Variation in techniques of selective antegrade cerebral perfusion in neonates undergoing aortic arch reconstruction - a comprehensive review.

Background: Despite the widespread adoption of selective antegrade cerebral perfusion (SACP) for neonatal aortic arch reconstruction, significant variability in techniques persists across institutions, reflecting limited supporting data and lack of consensus on best practices. This review aims to comprehensively characterize the utilization of SACP in the extant literature and highlight variation in practice to guide future research and standardization of care.

Methods: A comprehensive search was conducted using Embase, Medline/OVID, and NCBI/PubMed databases to identify studies published from 1999-2024 that contained the following terms: ('neonatal' OR 'neonate' OR 'newborn') AND ('aortic arch' OR 'Norwood' OR 'stage one') AND ('circulatory arrest' OR 'cerebral perfusion').

Advances and Innovation in Acute Type a Aortic Dissection.

The prompt and appropriate management of acute type A aortic dissections is imperative for patient survival. Advances in medical technology have broadened the adjuncts available to treat the spectrum of pathology within this population. The role of medical management prior to surgical intervention and the components of operative management, including cannulation strategies, neuroprotection, and the extent of aortic intervention, have been explored in-depth within the literature.

Aortic Rupture in a Pediatric Patient With Influenza.

Influenza can lead to significant morbidity and mortality in children. Aortopathy tends to occur in adults during influenza season; however, aortic pathology in children with influenza is exceedingly rare. This report describes a child who experienced an aortic rupture during an influenza infection without evidence of secondary bacterial infection or connective tissue disorder.

Critical left main coronary artery stenosis presenting as cardiac arrest in coarctation of the aorta patient.

Congenital coronary artery stenosis coexisting with aortic coarctation in nonsyndromic patients has not previously been reported. This report describes a nonsyndromic aortic coarctation patient who experienced intraoperative cardiac arrest due to a previously undiagnosed critical left main coronary artery stenosis. The patient was successfully resuscitated, underwent patch coronary ostioplasty, and was discharged home.

Hereditary haemorrhagic telangiectasia and SMAD4 mutation in a patient with complex single ventricle heart disease.

We report a case of hypoplastic left heart syndrome and with subsequent aortopathy and then found to have hereditary haemorrhagic telangiectasia/juvenile polyposis syndrome due to a germline SMAD4 pathologic variant. The patient's staged palliation was complicated by the development of neoaortic aneurysms, arteriovenous malformations, and gastrointestinal bleeding thought to be secondary to Fontan circulation, but workup revealed a SMAD4 variant consistent with hereditary haemorrhagic telangiectasia/juvenile polyposis syndrome. This case underscores the importance of genetic modifiers in CHD, especially those with Fontan physiology.

A Technique for Safe Redo Sternotomy in Patients with Aortic Proximity to the Sternum.

The risk of redo sternotomy is greatly elevated in the setting of aortic proximity to the sternum. Current strategies to avoid catastrophic neurologic injury upon sternal reentry include establishment of peripheral bypass with the use of deep hypothermia and low-flow bypass, both of which may increase risk of neurologic complications. Here, we describe a technique for safe sternal reentry and illustrate its successful use in a patient with close proximity of the aorta to the sternum.

Hearing Loss after Cardiac Surgery in Infancy: An Unintended Consequence of Life-Saving Care.

Objectives: To investigate the prevalence of hearing loss after cardiac surgery in infancy, patient and operative factors associated with hearing loss, and the relationship of hearing loss to neurodevelopmental outcomes.

Study Design: Audiologic and neurodevelopmental evaluations were conducted on 348 children who underwent repair of congenital heart disease at the Children's Hospital of Philadelphia as part of a prospective study evaluating neurodevelopmental outcomes at 4 years of age. A prevalence estimate was calculated based on presence and type of hearing loss.