Ross M. Ungerleider

Modified Ross Procedure to Prevent Autograft Dilatation

The most prominent, long-term complication after the Ross procedure is autograft dilatation that can present within 1 to 2 years after the Ross operation. We describe a modified Ross procedure in which the autograft is completely encased in a Dacron graft (Hemashield; Maquet Cardiovascular, Wayne, NJ) prior to implantation. We have performed 30 modified Ross procedures since October 2004. There has been no mortality, and at follow-up none of the patients showed autograft dilatation. This article describes our current technique, which we believe is consistently reproducible and may be especially applicable to adults who are at risk for autograft dilatation after the Ross procedure.

Human Innate Mycobacterium tuberculosis–Reactive αβTCR+ Thymocytes

The control of Mycobacterium tuberculosis (Mtb) infection is heavily dependent on the adaptive Th1 cellular immune response. Paradoxically, optimal priming of the Th1 response requires activation of priming dendritic cells with Th1 cytokine IFN-γ. At present, the innate cellular mechanisms required for the generation of an optimal Th1 T cell response remain poorly characterized. We hypothesized that innate Mtb-reactive T cells provide an early source of IFN-γ to fully activate Mtb-exposed dendritic cells. Here, we report the identification of a novel population of Mtb-reactive CD4− αβTCR+ innate thymocytes. These cells are present at high frequencies, respond to Mtb-infected cells by producing IFN-γ directly ex vivo, and display characteristics of effector memory T cells. This novel innate population of Mtb-reactive T cells will drive further investigation into the role of these cells in the containment of Mtb following infectious exposure. Furthermore, this is the first demonstration of a human innate pathogen-specific αβTCR+ T cell and is likely to inspire further investigation into innate T cells recognizing other important human pathogens.

Pentalogy of Cantrell with double-outlet right ventricle: a case of surgical correction

Pentalogy of Cantrell is characterised by a combination of severe defects in the middle of the chest including the sternum, diaphragm, heart, and abdominal wall. Mortality rate after cardiac surgery is usually high. We report a successful total correction of the cardiac defects in a case of Pentalogy of Cantrell with a double-outlet right ventricle prior to abdominal wall defect repair.

Common ground: Measuring intrainstitutional mortality among pediatric surgical procedures

BACKGROUNDnFor adult populations, hospitals that have low mortality rates for one surgical discipline tend to have low mortality rates for other surgical disciplines. We sought to determine to what degree mortality rates for high-risk pediatric surgical procedures were correlated within institutions.nnnMETHODSnHigh-risk operations performed on patients ≤ 10 years of age were identified in the 2003/2006 Kids Inpatient Databases and grouped into cardiac surgical, neurosurgical, and general surgical categories. We calculated the hospital-level risk-adjusted mortality rates of each category (categorical mortality) and of the other 2 categories combined (other mortality); then we calculated the correlation between these groups. Hospitals also were placed into quintiles based on excess other mortality and grouped categorical mortality were estimated.nnnRESULTSnCategorical mortality was correlated with other mortality (R = 0.22-0.26) for all 3 categories. Other mortality was a good predictor of categorical mortality, with categorical mortality rates at hospitals in the bottom quintile of other mortality, on average 1.58 times greater than those in the top quintile (P < .001). Correlations of categorical mortality with other mortality were significantly greater for the subgroup of Childrens General Hospitals (R = 0.43-0.57).nnnCONCLUSIONnHospitals with low mortality rates for 1 high-risk pediatric surgical specialty tended to have low rates for other specialties. This observation suggests that diverse surgical fields share institutional resources and processes that affect their mutual performance. Implementation of these common pillars may lead to broader improvements in quality than efforts focused on individual disciplines.

Valve-Sparing Replacement of the Aortic Root for a 2-year-old Child with Loeys-Dietz Syndrome

Loeys-Dietz syndrome is a newly recognized constellation that presents with aortic aneurysm or dissection similar to Marfans syndrome. We describe successful surgical treatment in a 2-year-old with the syndrome in whom we performed a valve-sparing replacement of the aortic root because of significant dilation of the aortic root and the ascending aorta.

Integration of leadership training for graduate and medical students engaged in translational biomedical research: Examining self-efficacy and self-insight

Introduction Formal training in team leadership is not taught in biomedical research graduate training programs or medical schools. Methods We piloted a Leadership Training Workshop for graduate biomedical and medical students enrolled in our Interprofessional Research Design Course. Results The Kane–Baltes self-efficacy survey demonstrated improved leadership skills (median scores pretraining and post-training were 71 and 76.6; paired t-test, p=0.04). Conclusions Most students demonstrated significant improvement in self-awareness pertaining to their own innate leadership styles.