ECMO cannulation controversies and complications.

Advances in extracorporeal life support have expanded indications for use extending beyond patients undergoing cardiac surgery. The approach to cannulation in patients requiring extracorporeal membrane oxygenation should be individualized and based on the specific clinical scenario in which the need arises. Adherence to proper techniques of vessel visualization, exposure, and cannulation along with accurate placement of cannulae will optimize flows and minimize complications in this setting.

Surgical management of anomalous aortic origin of a coronary artery.

Background: Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus traveling between the aorta and pulmonary artery is associated with ischemia and sudden death.

Methods: A retrospective review of 36 patients (23 male) who underwent operation between October 1992 and August 2008 for AAOCA was performed. Median age was 47 years (range, 13 to 82 years).

Congenital coronary anomalies and surgical treatment.

Coronary artery anomalies are not uncommon, occurring in 1.3% (range = 0.3-5.

The adult with congenital heart disease: medical and surgical considerations for management.

Purpose Of Review: The purpose of the present review is to outline some of the challenges of surgical and medical management in the adult with congenital heart disease (CHD).

Recent Findings: The number of adult patients with CHD continues to grow. These patients require specialized care and there are few cardiologists and surgeons, as well as other subspecialists (e.

Intramural left main coronary artery unexpectedly encountered during aortic root replacement.

We present an intramural left main coronary artery, unexpectedly encountered during aortic root replacement in a truncus arteriosus patient. Given the severely limited orifice, we opted to unroof the intramural portion of the left main coronary artery prior to implantation as a button. Until now there have been no reports in the literature describing unroofing an intramural coronary artery prior to reimplantation in an aortic root replacement operation.

Reoperations after initial repair of complete atrioventricular septal defect.

Background: Excellent surgical results have been reported after repair of complete atrioventricular septal defects (CAVSD); however, 5% to 10% require reoperation. We examine causes leading to reoperation and evaluate long-term outcome.

Methods: Between 1972 and 2007, 50 patients (26 male) underwent reoperation at our institution after initial repair of CAVSD (median interval, 15 months; range, 3 days to 29 years).

Management of the aortic root in adult patients with conotruncal anomalies.

Conotruncal anomalies such as tetralogy of Fallot, double outlet right ventricle, truncus arteriosus, and transposition of the great arteries are a group of congenital heart defects with abnormalities of the outflow tracts and great vessels. It is common for the ascending aorta and aortic root to be significantly dilated following initial repair of the conotruncal anomaly, and little information is available on the management of this increasing problem. Although there are few case reports of aortic dissection and rupture in the literature, it appears to be rare in the setting of a conotruncal anomaly and may be related to the absence of hypertension and smoking in many of these patients.

The modified Fontan procedure and prolonged pleural effusions.

The modified Fontan procedure may be complicated by prolonged pleural drainage. Predisposing factors are not fully understood. This study examines perioperative variables associated with prolonged effusions.

Use of recombinant factor VIIa (NovoSeven) in pediatric cardiac surgery.

Significant post-operative bleeding can be encountered in a small population of pediatric surgical patients requiring cardiopulmonary bypass (CPB). Recombinant factor VIIa (NovoSeven) has been advocated as a possible off-label rescue therapy for these individuals when conventional blood component therapy alone is inadequate. This study retrospectively evaluates rFVIIa administration for the treatment of severe bleeding in pediatric patients immediately after cardiac surgical procedures requiring CPB.

Hybrid intraoperative pulmonary artery stent placement for congenital heart disease.

Percutaneous branch pulmonary artery (PA) stenting can be challenging, especially in patients with stenosis of the right ventricular (RV) outflow tract or tortuous PA branches. In these cases, a hybrid procedure deploying PA stent(s) during cardiac surgery provides an alternative to relieve branch PA stenosis. The Mayo Clinic Congenital Cardiac surgical database was used to identify all patients having hybrid PA stent procedures.

Coarctation of the aorta presenting as systemic hypertension in a young adult.

Background: A 20-year-old male presented with a history of systemic hypertension. Examination revealed a systolic murmur with an early ejection click, and femoral pulses were markedly reduced.

Investigations: Physical examination, laboratory testing, electrocardiography, chest radiography, comprehensive echocardiography including pulsed-wave Doppler examination, and CT of the chest.

