Giant coronary artery aneurysm occluded completely by a thrombus.

A coronary artery aneurysm is an uncommon vascular disorder, and it can be a life-threatening disease when associated with rupture or an embolism. A 52-year-old man was found to have a 50-mm coronary artery aneurysm at the right coronary artery, and the aneurysm was completely occluded by a thrombus. He had no symptoms after arriving at our hospital, and his hemodynamics was stable.

Effect of procedural volume on the outcomes of congenital heart surgery in Japan.

Objectives: The present study developed a new risk model for congenital heart surgery in Japan and determined the relationship between hospital procedural volume and mortality using the developed model.

Methods: We analyzed 47,164 operations performed between 2013 and 2018 registered in the Japan Cardiovascular Surgery Database-Congenital and created a new risk model to predict the 90-day/in-hospital mortality using the Japanese congenital heart surgery mortality categories and patient characteristics. The observed/expected ratios of mortality were compared among 4 groups based on annual hospital procedural volume (group A [5539 procedures performed in 90 hospitals]: ≤50, group B [9322 procedures in 24 hospitals]: 51-100, group C [13,331 procedures in 21 hospitals]: 101-150, group D [18,972 procedures in 15 hospitals]: ≥151).

[Mitral and Aortic Valve Replacement and Tricuspid Valve Repair in a Patient with Metal Allergy].

We report a 63-year-old woman came to our hospital with exertional dyspnea, palpitations, and abdominal distention. Echocardiography showed mitral, aortic, and tricuspid valve insufficiency, for which surgery was indicated. Twenty-six years ago, during dental therapy, she was diagnosed with metal allergy.

Mid-term outcomes of Contegra implantation for the reconstruction of the right ventricular outflow tract to proximal branch pulmonary arteries: Japan multicentre study.

Objectives: To reveal the mid-term outcomes of Contegra implantation for the reconstruction of the right ventricular outflow tract to proximal branch pulmonary arteries in a multicentre study.

Methods: Between April 2013 and December 2019, 178 Contegra conduits were implanted at 5 Japanese institutes. The median age and body weight at operation were 16 months (25th-75th percentile: 8-32) and 8.

The mid-term outcome of Fontan conversion compared with primary total cavopulmonary connection.

Background: The indication of Fontan conversion (FC) from atriopulmonary connection (APC) to total cavopulmonary connection (TCPC) is unclear. We sought to analyze the mid-term outcome of prophylactic and therapeutic Fontan conversion compared with that of primary TCPC.

Methods: Patients with a univentricular heart who underwent cardiac catheterization at >18 years of age between July 2005 and July 2019 were included and divided into three groups: symptomatic APC patients who underwent therapeutic FC (t-FC, n = 13), asymptomatic APC patients after prophylactic FC (p-FC, n = 15), and patients who had primary TCPC procedure (pTCPC, n = 24).

Swiss-cheese ventricular septal defect closure by combination sandwich patch.

A 7-year-old boy with a history of neonatal pulmonary artery banding underwent almost complete closure of a sieve-like "Swiss-cheese" ventricular septal defect, using a combination sandwich patch technique through a right ventriculotomy. Although defects existed in the high-, mid-, and low-trabecular septa, a right ventriculotomy and division of the muscle trabeculations continuing the septal and moderator bands helped delineate the edges of the defects. Although patients with "Swiss-cheese" ventricular septal defects may be candidates for a Fontan operation conventionally, a combination patch technique could be considered the procedure of choice.

Long-term results of tricuspid reconstruction with pericardium in an infant.

We report the long-term clinical outcome of an 8-month-old infant who underwent tricuspid reconstruction using fresh autologous pericardium for severe tricuspid regurgitation due to defects in the leaflets of the tricuspid valve after ventricular septal defect closure and ablation. Ten years after surgery, the tricuspid function is good with mild regurgitation and mild stenosis. From the age of 8 months to 11 years, the patient's body weight and height increased fourfold and twofold, respectively.

Late management of the aortic root after repair of tetralogy of Fallot: A European multicentre study.

Objectives: We sought to determine the indications, type, and outcomes of reoperations on the aortic root after repair of tetralogy of Fallot (TOF).

Methods: Eleven centers belonging to the European Congenital Heart Surgeons Association contributed to the data collection process. We included 36 patients who underwent surgical procedures on the aortic root, including surgery on the aortic valve and ascending aorta, between January 1975 and December 2017.

Dilated cardiomyopathy associated with elephant trunk in Loeys-Dietz syndrome.

