Development of Congenital Cardiac Surgery in Toronto.

The development of congenital cardiac surgery required innovation by committed and talented individuals who integrated science, engineering and emerging medical knowledge while building a team of professionals dedicated to the care of patients. Life-long follow-up of these patients led to evolving management strategies to improve outcomes for neonates, infants, children and adults with congenital heart disease.

Pulmonary valve replacement late after repair of tetralogy of Fallot.

Background: Pulmonary valve incompetence is usually well tolerated after tetralogy of Fallot repair but may result in late progressive right heart failure as manifested by increasing fatigue, dyspnea, and frequently arrhythmias.

Methods: All patients who underwent pulmonary valve replacement in our center late after repair of tetralogy of Fallot were reviewed.

Results: Eighty-five patients had elective pulmonary valve replacement late (median, 9.

Arrhythmia and mortality after the Mustard procedure: a 30-year single-center experience.

Objectives: Our purpose was to assess the risk factors for late mortality, loss of sinus rhythm and atrial flutter after the Mustard operation.

Background: The Mustard operation provides correction of cyanosis with low surgical risk in transposition of the great vessels. However, right ventricular failure, loss of sinus rhythm, atrial flutter and death are frequent long-term complications.

Augmentation of pulmonary blood flow with an axillary arteriovenous fistula after a cavopulmonary shunt.

Of 320 children with cyanotic congenital heart malformations who had previously undergone cavopulmonary shunt operations, 11 had increasing cyanosis and exercise intolerance and were considered unsuitable for definitive repair, a Fontan procedure, or other palliation. Eight had a previous Glenn shunt and three had a previous bidirectional cavopulmonary connection. To augment pulmonary blood flow, 10 patients underwent creation of an ipsilateral axillary arteriovenous fistula.

Reoperation for recurrent aortic coarctation.

Background: Recurrence of stenosis is a complication of coarctation repair associated with major long-term morbidity. Persistent or exercise-provoked hypertension may indicate recurrent coarctation. Patients failing or not amenable to balloon dilation should be managed surgically.