Left Common Carotid Artery Isolation in a Newborn With Tetralogy of Fallot and DiGeorge Syndrome

Double-outlet right ventricle falls under the category of congenital heart disease known as conotruncal defects, which possess abnormal ventriculoarterial relationships.1 For complex cases, the surgeon must determine whether the left ventricle and one of the great arteries can be aligned using the ventricular septal defect to construct an unobstructed pathway or baffle, resulting in a 2-ventricle repair.2 Creation of the baffle can be complicated by anatomic obstructions because of prominent conal septum, straddling atrioventricular valve attachments, or location of the ventricular septal defect in the inlet septum, remote from any great artery. Three-dimensional (3D) printing has been applied in the management of many different congenital heart diseases.3 In this specific patient population, in whom communicating the complex intracardiac anatomy to the surgeon is so critical, the use of 3D modeling and printing is invaluable. We used this approach in a patient with dextrocardia, complex double-outlet right ventricle (S,L,A)1 and supratricuspid ring. She underwent pulmonary artery banding in infancy and had been doing relatively well clinically; so that any further surgical intervention was deferred until she was 8 years old. Although she was growing well and required no medication, …

Right-sided aortic arch with bilateral ductus: a rare case of nonconfluent pulmonary arteries without associated cardiac anomalies

A 11-year-old boy affected by truncus arteriosus (type 1) underwent a late complete repair in another institution.The right ventricular outflow tract reconstruction was performed with an 18-mm Contegra conduit (Medtronic Inc, Minneapolis, Minn) despite its contraindication in cases of pulmonary hypertension.An additional apical muscular ventricular septal defect was closed with a percutaneous device.His postoperative course was uneventful.At 18 years of age, he was referred to our institution for right ventricular dilatation and conduit endocarditis.A group D streptococcus was isolated on blood culture.Echocardiography and cardiac catheterization showed right ventricular dilatation, isosystemic right ventricular pressure, and aneurysmal dilatation of the conduit extending from the ventricular anastomosis.Computed tomography confirmed the angiographic findings, recording a giant aneurysm of the conduit (7.43ϫ9.59ϫ10.26cm) (Figure 1).This required urgent conduit replacement with a 25-mm Hancock (Figure 2).After surgery, a left lung atelectasia occurred.Vascular lesions may obstruct the bronchial tubes by compression.

The patent ductus arteriosus (PDA) is a vascular structure that connects the proximal descending aorta to the roof of the main pulmonary artery near the origin of the left branch pulmonary artery. This essential fetal structure normally closes spontaneously after birth. After the first few weeks of life, persistence of ductal patency is abnormal. The physiological impact and clinical significance of the PDA depend largely on its size and the underlying cardiovascular status of the patient. The PDA may be “silent” (not evident clinically but diagnosed incidentally by echocardiography done for a different reason), small, moderate, or large. Regardless of the size, complications may arise, and it is important for both pediatric and adult cardiologists to have an understanding of the pathophysiology, clinical implications, and management of PDA. The ductus arteriosus is a normal and essential fetal structure that becomes abnormal if it remains patent after the neonatal period. In normal cardiovascular development, the proximal portions of the sixth pair of embryonic aortic arches persist as the proximal branch pulmonary arteries, and the distal portion of the left sixth arch persists as the ductus arteriosus, connecting the left pulmonary artery with the left dorsal aorta (Figure 1). Normally, the distal right sixth aortic arch loses its connection to the dorsal aorta and degenerates. This transformation is complete by 8 weeks of fetal life. Figure 1. Schematic of embryonic aortic arch system. The 6 pairs of embryonic aortic arches are demonstrated (left-sided arches are numbered). The portions that normally involute are indicated by broken lines. The distal left sixth embryonic arch normally persists and becomes the PDA, connecting the left pulmonary artery to the proximal descending aorta. The right distal sixth arch normally involutes, as does the eighth segment of the right dorsal aorta (*), which results in a leftward aortic …

Type B Aortic Dissection Involving an Isolated Right-Sided Aortic Arch

Journal of Cardiac SurgeryVolume 36, Issue 10 p. 3671-3672 COMMENTARY The implications of the effect of tricuspid regurgitation on mortality in transcatheter aortic valve implantation patients with a low ejection fraction Oktay Korun, Corresponding Author Oktay Korun oktay_korun@hotmail.com orcid.org/0000-0002-5776-6993 Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey Correspondence Oktay Korun, Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 13 Tıbbiye Caddesi, Selimiye, 34668 Üsküdar, İstanbul, Turkey. Email: oktay_korun@hotmail.comSearch for more papers by this author Oktay Korun, Corresponding Author Oktay Korun oktay_korun@hotmail.com orcid.org/0000-0002-5776-6993 Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey Correspondence Oktay Korun, Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 13 Tıbbiye Caddesi, Selimiye, 34668 Üsküdar, İstanbul, Turkey. Email: oktay_korun@hotmail.comSearch for more papers by this author First published: 14 July 2021 https://doi.org/10.1111/jocs.15818Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue10October 2021Pages 3671-3672 RelatedInformation

How to Clamp and Bypass if There Is Single Artery Supply to the Head and That Contains Severe Stenosis?

