Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries.

Background: Asymmetry of the aortic valve leaflets has been known since Leonardo Da Vinci, but the relationship between size and shape and origin of the coronary arteries has never been examined. Our aim was to evaluate this anatomy in a population of pediatric patients using a cross-sectional study design.

Methods: Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study.

Aortic Arch Reconstruction Using Nonvalved Femoral Vein Homograft in High-Risk Neonates.

Aortic arch obstruction is often present with complex concomitant congenital heart defects (CHDs). The use of nonvalved femoral vein homograft (FVH) to reconstruct the aortic arch has distinct surgical advantages, including simplified reconstruction. We present an intraoperative video of a Yasui procedure utilizing FVH for aortic reconstruction in a 12-day-old (2.

Narrative review of single ventricle: where are we after 40 years?

Background And Objective: Key medical and surgical advances have been made in the longitudinal management of patients with "functionally" single ventricle physiology, with the principles of Fontan circulation applied to other complex congenital heart defects. The purpose of this article is to review all of the innovations, starting from fetal life, that led to a change of strategy for single ventricle.

Methods: Our literature review included all full articles published in English language on the Cochrane, MedLine, and Embase with references to "single ventricle" and "univentricular hearts", including the initial history of the treatments for this congenital heart defects as well as the innovations reported within the last decades.

Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis.

Background: Meta-analysis of the impact on clinical outcome from transcatheter closure of Fontan fenestration.

Methods: Cochrane, Embase, MEDLINE, and Open-Gray were searched. Parameters such as changes in oxygen saturation, cavo-pulmonary pressure, maximum heart rate during exercise, exercise duration, and oxygen saturation after fenestration closure were pooled and statistical analysis performed.

Anesthesia for Echocardiography and Magnetic Resonance Imaging in the African Clawed Frog ().

This report describes an anesthesia technique that we used to study cardiovascular anatomy and physiology with echocardiography and cardiac magnetic resonance (CMR) in 46 African clawed frogs () ( = 24 for electrocardiography and = 22 for CMR). For administration of anesthesia, 3 holding tanks, one each for transportation, sedation, and recovery, were filled with filtered water, with 0.05% buffered tricaine methasulfonate solution (MS-222) added into the sedation tank.

Biventricular Conversion for Hypoplastic Left Heart Variants: An Update.

Ongoing concerns with single-ventricle palliation morbidity and poor outcomes from primary biventricular strategies for neonates with borderline left heart structures have led some centers to attempt alternative strategies to obviate the need for ultimate Fontan palliation and limit the risk to the child during the vulnerable neonatal period. In certain patients who are traditionally palliated toward single-ventricle circulation, biventricular circulation is possible. This review aims to delineate the current knowledge regarding converting certain patients with borderline left heart structures from single-ventricle palliation toward biventricular circulation.

Ebstein's Anomaly: From Fetus to Adult-Literature Review and Pathway for Patient Care.

Ebstein's anomaly, first described in 1866 by Dr William Ebstein, accounts for 0.3-0.5% of congenital heart defects and represents 40% of congenital tricuspid valve abnormalities.

Essential role of cardiac computed tomography for surgical decision making in children with total anomalous pulmonary venous connection and single ventricle.

Background: Total anomalous pulmonary venous connection (TAPVC) is a major risk factor in infants with single ventricle (SV). Exact definition of TAPVC anatomy is crucial for surgical planning.

Aim: To evaluate the role of cardiac computed tomography (CT) in this setting.

The Secrets of the Frogs Heart.

The heart of the African clawed frog has a double-inlet and single-outlet ventricle supporting systemic and pulmonary circulations via a truncus, and a lifespan of 25-30 years. We sought to understand the unique cardiac anatomic and physiologic characteristics, with balanced circulation and low metabolic rate, by comparing the basic anatomy structures with focused echocardiography and cardiac magnetic resonance imaging. Twenty-four adult female African clawed frogs were randomly subjected to anatomic dissection (n = 4), echocardiography (n = 10), and cardiac magnetic resonance (n = 10).

Virtual Simulated Implantation of an Adult-Sized Left Ventricular Assist Device in a Pediatric Patient.

There is very limited experience with simulated virtual implantation of left ventricular assist devices (LVADs) to assess device fitness in pediatric patients. In this clinical vignette, we report the case of a 9-year-old male patient with dilated cardiomyopathy who underwent successful placement of an LVAD after virtual simulated implantation was performed. ().

Absorbable sutures for cardiopulmonary bypass purse strings in pediatric heart surgery.

Background: Absorbable sutures, commonly used in general surgery, are not routinely used as purse strings for arterial and venous cannulation for cardiopulmonary bypass in pediatric heart surgery. The general concern is absorbable sutures could predispose to immediate postoperative bleeding; this safety concern has been evaluated in this retrospective study.

