Patch angioplasty and neo-ostium creation for intramural left coronary artery.

Anomalous aortic origin of the coronary artery is a rare cardiac anomaly which induces myocardial ischemia and is associated with sudden death. We operated on a 25-year-old female with syncopal episodes who had an intramural left coronary artery. A neo-ostium was created in the left sinus but the initial neo-ostium seemed small because of the hypoplastic intramural segment of the left coronary artery.

Postnatal course of hypoplastic left heart complex and restrictive foramen ovale.

Hypoplastic left heart complex is a cardiac malformation at the mildest end of the spectrum of hypoplastic left heart syndrome. Recently, biventricular repair was proposed for such patients without retrograde flow to the ascending aorta. However, the preoperative course of these patients is unclear.

In vivo plaque composition and morphology in coronary artery lesions in adolescents and young adults long after Kawasaki disease: a virtual histology-intravascular ultrasound study.

Background: Coronary artery lesions (CALs) late after Kawasaki disease were characterized by endothelial dysfunction and low-grade inflammation, surrogate markers for atherosclerosis. We tested the hypothesis that CALs in patients long after Kawasaki disease are accompanied by atheroma-like features, as assessed by virtual histology-intravascular ultrasound, a new method to assess coronary plaque composition and morphology in vivo.

Methods And Results: Virtual histology-intravascular ultrasound was performed in 13 Japanese Kawasaki disease patients (median age, 18.

Removal of prostaglandin E2 and increased intraoperative blood pressure during modified ultrafiltration in pediatric cardiac surgery.

Objective: We investigated the relationship between serum prostaglandin E(2) and intraoperative blood pressure in pediatric cardiac surgery with modified ultrafiltration.

Methods: In 35 consecutive patients (31.6 +/- 26.

Suture repair of pectus excavatum at the time of cardiac surgery on an infant.

An 11-month-old girl was diagnosed with pulmonary atresia with intact ventricular septum and symmetrical pectus excavatum that had developed after prior palliative operation. We performed a transannular patch repair and atrial septal defect closure. Simultaneously, to prevent postoperative right ventricular outflow tract compression, the sternum was elevated by two 1-0 braided polyester horizontal mattress sutures on the posterior side of the third and fourth costal cartilages.

Pulmonary artery growth after Norwood and bidirectional Glenn procedure.

A 19-day-old boy diagnosed with hypoplastic left heart syndrome underwent stage I bilateral pulmonary artery banding and main pulmonary artery-to-descending aorta shunt. A restrictive atrial septal defect existing before stage I recurred after balloon atrioseptostomy. After stage II Norwood and bidirectional Glenn procedure at age nine months, the Nakata index decreased to 73 mm(2)/m(2) (pulmonary artery mean pressure: 15 mmHg) and multiple systemic venous collaterals developed.

Congenital pulmonary vein stenosis with anomalous pulmonary venous connection.

An 11-month-old boy with congenital pulmonary vein stenosis, partial anomalous pulmonary venous connection, and ventricular septal defect is described. Angiocardiography demonstrated stenosis between the right upper pulmonary vein and high superior vena cava and obstruction of the right lower pulmonary vein. For pulmonary vein stenosis, we performed transverse sutured plasty for the right upper pulmonary vein, followed by right lower lobectomy.

Stage I bilateral pulmonary artery banding maintains systemic flow by prostaglandin E1 infusion or a main pulmonary artery to the descending aorta shunt for hypoplastic left heart syndrome.

Since 2002, we have performed bilateral pulmonary artery banding for stage I palliation and maintained systemic flow by prostaglandin E1 infusion or a main pulmonary artery to the descending aorta shunt, and here report our experience. Three of the 4 patients were diagnosed with aortic atresia/mitral atresia and 1 with aortic stenosis/mitral stenosis. Balloon atrial septostomy was performed in 2 before stage I.

Surgical repair of coronary sinus orifice atresia with persistent left superior vena cava in heterotaxia.

A 6-month-old boy was diagnosed with coronary sinus orifice atresia, double-outlet right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and moderate common atrioventricular valve regurgitation associated with heterotaxy syndrome. Cardiac venous flow drained through a persistent left superior vena cava. We decided to perform coronary sinus orifice unroofing through the right atrium under a guide using a bougie.

Palliative management of a low-birth-weight infant with congenitally corrected transposition of the great arteries, severe restrictive foramen ovale, hypoplasia of the morphologically right ventricle, ventricular septal defect, and steno-insufficiency of the tricuspid valve.

A 3-month-old girl weighing 2160 g was diagnosed with congenitally corrected transposition of the great arteries, a ventricular septal defect, severe restrictive foramen ovale, hypoplasia of the morphologically right ventricle, and steno-insufficiency of the tricuspid valve. As her hemodynamic condition (which was comparable to that of the single ventricle with obstructed pulmonary venous pathway) deteriorated progressively, she underwent a palliative operation at 4 months of age. Postoperatively, she was managed with the "low resistance strategy" to achieve a stabilized state of the pulmonary circulation.

Truncus arteriosus repair after palliative bilateral pulmonary artery banding.

A 3.5-month-old girl was diagnosed with type I truncus arteriosus and severe pulmonary hypertension. We performed palliative bilateral pulmonary artery banding (right and left circumferences, 14 and 12 mm, respectively).

Relationship between increased blood pressure and hematocrit during modified ultrafiltration for pediatric open heart surgery.

Objective: Modified ultrafiltration increases blood pressure after cardiopulmonary bypass in children. To investigate the cause of this hemodynamic improvement, we assessed the relationship between increased blood pressure and hematocrit.

Methods: We retrospectively assessed 30 consecutive patients who underwent ventricular septal defect closure, and divided them into two groups: group M (modified ultrafiltration, n=15) and group C (conventional ultra-filtration, n=15).

First-stage angioplasty for a single ventricle with pulmonary artery coarctation.

We report first-stage palliation consisting of pulmonary artery angioplasty and a systemic-to-pulmonary shunt using a minimized cardiopulmonary bypass technique performed with modified ultrafiltration for two patients with a single ventricle, pulmonary atresia, patent ductus arteriosus, and pulmonary coarctation during early infancy. Postoperative early extubation (15 and 18 h) and bilateral pulmonary artery growth before the second stage (Nakata indexes, in mm2/m2: right 94, left 53; and right 209, left 70) were experienced. Less-invasive pulmonary artery continuity reconstruction at an early stage is advantageous for low-weight patients with a single ventricle and pulmonary coarctation.

Pediatric cardiac remodeling after cardiac resynchronization therapy.

A 1.8-year-old male required a conventional DDD pacemaker for an atrioventricular block after congenital heart surgery. Five years later, heart failure due to left ventricular (LV) dyssynchrony progressed and we performed cardiac resynchronization therapy (CRT).

Comparison of hemodynamics between Norwood procedure and systemic-to-pulmonary artery shunt for single right ventricle patients.

Objective: Despite that surgical outcomes of patients with hypoplastic left heart syndrome have improved, one of the problems remaining is the high interstage mortality after a stage I Norwood procedure. The purpose of this study was to determine the hemodynamic characteristics of hypoplastic left heart syndrome after a Norwood procedure. We examined the perioperative hemodynamic differences of the staged operation between the first stage of the Norwood procedure and systemic pulmonary shunt for single right ventricle patients.