Current practices for refractory chylothorax following congenital heart surgery.

Introduction: Chylothorax following paediatric cardiac surgery is associated with significant morbidity, particularly those that are refractory to conservative therapy. It is our impression that there is important variability in the medical, surgical, and interventional therapies used to manage refractory chylothorax between congenital heart programmes. We therefore conducted a survey study of current practices for managing refractory chylothorax.

Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies.

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy.

Anomalous left subclavian artery from the pulmonary artery in a neonate.

The presence of an isolated left subclavian artery arising from the pulmonary artery in a patient with d-transposition of the great arteries is exceedingly rare. Prior to undertaking repair of this congenital cardiac anomaly, identification of an isolated left subclavian artery originating from the pulmonary artery is imperative in order to plan the appropriate intervention to prevent the development of subclavian artery steal or vertebrobasilar insufficiency. We describe the case of a 5 day-old girl in whom an isolated left subclavian artery arising from the pulmonary artery was detected after surgical entry for repair of transposition of the great arteries.

Healthcare Disparities in Outcomes of a Metropolitan Congenital Heart Surgery Center: The Effect of Clinical and Socioeconomic Factors.

Objective: The purpose of this study is to identify the impact of demographic, socioeconomic, and clinical factors on congenital heart surgery outcomes.

Study Design: This retrospective cohort study included 234 congenital heart surgery patients from 2011 through 2015, in a racially/ethnically diverse metropolitan children's hospital. Outcomes included length of stay (LOS), age at first echocardiogram, length of mechanical ventilation, and incidence of complications.

Long-Term Outcomes of Children With Trisomy 13 and 18 After Congenital Heart Disease Interventions.

Background: The purpose of this study is to report short- and long-term outcomes after congenital heart defect (CHD) interventions in patients with trisomy 13 or 18.

Methods: A retrospective review of the Pediatric Cardiac Care Consortium (PCCC) identified children with trisomy 13 or 18 with interventions for CHD between 1982 and 2008. Long-term survival and cause of death were obtained through linkage with the National Death Index.

Long-gap esophageal atresia treated by growth induction: the biological potential and early follow-up results.

This study had two purposes. The first was to determine whether the growth procedure would allow true primary repairs of the most severe end of the esophageal atresia (EA) spectrum with the longest gaps (LG) and most rudimentary lower esophageal segments. The second goal was to provide the first short- to mid-term (3-12 years) follow-up data on the esophageal function and quality of life (QOL) data on the patients in this series.

Treatment of right ventricle to coronary artery connections in infants with pulmonary atresia and intact ventricular septum.

Objective: At the severe end of the spectrum of infants with pulmonary atresia and intact ventricular septum, the likelihood of significant right ventricle to coronary artery connections increases. Our purpose is to present the first series of right ventricle to coronary artery connections ligated off bypass before right ventricular decompression and to evaluate the consequences of this approach.

Methods: From 1988 to 2007, 19 patients with pulmonary atresia and intact ventricular septum had a total of 69 right ventricle to coronary artery connections identified preoperatively, and 10 more were located intraoperatively.

A flexible approach to achieve a true primary repair for all infants with esophageal atresia.

Our purpose is to present our results using a flexible surgical approach to achieve a true primary repair for all infants with esophageal atresia (EA). The proposed methods are designed to reach this goal, even when most of the intrathoracic esophagus is missing. What has made this goal attainable is the ability to rapidly induce esophageal growth.