Transcatheter Fontan completion: Creation of an extracardiac Fontan.

Patients with functionally univentricular hearts are usually palliated surgically. There have been several reports of successful attempts to complete the Fontan procedure without surgery. The pathways created at the time of the preconditioning were largely reminiscent of the lateral tunnel Fontan.

Surgical strategies and novel alternatives for the closure of ventricular septal defects.

A variety of therapies are available to close ventricular septal defects (VSDs). These include surgical closure on bypass, percutaneous device closure, as well as perventricular hybrid closure. Due to the incidence of heart block (1-5%) associated with percutaneous device closure of perimembranous VSDs, surgical closure presently remains the gold standard and preferred therapy for these defects.

Selective use of superficial temporal artery cannulation in infants undergoing cardiac surgery.

Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA). Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported.

Bilateral diaphragmatic palsy after congenital heart surgery: management options.

Diaphragmatic paralysis following phrenic nerve injury is a major complication following congenital cardiac surgery. In contrast to unilateral paralysis, patients with bilateral diaphragmatic paralysis present a higher risk group, require different management methods, and have poorer prognosis. We retrospectively analysed seven patients who had bilateral diaphragmatic paralysis following congenital heart surgery during the period from July, 2006 to July, 2014.

Use of high-frequency ventilation to wean off cardiopulmonary bypass in a patient with pulmonary hemorrhage after failure of conventional ventilation.

The management of an infant who underwent corrective surgery for a supracardiac total anomalous pulmonary venous drainage, which was complicated by the development of pulmonary hemorrhage while separating from cardiopulmonary bypass, is presented. Initiation of high-frequency oscillatory ventilation was effective in weaning the patient off cardiopulmonary bypass.

Urgent hepatic to azygous vein connection for thrombosis of hepatic vein to pulmonary artery conduit.

We report on an emergent use of hepatic-to-azygous vein connection using a 10-mm polytetrafluoroethylene graft in a 6-year-old girl who developed acute thrombosis of an extracardiac graft conduit from the hepatic veins to the pulmonary arteries. She had left atrial isomerism, interrupted inferior vena cava with azygous continuation, and had undergone surgical creation of bilateral superior cavopulmonary connections 5 years earlier. The emergency procedure to create hepatic-to-azygous connection resulted in successful salvage of the patient who was subsequently able to maintain stable oxygen saturations and experienced rapid regression of hepatic congestion and pleural effusions.

Anesthetic management of an infant with Joubert syndrome for cardiac surgery.

The anesthetic implications of Joubert syndrome in an infant who required cardiac surgery using cardiopulmonary bypass (CPB) is presented. Children with Joubert syndrome present with central apnea due to malformations in the midbrain and cerebellum. These patients have a marked sensitivity to opioids.

The Boy from Fez: A tale of five charities, and the global community, joining hands.

A case study in global cooperation between multiple charities and cardiac centers helped to save a 8-year-old Moroccan boy suffering a case of Laubry-Pezzi syndrome with severe aortic regurgitation and ventricular septal defect. His recuperation was aided by the support of communities in both Morocco and Qatar.

Further insights into the syndrome of prolapsing non-coronary aortic cusp and ventricular septal defect.

Ventricular septal defect (VSD) with prolapse of the right coronary cusp and aortic regurgitation can be managed surgically with the anatomical correction technique. However when the VSD is located underneath the non coronary cusp surgical management differs due to anatomical constraints and secondary pathological changes seen in the non coronary cusp. It is therefore important that the location of the VSD and the morphology of prolapsing cusp be characterised preoperatively in order to plan appropriate surgical repair.

Comparison of fracture patterns between rural and urban populations in a developing country.

Introduction: The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment.

Methods: This was a retrospective multicentre study involving two urban and three rural hospitals in Malaysia. The demographic data and anatomical location of fracture of patients admitted in 2007 were collected for analysis.

Results after mitral valve replacement with mechanical prostheses in young children.

Objective: We examined outcomes after mitral valve replacement in children younger than 8 years.

Methods: Medical records of patients who underwent mitral valve replacement from 1990 to 2006 were reviewed. Competing-risks methodology determined time-related prevalence and associated factors for death, repeated valve replacement, and survival without reoperation.

Anterior stabilisation of sacroilliac joint for complex pelvic injuries.

Sacroilliac joint diasthesis from high energy trauma is always complicated with chronic pain and long term morbidity. Open anterior stabilisation with plate allow direct reduction and stabilisation with biomechanically advantages. Here we report on four cases of pelvic injury with sacroiliac joint disruption treated with anterior plate stabilisation through a surgical approach similar to that used for anterior ring fractures.

Results of left atrioventricular valve reoperations following previous repair of atrioventricular septal defects.

Objectives: We report results of left atrioventricular valve reoperations (LAVVR) following atrioventricular septal defect (AVSD) repair and examine variables predictive of outcome.

