Emergency surgery for embolisation of Amplatzer device into the left atrium.

Occlusion of secundum atrial septal defects (ASD) by means of percutaneous transcatheter systems is increasingly used in clinical practice. A variety of different types and models of septal occluder devices are available nowadays, amongst which the Amplatzer device (Amplatzer Medical, Golden Valley, MN, U.S.A.), is regarded as one of increasing popularity. We report a case of attempted percutaneous transcatheter closure of a large ASD in an 11-year-old boy, complicated by device embolisation to the left atrium necessitating emergency surgery.

The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association.

OBJECTIVES: This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association. METHODS: The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively. RESULTS: A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P < .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P = .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death. CONCLUSIONS: Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.

Successful surgical repair of a giant arteriovenous fistula of the coronary arteries.

Large coronary arteriovenous fistulas (CAVF) cause severe symptoms and their repair involves the serious challenge of occluding the fistula while simultaneously preserving normal coronary flow. We present a case of a giant CAVF involving the right and left coronary arteries in a symptomatic adult patient and its successful surgical repair.

Subtle infective endocarditis and congenital cardiac disease.

Congenital cardiac disease is recognized as a major predisposing substrate for infective endocarditis. We present three cases of unanticipated intraoperative discovery of vegetations in patients with congenital cardiac malformations without preoperative clinical, laboratory or echocardiographic evidence of infective endocarditis, and their successful treatment. The relevant literature is reviewed, with emphasis of the need to maintain a high index of suspicion for the presence of endocarditis during repair of congenital cardiac lesions.

Early left ventricular function recovery after trap-door coronary transfer repair of ALCAPA in an adult patient.

Anomalous origin of the left coronary from the pulmonary artery (ALCAPA) is a rare congenital malformation, which may result in myocardial infarction, congestive heart failure, and sudden death if left untreated. Despite frequently advanced pathologic changes, there seems to be significant potential for the recovery of myocardial function in individuals with left ventricular dysfunction after the establishment of physiologic coronary circulation, particularly in the pediatric population. Reports of ALCAPA repair in adulthood are scarce and little information exists regarding the response of the left ventricle to revascularization in this age group. In this report, repair of ALCAPA in a significantly symptomatic adult patient with ventricular dysfunction is described, leading to an early recovery of left ventricular function.

Isolated congenital tricuspid insufficiency associated with right-sided congenital partial absence of the pericardium.

A unique case of successfully treated congenital tricuspid insufficiency (CTI) associated with partial absence of the right pericardium is described, and the clinical implications are discussed.

New xenograft valved conduit (Contegra) for right ventricular outflow tract reconstruction.

BACKGROUND: The well-known flaws of existing valved conduits for reconstruction of the right ventricular outflow tract (RVOT) continue to stimulate research for the elusive "perfect" conduit. In this study, we describe our experience with a glutaraldehyde-treated bovine jugular vein valved conduit (Contegra). METHODS: 55 years underwent implantation of a Contegra conduit. Diagnoses/procedures included repair of truncus arteriosus (2 patients), pulmonary atresia (3 patients), severe pulmonary insufficiency after prior repair of tetralogy of Fallot (9 patients), and replacement of degenerated valved conduit (1 patient). RESULTS: No operative deaths occurred. One patient required an early conduit replacement for unexplained valve thrombosis. The early postoperative mean transconduit pressure gradient was 7.7+/- 4.9 mm Hg. At a mean follow-up time of 18.5 +/- 6.9 months, all patients were asymptomatic with no discernible calcification in the valve or conduit or significant valve incompetence, while the mean transvalvular gradient remained low (11.1 +/- 4.5 mm Hg). CONCLUSION: The Contegra valved conduit is well suited for RVOT reconstruction, avoids the use of additional foreign material, and remains well functioning during early followup. Nonetheless, the long-term durability remains to be ascertained.