Midterm Results After Surgical Correction of Total Anomalous Pulmonary Venous Connection

Objective:To evaluate the surgical treatment of total anomalous pulmonary venous connection (TAPVC) and determination of predictors for postoperative death.Methods:Between 1995 and 2005,80 patients aged from 1 month to 12 years underwent surgical repair for supracardiac (39),cardiac (34),infracardiac (3)or mixed(4) type of TAPVC.Systemic pulmonary hypertension PH) in 53.8% of patients, half systemic PH in 26.3% and mild pH (<40 mmHg) were found by preoperative evaluations. Twelve patients (15%) had some degree of pulmonary vein obstruction preoperatively. Results: Seven patients (8.7%) died in the operating room. Early postoperative mortality (during 48 hours) occurred in 11 cases (13.7%) and nine patients died during first hospitalization. We did not have late mortality in survivors during follow-up period; therefore the overall mortality rate was 33.8%. The incidence of postoperative death was highest in the infracardiac type (2/3). Approximately two-thirds of dead patients (21/27) had presented with systemic PH and 89% of them had at least half-systemic PH preoperatively. Mortality rate in patients with normal pulmonary artery pressure (PAP) was zero. Conclusion: In contrast to early surgical results we had excellent mid-term outcome. The role of myocardial protection and surgical technique are the most probable causes of high death rate in our series. However influences of poor preoperative stabilization process as well as anesthetic technique and cardiopulmonary bypass related problems should be considered. PAP more than half of systemic pressure and patient age smaller than 3 months were the primary predictive factors for premature death (P<0.05)

Repair of post-infarction ventricular free wall rupture with TachoSil®

Introduction: Left ventricular free wall rupture (LVFWR) is a frequent cause of death after acute myocardial infarction, and its repair remains a surgical challenge. Case Presentation: TachoSil® is a ready-to-use equine collagen patch which has been successfully used for hemostasis in cardiovascular surgery. However, a limited number of studies have reported its application for LVFWR repair. In this study, we describe our initial experience using TachoSil® for LVFWR repair. Conclusions: A hemodynamic study was acceptable at a 12-month follow-up, and no complication was seen

Conduction disorders in continuous versus interrupted suturing technique in ventricular septal defect surgical repair

Background: Ventricular septal defects (VSD) is one of the most frequent congenital cardiac malformations and cardiac conduction disorders are still one of the serious postoperative complications in this surgery. Objectives: This study aimed to compare the incidence of conduction disorders with the use of continuous compared to interrupted suturing techniques in VSD surgical repair. Patients and Methods: Previously recorded data of 231 patients who underwent surgical closure of VSD between January 2009 and January 2012 at the Rajaie cardiovascular medical and research center were retrospectively reviewed. VSD surgical repair was performed using continues suturing technique in group A patients (n = 163, 70.6%) and interrupted suturing technique in group B patients (n = 68, 29.4%). Results: The most common concomitant congenital anomalywas Tetralogy of Fallot (27.3%). Twenty-four (10.4%) patients had intraoperative cardiac arrhythmia, including 19 (8.2%) transient and 5 (2.2 %) permanent arrhythmia. During their ICU stay, ventricular arrhythmia and complete heart block were observed in 34 (14.7%) and 5 patients (2.2%), respectively. At the time of the last follow-up, incomplete right bundle branch block (RBBB), complete RBBB, RBBB with left anterior hemi-block, and complete heart block were identified in 84 (36.4%), 42 (18.2%), 29 (12.6%), and 5 patients (2.2%), respectively. The results revealed that group A patients were most likely to have had cardiac arrhythmias during their ICU stay and at the time of last follow-up (P < 0.001), while the intraoperative incidence of cardiac arrhythmia during surgery was not statistically significant between the two groups (P = 0.06). Conclusions: In the absence of any statistical differences in the other risk factors between the two groups, the difference in the incidence of conduction disorders can be attributed to the type of suturing used during the procedure

Hemostatic Role of TachoSil Surgical Patch in Cardiac Surgery

Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria) is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients) or wait and see method (9 cases), were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20) of the surgeries were redo surgeries versus 100% (22/22) in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03).Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01), however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67).Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement

