Role of CT and MRI prior to redo sternotomy in paediatric patients with congenital heart disease.

AIM: To assess the value of computed tomography (CT) and magnetic resonance imaging (MRI) in the preoperative evaluation of congenital heart disease patients about to undergo redo sternotomy. MATERIALS AND METHODS: Forty-three patients (26 male, 17 female, median age 65 months) underwent contrast-enhanced CT and 24 patients (16 male, eight female, median age 89 months) underwent MRI prior to redo sternotomy for congenital heart disease. The informed consent requirement was waived by the institutional review board for this Health Insurance Portability and Accountability Act (HIPAA) compliant study. A standardized CT protocol utilizing a 64 section multidetector machine and an unenhanced and contrast-enhanced MRI multisequence protocol was used. Images were qualitatively graded and retrosternal distances were measured as part of a risk assessment score. RESULTS: There were no statistically significant differences between the observers' grades regarding most retrosternal structures at both CT and MRI, separately (p > 0.05); furthermore, both readers found CT to be superior to MRI in qualitative grading except one reader's grades for shunts/conduits (p = 0.107). κ-values were good to excellent (κ ≥ 0.61) for most structures in qualitative grading of cases and risk assessment scores. There were no significant differences between grades of important structures using the same technique based on Friedman's test (p > 0.05). Analysis showed no difference between risk scores given to CT and MRI patients (p > 0.05). CONCLUSION: The present findings demonstrate the value of imaging to evaluate retrosternal anatomy. CT could be more valuable than MRI and could play a pivotal role in the surgical planning of CHD patients prior to redo operations.

Novel techniques in the use of bivalirudin for cardiopulmonary bypass anticoagulation in a child with heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) occurs in both the pediatric and adult populations after exposure to heparin. Bivalirudin has been used as an alternative to heparin for adults undergoing cardiac surgery and cardiopulmonary bypass, but has only been used minimally in children for this purpose. We report the successful use of bivalirudin for anticoagulation during cardiopulmonary bypass in a small child with HIT, using novel techniques not previously described.