[Complex right cervical aortic arch repair: less is more].

Cervical aortic arch is a rare malformation that often has anatomical abnormalities of the supra-aortic trunks and may also be associated with aortic stenosis, aneurysms, or cardiac malformations. To correct them, symptomatic patients undergo surgery, which usually consists of a prosthetic graft repair, aortoplasty patch, or an end-to-end anastomosis. In addition, circulatory arrest and deep hypothermia are often required, as in aortic arch surgery.

Hemoadsorption Contribution in Failing Fontan Pediatric Heart Transplantation.

Introduction: A systemic inflammatory response is triggered in patients undergoing cardiothoracic surgery with cardiopulmonary bypass (CPB). This response is particularly evident in pediatric patients, especially those of low weight and after undergoing long CPB, and can severely impair the surgical result. Adsorptive blood purification techniques have been proposed to limit this systemic inflammatory response.

A geometry-based finite element tool for evaluating mitral valve biomechanics.

Mitral valve function depends on its complex geometry and tissue health, with alterations in shape and tissue response affecting the long-term restorarion of function. Previous computational frameworks for biomechanical assessment are mostly based on patient-specific geometries; however, these are not flexible enough to yield a variety of models and assess mitral closure for individually tuned morphological parameters or material property representations. This study details the finite element approach implemented in our previously developed toolbox to assess mitral valve biomechanics and showcases its flexibility through the generation and biomechanical evaluation of different models.

A toolbox for generating scalable mitral valve morphometric models.

The mitral valve is a complex anatomical structure, whose shape is key to several traits of its function and disease, being crucial for the success of surgical repair and implantation of medical devices. The aim of this study was to develop a parametric, scalable, and clinically useful model of the mitral valve, enabling the biomechanical evaluation of mitral repair techniques through finite element simulations. MATLAB was used to parameterize the valve: the annular boundary was sampled from a porcine mitral valve mesh model and landmark points and relevant boundaries were selected for the parameterization of leaflets using polynomial fitting.

Malnutrition and chyle leakage: A life-threatening duo in heart transplantation post-Fontan procedure.

Protein-losing enteropathy and chyle leakage may lead to severe malnutrition in heart transplantation for failing Fontan. Nutritional management may be challenging from defining nutrient needs to diagnosis of malnutrition enteropathy, and expertise is necessary. Body composition and hematological nutritional indices may help define malnutrition severity and guide nutritional strategy.

The Golden Proportion in the scallop geometry of normal mitral valves. When nature plays with jigsaw puzzles.

Introduction: The Golden Proportion is a particular geometric ratio between two segments. It results in an irrational number, commonly rounded to 1.618, or 0.

Colchicine: An Impressive Effect on Posttransplant Capillary Leak Syndrome and Renal Failure.

Capillary leak syndrome is a critical condition occasionally occurring posttransplant and is characterized by acute endothelial hyperpermeability leading to systemic protein-rich fluid extravasation and consequent hypovolemia, hypoperfusion, and acute kidney injury. Treatment is merely supportive and is based on osmotic drugs, diuretics, continuous renal replacement therapy, and surgical drainage. However, removal of the underlying inflammatory cause is mandatory to achieve stable resolution.

Coaptation Triangle and Golden Proportion in mitral valve anatomy. Does nature play with geometry?

Introduction: The Coaptation Triangle, or Tenting Area, can be identified on long-axis 2D images. Its assessment is a routine practice during echocardiographic mitral evaluation. The Golden Proportion is a particular geometric ratio between two segments.

Ventricular assist device in a failing total cavopulmonary connection: a new step-by-step approach.

The management of failing Fontan patients with mechanical circulatory support has been reported with unsatisfactory results. A 5-year-old girl, listed for heart transplantation for failing Fontan, underwent rescue extracorporeal membrane oxygenation support. As it was necessary to move the patient to the Berlin Heart Excor, a step-by-step approach was designed to obtain a gradual adaptation to this form of support.

Minimally Invasive Approach to Correct Anomalous Inferior Vena Cava Connection to the Left Atrium.

Anomalous drainage of the inferior vena cava into the left atrium is a rare congenital condition. A 20-year-old girl was referred for recurrent transient ischemic attacks. Transthoracic echocardiography revealed a large ostium secundum atrial septal defect, and computed tomography showed anomalous drainage of the inferior vena cava into the left atrium.

Liver stiffness modifications shortly after total cavopulmonary connection.

Objectives: Hepatic damage in Fontan circulation setting is well known. Mainly represented by fibrosis, it is still poorly understood. Transient hepatic elastography (Fibro-Scan) is a useful tool to test liver stiffness and is commonly used in the evaluation of liver fibrosis.

Use of oversized injectable valves in growing children for total repair of right ventricular outflow tract anomalies (preliminary results).

Right ventricular outflow tract surgery was originally confined to transannular patching, in the belief that pulmonary regurgitation was well tolerated. Because follow-up evaluations revealed the deleterious effects of pulmonary regurgitation, surgery today aims to spare or replace the valve. Available replacement devices have short lifetimes, considering growth mismatch in children.

Repair of an unusual aortic coarctation using an extracellular matrix patch.

The surgical treatment of neonatal aortic coarctation is usually accomplished with a termino-terminal anastomosis or a subclavian flap. The use of a patch to enlarge the isthmal narrowing may be an alternative but is frequently complicated by aneurysmal dilatation on the aortic wall opposite to the patch, probably because it disrupts the vascular anatomic integrity. Extracellular matrix patches promise to restore the original tissue structure and could therefore be a valid alternative to other materials.

Rescue mitral valve repair one hour after birth.

Congenital mitral regurgitation is rare and usually part of complex cardiac anomalies. When needed, early surgery represents a great challenge. In small babies avoiding valve replacement is desirable, but valve repair may be extremely complex.

Pulmonary valve replacement with mechanical prosthesis: long-term results in 4 patients.

Pulmonary valve replacement is rarely performed and is usually done with biological prostheses or grafts. The use of mechanical prostheses is still a debated issue. We analyzed the outcome of 4 patients at 11 years after pulmonary valve replacement with a mechanical prosthesis.