Recurrence rate of different techniques for repair of coarctation of aorta: A 10 years experience

Background and Aim : The main goal of this study was to assess the frequency of recurrent coarctation after repair using different surgical methods. Methods : Surgical results of repairs for coarctation of aorta (Co-A) in 188 patients under the age 14 years who were treated in Rajaee Heart Center, Tehran, Iran, were evaluated retrospectively. The most common methods included patch-graft aortoplasty (59), resection with end-to-end anastomosis (20.7) and subclavian flap aortoplasty (SCFA) (16.5). The remaining patients underwent bypass tube graft and excision with placement of a tube graft. Seventy eight percent had discrete stenosis while 22 had long segment narrowing. The patients were followed for 81.632.8 months. Results : The overall mortality rate was 2.6. The highest incidence rate of recoarctation was found in the patch-graft aortoplasty group (12.7) and the lowest was found in SCFA (3.2). The incidence of recoarctation in long-segment lesions was significantly higher than that in the discrete ones (30 vs. 4, P<0.001). In patients <1 year, the incidence of recoarctation was lower than that in the other age groups. Conclusion : The patch-graft aortoplasty technique had the highest incidence of recoarctation and SCFA had the lowest rate. Long-segment Co-A had a higher chance of recoarctation. In contrast to some previous reports, the incidence of recoarctation was not higher in the age below 1 year

The Effect of Zero Balance Ultrafiltration of Priming Blood on Clinical Outcomes of Infants Undergo Cardiopulmonary Bypass

Introduction: Pediatric Cardiopulmonary Bypass (CPB) circuit invariably requires priming with Packed Red Blood Cells (PRBCs). Metabolic composition of stored PRBCs is unphysiological. Commencement of PRBC primed CPB leads to rapid transfusion of massive metabolic load. This predisposes pediatric patients to the risk of complications such as electrolyte disturbances, citrate toxicity, acidosis and activation of the inflammatory response. The aim of this study is to evaluate the effect of ultrafiltration of priming blood on clinical outcomes infants undergo cardiopulmonary bypass.  Methods: This was a clinical trial, with two groups (intervention and control) and a sample of 60 infants referred to Shahid Rajaie Hospital in Tehran (30 patients in intervention and 30 patients in control group) that was carried out in 2017. Ultrafiltration was used on prime with Conventional Ultrafiltration (CUF) for patients in the intervention group during CPB, but in the control group only CUF was used. Arterial blood gas parameters, amount of bleeding, blood transfusion rate, the duration of mechanical ventilation, residence in the ICU and the level of electrolytes were measured. Data of this study was analyzed using the Chi-square test, T- test Independent-Sample, Repeated-measure, Mann Whitney U test by SPSS 25. Results: In terms of electrolytes, the prime solution used in the intervention group was significantly closer to physiological comparing to the control group (P<0.05). The intervention group showed significant reductions in postoperative blood loss; postoperative blood transfusion; time to extubation; the length of stay in the ICU; (P<0.05). The level of electrolytes and other parameters of arterial blood gas were similar in both groups. Conclusions: It can be concluded that the combination of the ultrafiltration of priming blood and CUF method effectively reduces the side effects of cardiopulmonary bypass

Different Presentation of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Adults: Case Reports

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac malformation. We report three cases of ALCAPA who survived to adulthood. The first case was a 51-year-old woman who complained of typical chest pain that was diagnosed with ALCAPA using cardiac catheterization and coronary computed tomographic angiography (CTA). The second case was a 30-year-old woman with a history of surgery for atrial septal defect at 10 years old who presented with progressive exertional dyspnea. Cardiac catheterization confirmed the diagnosis of ALCAPA. The third case was a 19-year-old man who was brought to our clinic due to aborted sudden cardiac death on the previous day. Cardiac catheterization and coronary CTA confirmed the diagnosis. They underwent the closure of orifice of the anomalous left coronary artery and grafting the left anterior descending artery concomitantly with mitral valve repair. All patients were followed up during a mean of 8.7 months and they were asymptomatic

The Outcomes of Superior Cavopulmonary Connection Operation: a Single Center Experience

