Tricuspid valve repair concomitant with the Norwood operation among babies with hypoplastic left heart syndrome.

Objectives: Among patients with hypoplastic left heart syndrome (HLHS), tricuspid valve regurgitation (TR) portends a poor prognosis. Our goal was to describe the outcomes of tricuspid valve reconstruction (TVR) concomitant with the Norwood operation and using two-dimensional echocardiography and evaluate the structural factors associated with successful functional correction.

Methods: We performed a retrospective, single-centre study of patients with HLHS undergoing TVR at the time of the Norwood operation.

Mortality and Reoperation Risk After Bioprosthetic Aortic Valve Replacement in Young Adults With Congenital Heart Disease.

Bioprosthetic aortic valve replacement (bAVR) in patients with congenital heart disease is challenging due to age, size and complexity. Our objective was to assess survival and identify predictors of re-operation. Data were retrospectively collected for 314 patients undergoing bAVR at 8 centers from 2000-2014.

Reintervention rates after bioprosthetic pulmonary valve replacement in patients younger than 30 years of age: A multicenter analysis.

Objectives: To assess the difference in time to and predictors of reintervention according to valve type in surgical bioprosthetic pulmonary valve replacement (PVR) in patients younger than 30 years of age from multiple centers.

Methods: Data were retrospectively collected for 1278 patients <30 years of age undergoing PVR at 8 centers between 1996 and 2015.

Results: Mean age at PVR was 19.

Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease.

Objectives: There are little recent data on the outcomes of mechanical aortic valve replacement (AVR) in children and young adults with congenital aortic valve disease. We sought to review the survival and associated thromboembolic or bleeding complications after mechanical AVR at a single center.

Methods: Data were retrospectively collected for 121 patients undergoing prosthetic AVR from 2000 to 2014.

Pathology of valved venous homografts used as right ventricle-to-pulmonary artery conduits in congenital heart disease surgery.

Objectives: Although valved venous homografts (VVHs) are used for establishing right ventricle-to-pulmonary artery continuity in some complex heart defects, the tissue changes that occur in situ have not been described. We review the gross and microscopic changes observed in explanted VVH conduits and their effects on functionality.

Methods: In total, 20 explanted VVH conduits were evaluated for valve integrity, presence of thrombus, and stenosis.

Three-Patch Aortic Root Reconstruction With Extended Left Main Coronary Artery Patch Augmentation in Neonates and Infants.

Left main coronary artery (LMCA) stenosis is present in approximately 5% of patients with congenital supravalvular aortic stenosis (SVAS) (Fig. 1) and is associated with an increased risk of sudden cardiac death. However, patients undergoing coronary artery intervention at the time of SVAS repair are at the highest risk of experiencing major adverse cardiac events.

Morphologic and histologic findings in bioprosthetic valves explanted from the mitral position in children younger than 5 years of age.

Background: Mitral valve replacement (MVR) in very young children is challenging. This study investigates the mechanisms for early bioprosthetic valve failure in very young patients through review of the macroscopic and microscopic findings in explanted bioprosthetic valves.

Methods: Patients who underwent MVR with a bioprosthetic valve at Boston Children's Hospital between January 2010 to April 2016 at <5 years of age were the subjects of this study.

Right ventricular outflow tract reintervention after primary tetralogy of Fallot repair in neonates and young infants.

Objective: To assess the outcomes following primary tetralogy of Fallot (TOF) repair in neonates and young infants with pulmonary stenosis (PS) and pulmonary atresia and compare differences in reintervention on the right ventricular outflow tract (RVOT) among those undergoing valve sparing repair (VSR), transannular RVOT patch (TAP), and right ventricle-to-pulmonary artery (RV-PA) conduit surgeries.

Methods: Data were collected retrospectively in 101 patients who underwent TOF repair over a 10-year period between January 2005 and September 2015. The primary endpoint was reintervention on the RVOT, defined as a surgical procedure or cardiac catheterization-based RVOT reintervention.

Augmentation of Bridging Leaflets in Repair of Atrioventricular Canal Defects.

Left atrioventricular (AV) valve regurgitation is the most common complication after a atrioventricular canal defect (AVCD) repair. Despite what appears to be a less complex repair, patients with partial and transitional AV canal have higher reoperation rates for left AV valve regurgitation and left ventricular outflow tract (LVOT) obstruction. Retraction of bridging leaflets with secondary attachments to the septal crest commonly produces increased tension and flattening of the medial left AV valve leaflet and LVOT obstruction after cleft closure.

Outcome and performance of bioprosthetic pulmonary valve replacement in patients with congenital heart disease.

Objectives: The goal of this single-center series was to assess differences in reintervention by the type of valve used for surgical bioprosthetic pulmonary valve replacement and to identify independent predictors of reintervention.

Methods: Data were retrospectively collected for 611 patients undergoing pulmonary valve replacement from 1996 to 2014. Kaplan-Meier estimation and Cox proportional hazards regression methodologies were used.

Photo-oxidized bovine pericardium in congenital cardiac surgery: single-centre experience.