Pulmonary regurgitation after tetralogy of Fallot repair: clinical features, sequelae, and timing of pulmonary valve replacement.

Pulmonary regurgitation following repair of tetralogy of Fallot is a common postoperative sequela associated with progressive right ventricular enlargement, dysfunction, and is an important determinant of late morbidity and mortality. Although pulmonary regurgitation may be well tolerated for many years following surgery, it can be associated with progressive exercise intolerance, heart failure, tachyarrhythmia, and late sudden death. It also often necessitates re-intervention.

Coronary artery aneurysm: case report.

Introduction: Aneurysms of the left main coronary artery are rare with an incidence of 0.1% in large angiographic series. The majority are atherosclerotic in origin.

Presence of plasticizer di-2(ethylhexyl)phthalate in primed extracorporeal circulation circuits.

Many centers advocate the use of a standby wet-primed extracorporeal membrane oxygenation (ECMO) circuit for rapid deployment during cardiopulmonary resuscitation. However, concerns with regard to the potential health hazards associated with the release of the plasticizer di-2(ethylhexyl)phthalate (DEHP) from the polyvinyl chloride (PVC) tubing exist. The purpose of this study was to determine the time course of DEHP release from a preprimed ECMO circuit and to evaluate the effect of PVC tubing coatings on DEHP release.

Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure.

Background: We sought to determine whether evolving techniques of aortic arch reconstruction used during the Norwood procedure decreased the incidence of postoperative aortic arch obstruction.

Methods: Our technique for aortic arch reconstruction in patients undergoing the Norwood procedure has evolved from using an allograft patch (classic group, n = 26) to primary connection of the pulmonary artery and arch (autologous group, n = 20). More recently, we have used a novel technique involving coarctation excision, an extended end-to-end anastomosis on the back of the arch, and a counterincision on the anterior descending aorta to sew in an allograft patch for total arch reconstruction (interdigitating group, n = 33).

Outcomes for patients with an aortopulmonary window, and the impact of associated cardiovascular lesions.

An aortopulmonary window is a communication between the ascending aorta and pulmonary trunk in the presence of two separate arterial valves, and is often complicated by other associated defects. We sought to determine management and related outcomes in patients with this malformation. We identified those patients presenting between 1969 and 1999 from the databases held in our Departments of Cardiology, Pathology and Cardiovascular Surgery.

Prevention of early sudden circulatory collapse after the Norwood operation.

Background: After modifications in our perioperative management protocol, we have observed a decrease in sudden circulatory collapse after the Norwood operation. The current study examines early outcomes after the Norwood operation in our unit in an attempt to identify variables that may have altered the risk of unexpected circulatory collapse.

Methods And Results: We studied 105 consecutive neonates who underwent a Norwood operation in our institution.

Atrioventricular septal defects: effect of bridging leaflet division on early valve function.

Background: Bridging leaflet division may facilitate repair of atrioventricular septal defects (AVSD). However, the consequences of bridging leaflet division on early valve function and mortality are not well defined.

Methods: Records of children undergoing AVSD repair between January 1995 and January 2002 were reviewed.

Late results of palliative atrial switch for transposition, ventricular septal defect, and pulmonary vascular obstructive disease.

Background: Palliative atrial switch (PAS) procedures that reroute pulmonary and systemic venous drainage and leave a ventricular septal defect (VSD) open have been used in the treatment of deeply cyanotic patients who have severe pulmonary vascular obstructive disease (PVOD). Palliative atrial switch is beneficial for patients with transposition of the great arteries or other complex lesions with VSD who show higher arterial oxygen saturation in the pulmonary artery than in the aorta (transposition hemodynamics/unfavorable streaming). We reviewed the early and late results of PAS (Mustard, n = 25; Senning, n = 3) in patients at two institutions.

Contact irritant dermatitis and anti-pruritic agents: the need to address the itch.

Contact irritant dermatitis can be defined by four interrelated elements: skin barrier disruption, epidermal skin changes, cytokine release, and nerve ending changes. The predominant symptom of eczema relates to the fourth constituent, which produces pruritic symptoms that are often neglected when using pre-formulated topical steroids and immunomodulators. Although the induction of pruritus with proteinases and cytokines demonstrates the close connections between immune and neurotrophic factors in the pathophysiology of pruritus, agents that specifically affect the cutaneous nerve endings are often beneficial for use in patients affected by dermatitis.