Arrival and survival of a 3-week-old boy from Pakistan with an arterial oxygen saturation of 17%.

In newborn infants, acute perinatal hypoxic/ischaemic events and associated hyperoxia/reperfusion injury frequently lead to devastating neonatal brain damage. The present report concerns a 3-week-old boy from Pakistan with d-transposition of the great arteries (d-TGA), prolonged and severe hypoxaemia, and multiresistant bacterial sepsis. The term newborn infant underwent public airline transportation to Europe and presented on the airport's runway with severe hypoxaemia (pulsoximetric oxygen saturations (SpO2) 17%) and systemic hypotension. The patient eventually underwent late balloon atrial septostomy, followed by a successful two-stage arterial switch operation. A clinical follow-up 3-5 years later revealed lack of cerebral dysfunction, adequate neurodevelopment, good biventricular function, regular coronary flow, as well as normal ECG, blood pressure and SpO(2). The findings may indicate the neonatal brain adjusts better to chronic, slowly worsening hypoxia than to acute hypoxia (eg, "birth asphyxia"), and also suggests a greater tolerance for chronic hypoxia in neonates vs adults.

Aortic valvuloplasty in pediatric patients substantially postpones the need for aortic valve surgery: a single-center experience of 188 patients after up to 17.5 years of follow-up.

BACKGROUND: Aortic valvuloplasty (AoVP) is an established procedure regarded as a valid alternative for surgical management of congenital aortic valve stenosis. However, its long-term efficacy in preventing or postponing aortic valve surgery remains uncertain for the individual patient. Therefore, the aim of this study was to study the long-term results of AoVP in pediatric patients and its efficacy in preventing or postponing aortic valve surgery. METHODS AND RESULTS: We reviewed up to 17.5 years of follow-up data of all 188 patients who received AoVP at the Deutsches Herzzentrum München. The patients were divided into those < 1 month of age (group < 1 month; n=68) and those > or = 1 month of age (group > or = 1 month; n=120) at the time of AoVP. After the first and second AoVP, moderate and severe aortic regurgitation developed in 29% and 14%, respectively, of the patients in group < 1 month and in 19% and 29%, respectively, of the patients in group > or = 1 month. Survival after 10 years free from aortic valve surgery was 59% (95% confidence interval, 45 to 73) in group < 1 month and 70% (95% confidence interval, 59 to 81) in group > or = 1 month. CONCLUSIONS: This study shows that the long-term results of AoVP of congenital aortic valve stenosis in pediatric patients and its efficacy in preventing or postponing aortic valve surgery are very good. About two thirds of the patients are free from aortic valve surgery 10 years after AoVP.

Transcatheter closure of a non-restrictive patent ductus arteriosus with an Amplatzer muscular ventricular septal defect occluder.

We report on successful occlusion of a large unrestrictive PDA in an adult patient with pulmonary hypertension.

Stenting of a restrictive foramen ovale in a patient with hypoplastic left heart syndrome.

Neonates with a severely restrictive foramen ovale and hypoplastic left heart syndrome (HLHS) present as an emergency. We report the case of a newborn in whom left atrial decompression was successfully achieved by stent implantation into the foramen ovale on the first day of life.