Materials And Methods: A single center, retrospective study, was conducted with criteria for inclusion patient <18 years of age, operation on with cardiopulmonary bypass for heart surgery from July 1, 2018 to June 30, 2020, with purse strings for cannulation performed with absorbable sutures.

Pre- and post-operative cardiovascular CT in Stage I single ventricle palliation.

Objectives: The aim of this study is to describe clinical utility of low dose cardiac computed tomography (CT) in the evaluation of single ventricle physiology before and after Stage I palliation.

Background: Despite the increased utilization of CT imaging and advancement of CT technology, there are limited studies describing the routine clinical use of cardiac CT and radiation dose parameters in the single ventricle Stage I palliation.

Methods: This single center, retrospective study included 57 infants with single ventricle physiology who underwent cardiac CT scans between January 1, 2016 and November 30, 2020.

Modern advances regarding interatrial communication in congenital heart defects.

Background: The interatrial communication, one of the most frequent congenital heart defects, represents an important intracardiac shunt between systemic and pulmonary circulations. Direction and magnitude of the interatrial shunting depends upon several features, including defect size, shape and location, pressure difference between right and left atrium, and difference in right and left ventricular compliance.

Methods: In this review article, the presence or absence of interatrial communication, and its role, have been analyzed, as they can have a critical impact on the cardiovascular physiopathology, and the interatrial communication can prove to be either clinically harmful, useful or indispensable.

A narrative review of modern approach and outcomes evaluation in congenital heart defects.

Objective: The purpose of this review is to highlight critical advances and innovative approaches to the most challenging clinical situations in congenital heart surgery, to establish a new perspective from which to evaluate current clinical practice patterns and contemporary United States program ranking systems.

Background: The past decades have witnessed substantial advances in the treatment of congenital heart defects. New strategies are deeply rooted in calculated risk-taking innovations.

Surgical approach for anomalous aortic origin of a coronary artery: A comparison of two techniques.

Background: Un-roofing is the most common technique utilized for repair of anomalous aortic origin of a coronary artery (AAOCA). There are very few publications directly comparing un-roofing to another surgical technique, like reimplantation.

Methods: The prospectively collected Children's Memorial Hermann Heart Institute Society of Thoracic Surgeon's Database was retrospectively reviewed from 2007 to 2021.

Development of a biventricular conversion program: A new paradigm.

Background: Borderline small ventricular size or technical issues precluding the use of both ventricles may lead to single ventricle palliation. Fontan complications have led some centers to look for alternatives to the traditional pathway. The objective of this study is to evaluate the essential philosophy and outcomes of a new biventricular (BiV) conversion program.

Results of Less Than 5-mm Right Ventricle-Pulmonary Artery Conduits in Single Ventricle Palliation.

Background: Our programmatic approach to single ventricle (SV) neonatal palliation has evolved to using smaller-size right ventricle to pulmonary artery (RV-PA) conduits for pulmonary blood flow. Therefore, we sought to compare the early outcomes of less than 5-mm versus 5-mm RV-PA conduits in SV patients undergoing neonatal palliation.

Methods: We performed a retrospective review of SV patients who had neonatal palliation with either a less than 5-mm or 5-mm RV-PA connection, constructed using a waterproof, breathable fabric membrane graft (Gore-Tex, Flagstaff, AZ).

Staged Palliation of Cyanotic Obstructive Lesions With a Modified Right Ventricular Outflow Procedure.

Background: Traditional palliation for biventricular cyanotic congenital heart lesions often involves staging with systemic-to-pulmonary arterial shunts to secure pulmonary blood flow (PBF) in the newborn period prior to complete repair. However, shunts may lead to life-threatening events secondary to shunt occlusion or acute coronary steal. They may be associated with morbidity secondary to diastolic runoff, systemic steal and volume loading, and do not provide pulsatile flow which has the potential to promote pulmonary artery (PA) growth.

Tailoring stents to fit the anatomy of unique vascular stenoses in congenital heart disease.

Background: Unique and small anatomical features often preclude the use of available vascular stents in pediatric patients with congenital heart disease (CHD).

Objectives: To report our experience and outcomes tailoring stents to fit unique anatomy, particularly in small children and infants with CHD.

Methods: Stent tailoring techniques included trimming, folding, and flaring.

Resource and cost considerations in treating hypoplastic left heart syndrome.

Hypoplastic left heart syndrome (HLHS) was a uniformly fatal diagnosis before 1983, when surgical treatment was first undertaken with the Norwood I operation as the first of 3-staged operations. Since then, operative survival rate of stage I has risen from 53% to over 90% in the current era, not only thanks to technical advances in surgery but also through prenatal diagnosis and imaging, enhanced cardiopulmonary bypass technology, better perioperative intensive care, and closer interstage monitoring. The improvements in patient outcomes achieved through rigorous multidisciplinary teamwork have come at a tremendous cost in manpower and resources, making HLHS still a challenge to all congenital heart programs, established or emerging.