Influence of tracheobronchomalacia on outcome of surgery in children with congenital heart disease and its management.

Background: Patients with complex congenital heart disease associated with tracheobronchomalacia (TBM) remain difficult to manage after cardiac surgery. We studied the influence of TBM on the outcomes of pediatric patients after cardiac surgery for congenital heart disease to determine how to manage these patients better.

Methods: Twenty-two consecutive pediatric patients who had TBM diagnosed by bronchoscopy or dynamic contrast bronchography before or after cardiac surgery for congenital heart disease during a 5.

Repair of anomalous left coronary artery from the right pulmonary artery.

Surgical correction of anomalous left coronary artery from the right pulmonary artery is achieved by either direct implantation of the left coronary artery into the aorta or creation of a conduit between the two. We modified a technique originally described by Tashiro for the main pulmonary artery, by using a circumferential section of right pulmonary artery wall to create a conduit with a side-to-side anastomosis onto the aorta.

Truncus arteriosus with interrupted aortic arch: successful repair using modified cardiopulmonary bypass and surgical techniques.

A neonate with truncus arteriosus (type 1) and interrupted aortic arch (type A) associated with an excessively large gap between interrupted aortic segments underwent successful reconstruction of the aortic arch with a partial subclavian flap aortoplasty plus bovine jugular patch (Contegra 200, Medtronic, Inc, Minneapolis, MN) using continuous selective low-flow cardiopulmonary bypass without circulatory arrest. The ventricular septal defect was closed with a Dacron (IMPRA, Inc, Tempe, AZ) patch, and a Contegra prosthesis was used to re-establish right ventricle to pulmonary artery continuity. At an 18-month follow-up, the patient was free of symptoms with normal development.

Changes in myocardial free amino acids during pediatric cardiac surgery: a randomised controlled trial of three cardioplegic techniques.

Objective: The developing heart has a much greater dependence on amino acid (AA) metabolism than the adult heart in determining its ischemic tolerance. Blood cardioplegia preserves myocardial free AAs in adult hearts but no clinical studies have looked at the effect of different cardioplegic techniques on intracellular free AAs in the pediatric heart.

Methods: Pediatric patients were randomised to receive intermittent antegrade cold crystalloid (CC), cold blood (CB) or cold blood cardioplegia with a 'hot shot' (CB+HS).

Free amino acids in hearts of pediatric patients with congenital heart disease: the effects of cyanosis, age, and pathology.

Background: The immature heart has a much greater dependence than the adult heart on amino acid transamination in determining its ischemic tolerance. Compared with adult hearts, experimental models of the immature heart have quantified higher resting concentrations of free amino acids (AA) which are depleted by acute hypoxia. However, we have found no clinical studies that have looked at the free AA profile of the immature human heart or the effects of cyanosis, age, and pathology upon this.

Randomized comparison between normothermic and hypothermic cardiopulmonary bypass in pediatric open-heart surgery.

Background: The purpose of this study is to investigate the effect of cardiopulmonary bypass (CPB) temperature on myocardial reperfusion injury, oxidative stress, and inflammatory response in pediatric open heart surgery.

Methods: Fifty-nine children (median age 78 months; interquartile range, 39-130) undergoing correction of simple congenital heart defects were randomized to receive either hypothermic (28 degrees C) or normothermic (35-37 degrees C) CPB. Troponin I and 8-isoprostane, complement activation C3a, interleukin (IL) -6, -8, and -10, were measured preoperatively, on removal of the aortic cross clamp, 30 minutes, 6, and 24 hours postoperatively.

Basal metabolic state of hearts of patients with congenital heart disease: the effects of cyanosis, age, and pathology.

Background: Experimental models have established numerous myocardial metabolic changes with chronic hypoxia and maturation. We conducted this study to specifically look at the effects of cyanosis, age, and pathology upon the basal metabolic state of the immature human heart.

Methods: One hundred and eighty-one pediatric patients (37 cyanotic, 144 acyanotic) undergoing open heart surgery were recruited.

Pathology-related troponin I release and clinical outcome after pediatric open heart surgery.

Background: Perioperative myocardial injury is determined by the ischemic duration, pathology, and preoperative myocardial status. Our aim was to evaluate pathology-related differences in troponin I (TnI) release, a sensitive and specific marker of myocardial injury, and its relation to clinical outcome after pediatric open heart surgery.

Methods: Troponin I was measured serially postoperatively in 133 children undergoing repair of atrial (ASD, n = 41) and ventricular septal defects (VSD, n = 46), and tetralogy of Fallot (TOF, n = 46).