4.5-mm "Ready-Made" Conduit for Primary Chest Closure After Norwood Procedure.

The Norwood procedure with the right ventricle-to-pulmonary artery (RV-PA) conduit has been the standard procedure for hypoplastic left heart syndrome. However, postoperative management can be challenging related to finding the correct balance between pulmonary and systemic blood flow. One can use hemostatic clips on the RV-PA conduit to temporarily restrict pulmonary blood flow.

"Invisible" Incision: Modified Horizontal Right Axillary Mini-Thoracotomy for Pediatric Cardiac Surgery.

Median sternotomy has been the standard surgical approach for pediatric cardiac surgery. The downside is that it leaves a notable and visible scar. Right axillary mini-thoracotomy provides a more aesthetically pleasing incision in addition to an earlier recovery time for patients.

Complete repair for Scimitar syndrome with transitional atrioventricular canal.

We describe an extremely rare case of a 15-year-old female, who underwent a complete repair for transitional atrioventricular canal with Scimitar syndrome by a two-patch technique including translocation of the Scimitar vein. This surgical technique offered superior patch shapes in order to better repair both anomalies.

Neonatal right mini thoracotomy for repair of critical pulmonary stenosis.

Over the last few decades, due to evolving surgical techniques and medical management, there has been a significant decrease in the rate of mortality and complications for neonates born with critical pulmonary valve stenosis. Median sternotomy is the standard approach; however, this longitudinal midline incision is invasive and leaves a significant scar. A right mini thoracotomy approach to this surgical repair decreases recovery time and the chance of possible future psychological distress from a visible median sternotomy scar.

An Analysis of Left Ventricular Retraining in Patients With Dextro- and Levo-Transposition of the Great Arteries.

Background: Patients with dextro (D)-transposition of the great arteries (TGA) who have undergone a previous atrial switch and for some patients with levo (L)-TGA (ie, no ventricular septal defect or outflow tract obstruction), the left ventricle (LV) may require retraining before late arterial switch. The purpose of this study was to analyze the results of LV retraining for these two entities.

Methods: This was a retrospective review of 51 patients enrolled in an LV retraining program.

Biatrial connection of partial anomalous pulmonary venous return.

We describe an extremely rare case of partial anomalous pulmonary venous return in a 3-year-old boy with an abnormal connection between the right upper pulmonary vein and the right middle pulmonary vein, which created biatrial communication hemodynamically. Patch closure on the orifice of the right upper pulmonary vein was performed to avoid distortion or kinking of the right pulmonary veins and the connection.

Left Ventricular Retraining and Late Arterial Switch for D-Transposition of the Great Arteries.

Background: For many decades, patients with d-transposition of the great arteries underwent an atrial switch procedure. Although many of these patients have continued to do well, a subset experience profound right ventricular failure. Some may be candidates for left ventricular (LV) retraining and late arterial switch.

Early complete repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals.

Background: Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals (PA/VSD/MAPCAs) is a complex and diverse form of congenital heart defect. Although most patients with PA/VSD/MAPCAs can wait until they are 3 to 6 months of age to undergo surgical reconstruction, there are three specific criteria that merit an earlier repair. These 3 criteria are (1) unremitting heart failure; (2) a ductus to one lung and MAPCAs to the other; and (3) hemitruncus to one lung and MAPCAs to the other.

Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg.

Objective: The optimal shunt size for patients who have the Norwood operation with a right ventricle-to-pulmonary artery conduit is controversial. The goal of this study is to compare outcomes of 2 shunt sizes in this population.

Methods: Between 2002 and 2010, 75 consecutive patients diagnosed with hypoplastic left heart syndrome and its variants underwent the Norwood procedure with a right ventricle-to-pulmonary artery conduit.

Early results of the "clamp and sew" Fontan procedure without the use of circulatory support.

Background: A modification of the Fontan operation was recently applied, which includes anastomoses of the extracardiac conduit to the right pulmonary artery and inferior vena cava using simple clamping with no additional circulatory support, venous shunting, pulmonary artery preparation, or prior maintenance of azygos vein patency. The objective of this study is to assess the outcomes of this novel off-pump "clamp and sew" Fontan procedure.

Methods: This is a retrospective review of all patients having a Fontan procedure between January 2009 and October 2010 at a single institution.

Aortic stenosis in a patient with Hurler's syndrome after bone marrow transplantation.

We describe a case of severe aortic stenosis in a 16-year-old male with Hurler's syndrome who had prior bone marrow transplantation. The excised aortic valve leaflets showed characteristic pathologic findings of Hurler's syndrome. This is the first case report of aortic valve replacement in a patient with Hurler's syndrome treated with bone marrow transplantation that demonstrates progression of the aortic valve disease despite treatment.

Performance of bovine pericardial valves in the pulmonary position.

Background: The purpose of this study is to determine the outcome and performance of bovine pericardial valves in the pulmonary position.

Methods: This is a retrospective review of all patients with congenital heart disease who had pulmonary valve replacement using a bovine pericardial valve from 2002 to 2009 at a single institution.

Results: There were 73 consecutive patients, with a median age of 17.

Valve-sparing aortic root replacement with repair of leaflet prolapse after Ross operation.

The need for reoperation remains a principal limitation of the Ross procedure and most commonly includes replacement of the neo-aortic valve. Valve-preserving aortic root replacement has recently evolved into an increasingly accepted treatment modality for patients with neo-aortic valve regurgitation. Leaflet prolapse, however, may be present, making composite replacement the most frequent choice.