Introduction: Age, hypertension, and diabetes can cause significant alterations in arterial structure and function, including changes in lumen diameter (LD), intimal-medial thickness (IMT), flow velocities, and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers, and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patients with hypertension and diabetes for 2 age groups. Methods: We studied 250 patients with both diabetes and hypertension. Patients were divided into 2 age groups with the old age group being 56 to 75 years and the young age group 35 to 55 years. The bilateral common carotid and internal carotid arteries were evaluated with B-mode ultrasound and Doppler examinations. The LD and IMT were measured for both common carotid arteries, and spectral waveform parameters and indices were recorded for both internal carotid arteries. Results: The difference in LD between the left and right common carotid arteries for the old age group was 11.64% and for the young age group was 6.42%, with significant P values of <.05 for both age groups. The difference in IMT between the left and right common carotid arteries was 18.27% in the old age group compared with 15.38% in the young age group, with significant P values of <.05. There was a difference in peak systolic velocity between the left and right internal carotid arteries of 4.85% in the old age group which was not significant, compared with 14.28% in the young age group with a significant P value <.05, whereas the difference in end-diastolic velocity between the left and right internal carotid arteries was not significant for both age groups. Differences between the right and left internal carotid arteries for resistive index, pulsatility index, and pressure gradient were significant only in the young age group. Conclusion: We found significant differences between the right and left common carotid and internal carotid arteries in patients with diabetes and hypertension which were more prominent in the young age group. Values for common carotid IMT and LD were significantly higher in the left common carotid artery versus the right common carotid artery in both age groups. Differences between the 2 carotid sides may be attributed to anatomic variations in the common carotid artery origins which lead to differences in stress between the 2 sides.

The Department of Pediatric Cardiac Surgery in Gdansk is the only pediatric cardiac surgery center in northern Poland providing comprehensive treatment to children with congenital heart defects. The Department of Pediatric Cardiac Surgery in Gdansk currently offers a full spectrum of advanced procedures of modern cardiac surgery and interventional cardiology dedicated to patients from infancy to adolescence. January 19, 2016 marked the official opening of its new location.

Down syndrome or trisomy 21 is a condition where extra genetic material causes mental and physical delays and deficits. It affects 1 in every 650 babies. Abnormalities of the cardiovascular system are common in down syndrome. Approximately half of all infants born with down syndrome have a heart defect. The most common heart defects in down syndrome are the following: atrioventricular septal defect (45%), ventricular septal defect (35%), atrial septal defects (8%) and patent ductus arteriosus (7%), tetralogy of Fallots (4%). A Two years one-month-old baby was admitted in cardiac surgery department of Dhaka Shishu Hospital, with the diagnosis of Down syndrome with VSD,ASD& PDA with moderate pulmonary arterial hypertension. Clinical examination revealed diastolic murmur over mitral area. The child was treated with face musk oxygen, diuretics and digoxin and was stabilized medically and then was selected for surgery. We used balanced anesthetic technique using oxygen, air, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB) with moderate hypothermia. Patient tolerated the whole procedure well and was ventilated electively for 4hrs in the intensive care unit. He was discharged on the 8thpostoperative day. Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 39-42

A newborn male was transferred for severe cyanosis and suspected transposition of the great arteries and ventricular septal defect (VSD). An emergency balloon septostomy was performed. The position and commitment of VSD and great arteries were more precisely defined by echocardiography. There was double-outlet left ventricle (DOLV) with doubly committed VSD, l-malposition of the great arteries, and pulmonary stenosis. The infundibular septum was virtually absent. A modified Blalock–Taussig shunt was inserted before a Rastelli-type corrective surgery was performed at 20 months of age. The VSD was closed, the pulmonary trunk was transsected, …

The authors report a case of a neonate that was operated on with the diagnosis of right aortic arch and aberrant left subclavian artery and anomalous origin of right pulmonary artery from ascending aorta. Computed tomography (CT) scan suggested double aortic arch and cardiac catheterization suggested anomalous origin of right pulmonary artery from ascending aorta versus aorto-pulmonary window. The final diagnosis was made at the operation. There was a right aortic arch and aberrant left subclavian artery and persistent ductus arteriosus. Surgical repair consisted of section of the ductus arteriosus and reimplantation of the right pulmonary artery in the main pulmonary artery.

