Giuseppe Caianiello

Stenting of bilateral arterial ducts in complex congenital heart disease.

Bilateral arterial ducts serving nonconfluent pulmonary arteries is a very rare pattern of pulmonary blood flow in congenital heart disease with pulmonary atresia. In this setting, neonatal ductal closure might result in abrupt pulmonary hypoperfusion and life-threatening systemic hypoxia, thereby indicating emergent surgical palliation or repair. However, percutaneous arterial duct stenting might be an alternative to surgery, especially in high-risk patients. This article reports on two critical neonates with complex heart disease and discontinuous pulmonary arteries dependent on bilateral arterial ducts who successfully underwent transcatheter ductal stenting as first-step palliation toward lower-risk corrective surgery.

Hybrid transcatheter-surgical strategy in arterial tortuosity syndrome.

Arterial tortuosity syndrome is a rare connective tissue disorder characterized by elongation and tortuosity of large elastic arteries resulting in multiple vascular stenoses. This article reports on a novel hybrid transcatheter-surgical strategy to treat bilateral peripheral pulmonary artery stenoses due to this syndrome. Operation consisted of stent implantation by midline sternotomy and reductive reconstruction of the proximal pulmonary arteries. This approach resulted in right ventricular overload relief and sudden improvement of the patients clinical condition.

Aortic coarctation with persistent fifth left aortic arch

A neonate with severe aortic coarctation showed a double lumen transverse aorta (persistent fifth aortic arch) with both channels joining at the isthmus where the obstruction was confirmed by echocardiography and cardiac catheterization. Surgical repair was performed with a pantaloon-shaped patch. Persistent fifth aortic arch does not result in a vascular ring and, per se, is not hemodynamically significant unless associated with other cardiac malformations.

Hybrid palliation in complex congenital heart malformation with duct-dependent isolated pulmonary artery

A 2 month-old infant with severe congestive heart failure due to unrestrictive ventricular septal defect and absence of the left pulmonary artery was submitted to a hybrid transcatheter-surgical palliation consisting in percutaneous re-canalization of the occluded arterial duct-left pulmonary artery complex and surgical banding of the right pulmonary artery. The post-operative course was uneventful and the baby was discharged in a few days under mild anti-congestive therapy. This hybrid approach was highly effective in stabilizing this critical infant in view of a later and safer surgical repair.

OC170: Prenatal diagnosis improves short term outcome in Transposition of the Great Arteries

Echogenic ovarian foci (EOF) are common ultrasound findings of unclear significance. Objectives: to follow up natural course of EOF and to determine potential for malignant transformation. Materials and Methods: Sixty five patients with EOF in one or both ovaries were followed with yearly pelvic ultrasound for 10 years. Results: EOF were bilateral in 53 patients, unilateral in 12 patients. EOF had clustered pattern in 83 ovaries and were singular in 35 ovaries. EOF were peripheral in 67 ovaries, had central location in 18 and had mixed distribution in 33 ovaries. During longitudinal follow up EOF stayed unchanged in 99 ovaries, increased in size in 12, decreased or became undetectable in 7 ovaries. Ovarian specimens were obtained in 6 patients (total 9 ovaries) who had gynecologic surgery for reasons unrelated to EOF. Epithelial inclusion cysts were detected in 5 ovaries, simple calcifications in 4 ovaries. None of the patients developed ovarian malignancy over 10-year observation period. Conclusion: EOF are benign findings and their appearance changes over time. In our series EOF did not signify ovarian pathology and required no follow-up.