Late presentation of cor triatriatum with persistent levoatrial cardinal vein.

An asymptomatic 10-year-old boy presented with reduced exercise tolerance and an echocardiographic diagnosis of cor triatriatum. Transthoracic and transesophageal echocardiography failed to reveal the persistent levoatrial cardinal vein discovered at surgery. In patients with late presentation of cor triatriatum with severe mitral inflow obstruction and a small patent foramen ovale, an alternative communication between the posterior collecting chamber and the systemic venous circulation should be sought with alternative imaging techniques.

Inflammatory cytokines in pediatric cardiac surgery and variable effect of the hemofiltration process.

Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response and has a multitude of biological consequences, ranging from subclinical organ dysfunction to severe multiorgan failure. Pediatric patients are more prone to have a reaction that can jeopardize their outcome. Cytokines are supposed to be important mediators in this response: limiting their circulating levels is, therefore, appealing. We investigated the pattern of cytokine release during pediatric operation for congenital heart anomalies in 20 patients, and the effect of hemofiltration. Tumor necrosis factor alpha (TNF-alpha) was elevated after anesthesia induction and showed significant decrease during CPB. Hemofiltration reduced its concentration, but the effect disappeared on the following day. Interleukin-1 (IL-1) increased slowly at the end of CPB and hemofiltration had no effect. Interleukin-6 (IL-6) showed a tendency toward augmentation during rewarming and hemofiltration did not significantly affect the course. Soluble interleukin-6 receptor (sIL-6r) had a pattern similar to TNF-alpha, but hemofiltration had no effect. On the other hand, interleukin-8 (IL-8) behaved like IL-6. Our findings suggest that baseline clinical status, anesthetic drugs, and maneuvers before incision may elicit a cytokine response, whereas rewarming is a critical phase of CPB. Hemofiltration is effective in removal of TNF-alpha, but its role is debatable for the control of IL-1, IL-6, sIL-6r and IL-8 levels.

Better surgical prognosis for patients with complete atrioventricular septal defect and Down's syndrome.

BACKGROUND: Several studies have shown that Down's syndrome is not a risk factor for biventricular repair of complete atrioventricular septal defects. However, few data are available about the comprehensive outcome of all the cardiac surgical procedures in patients with trisomy 21, including palliative surgery. METHODS: This is a retrospective study of 206 consecutive patients who underwent cardiac surgery from January 1992 to January 2002. Data about mortality and morbidity were analyzed and the impact of Down's syndrome was evaluated. RESULTS: Overall mortality was 7.7%. Actuarial survival was 94% among patients with Down's syndrome versus 86% of the group with normal karyotype (p = 0.12). The presence of unbalanced ventricles was the only independent risk factor affecting survival at multivariate analysis (p < 0.0001). The need for a Norwood type surgery was more frequent among non-Down patients (12.0% vs 1.5%, p = 0.02) as was the prevalence of pulmonary artery banding operations (22.9% vs 9.3%, p = 0.04). Cumulative mortality after palliation was higher in non-Down patients (44% vs 2.9%, p = 0.0001). Freedom from reoperation was lower in the group with normal chromosomes in respect to patients with Down's syndrome (81.4% vs 94.6%, p = 0.04), due to the higher prevalence of anomalies of the mitral valve (4.9% vs 1.8%, p = 0.03) or left ventricular outflow tract (7.3% vs 0%, p = 0.01). CONCLUSIONS: Down patients showed a decreased risk for biventricular repair and lower mortality and morbidity in cases of complex cardiac malformations requiring complex palliative operations.

[A new approach to the closure of patent ductus arteriosus in premature infants]. / Sviluppo di una nuova tecnica chirurgica di chiusura della pervietà del dotto arterioso in neonati.

Minimally invasive surgical techniques have been employed successfully for a wide spectrum of cardiothoracic procedures. These approaches were proven to be as safe and effective as traditional surgical techniques. Unfortunately, it remains a lack of adequate instrumentations and anatomic features, particularly in the pediatric pool of patients. We have employed a new surgical approach for closing a patent ductus arteriosus in low weight newborn (< 2.5 kg), performing a superior extrapleuric approach. This report demonstrates that this technique is safe and reproducible, and is our opinion that it may substitute the medical management of patent ductus arteriosus.

Minimally invasive surgical closure of patent ductus arteriosus in premature infants: a novel approach.

Recent advancement of minimally invasive cardiac surgical procedures have prompted the use of minimal incisions to perform operations on patients with congenital heart defects. In this report, we describe a new technique for closure of a patent ductus arteriosus, using an anterior extrapleural approach. We present our technique and results in five low-weight infants. This approach is safe and effective, shortens hospital stay, and is less invasive than classical approaches.