Long-Term Outcomes of Ascending Sliding Arch Aortoplasty.

Background: Coarctation of the aorta can be associated with significant hypoplasia of the aortic arch. In contrast to patch aortoplasty, ascending sliding arch aortoplasty uses viable autologous tissue for potential growth in children. We reviewed the mid- to long-term outcomes of this technique. Methods: Between 2002 and 2023, 28 patients underwent ascending sliding arch aortoplasty for the patients with coarctation of the aorta (n = 22) and interrupted aortic arch (n = 2). Four patients underwent previous surgical coarctation repair at other institutions. The median patient age and body weight were 28.5 months (3 weeks to 15.6 years) and 13.4 kg (3.7-70 kg), respectively. Results: Although one patient had a recurrent nerve injury postoperatively, there were no other major morbidities or mortalities. The last follow-up echocardiography demonstrated that the mean peak velocity improved from 3.9 ± 0.6 to 0.9 ± 0.8 m/s, and the pressure gradient improved from 63.6 ± 21.5 to 7.1 ± 7.7 mm Hg. The postoperative diameters of the ascending aorta, proximal arch, distal arch, and isthmus all increased significantly. The mean postoperative length of stay was 5.9 ± 2.1 days, and the median follow-up time was 7.3 years (10 days to 20.5 years). No reoperation or catheterization-based intervention was performed for residual coarctation. Conclusions: Ascending sliding arch aortoplasty is safe and effective for treating coarctation of the aorta with aortic arch hypoplasia. This technique is applicable for children ranging in size from neonates to older children (or adolescents), recurrent coarctation cases, and provides complete relief of narrowing by utilizing viable native aortic tissue.

Association between oral frailty and lower urinary tract symptoms among middle-aged and older adults in community-dwelling individuals: a cross-sectional study.

PURPOSE: We assessed the association between oral frailty risk and LUTS among middle-aged and older adults in a community-dwelling population. METHODS: This cross-sectional study was conducted among 586 subjects aged ≥ 40 years who participated in the Iwaki Health Promotion Project in Hirosaki, Japan. We used the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) to assess LUTS. LUTS was defined as an IPSS score of 8 or higher or meeting diagnostic criteria for OAB. Oral frailty risk was defined as experiencing two or more of the following: decreased chewing ability, decreased biting force, and dry mouth sensation. Physical performance (10-m gait speed and grip strength) was used for analysis. The association between oral frailty risk and LUTS was examined using multivariate logistic regression analyses. RESULTS: The study included 218 men and 370 women, of whom 140 had LUTS. The mean age of this cohort was 59 years. Significant differences were observed between the LUTS and non-LUTS groups, including age, hypertension, history of CVD, depressive status, sleep disturbance, and 10 m gait speed. The prevalence of oral frailty risk was significantly higher in the LUTS group than in the non-LUTS group (26% vs. 11%, P < 0.001). Multivariate analysis revealed that age, male gender, and oral frailty risk (odds ratio: 2.67, 95% confidence interval: 1.57-4.51, P < 0.001) were independent factors for LUTS. Moreover, oral frailty risk was an independent factor in both participants aged < 65 years and participants aged ≥ 65 years. CONCLUSIONS: Oral frailty was independently associated with LUTS.

Comprehensive management of type A acute aortic dissection in the paediatric population with ACTA 2 mutation: case reports and literature review of paediatric aortic dissection.

Acute aortic dissection in the paediatric population is rare but lethal. We present two paediatric cases of type A acute aortic dissection that required emergent procedures and were later found to have genetic mutations. High index of suspicion, early clinical diagnosis, prompt treatment, the advantageous collaboration between the paediatric team and aortic surgeons, and familial genetic testing are paramount to achieve a good outcome.

Retrograde cerebral perfusion for intracardiac air embolism in Fontan procedure.

We report the case of a 5-year-old boy who suffered from an intracardiac air influx with suspected cerebral air embolism during the Fontan procedure. We immediately transformed the cardiopulmonary bypass circuit to perform a retrograde cerebral perfusion, which resulted in successful neuroprotection. He was extubated in the operating room without any neurological defects.

Modified biatrial heart transplantation after bilateral bidirectional cavo-pulmonary shunts.

We describe a patient who underwent modified biatrial anastomosis heart transplantation after the bilateral Glenn procedure. We introduced a new surgical technique to use the native central pulmonary artery as systemic venous return, which was anastomosed to right atrium, and then, biatrial anastomosis was performed.

Modified atrioventricular valve replacement in children.

One major challenge of atrioventricular valve replacement in children is the small size of the native valve annulus. In addition, in cases of atrioventricular septal defect, the atrioventricular node (AVN) shifts to a different location, making this condition difficult to treat. This report describes a technique that uses a trapezoid-shaped patch to separate the implanted valve suture-line from the AVN, which allows surgeons to implant larger valves while simultaneously preventing injury to the AVN.

Heart Transplantation in a Case of Scimitar Syndrome.

