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Congenital & Pediatric
Azygos Vein Patch for Enlarging Anastomosis of Ascending Aorta and Neoaorta After Norwood Procedure
Pericardium and polytetrafluoroethylene are popular patch materials, although they have some deficits in use for thin and small vessels. We present a case of post-Norwood hypoplastic left heart syndrome that required enlargement of the anastomosis between the native ascending aorta and the neoaorta at the time of a bidirectional Glenn procedure. The azygos vein was a useful material for patch augmentation of a hypoplastic ascending aorta.Mitral Valve Operation After Tetralogy of Fallot Repair: Early and Late Outcomes
There is a paucity of data regarding reoperation for mitral valve (MV) disease after tetralogy of Fallot (TOF) repair. We aimed to characterize this population and to analyze outcomes.Trends in the Hospital Care of Neonates With Hypoplastic Left Heart Syndrome in the United States
Surgical outcomes of first-stage palliation for hypoplastic left heart syndrome (HLHS) are vastly improved from prior eras and are well described, but rates and determinants of nonsurgical management are understudied, particularly on the national scale.Traumatic Hemomediastinum and Hemothorax in a Patient With Totally Corrected Tetralogy of Fallot
An 18-year-old Japanese youth was transferred to our emergency department because of a traffic accident. He had a past history of total correction for tetralogy of Fallot as an infant. Chest computed tomography revealed hemomediastinum and hemothorax. In an emergency operation, massive bleeding from the mediastinum was observed. Bleeding arose from the torn Blalock-Taussig shunt and right subclavian artery. Hemostasis was achieved by clipping the shunt and suturing the subclavian artery. This is a rare case of a patient with hemomediastinum caused by torn Blalock-Taussig shunt after a high-impact accident who survived it by operation.Modified Blalock-Thomas-Taussig Shunt Using Femoral Artery Homograft
Modified Blalock-Thomas-Taussig shunts are typically performed with biosynthetic polytetrafluoroethylene grafts. However, biologic conduits are being increasingly investigated. We herein report a case in which a femoral artery homograft was effectively used as material for a Blalock-Thomas-Taussig shunt.Virtual Imaging for a Complex Case of Previous Coarctation Repair
Repeated surgical procedures for previous aortic coarctation is challenging. Three-dimensional imaging may be useful to visualize the complex anatomy more clearly than with computed tomography imaging, possibly leading to better outcomes. To evaluate the feasibility and efficacy of virtual imaging for preoperative planning of thoracic aortic surgery in this case, we used Vesalius 3D software, 3-dimensional image processing software, and detailed anatomic exploration. This technology may serve to optimize anatomically complex thoracic aortic surgery.Direct Hepatic Vein Connection to Left Atrium Without Congenital Anomaly in Adult Heart Disease
Anomalous hepatic venous connection without other cardiac anomalies is a rare condition but does not have high clinical significance. We describe a patient in whom a portion of the left hepatic vein was directly connected to the left atrium, without intracardiac or extracardiac anomalies. A left-to-right shunt with tricuspid regurgitation and atrial fibrillation occurred from right atrial volume overload. Shunt ligation with tricuspid valvuloplasty and a maze procedure were performed as a treatment.Intraoperative Stent Placement for the Treatment of Congenital Pulmonary Vein Atresia
A 2-month-old infant presenting with failure to thrive was found to have right upper and right lower pulmonary vein atresia and underwent 2 failed transcatheter recanalization attempts. A hybrid intervention including pulmonary vein identification, ostial resection, venoplasty, and intraoperative stent placement is described and 2.5 years of subsequent follow-up is presented.Totally 3D Endoscopic Repair of Double-Chambered Right Ventricle
Double-chambered right ventricle (DCRV) is a rare malformation that may develop after ventricular septal defect (VSD) closure. We describe a case of a 34-year-old women who underwent VSD closure in her infancy with a small Y-collar incision. She developed dyspnea on exertion and was recommended for surgery. She desired minimally invasive surgery for a cosmetic reason. We performed a totally 3e-dimensional endoscopic minimally invasive repair of DCRV. Endoscopic repair of DCRV after VSD closure for an adult is possible with an excellent view.“Invisible” Incision: Modified Horizontal Right Axillary Mini-Thoracotomy for Pediatric Cardiac Surgery
Median sternotomy has been the standard surgical approach for pediatric cardiac surgery. The downside is that it leaves a notable and visible scar. Right axillary mini-thoracotomy provides a more aesthetically pleasing incision in addition to an earlier recovery time for patients. However, this contemporary thoracotomy provides a smaller and deeper view of the heart that can make the procedure more difficult. This report describes the modified techniques used to provide an excellent surgical exposure through the right axillary mini-thoracotomy, which also allows patients to have an “invisible” incision.Intra-atrial Approach for Infracardiac Total Anomalous Pulmonary Venous Connection
Patients with total anomalous pulmonary venous connection have various forms of pulmonary veins. Because pulmonary vein obstruction is a major and critical complication, it is necessary to create as large an anastomosis as possible while considering the positional relationship with the left atrium. Here, we report the case of a female neonate diagnosed with infracardiac total anomalous pulmonary venous connection and hypoplastic common pulmonary vein. The operation was performed by a sutureless technique in the intra-atrium.
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