patient underwent an open repair with a 14-mm polyester tube graft prosthesis. The pathologic examination showed nonspecific dystrophic changes with loss of elastin fibers in the media of the aorta. The graft was patent on computed tomographic angiography performed 1 month after the operation. Because of the high risk of rupture, early elective repair is suggested.