We present a rare clinical scenario of a patient with tetralogy of Fallot, hypertrophic cardiomyopathy, and concomitant scimitar syndrome. We created a scimitar vein cuff from a recipient heart, performed its translocation, and subsequently performed heart transplantation. This ingenuity reduces the likelihood of scimitar vein obstruction.

Conduction disorders after perimembranous ventricular septal defect closure: continuous versus interrupted suturing techniques.

OBJECTIVES: The aim of this study was to investigate postoperative conduction disorder differences between continuous and interrupted suturing techniques for the closure of perimembranous outlet-type ventricular septal defects (VSDs) in both tetralogy of Fallot (ToF) and isolated VSD cases. METHODS: Patients aged 4 years or younger who underwent VSD closure for ToF (n = 112) or isolated perimembranous outlet-type VSD (n = 73) from April 2010 to December 2018 at 3 centres were reviewed. Patients either received continuous suturing for ToF (C-ToF, n = 58) or isolated VSD (C-VSD, n = 50), or interrupted suturing for ToF (I-ToF, n = 54) or isolated VSD (I-VSD, n = 23). Cohorts did not differ in preoperative characteristics. Postoperative conduction disorder differences upon discharge and postoperative year 1 (POY1) were evaluated by electrocardiography. RESULTS: The C-ToF group showed significantly shorter PQ intervals (124.0 vs 133.5 ms; P = 0.042 upon discharge, 125.3 vs 133.5 ms; P = 0.045 at POY1) and QRS durations (98.0 vs 106.2 ms; P = 0.031 upon discharge, 97.3 vs 102.5 ms; P = 0.040 at POY1) than the I-ToF group. Right bundle branch block incidence was significantly lower in the C-ToF versus I-ToF groups (56.8 vs 75.9; P = 0.045 upon discharge, 56.8 vs 75.9; P = 0.045 at POY1). Heart rates were significantly lower in the C-ToF versus I-ToF groups at POY1 (109.2 vs 119.3 bpm; P < 0.001). No parameters significantly differed between C-VSD and I-VSD groups. Multivariable analyses confirmed the group (C-ToF versus I-ToF) as a significant covariate in postoperative heart rate, PQ interval, QRS duration and right bundle branch block outcomes at POY1 (P = 0.013, 0.027, 0.013 and 0.014, respectively). CONCLUSIONS: A continuous suturing technique for the closure of outlet-type VSD in ToF could reduce the incidence of postoperative right bundle branch block, shorten the PQ interval and lower heart rate. SUBJECT COLLECTION: 110, 138, 139.

Sutureless Repair With Extended Atriotomy for Post-Repair Pulmonary Venous Obstruction.

Post-repair pulmonary venous obstruction is a common cause of reoperation after total anomalous pulmonary venous return repair. Herein, we report 3 cases of specific type of post-repair pulmonary venous obstruction with eccentric stenosis of pulmonary vein ostium due to retained composite neoseptum and the technique used for subsequent repair.

Perioperative evaluation of neonatal aortic arch thrombosis.

Herein, we present a neonatal case of coarctation of the aorta, with aortic arch thrombus confirmed by echocardiography. We performed thrombus removal and aortic arch repair emergently. This critical condition necessitates quick preoperative evaluation with echocardiography. Moreover, postoperative evaluation using computed tomography is reasonable to assess an aortic arch configuration, and exclude the remnant thrombus.

Surgical Management of Intraoperative Aortic Dissection in Type 3 Loeys-Dietz Syndrome with MYH11 Co-Mutation.

A 57-year-old female with Loeys-Dietz syndrome type 3 and MYH11 gene mutation underwent unexpected intraoperative ascending aortic dissection and subsequent rapid progression of the aortic arch dissecting aneurysm. Intra-surgical contingency plans with regard to aortic dissection and aneurysm should be considered for Loeys-Dietz syndrome, especially with comorbid mutations.

Intrinsic Coronary Stenosis With Ventricular Dysfunction in Tetralogy of Fallot.

Intrinsic coronary anomalies in tetralogy of Fallot are rare manifestations that are difficult to diagnose, especially when accompanied by ventricular dysfunction in the postoperative period. We present a case of severe left ventricular dysfunction after repair of tetralogy of Fallot. Coronary angiography revealed intrinsic left main coronary stenosis. Therefore, we emergently performed patch augmentation of the left main coronary artery concomitantly with residual ventricular septal defect closure. While evaluating patients with tetralogy of Fallot, especially in the presence of ventricular dysfunction, intrinsic coronary anomalies should be kept in mind. Coronary angiography is effective in diagnosing coronary anomalies.

Slit Orifice Aortic Cusp Extension Technique for Small Bicuspid Valves.

We describe a modification to the aortic cusp extension technique that eliminates aortic regurgitation in pediatric small bicuspid valves. This simple and reproducible cusp extension technique secures coaptation and commissure suspension of the reconstructed aortic valve and may act as a bridge option for forthcoming reoperations.