Alternative Hybrid Approach to Promote Native Pulmonary Artery Growth in Pulmonary Atresia VSD MAPCAs.

We present a case of right ventricle to pulmonary artery hybrid perforation and stenting in a patient with pulmonary atresia with ventricular septal defect major aortopulmonary collaterals and diminutive native pulmonary arteries, then discuss how it compares with established approaches. (Level of Difficulty: Advanced.).

Direct Percutaneous Transthoracic Cardiac Access for Recanalization of Longstanding Branch Pulmonary Artery Atresia.

We describe the use of direct percutaneous cardiac access to recanalize an atretic right pulmonary artery in an adolescent with complex congenital heart disease and right heart failure. This case highlights the problems associated with loss of central venous access and potential advantages of a direct cardiac approach to catheterization. (Level of Difficulty: Intermediate.).

Cryopreserved valved femoral vein homografts for right ventricular outflow tract reconstruction in infants.

Background: We have previously reported use of cryopreserved valve femoral vein homograft (FVH) conduits for biventricular repairs in infants needing right ventricular outflow tract (RVOT) reconstruction. This study aims to compare FVH conduits with aortic (A) and pulmonary (P) homografts with regards to intermediate- and long-term outcomes. Methods: Retrospective review was conducted of all infants between 2004 and 2016 who underwent biventricular repair with RVOT reconstruction using homograft conduits. Patients were divided into A, P, and FVH groups based upon type of conduit received (N = 57 [A = 13; P = 21, FVH = 23]). Groups were compared using univariate and multivariable Cox regression analyses. The Nelson-Aalen estimator of cumulative hazard and Kaplan-Meier curves were used to identify differences in freedom from catheter reintervention and reoperation. Results: The 2 groups were comparable except for greater incidence of delayed sternal closure and longer hospital length of stay in the FVH group. The follow-up was longer for A and P groups compared with the FVH group (P < .001). Multivariable Cox regression, adjusting for difference in the length of follow-up, revealed comparable freedom from overall reintervention between the groups. Younger age at implantation was the only independent predictor of overall reintervention (hazard ratio per day younger age, 1.06; 95% confidence interval, 1.02-1.11; P = .002). Nelson-Aalen cumulative hazard analysis revealed greater freedom from percutaneous reintervention with use of FVH. Kaplan-Meier analysis showed comparable freedom from reoperation for all three conduits. Conclusions: Valved femoral vein homograft conduits are comparable with aortic and pulmonary homografts for RVOT reconstruction in infants undergoing biventricular repairs.

Tetralogy of Fallot: Pushing Through Despite Long Odds.

The natural history of tetralogy of Fallot depends on whether a transannular pulmonary valve patch or shunt surgery was necessary in infancy. This case illustrates the feasibility of cardiac rest on extracorporeal membranous oxygenation for a very ill adult with conduit endocarditis who received a right ventricle-to-pulmonary artery valveless conduit for later transcatheter pulmonary valve replacement. (Level of Difficulty: Advanced.).

Cardiac Arrest Secondary to Traumatic Aortopulmonary Window During Transcatheter Pulmonary Valve Implantation in Supported Ross.

We present a patient with a supported Ross procedure and severe pulmonary homograft stenosis who developed cardiac arrest while undergoing transcatheter pulmonary valve replacement and was found to have a large iatrogenic aortopulmonary window. Cardiopulmonary resuscitation was initiated followed by covered stent placement, extracorporeal membrane oxygenation support, and ultimately emergent surgery with a good outcome. (Level of Difficulty: Advanced.).