Transcatheter closure of partially ligated vertical vein after surgical correction of supracardiac total anomalous pulmonary venous connection

Total anomalous pulmonary venous connection [TAPVC] is an anomaly in which the pulmonary veins are directly connected to one of the systemic veins or drain into the right atrium. Management of pulmonary hypertension after the total correction of this congenital cardiac anomaly is very important. Unligation of the vertical vein in the supracardiac type of this anomaly can be a draining pathway for the prevention of postoperative pulmonary hypertension crisis. Late onset transcatheter closure of the unligated vertical vein after a decrease in pulmonary pressure with the Amplatzer vascular plug type 1 can prevent residual left-to-right shunting. Here we describe two patients who previously underwent surgical correction of supracardiac TAPVC and their vertical veinwas partially ligated due to severe pulmonary hypertension. Consequently, because of increased left-to-right shunting in the follow-up period, transcatheter occlusion of the vertical vein was done for them and this procedure seemed safe and less invasive compared to the surgical approach. At 2 years' follow-up, there was marked pulmonary artery pressure and clinical improvement

Evaluation of thymic changes after median sternotomy in children

In patients who undergo median sternotomy to treat congenital heart diseases, a thymectomy is performed to yield better access to the cardiac system. In this study we have used MRI to evaluate the changes in size, shape and location of the thymus after midsternatomy. This case-control study was performed during 2011-2012 in Shiraz, Iran. Eligible participants between 5-17 years of age were divided into case and control groups [n=13 per group]. Each participant underwent a median sternotomy at least one year prior to study entry. Participants were initially examined by a cardiologist and then referred for MRI. A radiologist examined all MRI images. The thymus was observed in all control group patients and in only 7 [53.8%] patients in the case group. There was a significant relationship noted in terms of mean age in the group whose thymus was visible and the group in which the thymus was not visible. We have observed no significant difference in thymic visibility between these two groups based on the mean age at midsternatomy. In pediatric patients undergoing cardiac surgery the possibility of remaining or regenerated thymic tissues may be evaluated by MRI. The remaining portion of the thymus may have any shape, size or location. Therefore, it can be misinterpreted as a mass if a patient's previous surgical history and age at the time of surgery are not taken into consideration

Additive effect of phosphodiesterase inhibitors in control of pulmonary hypertension after congenital cardiac surgery in children

Control of residual pulmonary arterial hypertension [PAH] after closure of left to right shunts in children is still a challenging issue. The purpose of this study was to compare the effect of two phosphodiesterase inhibitors in pediatric cardiac surgical patients. A total of 48 postoperative children were enrolled in the study between 2008 and 2010. Patients were stratified based upon choice of pulmonary vasodilator into three equal groups [n=16]; Milrinone group received intravenous milrinone [0.75 micro/kg/min], Sildenafil group received oral sildenafil [0.3 mg/kg every 3 hours] and the Combination group received both medications. Demographic variables and types of congenital anomalies were not different among the 3 groups. Patients in the Combination group had higher preoperative pulmonary artery to aortic [PA/AO] pressure ratios compared to other two groups [P=0.001]. Postoperatively, patients in Milrinone group incurred lower systolic PA and PA/AO pressures compared to Sildenafil group [P=0.014, 0.003], but it was the same in Sildenafil and Combination group [P=0.2; 0.330 respectively]. Pulmonary hypertensive crisis was noted in 6 patients in Sildenafil group, and 3 patients in Combination group [P=0.02]. Significant rise in PA pressure was noticed after discontinuation of drug in Milrinone group [P=0.001], which was not observed in the Combination group [P= 0.6]. No mortality was noticed in any of the groups. Intravenous milrinone is more effective than oral sildenafil in control of postoperative PAH and elimination of pulmonary hypertensive crisis. Combination of two drugs reduces the risk of rebound pulmonary arterial hypertension after discontinuation of milrinone

Aneurysmal aorto-left ventricular tunnel

Aorto-left ventricular tunnel [ALVT] is a congenital anomaly of aortic root which is an extra cardiac connection between the aorta and the left ventricle. It is usually short and direct but this report describes an aneurysmal aorto-ventricular tunnel which due to large left ventricular and small aortic hole culminated in aneurysm. This type of ALVT might be misdiagnosed as other cardiac lesions