Abstract Introduction: The superior cavopulmonary connection operation is one of the stages of the palliative surgical management for patients with functionally single ventricle. After surviving this stage, the patients are potential candidates for the final palliative procedure: the Fontan operation. Objectives: This study aimed to analyze the outcomes of superior cavopulmonary connection operations in our center and to identify factors affecting the survival and the progression to Fontan stage. Methods: The outcomes of 161 patients were retrospectively analyzed after undergoing superior cavopulmonary connection operation in our center between 2005 and 2015. Results: The early mortality rate was 2.5%. Five (3.1%) patients underwent takedown of the superior cavopulmonary connection. The rate of exclusion from the Fontan stage was 8.3%. Statistical analysis revealed that elevated mean pulmonary artery pressure preoperatively and the prior palliation with pulmonary artery banding were risk factors for both early mortality and takedown; however, the age, the morphology of the single ventricle and the type of operation were not considered risk factors. Conclusion: The superior cavopulmonary connection operation can be performed with low rate mortality and morbidity; however, the elevated mean pulmonary artery pressure preoperatively and the prior pulmonary artery banding are associated with poor outcomes

The Results of a 2-year Experience in Pediatric Heart Transplant in Rajaie Cardiovascular Medical and Research Center

Introduction: Heart transplantation is the ultimate treatment method for many infants and children with the diagnosis of cardiomyopathy or final stages of congenital heart failure. Purpose: This report provides the results of children's heart transplantation in Shahid Rajaie Heart Center during a 2-year period. Methods: Studying retrospective information of heart-transplanted children between 2012 and 2015. Results: Nineteen cases of pediatric heart transplantation were performed between 2012 and 2015 on children aged between 16 months and 14 years with an average age of 10 months. Among these, 14 (73.7%) cases were male and 5 (26.3%) cases were female. Among heart-transplanted cases, 10 (52.6%) cases were diagnosed with idiopathic dilated cardiomyopathy, 1 (5.3%) case was diagnosed with myocarditis, 7 (36.8%) cases were diagnosed with left ventricular (LV) noncompaction, and 1 (5.3%) case was diagnosed with myocarditis and LV noncompaction. After the heart transplantation, two cases suffered from pericardial effusion, three cases suffered from renal failure, three cases suffered from the right heart failure, three cases received extracorporeal membrane oxygenation, one case suffered from hypersensitivity to mycophenolate mofetil, and one case suffered from polyradiculopathy. Conclusion: Our short-term experience shows good results with low mortality rates and controlled complications of heart transplantation. Although we are in the early stages and are going through experiences, we expect to get better results given that there is an increase in the number of donors alongside improvements in immunosuppressive treatments and appropriate antibiotics

Mid-term outcomes of surgical repair for anomalous origin of the left coronary artery from the pulmonary artery: In infants, children and adults

Background: Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We sought to evaluate in-hospital and mid-term outcomes of patients with a diagnosis of ALCAPA who underwent surgical repair. Objectives: The objective of this study is to evaluate the mid-term outcomes of surgical repair of ALCAPA at our center and to analyze the surgical techniques used. Materials and Methods: In a retrospective study, we analyzed early and mid-term clinical and echocardiographic data to determine the outcomes of patients who underwent surgical repair of ALCAPA in our institution between 2005 and 2015. Results: Twenty-one patients underwent surgical repair for ALCAPA using aortic reimplantation (n = 10, 47.6%), ostial closure. (n = 8, 38.1%), or ligation. (n = 3, 14.3%). The median age of patients was 24. months. (range 22 days to 51 years). There were 2 (9.5%) in-hospital mortalities in infants undergoing the reimplantation technique. All patients were followed up for a median of 21 months. (range 1–60 months). No patients required reoperation, and there was no mortality from discharge to mid-term follow-up. Severe early postoperative mitral regurgitation. (MR) was associated with composite end-point, defined as a combination of mortality after surgery, moderate to severe MR, and moderate to severe left ventricular dysfunction at late follow-up. (P = 0.019) while mitral valve repair was not. (P = 0.469). Conclusion: The surgical management of ALCAPA can be associated with good in-hospital and mid-term outcomes regardless of the age, at which the patient has been operated