Is there any need for a shunt in the treatment of tetralogy of Fallot with one source of pulmonary blood flow?

Objectives: In symptomatic patients, performing a primary repair of tetralogy of Fallot (TOF), irrespective of age or placing a shunt, remains controversial. The aim of the study was to analyse the policy of primary correction.

Methods: Between May 2005 and May 2012, a total of 87 consecutive patients with TOF, younger than 6 months of age, underwent primary correction.

Coronary interventions in congenital heart diseases: from preterm to young adult patients.

Background: The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions.

Methods And Results: Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.

Interventions after Norwood procedure: comparison of Sano and modified Blalock-Taussig shunt.

Improved results have evolved from the modified Norwood procedure (NP). This study compares the incidence of interventions after NP with the Sano (n = 37) and modified Blalock-Taussig (BT n = 70) shunt. Incidence, location, interval of interventions, and weight were retrospectively analysed for 107 neonates undergoing NP during the period from October 2002 to December 2009.

Tranexamic acid: an alternative to aprotinin as antifibrinolytic therapy in pediatric congenital heart surgery.

Objective: There has been concern about the usage of aprotinin, an antifibrinolytic drug that was often used in pediatric cardiac surgery until 2006. At our center, these concerns led to the replacement of aprotinin with tranexamic acid for antifibrinolytic treatment.

Methods: In this retrospective observational study, two groups of pediatric patients were studied during two different periods, receiving either aprotinin (n=70) or tranexamic acid (n=70) upon cardiac surgery.

Surgical treatment of transposition of great arteries with ventricular septal defect and left ventricular outflow tract obstruction: midterm results.

Our purpose was to evaluate our single-center experience with the treatment of transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO). Between 1992 and 2009, 42 patients were operated on. Twenty-three patients underwent the Rastelli operation, 8 patients underwent arterial switch operation (ASO) with associated LVOTO procedures, 4 patients underwent the réparation à l'étage ventriculaire (REV) procedure, 3 patients underwent the Bex/Nikaidoh (BN) procedure, and the Fontan operation was performed in 4 patients.

A novel approach to the repair of tetralogy of Fallot with absent pulmonary valve and the reduction of airway compression by the pulmonary artery.

Controversy persists regarding the management of patients suffering from tetralogy of Fallot with absent pulmonary valve syndrome. Airway obstruction caused by the dilated pulmonary arteries is the determining factor in the mortality of symptomatic newborns and infants. A number of surgical techniques for the reduction of bronchial obstruction have been proposed, producing variable results.

Ross-Konno operation in children.

The Ross-Konno procedure is an excellent technique for the treatment of complex multilevel left ventricular outflow tract obstruction with severe annular hypoplasia and a dysplastic aortic valve. The operation can be performed earlier in life, thus avoiding repeated surgical reinterventions, which may provide only short-term palliation and potentially exacerbate ventricular function. The Ross-Konno procedure increases our therapeutic choices for neonates or infants with critical aortic stenosis, who show unacceptable results following open valvotomy or balloon valvotomy.

Surgery for subvalvar aortic stenosis - resection of discrete subvalvar aortic membrane.

Discrete subvalvar aortic membrane is characterized by a fibromuscular shelf located at the area of aortomitral continuity with the extension toward the interventricular septum. As compared to other congenital heart defects, discrete subvalvar aortic membrane is virtually never recognized in early infancy, but appears to be an 'acquired' lesion, typically seen in patients with a more acute angle between the long axis of the left ventricle and the aorta. This angulation leads to imbalance in shear forces, which causes the proliferation of tissue that forms the membrane.

Open valvotomy for aortic valve stenosis in newborns and infants.

The most appropriate management of aortic stenosis in children remains controversial. Both balloon and surgical valvotomy are firmly established as effective initial treatments with encouraging survival rates even in the troublesome neonatal group. Improved early results are based rather on the better understanding of the limits of a biventricular repair than on the method of treatment.

Comprehensive Aristotle score: implications for the Norwood procedure.

Background: Aristotle score is emerging as a reliable tool to measure surgical performance. We estimated the comprehensive Aristotle score for the Norwood procedure, correlated it with survival, and considered its impact on surgical management of hypoplastic left heart syndrome.

Methods: Comprehensive Aristotle score was retrospectively calculated for 39 consecutive Norwood procedures performed from 2001 to 2004.

Modified Children's II operation on the beating heart allows growth potential.

We describe a modification of the Children's II operation for hypoplastic left heart syndrome allowing growth potential to be performed without circulatory and cardiac arrest.

Perioperative management in pediatric heart transplantation from 1988 to 2001: anesthetic experience in a single center.

Pediatric cardiac transplantation is currently an accepted option for end-stage heart disease and congenital cardiac malformations. This report focuses on the anesthetic perioperative management in 12 yr. From 1988 to 2001 we performed 90 heart transplantations in 88 children, infants and neonates.

Ventricular cardiac-assist devices in infants and children: anesthetic considerations.

Objective: The application of a mechanical cardiac-assist device is now a common procedure in modern cardiac surgery in patients with end-stage failure, whereas in pediatric patients it is still a great challenge. In the recent literature, a broad range of survival and weaning rates have been reported, depending on the variety of mechanical devices and the choice of patients with different conditions before implantation or if the device is used in emergency surgery. In this article, the authors report their experience with pediatric cardiac-assist devices and the perioperative anesthesia management in this group of patients.