A modified hybrid stage I procedure for treatment of hypoplastic left heart syndrome: an original surgical approach.

We present an original surgical approach--posterolateral thoracotomy--for hybrid stage I procedure. This is a review of prospectively collected data on patients treated for hypoplastic left heart syndrome (HLHS) using a hybrid approach (n=33) between December 2007 and March 2010. The hybrid approach includes pulmonary artery bands, a ductal stent through posterolateral thoracotomy access. Overall survival was 88.5%. Our original surgical approach in hybrid stage I on patients treated for HLHS can yield acceptable intermediate results that are comparable with a traditional Norwood strategy. Potential advantages of the lateral thoracotomy in the hybrid approach include the avoidance of median sternotomy, minimal postoperative pericardial adhesions, better access to patent ductus arteriosus (PDA) stenting, the possibility of visual and manual control of the stent position, and short operative time.

Anomalous origin of the right coronary artery from the pulmonary artery with aortopulmonary window.

This report describes a rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with a large aortopulmonary window in a 2-month-old boy. The right coronary artery was exposed to systemic pressure and carried fairly well-oxygenated blood to the myocardium. Closure of the aortopulmonary window alone could have caused acute myocardial ischemia. The purpose of this case report is to describe successful diagnosis and management of anomalous origin of the right coronary artery associated with an aortopulmonary window. The pathological findings and the physiological effects, clinical importance, and method of correction used are discussed.

Results of surgery for Ebstein anomaly: a multicenter study from the European Congenital Heart Surgeons Association.

OBJECTIVE: Since most centers' experience with Ebstein anomaly is limited, we sought to analyze the collective experience of participating institutions of the European Congenital Heart Surgeons Association with surgery for this rare malformation. METHODS: The records of all 150 patients (median age 6.4 years) who underwent surgery for Ebstein anomaly in the 13 participating Association centers between January 1992 and January 2005 were reviewed retrospectively. Patients with congenitally corrected transposition were excluded. RESULTS: Most patients (81%) had Ebstein disease type B or C and significant functional impairment (61% in New York Heart Association class III or IV) and 16% had prior operations. Surgical procedures (n = 179) included valve replacement (n = 60, 33.5%), valve repair (n = 49, 27.3%), 1(1/2) ventricle repair (n = 46, 25.6%), palliative shunt (n = 13, 7.26%), and other complex procedures (n = 11, 6.14%). There were 20 hospital deaths (operative mortality 13.3%) after valve replacement in 5 patients, valve repair in 3, 1(1/2) ventricle repair in 7, palliative procedures in 3, and miscellaneous procedures in 2. Younger age and palliative procedures were univariate risk factors for operative death, but only age was an independent predictor on multivariable analysis. CONCLUSIONS: Most patients coming to surgery presented in childhood and were significantly symptomatic. More than half underwent valve replacement or repair, but a considerable proportion had severe disease necessitating 1(1/2) ventricle repair or palliative procedures. Operative mortality did not differ significantly among repair, replacement, and 1(1/2) ventricle repair but was associated with palliative procedures for severe disease early in life, young age being the only independent predictor of operative death.