Autologous vascularised pericardial flap tunneling technique in Scimitar syndrome repair with dextrocardia: lessons from the Senning procedure.

Scimitar syndrome is a rare variant (5%) of partial abnormal pulmonary venous return. Surgery is required when pulmonary overcirculation is present. Following repair, Scimitar vein stenosis occurs in approximately 20%. We applied a variant of the atrial switch technique using autologous pericardial flap in a patient with Scimitar syndrome and dextrocardia. This tunneling technique allowed tension-free anastomosis and minimal Scimitar vein rotation

Treatment of a severe distal thoracic and abdominal coarctation with cutting balloon and stent implantation in an infant: From fetal diagnosis to adolescence.

Abdominal coarctations are rare. Surgical treatment is difficult and requires re-interventions to adjust the graft material to patient growth. We report effective treatment by interventional catheterization in an infant with the concern to allow adjustment for growth and prevention of vessel damage. After the diagnosis of abdominal coarctation at 27 weeks of gestation, an infant developed hypertension (170/70 mmHg) at 3 months of age despite medical therapy. Angio CT confirmed a 2 mm diameter, 2.3-cm-long coarctation of the descending aorta. At 4 months, a dilatation was performed using a 3 mm cutting balloon and a 5 mm Opta® balloon, Cordis®. Two noncovered Palmaz® Genesis™ XD PG1910P stents were required to keep the aortic lumen open. At 15 months, an Adventa™ V12 vascular 12 × 61 mm long covered stent was implanted to exclude an aneurysm which developed between the two stents. At 3 and 9.5 years, the stents were further dilated with a high-pressure balloon to reach 11 mm aortic diameter with no residual pressure gradient, and normal blood pressure. The use of cutting balloons and stent implantation is an effective way to relieve severe obstruction in middle aortic syndrome in neonates. The technical issues encountered were the need for a low profile sheath and material to avoid femoral artery damage, and the need to use stents that can be further expanded to adult size

A Rare Case of Infective Mediastinitis after Melody Valve Implantation

Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease. Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation. There are various treatments for native or prosthetic valve endocarditis. Surgical intervention, combined with intravenous antibiotic treatment, is of paramount importance, in case of concomitant mediastinal infection, in order to ensure the radical debridement of all infected tissue, avoiding any recurrent endocarditis. In this report, we describe a rare case of mediastinitis, associated with an infected endocarditis, occurring 8 months after Melody (MedtronicÒ, Minneapolis, USA) valve implant, successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract

Innovations 2022 en cardiologie pédiatrique

En 2022, trois grands thèmes en cardiologie pédiatrique ont retenu toute notre attention. De la vie fœtale à l’adolescence, les sujets sont très variés et illustrent ainsi le large champ de compétence de notre équipe de pédiatres cardiologues. Premièrement, malgré le fait que la coarctation de l’aorte (CoAo) est une des cardiopathies congénitales les plus fréquentes, son diagnostic prénatal reste un challenge. La subtilité des signes échographiques de la CoAo lors de l’examen morphologique du 2ème trimestre de grossesse rend le dépistage difficile. Or, le pronostic de ces patients dépend d’une prise en charge rapide en période néonatale. Le développement de l’IRM cardiaque fœtale et des connaissances en cardio-génétiques tentent à améliorer le dépistage de cette malformation cardiaque. Deuxièmement, le syndrome de tachycardie posturale (POTS) est un syndrome affectant la qualité de vie de nos patients adolescents. Des paramètres simples tels que la fréquence cardiaque et la tension artérielle durant un test sur table basculante, permettent d’orienter la prise en charge ainsi que le pronostic donné aux patients. Une nouvelle hypothèse sur l’étiologie du POTS est évoquée depuis la vaccination contre le COVID-19. Troisièmement, l’hypertension pulmonaire (HTP) en période post-opératoire de cardiopathie congénitale est une complication grave, pouvant mener à une dilatation aiguë du ventricule droit, un collapsus circulatoire et le décès du patient. Sur les dernières années, l’utilisation de vasodilatateurs pulmonaires dans le traitement de l’HTP post-opératoire est devenue « à la mode ». Une remise en question de cette pratique est abordée dans la dernière partie de cet article

An unusual cause of right ventricular outflow tract obstruction.

A 7-day-old boy born from an uneventful pregnancy presented with cyanosis and desaturation after a normal postnatal adaptation. Initial echocardiography showed a right ventricular outflow tract (RVOT) obstruction with duct-dependent circulation. PGE1 infusion and invasive ventilation were initiated before the patient was referred to our institution. Echocardiography (left upper panel) showed a free-moving, hypoechogenic, 1 cm round-shaped structure in the pulmonary trunk (asterisk). Colour-Doppler interrogation did not show any flow within the structure. The RVOT was almost totally obstructed and this anomaly seemed to belong to the pulmonary valve. Because of the high suspicion of valvar dysplasia, the patient was brought to the catheterization laboratory [...