A 14-year-old boy presented to our institution with a diagnosis of acute type A dissection. He was diagnosed with Loeys-Dietz syndrome and underwent aortic valve sparing repair at the age of 9 years. Emergency total arch repair with elephant trunk (ET) was performed successfully; echocardiogram before discharge showed normal left ventricular function and size.

Expectations and limitations after bilateral pulmonary artery banding.

Objectives: Bilateral pulmonary artery banding (bil-PAB) has been developed as a part of a hybrid procedure for hypoplastic left heart syndrome (HLHS). We use this procedure for palliation of complex congenital heart disease, particularly in patients with arch anomaly. We reviewed our experience with bil-PAB.

Management of partial anomalous pulmonary venous connection in single ventricle.

We herein report a case of a hypoplastic left heart syndrome variant complicated with partial anomalous pulmonary venous connection to the left innominate vein. We left the vertical vein at the time of the bidirectional Glenn procedure, and ligated the vertical vein at the time of the total cavopulmonary connection procedure, without reconnecting the vertical vein to the left atrium. Because of the development of an interlobar vein draining from the left upper lung into the lower lung after the bidirectional Glenn procedure, the circulation of the left upper lung was preserved after the total cavopulmonary connection procedure.

Surgical repair of aortic regurgitation with left ventricular aneurysm diagnosed preoperatively as aortico-left ventricular tunnel.

Aortico-left ventricular tunnel (ALVT) is a rare congenital anomaly presenting abnormal connection between the ascending aorta and the left ventricle. In most reported cases, the aortic end of the tunnel is above the right coronary sinus. Cases of ALVT related to the left aortic sinus are extremely rare.

A successful patch angioplasty with auto-pulmonary wall for congenital coronary left main trunk occlusion in a young child.

Congenital occlusion of the left main coronary trunk is a life-threatening abnormality, and its optimal management remains controversial. This report describes a case of successful patch angioplasty with auto-pulmonary artery for a 12-year-old boy with congenital left main trunk occlusion. We divided the main pulmonary artery, harvested a pulmonary artery wall strip, and performed patch angioplasty of the occluded left main trunk ostium.

[Association of lung volume with shunt size in Starnes' procedure in neonates with severe Ebstein's anomaly].

Our modification of Starnes' procedure reduces right ventricular volume using only "suture plication" to improve surgical outcomes. However, shunt size in the procedure varies widely between patients. As this may be related to small lung volume, we estimated lung volume in each patient using computed tomography (CT).

Spontaneous disappearance of a saphenous vein graft pseudoaneurysm after coronary artery bypass grafting.

A saphenous vein graft pseudoaneurysm is a rare complication of coronary artery bypass grafting. Its natural course is largely unknown because there have been few observational studies of medically observed patients. We herein report a case of spontaneous regression of a saphenous vein graft pseudoaneurysm in the early postoperative period, which has never been described, to our knowledge, in the previous literature.

Single-center experience of arch reconstruction in the setting of Norwood operation.

Background: Arch reconstruction is a key part of the Norwood operation for hypoplastic left heart syndrome and is related to late morbidity. Since 2003, our surgical technique has been standardized to a right ventricle to pulmonary artery conduit, arch reconstruction with homograft patch, and Damus-Kaye-Stansel anastomosis onto homograft patch, with partial or complete resection of any coarctation ridge. We studied the impact of the surgical approach on arch reinterventions and outcome.

Repair of isolated aortic coarctation over two decades: impact of surgical approach and associated arch hypoplasia.

Objectives: A variety of surgical approaches and techniques are used for isolated coarctation repair. We have retrospectively reviewed our results of isolated repair of coarctation over the last 20 years, to establish whether the approach affects clinical outcome and the need for re-intervention.

Methods: Two hundred and eighty-eight patients who underwent isolated repair for coarctation of the aorta at Birmingham Children's Hospital between 1991 and 2010 were enrolled in this study.

The impact of extracardiac conduit-total cavopulmonary connection on apicocaval juxtaposition.

Objectives: Modifications of the Fontan procedure are applied to a wide range of complex congenital heart defects with single ventricle physiology. We examined the pathway and the clinical results of extracardiac conduit-total cavopulmonary connection (EC-TCPC) for a malpositioned heart with apicocaval juxtaposition.

Methods: Of the 365 patients who underwent EC-TCPC since 1994, 56 patients with a malpositioned heart with apicocaval juxtaposition were included in this retrospective study (group 1).