Anatomic and non-anatomic substrates in infants with two ventricles undergoing aortic arch repair.

Objectives: We sought to examine the relative importance of surgical lesion complexity versus the presence of genetic/syndromic/extracardiac anomalies (GSAs) in determining survival, morbidity or need for reinterventions following repair for aortic arch hypoplasia.

Methods: A single-centre, retrospective cohort study of infants undergoing biventricular aortic arch repair sternotomy from 2010 to 2021 was conducted. Survival analysis was performed using Kaplan-Meier methods, with additional Bayesian survival modelling for subgroups.

Transcatheter pulmonary valve insertion, expanded use (beyond large conduits from the right ventricle to pulmonary artery), and future directions.

Transcatheter pulmonary valve insertion is the most important advance in congenital interventional cardiology since atrial septal defect devices became commonly available 15 years ago. It has changed the way we look at a number of diverse diagnoses and changes how we plan, diagnose, operate, and follow-up patients. It has changed how we counsel families expecting a child that may benefit from it.

Transcatheter pulmonary valve insertion, expanded use and future directions.

Transcatheter pulmonary valve replacement with the Melody® valve is an accepted alternative to surgical replacement of the pulmonary valve for some patients and therefore a complementary strategy in the long-term management of several groups of patients with congenital heart disease. It allows at least extending the time between sternotomies and possibly improving late outcomes. With a combined surgical and percutaneous approach, late morbidity for some of these patients will likely be diminished.

Transcatheter pulmonary valve insertion: when, how, and why.

Transcatheter pulmonary valve replacement is fast becoming an accepted alternative to repeat surgical pulmonary valve replacement for selected patients and therefore a complementary strategy in the long-term management of those requiring surgical pulmonary valve replacement. With a combined surgical and percutaneous approach, late morbidity for some of these patients may be diminished. This manuscript will review the current indications for this procedure, its limitations, and its benefits.

Cardiac catheterisation of patients with common arterial trunk and transposition of the great arteries.

Cardiac catheterisation continues to play an important role in the long-term management of patients with common arterial trunk and transposition of the great arteries. Although non-invasive imaging has largely eliminated the need for diagnostic catheterisation in newborns with these congenital cardiac lesions, cardiac catheterisation is an important tool for the diagnosis of a variety of problems encountered after surgical intervention, and allows interventions to be performed when feasible. We review the indications for cardiac catheterisation and describe the specifics for various interventional procedures for these patients in this manuscript.

The hybrid approach--current knowns and unknowns: the perspective of cardiology.

The hybrid approach to the treatment of patients with hypoplastic left heart syndrome most commonly includes transcatheter placement of a stent in the arterial duct and surgical placement of bands on the branch pulmonary arteries via median sternotomy. This manuscript will review the concept of hybrid palliation and discuss topics related to several time intervals: peri-procedural, post-procedural, interstage, and comprehensive stage 2.

In utero cardiac fetal surgery: laser atrial septotomy in the treatment of hypoplastic left heart syndrome with intact atrial septum.

Objective: The purpose of this study was to report a novel technique, laser atrial septotomy, for the in utero treatment of hypoplastic left heart syndrome with intact atrial septum.

Study Design: In utero atrial septotomy by Neodymium-YAG laser photofulguration in a fetus with hypoplastic left heart syndrome (HLHS) and intact atrial septum was performed at 30 4/7 weeks of gestation. Percutaneous fetal cardiocentesis was performed to guide a contact (Neodymium-YAG) laser fiber into the right atrium with the objective of creating an interatrial communication by photofulguration of the septal tissue.

Advances in fetal cardiac intervention.

Fetal cardiac intervention is in a rapid state of progress now. Attempts are being made to prevent fetal hydrops due to congenital heart defects, to recruit hypoplastic ventricles, to create a two-ventricle circulation after birth, and to remodel the fetal pulmonary vascular bed whose outlet is obstructed. Open heart surgery in the fetus has yet to be done successfully, but interventions for improved cardiac outcomes are now being tested.