Objectives: Dye-mediated photo-oxidation of pericardium is an alternative method to chemical treatment with glutaraldehyde for cross-linking collagen, providing biostability of the patch material while avoiding late calcification and cytotoxicity. There are few data available, on using photo-oxidation-treated pericardium, in congenital cardiac surgery. This study reports the outcomes using Photofix™ bovine pericardium in neonates, infants, children and young adults undergoing paediatric cardiac surgery.

Outcomes and Short-Term Follow-Up in Complex Ross Operations in Pediatric Patients Undergoing Damus-Kaye-Stansel Takedown.

Review echocardiography and outcomes before and after Ross procedures, including patients undergoing biventricular conversion with Damus-Kaye-Stansel (DKS) takedown. A retrospective review was performed on 62 patients undergoing simple (control group) and complex Ross procedures, including 12 patients who underwent biventricular conversion with Ross operation and DKS takedown (complex). Echocardiography was reviewed preoperatively and at discharge and late follow-up.

Review of Congenital Mitral Valve Stenosis: Analysis, Repair Techniques and Outcomes.

The spectrum of congenital mitral valve stenosis (MS) consists of a complex of defects that result in obstruction to left ventricular inflow. This spectrum includes patients with underdeveloped left heart structures (Fig. 1) to those with isolated congenital MS.

Histology of Pericardial Tissue Substitutes Used in Congenital Heart Surgery.

Pericardium is used as a tissue substitute during pediatric heart surgery. However, little is known about the histological characteristics of pericardial tissue substitutes. We searched our clinical and Pathology databases to identify cases in which glutaraldehyde-preserved autologous pericardium, PhotoFix bovine pericardium, or Peri-Guard Repair Patch glutaraldehyde-preserved bovine pericardium was used as patch material during cardiac surgery and in which explanted tissue substitute was available for histologic examination.

Outcomes of surgery for young children with multivessel pulmonary vein stenosis.

Objective: We pursued a multimodality approach to the treatment of patients with pulmonary vein stenosis, incorporating sutureless surgical repair, catheter interventions, and adjunctive chemotherapy. We report our outcomes after surgery.

Methods: Between January 2007 and August 2013, 49 patients with multivessel pulmonary vein stenosis underwent operations at our institution.

Biventricular repair for common atrioventricular canal defect with parachute left atrioventricular valve.

Objectives: Parachute left atrioventricular (AV) valve can complicate repair of common atrioventricular canal (CAVC), and single-ventricle palliation is sometimes preferred. The goal of this study is to review our single institutional experience in biventricular repair in this patient group.

Methods: The demographic, procedural and outcome data were obtained for all children who underwent biventricular repair for complete CAVC with parachute [single left ventricular (LV) papillary muscle] or forme fruste parachute left AV valve (closely spaced LV papillary muscles) from 2001 to 2012.

Ring-reinforced Sano conduit at Norwood stage I reduces proximal conduit obstruction.

Background: Reinterventions for proximal conduit obstruction or on the pulmonary arteries are frequent after the Sano-modified stage I Norwood palliation of hypoplastic left heart syndrome. We report our initial experience with a modified Sano technique using a ring-reinforced graft inserted transmurally through the right ventricle with a limited ventriculotomy.

Methods: All patients who underwent the Sano-modified stage I Norwood procedure using a modified "dunked" technique from September 2010 to September 2012 at our institution were reviewed.

Mechanisms of tricuspid regurgitation in patients with hypoplastic left heart syndrome undergoing tricuspid valvuloplasty.

Objectives: Tricuspid regurgitation (TR) remains a risk factor for morbidity and mortality through staged palliation in patients with hypoplastic left heart syndrome (HLHS). Reports on the mechanisms associated with TR in patients with HLHS are limited. Thus, we sought to describe our experience with tricuspid valve (TV) repair in these patients, focusing on the mechanisms of TR and corresponding surgical techniques.

Takedown of cavopulmonary shunt at biventricular repair.

Objective: With advances in valve repair and ventricular recruitment strategies, patients initially palliated with single ventricle physiology have been increasingly brought to biventricular circulation. Few data are available on the technical aspects and outcomes after takedown of the superior cavopulmonary anastomosis (bidirectional Glenn [BDG]). We reviewed a single-institutional experience in BDG takedown.

Accelerated degeneration of a bovine pericardial bioprosthetic aortic valve in children and young adults.

Background: Experience with aortic valve replacement (AVR) with current-generation pericardial bioprostheses in young patients is limited. The death of a child with accelerated bioprosthetic aortic stenosis prompted enhanced surveillance of all such patients at our institution.

Methods And Results: We reviewed records of 27 patients who had undergone AVR (median follow-up, 13.

Pediatric thoracic organ transplants: challenges in primary care.

Pediatric nurse practitioners (PNP) confront numerous challenges when delivering care to infants, children, and adolescents who receive thoracic organ transplants. Today, thoracic organ transplantation is an acceptable and viable option for infants, children, and adolescents with end stage cardiac and pulmonary disease. Despite the plateau in the actual numbers of thoracic organ transplants performed annually in the United States, they are still being performed in a significant number.