Alessandro Giamberti

Treatment of pulmonary artery stenosis after arterial switch operation: Stent implantation vs. balloon angioplasty

The development of pulmonary artery stenosis is a potential complication during the mid‐ to long‐term follow‐up after arterial switch operation (ASO) for transposition of the great arteries. Surgical results have been disappointing and conventional balloon dilation yields a fairly important incidence of failures and recurrences. We evaluated our results with implantation of balloon‐expandable stents in 5 out of 13 patients with a previously attempted unsuccessful conventional balloon dilation of pulmonary artery branch stenosis after ASO. In two more cases, stents were used as a primary procedure. Balloon angioplasty achieved a 15% increase in mean diameter of the stenosis vs. 124% with the use of stents (P < 0.01), a 10% decrease of the pressure gradient across the stenosis vs. 71% of stents (P < 0.01), and a 10% drop in RV/aorta pressure ratio vs. 43% of stents (P < 0.01). Compared to conventional balloon angioplasty in our series, stents were more effective in the treatment of patients with peripheral pulmonary artery stenosis after ASO. Balloon dilation should be considered in selected cases unsuitable for treatment with endovascular stents. Cathet. Cardiovasc. Intervent. 50:207–211, 2000.

Total cavopulmonary direct anastomosis: a logical approach in selected patients.

A 2.5-year-old boy with a diagnosis of situs solitus, tricuspid atresia, anatomically corrected malposition of the great arteries (S,D,L), left juxtaposition of atrial appendages, and pulmonary stenosis underwent successful total cava-to-pulmonary connection by means of a superior vena cava-to-pulmonary artery end-to-side anastomosis associated with an inferior vena cava-to-pulmonary artery direct anastomosis. Anatomic features and surgical technique are described.

Prophylactic atrial arrhythmia surgical procedures with congenital heart operations: review and recommendations.

Specific congenital heart anomalies significantly increase the risk for late atrial arrhythmias, raising the question whether prophylactic arrhythmia operations should be incorporated into reparative open heart procedures. Currently no consensus exists regarding standard prophylactic arrhythmia procedures. Questions remain concerning the arrhythmia-specific lesions to perform, energy sources to use, need for atrial appendectomy, and choosing a right, left, or biatrial Maze procedure. These considerations are important because prophylactic arrhythmia procedures are performed without knowing if the patient will actually experience an arrhythmia. This review identifies congenital defects with a risk for the development of atrial arrhythmias and proposes standardizing lesion sets for prophylactic arrhythmia operations.

Neonatal pulmonary autograft implantation for cardiac tumor involving aortic valve

We diagnosed in a 4-day-old neonate a cardiac tumor involving the left atrium, left atrioventricular junction, left ventricular outflow tract, and aortic valve with severe subvalvular and valvular aortic stenosis. The critical involvement of the aortic valve and the scarcity of neonatal cardiac donors led us to perform a successful replacement of the aortic root with a pulmonary autograft, using a very small homograft for the native pulmonary valve (Ross operation).

Pitfalls in echocardiographic-based repair of aortic coarctation

The knowledge of echocardiographic pitfalls, which may impair the correct indication for surgery of aortic coarctation, is of great importance to pediatric cardiologists. We believe that only the suspicion of coronary artery anomalies is a clear indication to perform a cardiac catherization.

Modified fontan operation

From November 1988 to October 1991 30 patients underwent a total extracardiac right heart bypass for complex cardiac anomalies by means of bidirectional cavopulmonary anastomosis and interposition of a conduit from the inferior vena cava to the pulmonary artery. Mean age at surgery was 6.4 years and mean weight 19.2 kg. There was 1 hospital death (3%) due to a borderline indication for a Fontan operation. 2 patients had further surgery: In 1 the repair was taken down due to the stenosis of the left pulmonary artery and the patient was left with a bidirectional cavopulmonary anastomosis only, the second patient required a revision of the cavopulmonary anastomosis due to a stenosis of the superior vena cavaright pulmonary artery junction. There were no late deaths and the survivors are in good clinical condition a mean of 15.1 months after the operation. We propose this technique as an alternative surgical option in candidates for a Fontan operation in whom atrial septation is hazardous including those with 1) hypoplasia or atresia of the left atrio-ventricular valve, 2) common atrioventricular valve, 3) anomalies of systemic and/or pulmonary venous return, or 4) auricular juxtaposition.ZusammenfassungZwischen November 1988 und Oktober 1991 wurde bei 30 Patienten mittels bidirektionaler kavopulmonaler Anastomose und Conduitinterposition (zwischen V. cava inferior und Pulmonalarterie) ein totaler extrakardialer Rechtsherzbypass angelegt. Das mittlere Patientenalter zum Zeitpunkt der Operation betrug 6,4 Jahre, das mittlere Körpergewicht 19,2 kg. 1 Patient (3%) verstarb perioperativ bei grenzwertiger Operationsindikation. Bei 2 Patienten waren weitere Eingriffe notwendig: Imal ein Fontan-Take-down infolge einer linksseitigen Pulmonalarterienstenose— der Patient verblieb mit einer bidirektionalen kavopulmonalen Anastomose. Beim 2. Patienten erforderte eine Stenose die Revision der kavopulmonalen Anastomose. Alle überlebenden Patienten sind in guter klinischer Verfassung, im Mittel 15.1 Monate nach der Operation. Spättodesfälle traten nicht auf. Wir empfehlen diese Methode als chirurgische Alternative für jene Fontan-Operationskandidaten, bei denen eine intraatriale Tunnelierung bzw. Septierung mit einem höheren Risiko verbunden ist: 1. bei Hypoplasie oder Atresie der linken Atrioventrikularklappe, 2. bei gemeinsamer Atrioventrikularklappe. 3. bei Anomalien des system- oder pulmonalvenösen Rückflusses bei Herzohr-Juxtaposition.