Introduction: Congenital structural anomalies of the pulmonary artery in children, encompassing defects such as pulmonary atresia (PA), pulmonary stenosis (PS), pulmonary artery hypoplasia, and tetralogy of Fallot (ToF), pose significant challenges in pediatric cardiac surgery due to impaired blood flow in pulmonary circulation. Traditional options for conventional repair-including autologous materials such as the native pericardium and synthetic materials such as artificial patches-have limitations including a lack of growth potential and vulnerability to restenosis over time. ProxiCor® patches, based on the extracellular matrix (ECM), have emerged as biologically compatible substitutes capable of fostering tissue regeneration. The primary outcomes of this study were the safety (absence of patch-related complications such as restenosis, dilation, aneurysm, infection, or thrombosis) and feasibility (intraoperative handling and surgical success) of ProxiCor® for pulmonary artery and right ventricular outflow tract (RVOT) reconstruction in a single-center pediatric cohort. Secondary outcomes included mortality, postoperative complications (prolonged mechanical ventilation > 72 h, need for continuous renal replacement therapy (CRRT), and intensive care unit (ICU) and hospital stay), and qualitative echocardiographic assessment of vessel patency during follow-up. Patients and methods: A retrospective analysis was conducted in 25 consecutive pediatric patients who underwent pulmonary artery or RVOT reconstruction with ProxiCor® at the Department of Pediatric Cardiac Surgery in Poznań (Poland) between the years 2023 and 2024. Surgical techniques, clinical outcomes, and follow-up data were assessed using transthoracic echocardiography (TTE). Results: The median age was 224 (Q1-Q3: 124-362) days, and median weight was 4.2 (Q1-Q3: 2.8-8.5) kg. Procedures targeted repairs of the main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and RVOT. Diagnoses included tetralogy of Fallot (ToF), pulmonary artery stenosis (PS), pulmonary atresia (PA), pulmonary artery hypoplasia, and anomalous left coronary artery from the pulmonary artery (ALCAPA). The mortality rate stood at 8% (2/25), stemming from multiorgan failure and hemorrhagic stroke, unrelated to the patch. Over a median observation period of 483 (Q1-Q3: 363-584) days, no patch-related complications (e.g., restenosis or dilation) arose. The median hospitalization time was 22 (Q1-Q3: 8.5-38.5) days. Conclusions: ProxiCor® ECM patches appear to be safe and feasible for use in pulmonary artery and RVOT reconstruction, with favorable early outcomes. However, the small cohort size, lack of a control group, and limited mid- to long-term echocardiographic data preclude definitive conclusions about long-term outcomes or comparative effectiveness.

The prenatal detection of a right-sided aortic arch achieved mainly by targeted visualization of the threevessel and three vessels and trachea (3VT) view, with or without color Doppler, has been discussed recently in this journal1–4. Two typical forms of a right aortic arch can be distinguished5,6. In one condition a vascular ring is found around the trachea, the so-called U-sign prenatally (Figure 1)2,3. The trachea and esophagus are entrapped between the right aortic arch and the left ductus arteriosus and this abnormality is often an isolated incidental finding prenatally2. In the other condition, both the aorta and ductus arteriosus lie to the right of the trachea without a vascular ring. This condition is very commonly associated with cardiac anomalies5. The branching pattern of the great vessels arising from the aortic arch in both conditions is of major interest in pediatric cardiology5,6. The right aortic arch without a vascular ring usually exhibits mirror image branching of the arteries with the left innominate (brachiocephalic) artery arising first followed by the right common carotid and right subclavian artery6. By contrast, the right aortic arch with vascular ring very often has an association with an aberrant left subclavian artery. The left common carotid arises first from the aortic arch, followed by the right common carotid, right subclavian artery, and finally a retroesophageal vessel segment from which the left subclavian artery arises and the ductus arteriosus connects. The retroesophageal (and retrotracheal) vessel segment is known as the diverticulum of Kommerell. In other words, the left subclavian artery is connected ventrally to the ductus arteriosus arising from the left pulmonary artery, and dorsally through the Kommerell’s diverticulum to the descending aorta. In postnatal life, after closure of the ductus arteriosus, blood enters the left subclavian artery via the descending aorta and Kommerell’s diverticulum4. Prenatal assessment of a right-sided aortic arch and its branching pattern requires scanning in such planes as a transverse 3VT view (Figure 1), oblique cephalad Left

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