The Cavoatrial Anastomosis Procedure in Anomalous Connection of Superior Vena Cava to Left Atrium

Anomalous connection of the superior vena cava to the morphologic left atrium is a rare congenital systemic venous abnormality. As opposed to pulmonary venous anomalies, the significant right-to-left shunt in these patients warrants a correction early in life. Optimal repair technique for combined pulmonary and systemic venous anomalies is not defined yet. Herein, we describe a neonate with such a diagnosis treated with cavoatrial anastomosis, known as Warden procedure with excellent results

Depth of anesthesia by Narcotrend® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens

Background: Depth of anesthesia may be insufficient in pediatric cardiac anesthesia if a total intravenous anesthetic regimen with opioids and midazolam is used during cardiopulmonary bypass. The advantages of sevoflurane-based balanced anesthesia may be (1) a more graduated regulation of the depth of anesthesia during cardiopulmonary bypass and (2) a reduction in postoperative ventilation time for children in comparison with total intravenous anesthesia. Aim: To evaluate a possibly positive effect of sevoflurane-based balanced anesthesia in children undergoing cardiac surgery we analyzed whether this anesthetic regimen had a significant effect related to (1) depth of anesthesia, (2) the need for opioids during cardiopulmonary bypass as well as on postoperative characteristics such as (3) time of postoperative ventilation, and (4) duration of stay in the intensive care unit in comparison with total intravenous anesthesia. Methods: In a retrospective analysis, data from heart-lung machine protocols from 2013 to 2016 were compared according to anesthetic regimen (sevoflurane-balanced anesthesia, n = 70 vs. total intravenous anesthesia, n = 65). Children (age: 8 weeks to 14 years) undergoing cardiac surgery with cardiopulmonary bypass were included. As a primary outcome measure, we compared Narcotrend® system–extracted data to detect insufficient phases of anesthetic depth during extracorporeal circulation under moderate hypothermia. Postoperatively, we measured the postoperative ventilation time and the number of days in the intensive care unit. Furthermore, we analyzed patients’ specific characteristics such as opioid consumption during cardiopulmonary bypass. Regression analysis relating primary objectives was done using the following variables: anesthetic regimen, age, severity of illness/surgery, and cumulative dosage of opiates during cardiopulmonary bypass. Results: No significant differences were observed in descriptive patient characteristics (age, body weight, height, and body temperature) between the two groups. Further, no significant differences were found in depth of anesthesia by analyzing phases of superficial B1-C2-electroencephalography Narcotrend® data. No marked difference between the groups was observed for the duration of postoperative intensive care unit stay. However, the postoperative ventilation time (median (95% CI, hours)) was significantly lower in the sevoflurane-based balanced anesthesia group (6.0 (2.0-15.0)) than in the total intravenous anesthesia group (13.5 (7.0-25)). A higher dosage of opioids and midazolam was required in the total intravenous anesthesia group to maintain adequate anesthesia during cardiopulmonary bypass. Regression analysis showed an additional, significant impact of the following factors: severity of illness and severity grade of cardiac surgery (according to Aristotle) on the primary endpoint. Conclusion: In children undergoing cardiac surgery in our department, the use of sevoflurane-balanced anesthesia during cardiopulmonary bypass showed no superiority of inhalational agents over total intravenous anesthesia with opioids and benzodiazepines preventing phases of superficial anesthesia, but a marked advantage for the postoperative ventilation time compared with total intravenous anesthesia

Intracardiac Extension of Wilms Tumor: A Case of a 2.5-Year-Old Girl Presenting with Upper Venous Congestion Caused by Tumor Growth into the Right Cardiac Ventricle

