Dissecting the Management and Outcomes of Thoracic Aortovascular Disease During the COVID-19 Pandemic.

Objective: The COVID-19 pandemic has forced the cancellation of planned surgery and led to significant surgical service reductions. Early intervention in aortovascular disease is often critical and cannot be deferred despite these reductions. There is urgent need to evaluate the provision and outcomes of thoracic aortovascular intervention during the peak of the pandemic.

Cardiac surgery outcome during the COVID-19 pandemic: a retrospective review of the early experience in nine UK centres.

Background: Early studies conclude patients with Covid-19 have a high risk of death, but no studies specifically explore cardiac surgery outcome. We investigate UK cardiac surgery outcomes during the early phase of the Covid-19 pandemic.

Methods: This retrospective observational study included all adult patients undergoing cardiac surgery between 1st March and 30th April 2020 in nine UK centres.

Aorto-Tracheopexy in the Treatment of Hunter Syndrome.

Hunter syndrome is a multisystem genetic disease in which a significant proportion of morbidity and mortality arise from respiratory dysfunction. Notably, tracheal abnormalities in Hunter syndrome can compromise clinical stability, and management is primarily supportive. We describe here the first successful implementation of aorto-tracheopexy in a 19-year-old patient as a surgical strategy to resolve progressive respiratory deterioration.

Duplicated left pulmonary artery: an unknown disease? Three case reports and review of the literature.

We report three cases of an abnormal finding of duplicated left pulmonary artery: two of these occurring in children with Kabuki syndrome and configuring the setting of a pseudo-pulmonary sling without any clinical or cardiac cross-sectional evidence of tracheal compression. The other case instead represents duplicated left pulmonary artery with pulmonary sling caused by the retro-tracheal course of the lower left pulmonary artery associated with "Christmas Tree" arrangement of the tracheo-bronchial system. In both patients with pseudo-pulmonary sling and Kabuki syndrome, the abnormal finding was incidental during echocardiographic examination and neither of the patients required surgical repair for the condition.

Options for the failing ventricle in pediatric heart disease.

The management of the pediatric patient with the failing ventricle poses its own therapeutic challenges, not least because patient size limits options available. Once medical management has hit its ceiling, attention is turned to surgical options for mechanical support. The approach to these options has to bear in mind that there may be many potential causes for pump failure, and that these occur often in the context of pulmonary hypertension and poor gas exchange.

Increasing donor-recipient weight mismatch in pediatric orthotopic heart transplantation does not adversely affect outcome.

Objective: The aim of the study was to show the effect of heart transplant donor-recipient weight mismatch on mortality, right-ventricular (RV) failure, and medium-term control of systemic blood pressure.

Methods: From 2000 to 2008 inclusive, 161 patients undergoing orthotopic heart transplantation at our unit were retrospectively analyzed. The cohort was divided into three groups of similar size depending on the tertile ranges of the donor-recipient weight ratio.

Re-repair of the left atrioventricular valve in atrioventricular septal defects: the morphologic approach to the role of Gore-tex band reduction annuloplasty.

Objectives: Incompetence of the left atrioventricular valve remains the final Achilles' heel of repair of atrioventricular septal defects (AVSDs), despite low operative mortality in the modern era. We have analysed the morphological basis for valvar incompetence in our own series of repairs, and in doing so, reviewed the morphology of the annulus in AVSDs, before and after surgical repair.

Methods: We reviewed retrospectively re-repair operations of the left atrioventricular valve following previous repair of AVSDs at the Great Ormond Street Hospital from 1 January 1994 to 31 December 2007.

Mitral valve repair: critical analysis of the anatomy discussed.

In this brief review, we discuss the anatomy of the mitral valve pertinent to surgical repair. First, we emphasise the need for diagnosticians to describe the valve in the context of the position of the heart within the body, following the standard rules of anatomy, and using attitudinally appropriate descriptions. It has become customary to describe cardiac structures as if the heart is positioned on its apex.

Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: the morphologic perspective.

Objective: The mortality following repair of atrioventricular septal defects has fallen dramatically in the last 4 decades, but reoperation for late regurgitation across the left atrioventricular valve has remained disconcertingly stagnant. Seeking potential structural causes, we compared the morphology of the surgically created septal leaflet of the left valve following repair of atrioventricular septal defects to the aortic leaflet of the normal mitral valve.

Methods: We compared the mitral valves of 92 normal hearts to the left ventricular components of the bridging leaflets of hearts with atrioventricular septal defect with common atrioventricular junction, determining the shape of the leaflets and the arrangement of the subvalvar apparatus.

Development of the atrioventricular valves: clinicomorphological correlations.

The atrioventricular valves are formed from a complex arrangement of an annulus and leaflets, supported by a subvalvar apparatus that is composed of tendinous cords and papillary muscles. Although much has been said and written about their development, the exact nature of the process has yet to be fully elucidated. We believe that this is vital, since unraveling this complex process holds the key to the understanding of many of the congenital malformations that may afflict the valves.

Problems with the right ventricular outflow tract: a review of morphologic features and current therapeutic options.

Repair of complex malformations that necessitate restoration of continuity between the right ventricle and the pulmonary arteries can now safely be performed with low morbidity and mortality. Major concerns still remain on the long-term outlook for these patients, and about the durability of the different prostheses used to restore that continuity, whether during initial correction or at the time of reintervention for failure of the conduit or pulmonary regurgitation. In this review, we discuss the salient morphologic features of the right ventricular outflow tract, and then focus on the indications for early and late intervention, current therapeutic options, and outcomes.

Long-segment tracheal stenosis: slide tracheoplasty and a multidisciplinary approach improve outcomes and reduce costs.

Objective: Long-segment tracheal stenosis is rare, life-threatening, difficult, and expensive to treat. Management remains controversial. A multidisciplinary tracheal team was formed in 2000 to deal with a large number of children with airway problems referred for management.

Method and value of digital recording of operations for congenital heart disease.

Purpose: We describe the methods we have used to employ digital video techniques in the teaching of surgery for congenital heart disease.

Description: This paper describes the hardware and software required to initiate and utilize digital video in surgery for congenital heart defects. Images are collected through a headlight camera and stored on standard digital-video camera tape.