Risk factors for distal Contegra stenosis: results of a prospective European multicentre study.

Objectives The EUCon study was designed to identify risk factors for distal anastomotic stenosis after bovine jugular vein (Contegra) implantation in children. Methods Between March 2006 and August 2008, 104 devices were implanted in nine European centers. Preoperative, intraoperative, and follow-up data (at discharge, 6, 12, 24 months) including standardized echocardiography were prospectively registered, source data verified and collected in a central database. Main endpoint was distal stenosis (either postvalvular gradient of ≥50 mm Hg or need for intervention for distal stenosis). Eight potential risk factors (age <2 years, diagnosis, running suture, use of glue, flapless anastomosis, oversizing less than + 2 z, anticoagulation, implantation site) were investigated. Cox regression, decision tree analyses, and "Clustering by Response" were applied. Results Patient age ranged from 0 to18 years, mean 6.0 ± 6.1, median 3.2 years. Implantation reasons: 88% congenital malformations, 12% Ross operations. Follow-up was 88.3% complete. Durability (freedom from death, reoperation, degeneration, endocarditis, and explantation) compared well to corresponding homograft literature. Sixteen patients reached study endpoints. Age <2 years was the only invariably significant risk factor (p = 0.044); "Clustering By Response" found young anticoagulated patients with oversized conduits to be at a higher risk than the others (p = 0.018, OR = 3.2). Conclusion Patient age is the main risk factor for development of distal anastomosis stenosis after Contegra implantation. The influence of the other investigated factors is too small to be proven in 104 patients after 2 years, or other risk factors must be taken into consideration to explain outcome differences among recipients under 2 years.

Epidural analgesia in the surgery of congenital tracheal stenosis: slide tracheoplasty on cardiopulmonary bypass.

Epidural analgesia in children is highly effective and safe; however, it has not enjoyed great popularity in surgery that requires cardiopulmonary bypass. A major concern is the possibility of damage to blood vessels with the epidural needle or catheter and epidural hematoma formation. There seems to be a low incidence of epidural hematoma if certain guidelines are followed, so that in children, epidural analgesia can be used in selected patients, with safety, when surgical repair requires cardiopulmonary bypass. Epidural morphine has been used for clinical pain relief in pediatric cardiac surgery. Improved pulmonary function, suppressed hormonal and metabolic stress responses, easy early tracheal extubation, and good analgesia and sedation that allows neurological examination to alert any possibles hidden complications, are the advantages. A dedicated medical team is essential in the perioperative management to achieve maximum benefit for these patients.

[Comparative study of thoracic approaches in atrial septal defect closure]. / Estudio comparativo de la vía de abordaje en el cierre de la comunicación interauricular.

Our early experience in approaching ASD by right thoracotomy as opposed to midline sternotomy is presented. Between July 2000 and December 2001, 15 patients (group A) were operated by right thoracotomy. Mean age of patients was 8.6 years and mean weight was 31.6 kg. In the same period, midline sternotomy was used in 16 patients (group B). Mean age was 4.7 years and weight was 16.5 kg. The duration of the procedure, by-pass, and aortic cross-clamping were similar. Bleeding was 265 ml (8.4 ml/kg) in group A, and 152 ml (9.2 ml/kg) in group B. The duration of the ICU stay and time of discharge were 2.4 days and 6 days in group A, and 2.23 days and 6.87 days in group B, respectively. No significant differences were found in ASD closure by thoracotomy and sternotomy. The cosmetic appearance acceptance of right thoracotomy was excellent.

Estudio comparativo de la vía de abordaje en el cierre de la comunicación interauricular / Comparative study of thoracic approaches in atrial septal defect closure

Presentamos nuestra experiencia inicial en cierre de la comunicación interauricular (CIA) por vía derecha, comparándola con esternotomía media. Entre julio de 2000 y diciembre de 2001, 15 pacientes (grupo A) fueron intervenidos por toracotomía derecha. La media de edad fue de 8,6 años y el peso medio, de 31,6 kg. En el mismo período, 16 pacientes (grupo B) fueron intervenidos por esternotomía media. La edad media fue de 4,7 años y el peso, de 16,5 kg. Las duraciones de la intervención, de la circulación extracorpórea y de la isquemia cardíaca fueron similares. El drenaje total fue de 265 ml (8,4 ml/kg) en el grupo A, y de 152 (9,2 ml/kg) en el grupo B. La estancia media en la UCI y postoperatoria fue de 2,4 y 6 días, respectivamente, en el grupo A, y de 2,23 y 6,87 días, respectivamente, en el grupo B. No encontramos diferencias significativas en el cierre de CIA por toracotomía o esternotomía. Por toracotomía derecha el resultado estético fue excelente (AU)

Aortic coarctation, vascular ring, and right aortic arch with aberrant subclavian artery.

Right aortic arch, in all situations, is relatively rare. In association with coarctation and vascular compression, it is extremely rare. We present a patient with a right aortic arch and an aberrant left subclavian artery, in addition to coarctation. This was dealt with through a left thoracotomy by dividing the ligamentum arteriosum and placing a Dacron graft from the ascending aorta to the descending aorta.

Retorno venoso pulmonar total anómalo en pediatría: importancia del diagnóstico ecocardiográfico y de la cirugía precoz / Total anomalous pulmonary venous connection in the pediatric age:iImportance of echocardiographic diagnosis and early repair

Introducción y objetivos. Estudiamos los pacientes afectados de retorno venoso pulmonar total anómalo intervenidos en nuestro centro. Presentamos la importancia del diagnóstico ecocardiográfico exclusivo previo a la cirugía. Métodos. Desde 1990 hasta 1999, 14 pacientes fueron intervenidos de dicha cardiopatía en nuestro centro. El sitio de drenaje fue en 6 pacientes supracardíaco, 4 infracardíaco, 1 cardíaco (seno coronario) y en 3 pacientes mixto. En 11 casos el diagnóstico se realizó por estudio ecocardiográfico, siendo los hallazgos corroborados durante la cirugía. Resultados. Sólo hubo una muerte durante la intervención quirúrgica, relacionada con un ventrículo izquierdo pequeño, y a los 35 días de la intervención se produjo otro fallecimiento por sepsis. Durante el postoperatorio inmediato, el control y tratamiento de la hipertensión pulmonar fueron los objetivos primordiales. Tras un seguimiento medio de 50 meses, sólo un paciente precisó reintervención; el resto de pacientes se encuentra asintomático. Conclusiones. El diagnóstico ecocardiográfico de esta cardiopatía puede ser suficiente para indicar la cirugía. Así mismo la corrección quirúrgica precoz del retorno venoso pulmonar anómalo total puede ser realizada con bajo riesgo y buenos resultados a medio plazo (AU)