While Wilms tumors (WT) typically present solely with an abdominally palpable mass, rare cases exhibiting vascular tumor growth can also present with circulatory problems. Here, we report the case of a 2.5-year-old girl presenting with upper venous congestion and arterial hypertension as the primary symptoms of intraventricular tumor growth exhibiting remarkable tubular and perfused morphology. Clinical situation stabilized after initiation of neoadjuvant chemotherapy (NAC) with actinomycin D and vincristine, followed by surgical resection via laparotomy and sternotomy supported by cardiopulmonary bypass and deep hypothermia. Our results highlight the previously reported feasibility of this approach, even in primarily unstable patients

Aortic Coarctation a Systemic Vessel Disease-Insights from Magnetic Resonance Imaging

Background Even after successful aortic coarctation (CoA) repair, hypertension causes premature morbidity and mortality. The mechanisms are not clear. The aim was to evaluate elastic wall properties and aortic morphology and to correlate these results with severity of restenosis, hypertension, aortic arch geometry, noninvasive pressure gradients, and time and kind of surgical procedure. Methods Eighty-nine patients (17 +/- 6.3 years) and 20 controls (18 +/- 4.9 years) were examined using magnetic resonance imaging (MRI). In addition to contrast-enhanced MR angiography and flow measurements, CINE MRI was performed to assess the relative change of aortic cross-sectional areas at diaphragm level to calculate aortic compliance (C). Results Fifty-four percent of all patients showed hypertension (> 95th percentile), but more than half of them had no significant stenosis (defined as >= 30%). C was lower in CoA than in controls (3.30 +/- 2.43 vs. 4.67 +/- 2.21 [10 (-5) Pa (-1) m (-2) ]; p = 0.024). Significant differences in compliance were found between hyper- and normotensive patients (2.61 +/- 1.60 vs. 4.11 +/- 2.95; p = 0.01), and gothic and Romanesque arch geometry (2.64 +/- 1.58 vs. 3.78 +/- 2.81; p = 0.027). There was a good correlation between C and hypertension ( r = 0.671; p < 0.01), but no correlation between C (and hypertension) and time or kind of repair, restenosis, or pressure gradients. Conclusion The decreased compliance, a high rate of hypertension without restenosis, and independency of time and kind of repair confirm the hypothesis that CoA may not be limited to isthmus region but rather be a widespread (systemic) vascular anomaly at least in some of the CoA patients. Therefore, aortic compliance should be assessed in these patients to individually tailor treatment of CoA patients with restenosis and/or hypertension

Chirurgia zastawki płucnej i drogi odpływu z prawej komory u dorosłych: 23-letnie doświadczenie

