Nonobstructive mechanical prosthetic valve thrombosis with acute stroke.

Nonobstructive prosthetic valve thrombosis occurs more frequently during the early postoperative period due to increased thrombogenicity precipitated by inadequate anticoagulation. There is currently no consensus in the management of prosthetic valve thrombosis. We describe a patient with acute stroke secondary to nonobstructive prosthetic valve thrombosis that was due to inadequate anticoagulation.

Collateral damage in a neonate with transposition of the great arteries.

Following an arterial switch operation, aortopulmonary collateral arteries causing an over loading of the pulmonary vasculature and necessitating prolonged postoperative mechanical ventilation were coil embolized resulting in a rapid resolution of the problem.

Repair of Kommerell's diverticulum with aberrant left subclavian artery in an elderly patient with right aortic arch and dysphagia lusoria.

A 60-year-old femalepresented with progressive dysphagia and was found to have a right-sided aortic arch with external posterior compression of the upper esophagus due to severe compression from a Kommerell's diverticulum with an aberrant left subclavian artery. This patient underwent division of the diverticulum with an aorto-subclavian graft implantation under femoro-femoral bypass and recovered uneventfully. A review of the literature and discussion of the surgical management is presented.

Arterial switch operation: troponin T does not predict ventilation requirements.

The aim of this study was to assess whether postoperative cardiac troponin T levels could predict ventilation requirements in infants undergoing the arterial switch operation. Cardiac troponin T was measured 6 hours after aortic cross clamping and prior to tracheal extubation in 20 consecutive patients; 10 had simple and 10 had complex (with ventricular septal defect) transposition of the great arteries. The mean plasma troponin T level prior to extubation did not differ significantly in patients who were re-intubated and those who were successfully extubated.

Selection of monitoring site and outcome after neonatal coarctation repair.

To assess whether simultaneous invasive arterial pressure monitoring of right upper and lower limbs in neonatal aortic coarctation with or without arch hypoplasia has an impact on surgical decision-making and outcome, data of 140 newborns who underwent emergency surgical repair over 15 years were analyzed retrospectively. The 36 who had simultaneous right arm and lower limb arterial pressure monitored intraoperatively were assigned to group 1. The other 104 who had blood pressure monitored invasively at a single site (either upper or lower limb) were allocated to group 2.

Methemoglobinemia masquerading as pulmonary hypertension.

Pulmonary arterial hypertension is known to occur postoperatively after closure of VSD. It results in a low cardiac output state with need for ventilation and frequent bagging. Methemoglobinemia, a condition associated with toxic ingestions, has been described in this setting.

Myocardial protection during neonatal cardiac surgery.

Myocardial protection is of major concern in neonatal cardiac surgery where coronary ostial transfer is required as part of the surgical procedure. Retrograde coronary sinus perfusion (RCSP) of cold cardioplegic solution was evaluated in infants undergoing arterial switch operations. Hemodynamic measurements and postoperative cardiac troponin I (cTnI) levels were estimated in addition to transthoracic echocardiography to assess the extent of myocardial injury.