Reoperation after modified Björk procedure for tricuspid atresia.

Rarely performed nowadays, the Björk procedure is an alternative to the Fontan palliation for biventricular repair in patients with tricuspid atresia. The right atrium to right ventricle conduit failure leads to serious long-term complications. The management of such patients at high surgical risk remains challenging. We report a successful reoperation in a young adult 25 years after the modified Björk intervention, who presented with severely narrowed and calcified valved conduit.

Atrial septal defect closure in adults: A ten-year experience.

INTRODUCTION: Atrial septal defects (ASD) constitute the most frequent congenital heart disease in adults and ostium secundum (OS) the most common type. Benefit of its closure in adulthood has long been controversial. AIM: To evaluate outcomes of OS-ASD closure in adults. METHODS: Retrospective cohort study, over a ten-year period from 2008 to 2018. All adults (≥20 years old) who benefited from OS-ASD closure were included. Study endpoints were closure success rate, functional status evolution and incidence of new arrhythmias at 12 months. RESULTS: Fifty patients were recruited. Dyspnea (≥ NYHA II) was noted in 58% and arrhythmia in 18% of patients. Feasibility of a percutaneous closure was 50%. Closure success rate was 100%. Surgery was associated with high postoperative morbidity with longer hospitalization stay (20 vs. 4 days, p <0.001). At 12 months, an improvement in functional status was observed in 79%. Incidence of new arrhythmias was 5%. A significant decrease in right cavities dilation as well as pulmonary arterial pressure has been reported. CONCLUSIONS: Immediate results of OS-ASD closure in adults are satisfactory. Percutaneous closure is associated with reduced hospital morbidity. At 12 months, a significant improvement in functional status was observed however the possible occurrence of new arrhythmias imposes a close follow-up.

Acute ischemia of the lower limb on ECMO: risk factors and preventive modalities.

The acute ischemia of the lower limb on the veno-arterial Extracorporeal Membrane Oxygenation (ECMO) is a frequent and dangerous complication that can put the vital and functional prognosis at risk. Several risk factors have been incriminated and the lack of a sufficient distal perfusion is the most common. We report the case of an 11-year-old girl with veno-arterial ECMO for acute myocarditis complicated by severe acute lower limb ischemia.

The modified Fontan procedure with use of extracardiac conduit in adults: analysis of 32 consecutive patients.

BACKGROUND: Uncommonly, adults with functionally univentricular hearts are becoming candidates for a Fontan procedure. The purpose of this study was to evaluate the course of patients undergoing the modified Fontan procedure with an extracardiac conduit in recent years. METHODS: Between January 2003 and December 2013, 32 adult patients (17 female and 15 male) underwent total cavopulmonary connection (TCPC) with extracardiac conduit. The median age at procedure was 24.5 years (interquartile range [IQR] 20 to 33 years). The diagnoses included double-inlet left ventricle (DILV) in 10 patients (31.2%), tricuspid atresia in 8 patients (25%), double-outlet right ventricle in 4 patients (12.5%), heterotaxia in 4 patients (12.5%), and mitral atresia in 2 patients (6.2%). Seventy-eight percent of patients had undergone at least one prior palliative procedure; the most common procedures were Blalock-Taussig shunt (16 patients), superior cavopulmonary shunt (12 patients), and pulmonary artery banding (6 patients). All patients underwent cardiac catheterization preoperatively. Aortic cross-clamping was necessary in 15 patients for intracardiac procedures. Fenestration was required in 9 patients (28%). Four concomitant intraoperative cryoablation procedures were performed. RESULTS: There was no hospital mortality. One patient (3.1%) died 6 months after undergoing TCPC. Morbidities included prolonged pleural effusion lasting more than 7 days in 20 patients (62.5%), atrial arrhythmias in 4 patients (12.5%), and permanent pacemakers in 3 patients (9.3%). The median follow-up time was 33 months (interquartile range [IQR], 10.5 to 50 months). Actuarial survival was 91.83% (95% confidence limits, 71.07 to 97.89) at 1 year and 5 years. Ninety-two percent of patients were in New York Heart Association class I or II at follow-up. The median postoperative oxygen saturation was 95% (IQR, 93% to 95.5%). Cardiac arrhythmia occurred in 4 patients. Systolic ventricular function improved during follow-up for all patients except 1 patient, who underwent cardiac transplantation 7 months after the TCPC. CONCLUSIONS: The modified Fontan procedure with use of an extracardiac conduit can be performed in adults with encouraging early and midterm results. The majority of late survivors had improved quality of life. The incidence of late death, reoperation, arrhythmias, and thromboembolic events was low during follow-up.