  Background: Surgery of the pulmonary valve, right ventricular outflow tract, and pulmonary artery falls under the domain of paediatric cardiac surgery. However, 97 adult patients underwent such operations in our institution from 1993 to 2016. Aim: This study aims to analyse preoperative risk factors, intraoperative data, postoperative outcomes, and long-term survival to identify the potential predictors of mortality and high-risk patients. Methods: We divided our patient cohort into three groups in accordance with surgical indications: 17 patients with pulmonary valve endocarditis (group A), 70 patients with congenital defects involving the pulmonary valve (group B), and 10 patients who underwent pulmonary valve surgery for other indications, such as tumour or other acquired valvular disease (group C). Results: Gender distribution was comparable in all the three groups, with about 40% of the total number of patients being female. The mean age was 35.9 ± 15.7 years. Sixty (61.9%) patients had a history of cardiac surgery. Various concomitant cardiac surgical procedures were necessary in 49 (50.5%) cases. There were two (11.8%) in-hospital deaths in group A, two (2.9%) in group B, and none in group C. Within the mean follow-up time of 6.6 ±7.2 years, three (17.7%) patients in group A, two (2.9%) in group B, and four (40%) in group C died. Conclusions: Adult patients with pulmonary valve disease are often previously heart-operated and often need concomitant procedures. The operative risk in patients with pulmonary valve endocarditis is high. Surgery of congenital defects of the pulmonary valve is safe and can be performed with excellent outcomes.Wstęp: Operacyjne leczenie chorób zastawki płucnej, drogi odpływu z prawej komory oraz tętnicy płucnej jest domeną kardiochirurgii dziecięcej. W latach od 1993 do 2016 zostało w naszej klinice przeprowadzonych 97 takich zabiegów u dorosłych pacjentów. Cel: Celem pracy była analiza czynników ryzyka, danych chirurgicznych oraz krótko- i długoterminowych wyników leczenia, dzięki czemu możliwa była identyfikacja potencjalnych czynników prognostycznych oraz pacjentów obarczonych wysokim ryzykiem. Metody: Podzieliliśmy badaną kohortę na trzy grupy, według wskazań do operacji: 17 pacjentów z infekcyjnym zapaleniem wsierdzia (grupa A), 70 chorych z wrodzonymi wadami serca obejmującymi zastawkę płucną, drogę odpływu z prawej komory lub tętnicę płucną (grupa B), oraz 10 pacjentów, u których operacja w zakresie wyżej wymienionych struktur została wykonana z innych wskazań, takich jak guzy lub inne nabyte schorzenia (grupa C). Wyniki: We wszystkich trzech grupach około 40% pacjentów stanowiły kobiety. Średni wiek wynosił 35.9 ±15.7 lat. Sześćdziesięciu (61.9%) pacjentów było już wcześniej operowanych kardiochirurgicznie. W 49 (50.5%) przypadkach oprócz zabiegu na omawianych strukturach, konieczne były różne dodatkowe procedury w ramach tej samej operacji. Zaobserwowaliśmy dwa (11.8%) zgony w przebiegu pooperacyjnym w grupie A, dwa (2.9%) w grupie B i żadnego w grupie C. Podczas obserwacji trwającej średnio 6.6 ±7.2 lat, zmarło trzech (17.7%) pacjentów z grupy A, dwóch (2.9%) z grupy B oraz czterech (40%) z grupy C. Wnioski: Dorośli pacjenci operowani z powodu patologii zastawki płucnej często byli już leczeni kardiochirurgicznie i często wymagają dodatkowych procedur. Ryzyko operacyjne u chorych z infekcyjnym zapaleniem wsierdzia jest wysokie. Operacje wad wrodzonych drogi odpływu z prawej komory i zastawki płucnej są obarczone niskim ryzykiem a wyniki takiego leczenia są bardzo dobre

Psychosocial Impact of Congenital Heart Diseases on Patients and Their Families: A Parent's Perspective

Background: Currently, over 90% of children with congenital heart disease (CHD) survive into adulthood. As a consequence the psychosocial impact on children and their families has become an important outcome measure. Therefore, the goal of this study was to assess the psychosocial impact from a parent's perspective and to identify possible predictors. Methods: We included all parents of children who underwent open-heart surgery in the years 2010 and 2011 at the Department of Cardiothoracic Surgery at University Hospital Heidelberg and invited them to complete standardized questionnaires. Psychosocial outcome was measured via parent self- and proxy reporting of family burden (Family Burden Questionnaire, FaBel), health-related quality of life (KidScreen-10), developmental problems (Five-to-Fifteen, FTF), and mental health problems (Strength and Difficulties Questionnaire, SDQ). Results: In total, 113 families returned the questionnaires completely (71.5%). The Aristotle Basic Complexity score and the STAT 2020 Score overall did not predict the psychosocial impact, whereas the number of surgical operations did significantly predict psychosocial impact across all domains in this study cohort. Conclusions: These data suggest that the number of surgical operations might be a relevant predictor for the long-term psychosocial impact on families suffering from CHD and a potential connecting factor for specialized psychological support. When setting up screening instruments or support programs the entire family must be considered. Keywords: adult congenital heart disease; cardiac (use in combination); cardiology; complications; congenital heart disease (CHD); congenital heart surgery; morbidity); outcomes (includes mortality; quality of life; surgery