Enrico Cetrano

Surgical Treatment of Transposition of the Great Arteries With Bilateral Intramural Coronary Arteries

A 33-day-old neonate with transposition of the great arteries, ventricular septal defect, and intramural course of both coronary arteries underwent successful arterial switch repair. At a follow-up time of 36 months, left ventricular function and coronary arterial anatomy at angiography were normal. Optimal treatment of such rare coronary arterial abnormality may allow functional and anatomic results comparable to usual coronary arterial patterns in transposition of the great arteries.

Managing major vessel injuries with a Fogarty catheter during chest re-opening in children

Injury of structures, leading to a major bleeding during chest opening, is a severe and potentially life-threatening complication, especially in redo cardiac surgery, both in adults and children. In three paediatric redo operations performed via midline sternotomy, we managed this complication successfully and uneventfully by using an inflated Fogarty catheter to plug the blood leak from the injured vessel before repairing the lesion under direct vision in a bloodless surgical field. Herein we report in detail the technique used and a comment on our experience.

Primitive intrapericardial teratoma associated with yolk sac tumour

An intrapericardial vacuolated mass compressing and displacing the heart was diagnosed by echocardiography in a foetus of 22 weeks gestation. The birth was induced for early signs of foetal distress at 29 weeks and, after two initial pericardial evacuation procedures, the tumour was resected radically 7 days after birth at a weight of 1.55 kg. Mass histology showed teratoma associated with yolk sac tumour. We comment on the overall approach adopted after foetal diagnosis and the histopathological features of the tumour, and try to draw conclusions on patient outcome data.

Edwards Sapien 3 Valve for Mitral Replacement in a Child After Melody Valve Endocarditis

We present the surgical implantation in mitral position of the Edwards Sapien 3 valve for prosthetic valve endocarditis in a severely ill child after multiple valve replacements. The procedure was safely performed and provided adequate hemodynamic results in the short term. This report highlights the excellent potential of Sapien 3 valve for the treatment of mitral valve disease in children with a mitral valve annulus of appropriate size. Of note, the use of the Sapien 3 valve should be considered when a bioprosthesis is required at the time of valve re-replacement.

Long-Term Outcomes After Extracardiac Fontan Takedown to an Intermediate Palliative Circulation

BACKGROUND Acute failure of the Fontan circulation is rare but remains associated with high morbidity and mortality rates. Little is known about the long-term outcome of patients who underwent Fontan takedown to an intermediate palliative circulation and their potential candidacy for redo Fontan completion. METHODS Patients followed up at a single institution who underwent takedown of a Fontan circulation to an intermediate palliative circulation within 2 months of extracardiac Fontan completion were reviewed. RESULTS Between October 1990 and December 2015, 18 patients underwent Fontan takedown to a superior cavopulmonary connection (with or without an additional shunt) at a median age of 3.3 years (range, 1.8 to 8.0) and median weight of 13.8 kg (range, 8.0 to 27.0 kg). Takedown was required during the Fontan procedure itself in 2 patients, and within the first 2 postoperative months in 16 patients (median time to takedown, 3 days). Seventeen patients survived the post-takedown period and 3 ultimately underwent successful redo Fontan. Four patients required heart transplantation, with 2 deaths. In patients with extended intermediate palliation, median arterial oxygen saturation was 84% (range, 76% to 92%) at a median follow-up of 6.3 years (range, 0.7 to 25.9). CONCLUSIONS Takedown to a superior cavopulmonary connection is an effective treatment option and, in some patients, acts as a bridge to subsequent redo Fontan completion or heart transplantation. An extended intermediate palliative circulation is tolerated for several years with reasonable oxygen saturation levels at rest. In our experience, an early takedown strategy to a superior cavopulmonary connection is the treatment of choice for acute Fontan failure.

Intraoperative coronary revision but not coronary pattern is associated with mortality after arterial switch operation

OBJECTIVES We sought to determine differences in baseline characteristics and clinical outcomes in a consecutive series of patients undergoing arterial switch operation (ASO), assessing the effect of coronary anatomy on postoperative mortality, both overall and adjusted for surgical era. METHODS From January 2000 to May 2015, 283 consecutive patients underwent ASO for transposition of the great arteries. A total of 103 patients (36.4%) had an associated ventricular septal defect and 23 (8.1%) had an aortic arch obstruction. Coronary anomalies were present in 119 (42%) patients. RESULTS Overall survival was 93.0 ± 1% at 15 years (19 events). Intraoperative revision of the coronary anastomosis was required in 8 patients (2.8%) due to inability to wean from cardiopulmonary bypass (CPB) or post-CPB myocardial ischaemia. Surgical revision was neither related to the underlying coronary anatomy ( χ 2  =   0.681, P  = 0.4091) nor to the surgical era ( χ 2  =   0.682, P  = 0.4090). Univariable analysis suggested decreased mortality rate for infants who underwent surgery during 2008 or later ( P  = 0.01). In multivariable analysis, intraoperative coronary button revision was the only predictor of mortality [ P  < 0.001, hazard ratio (HR) 12.01, 95% confidence interval (CI) 3.85-37.49], whereas surgical era (before 2008) failed to achieve statistical significance ( P  = 0.057, HR 2.19, 95% CI 0.96-12.04). CONCLUSIONS In the recent era, unusual coronary patterns do not affect survival following ASO, whereas intraoperative coronary button revision is a predictor of mortality. Preventive strategies aimed towards intraoperative detection of impaired coronary perfusion are useful tools that might be considered for all patients in order to improve outcomes.

The role of cardiac magnetic resonance to address the treatment of choice for pulmonary valve replacement late after repair of Tetralogy of Fallot

Background Severe right ventricular (RV) dilation and dysfunction due to chronic pulmonary regurgitation (PR) requires pulmonary valve replacement (PVR) late after repair of Tetralogy of Fallot (rTOF). Cardiac magnetic resonance (CMR) is the gold standard method to evaluate the pathophysiology after rTOF and the main tool to support the decision for PVR in asymptomatic patients. Given the various options available for PVR, we sought to evaluate the usefulness of CMR to address patients towards either a surgical or an interventional procedure.