Functional total anomalous pulmonary venous drainage by left atrium-to-superior vena cava shunt.

Total anomalous pulmonary venous connection is occasionally associated with a functional single ventricle and is thought to be a risk for the staged Fontan approach. We report a patient with a very rare presentation of mitral atresia and intact atrial septum with physiologically total anomalous pulmonary venous drainage by a connecting vein between the left atrium and the superior vena cava. A surgical atrioseptectomy as a functional repair of total anomalous pulmonary venous connection and pulmonary artery banding was successfully performed as the first palliation for Fontan completion.

Regression of marked myocardial sinusoids associated with hypoplastic left heart syndrome during staged Fontan approach.

The anatomic subtype of mitral stenosis, aortic atresia, and myocardial sinusoids is reported to be associated with increased mortality for staged repair for hypoplastic left heart syndrome. We herein report a very rare case of this subtype of hypoplastic left heart syndrome presenting with marked myocardial sinusoids in the left ventricle, which nearly disappeared after successful Fontan completion. Our successful experience suggests marked myocardial sinusoids per se are not a risk factor for surgical palliation in hypoplastic left heart syndrome.

Cardiac surgery late after heart transplantation: a safe and effective treatment option.

Objective: Owing to the improved long-term outcome after cardiac transplantation, cardiac allograft vasculopathy or valvular disease is developing late after heart transplantation in a growing number of patients. In this study, we evaluated our results of nonretransplant cardiac surgery in these patients and compared them with those after retransplantation.

Methods: Since 1983, a total of 867 heart transplantations have been performed at our institution.

Improved results after repair of complete atrioventricular septal defect.

Background: This study evaluates the historical impact on the outcomes of early primary repair of complete atrioventricular septal defect (AVSD) at our institute.

Methods: Since 1976, a total of 185 children with complete AVSD have been referred to our unit. Prior to 1990, 78 children received conservative therapy, and selected 51 patients underwent surgical repair (group 1).

Acute treatment of ST-segment-elevation myocardial infarction: is there a role for the cardiac surgeon?

Background: Several attempts from single institutions to treat acute myocardial infarctions with bypass surgery never reached widespread acceptance in the cardiology and surgical community. Owing to a variety of new surgical techniques, this old dogma has to be reconsidered under the light of patient-adjusted optimal treatment algorithms.

Methods: Between August 2002 and August 2007, 112 patients, mean age of 66 years (range, 41 to 85 years), underwent emergency coronary artery bypass grafting (untreatable or rejected by the referring cardiologists within 48 hours after onset of symptoms).