Vascular rings and pulmonary sling

This book presents and explains the latest developments in surgery for congenital digestive tract malformations, tumors, abdominal trauma, and the most important acquired digestive disorders. Particular attention is paid to minimally invasive and innovative techniques. In addition to clear descriptions of the surgical procedures that highlight useful tips and tricks, for each condition the clinical presentation is well illustrated and information is provided on pathogenesis. The book also includes general chapters that address the anatomy of the abdomen in children, diagnostic issues, the problem of clinical nutrition, and other aspects of management in pediatric patients with gastrointestinal pathologies. Pediatric Digestive Surgery will serve as a comprehensive and up-to-date reference for all pediatric surgeons. It will provide the trainee with easily understood, concise guidance while offering the more experienced surgeon valuable updates on the latest thinking and practice in the field

Long-term follow-up after radiofrequency ablation of ectopic atrial tachycardia in young patients

Aim: Ectopic atrial tachycardia (EAT) is a common arrhythmia in children, adolescents, and young adults. Radiofrequency (RF) ablation is often considered the treatment of choice in this population. We sought to evaluate the long-term follow-up after RF ablation. Methods and Results: We retrospectively analyzed 36 young patients (age range 8-29 years), with clinical signs and symptoms suspected for EAT who underwent an electrophysiological study in our center. We evaluated the safety and acute success rate of ablation and the long-term follow-up. Ectopic foci were more frequently localized in the right atrium along the crista terminalis (28%) and EAT was successfully terminated in 97% of patients. At median follow-up (38 months), the recurrence rate was 20% with mostly recurrences expressed within 6 months. Conclusions: The study confirmed the safety and high acute success rate of EAT ablation in a population of children, adolescents, and young adults. Therefore, catheter ablation of EAT can be considered early in the course of treatment of these patients. The evidence of most recurrences within 6 months could be useful for advising patients on likely outcomes

What have we learnt 50 years after the first Fontan procedure?

The Fontan procedure is often the only definitive palliative surgical option for patients with a variety of complex CHD sharing in common, a single, dominant ventricle. In recent decades, imaging and therapeutic improvement have played a crucial role in those patients in whom many complications can hamper their life. After 50 years from the first procedure, heart transplantation remains the only definitive treatment for those with a failing Fontan circulation

Anomalous origin of the right coronary artery from the pulmonary artery or coronary artery fistula: when the diagnosis is uncertain

The anomalous origin of the right coronary artery from the pulmonary artery is a rare congenital coronary anomaly with a reported incidence of approximately 0.002%. Usually, the diagnosis is made by echocardiography leaving computed tomography or angiography only to diagnostic completion in doubtful cases or for interventional procedures.Herein we report a doubtful case of a patient with a diagnosis of coronary fistula between the right coronary and the pulmonary artery that proved to be an anomalous origin of the coronary artery from the pulmonary artery. The patient underwent corrective surgery with translocation of the coronary artery on the aorta

Echocardiographic score to predict neonatal surgery for aortic coarctation in newborns with prenatal suspicion and patent ductus arteriosus

Introduction The evaluation of upcoming Aortic Coarctation (CoA) in new-borns with prenatal suspicion entails a close echocardiographic monitor until Arterial Duct (AD) closure, in a department with pediatric cardiological and surgical expertise. The significant number of false-positive prenatal diagnoses causes parental stress and healthcare costs. Aim The aim of this study was to elaborate an echocardiographic prediction model to be employed at birth when PDA is still present, in patients suspected of CoA during fetal life in order to foretell CoA requiring neonatal surgical intervention. Methods This retrospective monocentric study included consecutive full-term and late preterm neonates with prenatal suspicion of CoA born from 01 January 2007 to 31 December 2020. Patients were divided into two groups according to the need for aortic surgery (CoA - NoCoA). All patients underwent a comprehensive transthoracic echocardiographic exam in presence of PDA. Multivariable logistic regression was used to create a coarctation probability model (CoMOD) including isthmal (D4), transverse arch (D3) diameters, the distance between a left common carotid artery (LCA) and left subclavian artery (LSA), presence/absence of ventricular septal defect (VSD) and bicuspid aortic valve (BAV). Results We enrolled 87 neonates (49 male, 56%). 44 patients developed CoA in need of surgical repair. Our index CoMOD showed an AUC = 0.9382, high sensitivity (91%) and specificity (86%) in the prediction of CoA in neonates with prenatal suspicion. We classified neonates with CoMOD > 0 to be at high risk for surgical correction of CoA, with good PPV (86.9%) and NPV (90.9%). Conclusions CoMOD > 0 is highly suggestive of the need for CoA corrective surgery in newborns with prenatal suspicion

Dilated cardiomyopathy in a pediatric population: Etiology and outcome predictors - A single-center experience

Aim: The aim of the study was to assess predictors of outcome in patients hospitalized for dilated cardiomyopathy (DCM) and severe left ventricular dysfunction. Patients & methods: 83 pediatric patients hospitalized for heart failure due to DCM with coexistent left ventricular dysfunction were enrolled.Results: Overall, 5-year survival free from heart transplantation was 69.8%. Normalization of left ventricular function was achieved in 39.8% of patients during follow-up: younger age, less necessity of inotropic support and other than idiopathic DCM predicted left ventricular function, while familial history for cardiac disease or sudden death and inotropic support during hospitalization were associated with poorer outcome. Conclusion: Almost 40% of patients with DCM experienced a complete normalization of cardiac function. Outcome was extremely variable according to the type of DCM