Methods: Multiple demographics and operative variables were analyzed to determine factors affecting survival and reoperation.

Results: Forty patients following partial (n = 9) or complete (n = 31) AVSD repair underwent 47 LAVVR (1992-2005).

Aortic and mitral valve replacement in children: is there any role for biologic and bioprosthetic substitutes?

Objective: The ideal valve substitute in children does not exist. Biologic and bioprosthetic valves do not require anticoagulation, however their use is complicated by accelerated degeneration and requirement for reoperation. We examine results following mitral (MVR) or aortic (AVR) replacement with biologic and bioprosthetic valves at our institution.

Mechanical valves versus the Ross procedure for aortic valve replacement in children: propensity-adjusted comparison of long-term outcomes.

Objective: We aimed to identify characteristics differentiating children undergoing aortic valve replacement by using mechanical prostheses versus the Ross procedure and to compare survival and the need for aortic valve reoperation after each procedure.

Methods: From 1983 to 2004, 346 children underwent aortic valve replacement (215 underwent the Ross procedure and 131 underwent placement of a mechanical prosthesis). Factors associated with procedure choice were used to construct a propensity score for use as a covariate in regression models to adjust for potential confounding by indication.

Surgical strategy to establish a dual-coronary system for the management of anomalous left coronary artery origin from the pulmonary artery.

Background: Optimal repair of anomalous origin of left coronary artery from pulmonary artery (ALCAPA) relies on the creation of a dual-coronary system. If the anomalous coronary arises at a long distance from the aorta, we use various coronary extension techniques to facilitate tension-free implantation.

Methods: Thirty patients underwent ALCAPA operations using direct coronary transfer (n = 11) or coronary extension techniques (n = 19).

Neoaortic bicuspid valve in arterial switch operation: mid-term follow-up.

Background: We sought to identify the prevalence of bicuspid pulmonary valve among patients with transposition of the great arteries undergoing the arterial switch operation and evaluate functional integrity of that valve in the neoaortic position.

Methods: Between October 1985 and December 2001, 391 patients had an arterial switch operation for transposition and its variants. Perioperative information and follow-up data were available for 342 patients.

Fontan completion without surgery.

Objective: There are several modifications introduced in the preparation for a subsequent non-surgical transcatheter completion of the Fontan procedure. We report our experience with one type of the modification and the short-term results following its implementation.

Methods: During bidirectional cavopulmonary connection (BCPC) an intra-atrial lateral tunnel is additionally created, as intended for a Fontan procedure but fenestrated with a 10-14 mm aperture.

Early outcome of reamed interlocking nail for non-union of tibia.

Aseptic non-union is a major problem following complicated fracture tibia, which carries significant morbidity and prolonged course of treatment. Plate fixation and autogenous bone grafting has been established as a method of treatment. However the risk of infection, implant failure and donor site morbidity are high.

Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve?

Objective: There is lack of information regarding the long-term behavior of aortic valve reconstruction with pericardium (AoR). A 16-year follow-up is reported here.

Methods: Between 1988 and 1995, 92 consecutive patients had AoR with bovine (Group I, n=27) or glutaraldehyde-treated autologous pericardium (Group II, n=65).

Coarctation of aorta repair at the National Heart Institute (1983-1994).

This retrospective study illustrates our approach to this problem over the years, from performing subclavian flap aortoplasty initially to the more accepted procedure now, which is resection and end-to-end anastomosis. Coarctation of aorta in our population is seen in a varying age groups and are also associated with other cardiac anomalies including both acyanotic and cyanotic congenital cardiac defects. Therefore a wide variety of surgical procedures were performed including resection of the coarcted segment and end-to-end anastomosis, subclavian flap aortoplasty, patch aortoplasty and synthetic tube graft interposition.

Repair of atrioventricular valve regurgitation in the modified Fontan operation.

Objective: To evaluate the prevalence, impact and outcome of repair of atrioventricular valve regurgitation (AVVR) in Fontan patients.

Methods: We retrospectively reviewed 340 Fontan patients from 1986 to 2001. Twelve patients with valve closure or replacements were excluded.

Partial resection of pelvis and salvage of the lower limb in the treatment of malignant pelvic tumours.

Malignant pelvic tumours often present late, hence a high index of suspicion should be maintain in order to arrive at the diagnosis. This is particularly true for those who have unusual symptoms. A proper planning and staging strategies is required to save the limb, and the limb salvage surgery is at present the surgery of choice to achieve local control and restoring optimum functions of the lower limbs as being illustrated by our three cases.

Obstruction of mechanical heart valve--diagnosis, surgical treatment and outcome.

From 1982 till 1999, our department performed a total of 2970 heart valve replacements--92% of which were with mechanical heart valves. During this period, there were 8 patients who came to our department with mechanical heart valve obstruction. All these patients presented with signs of heart failure or compromised haemodynamic.