The pulmonary autograft after the Ross operation : results of 25 year follow-up in a pediatric cohort

Progressive autograft dilation and need for later reoperation remain major concerns of the Ross procedure. The study investigates the clinical outcome after the Ross operation, including a longitudinal analysis of autograft dimensions over 25 years. From November 1991 to April 2019, 137 patients underwent a Ross procedure at the University Hospitals of UCL (Université catholique de Louvain)-Brussels and Ghent. Inclusion criteria were less than or equal to 18 years of age and pulmonary autograft implantation by root replacement. Outcome focused on survival, reoperation rate, and autograft size evolution through linear mixed-model analysis. A Ross or Ross-Konno operation was performed in 110 (80%) and 27 (20%) patients at a median age of 10.4 (interquartile range [IQR], 4.7-14.3) years and 0.5 (IQR, 0.04-5.2) years, respectively. Overall 10-year and 20-year survival was 87% ± 3% and 85% ± 3%, respectively, but was 93% ± 3% for isolated Ross patients. Right ventricular outflow tract-conduit exchange was required in 20.3%, whereas autograft-related reoperation was performed in 14 (10.7%) patients at a median interval of 14 (IQR, 9-16) years, for aortic regurgitation (n = 2) and autograft dilation (n = 12). Autograft z-values increased significantly at the sinus and sinotubular junction (STJ) compared with the annulus (annulus = 0.05 ± 0.38/y, sinus = 0.14 ± 0.25/y, STJ = 0.17 ± 0.34/y; P = .015). The z-value slope for autograft dimensions was significantly steeper for Ross-Konno vs Ross patients (annulus: P = .029; sinus: P < .001; STJ: P = .012), and for children having aortic arch repair (annulus: P = .113, sinus: P = .038; STJ: P = .029). The Ross operation offers children requiring aortic valve replacement an excellent survival perspective, with an acceptable risk of autograft reoperation within the first 25 years. Contrary to the autograft annulus, dilation of the sinus and STJ size is of concern. Closer surveillance of autograft dimensions might be required in patients who underwent a Ross-Konno procedure or aortic arch reconstruction

Heart transplantation using a donor with partial anomalous pulmonary venous connection and atrial septal defect.

Over the last decade, the shortage of donors has led to increased waiting time prior to transplantation and its related mortality. Therefore, extended criteria for donor hearts have been proposed. In this report, we describe a successful transplantation despite a diagnosis of partial abnormal pulmonary venous return associated with an atrial septal defect sinus venosus and persisting left-sided superior vena cava. Knowledge in congenital cardiac disease can broaden the definition of 'marginal' donor hearts and allow their use without increasing the risk of transplantation

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

Minimally invasive robotic excision of a cardiac septal neuroendocrine metastasis.

We present a rare case of a myocardial neuroendocrine metastasis in a 45-year-old male patient. The tumor was localized on the left side of the interventricular septum. Complete surgical excision of the tumor was successfully performed robotically  through a left atriotomy, using a transmitral approach. The patient's postoperative course was uneventful. A robotic mini-invasive approach is a safe and feasible alternative to conventional surgery and should be considered when the anatomy is suitable for a minimally invasive procedure. FULL TEXT and VIDEOS Free online (https://mmcts.org/tutorial/1497

Thoracic duct-azygos vein anastomosis in an infant with superior vena cava syndrome and recurrent chylothorax.

In this study, we describe an intrathoracic microsurgical lymphatico-venous anastomosis as an alternative surgical technique for the treatment of refractory chylothorax in an infant. This procedure allowed us to restore enteral nutrition within days of surgery. At 3-year follow-up, there was no recurrence of pleural effusion

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 [...

A Rare Case of Late LAD Reimplantation after Arterial Switch Operation

Arterial switch operation (ASO) is a complex neonatal operation in which transfer of the coronary arteries origins is the key to success. Coronary events after a successful ASO are not uncommon. We describe a rare case of a child who underwent an ASO in the neonatal period with one coronary (LAD) described as atretic left in place. At age seven, he developed myocardial ischemia due to retrograde flow with a steal phenomenon from the LAD into the pulmonary artery. The patient underwent a late LAD reimplantation. This case underscores that even very small ostia should be translocated at the time of ASO