Echocardiographic Assessment of Ebstein's Anomaly in a 60-Year-Old Man

We present an echocardiographic evaluation of an elderly man affected with Ebstein's anomaly. In the natural history of this congenital disease only 5% of patients survive beyond the fifth decade. The patient presented severe right heart failure and he was refered to our institution for heart transplantation

The impact of native Fallot anatomy on future therapeutic requirements and outcomes at follow-up

Abstract Background In patients with repaired Fallot, subsequent surgical or interventional procedures and adverse cardiac events are frequent. We aimed to evaluate the impact of a simple pre-operative anatomic classification based on the size of the pulmonary valve (PV) annulus and branches on future therapeutic requirements and outcomes. Method This is a single-center retrospective analysis of patients operated for Fallot before the age of 2 years, from January 1990. Pre-operative anatomy, surgical and interventional procedures and adverse events were extrapolated from clinical records. Results Among the 312 patients, a description of the PV and pulmonary arteries (PAs) native anatomy was known in 239 patients (male:147, 61.5%), which were divided in the following 3 groups: group 1 (65 patients) with normal size of both PV and PAs; group 2 (108 patients) with PV hypoplasia but normal size PAs; group 3 (66 patients) with concomitant hypoplasia of the PV and PAs. During the 12.7 years (IQR 6.7–17) follow-up time, 23% of patients required at least one surgical or interventional procedure. At Kaplan–Meier analysis, there was a significant difference in requirement of future surgical or interventional procedures among the 3 groups (p < 0,001). At multivariate Cox regression analysis, hypoplasia of PV and PAs was an independent predictor of subsequent procedures (HR:3.1,CI:1.06–9.1, p = 0.03). Conclusion Native anatomy in Tetralogy of Fallot patients affects surgical strategy and follow-up. It would be therefore advisable to tailor patient’s counseling and follow-up according to native anatomy, rather than following a standardized protocol

The different surgical impact of the superior cavoatrial incision in children and adults

Introduction:The single- and double-patch repairs are undoubtedly the most commonly used techniques for the surgical management of partial anomalous pulmonary venous connection associated with sinus venosus atrial septal defect. The aim of this study was to retrospectively compare early and long-term surgical outcomes in paediatric and adult patients, focusing in particular on the occurrence of ectopic atrial rhythm.Material and methods:Seventy patients (male: 38, 54.2%) underwent surgical repair for partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. Forty-nine patients (70%) underwent surgical repair in paediatric age (&lt;16 years old), while 21 of (30%) patients were operated in adulthood. Thirty patients (42.8%) underwent single-patch repair and 39 patients (55.7%) underwent double-patch repair. In only one patient, the Warden procedure was performed (1.4%). Median follow-up time was 52 months (IQ 15.1-113).Results:The type of surgical technique didn't affect the incidence of ectopic atrial rhythm (26.6% in single-patch group and 25.6% in double-patch groups, p = 0.9). At long-term follow-up, ectopic atrial rhythm, as an expression of sinoatrial node disturbance, was however significantly more frequent in the paediatric population (28.8% paediatric group and 4.7% adult group, p = 0.02).Conclusions:The higher incidence of ectopic atrial rhythm in children is probably related to the closer position of the sinus node to the superior cavoatrial incision, which makes irreversible iatrogenic traumatism more likely to occur. Surgical techniques that avoid any manipulation on the superior cavoatrial junction should, therefore, be preferred for children undergoing partial anomalous pulmonary venous connection repair

Retrosternal Clots After Fontan Surgery by Systematic Evaluation With Transthoracic Ultrasound

Objectives: Bleeding is a common, serious, and often subtle complication after total cavopulmonary connection surgery. The aim of the present study was to assess the incidence of retrosternal clots after surgery, which were searched for systematically with transthoracic ultrasound. Design: Retrospective study. Setting: Single center. Participants: Total cavopulmonary surgeries were reviewed from January 2016 to May 2019. Interventions: Thoracic ultrasound with careful evaluation of the retrosternal area was performed at different postoperative times (12-36 hours, 5-7 days, and before discharge) as completion of routine echocardiography. Measurements and Main Results: Among 37 children undergoing total cavopulmonary connection (mean age 5.5 ± 1.8 years [range 2.4-11.7]; mean body surface area 0.7 ± 0.1 m2 [range 0.3-1.6 m2]), retrosternal clots were detected in 18 (48.6%). Of these, 7 (13.5%) had small clots (1 cm-2-3 cm). Four of the 6 detected large clots required surgical revision, and in the other 2 patients, the clots were not treated because the patients’ conditions were clinically stable. When 3 major groups (group 1—no or small clots, group gropu 2 are small to moderate or moderate, group 3—large clots) were evaluated, no significant differences were noted in age, body surface area, CPB time, conduit type, or the number of previous surgeries. Conclusions: With thoracic ultrasound diagnosis, existence of retrosternal clots was found to be very common after to

The Hemodynamic Effect of Modified Blalock&ndash;Taussig Shunt Morphologies: A Computational Analysis Based on Reduced Order Modeling

The Modified Blalock Taussig Shunt (MBTS) is one of the most common palliative operations in case of cyanotic heart diseases. Thus far, the decision on the position, size, and geometry of the implant relies on clinicians&rsquo; experience. In this paper, a Medical Digital Twin pipeline based on reduced order modeling is presented for fast and interactive evaluation of the hemodynamic parameters of MBTS. An infant case affected by complete pulmonary atresia was selected for this study. A three-dimensional digital model of the infant&rsquo;s MBTS morphology was generated. A wide spectrum of MBTS geometries was explored by introducing twelve Radial Basis Function mesh modifiers. The combination of these modifiers allowed for analysis of various MBTS shapes. The final results proved the potential of the proposed approach for the investigation of significant hemodynamic features such as velocity, pressure, and wall shear stress as a function of the shunt&rsquo;s morphology in real-time. In particular, it was demonstrated that the modifications of the MBTS morphology had a profound effect on the hemodynamic indices. The adoption of reduced models turned out to be a promising path to follow for MBTS numerical evaluation, with the potential to support patient-specific preoperative planning

The Hemodynamic Effect of Modified Blalock–Taussig Shunt Morphologies: A Computational Analysis Based on Reduced Order Modeling

The Modified Blalock Taussig Shunt (MBTS) is one of the most common palliative operations in case of cyanotic heart diseases. Thus far, the decision on the position, size, and geometry of the implant relies on clinicians’ experience. In this paper, a Medical Digital Twin pipeline based on reduced order modeling is presented for fast and interactive evaluation of the hemodynamic parameters of MBTS. An infant case affected by complete pulmonary atresia was selected for this study. A three-dimensional digital model of the infant’s MBTS morphology was generated. A wide spectrum of MBTS geometries was explored by introducing twelve Radial Basis Function mesh modifiers. The combination of these modifiers allowed for analysis of various MBTS shapes. The final results proved the potential of the proposed approach for the investigation of significant hemodynamic features such as velocity, pressure, and wall shear stress as a function of the shunt’s morphology in real-time. In particular, it was demonstrated that the modifications of the MBTS morphology had a profound effect on the hemodynamic indices. The adoption of reduced models turned out to be a promising path to follow for MBTS numerical evaluation, with the potential to support patient-specific preoperative planning