Zbigniew Kordon

Operative treatment of truncus arteriosus communis coexisting with tricuspid atresia

The coexistence of tricuspid atresia and common arterial trunk is extremely rare. We present a successful three-stage surgical treatment of this defect. The first stage included disconnection of the pulmonary arteries from the common trunk, atrial septectomy and systemic-to-pulmonary shunt; the second stage, a hemi-Fontan procedure; and the third stage, a fenestrated Fontan completion. The child is now 8 years old and is developing well.

Oxidative Stress Biomarkers and Left Ventricular Hypertrophy in Children with Chronic Kidney Disease

Cardiovascular diseases remain the most frequent cause of morbidity and mortality in patients with chronic kidney disease (CKD). The aim of the study was to assess the association between oxidative stress biomarkers and cardiovascular risk factors and left ventricular hypertrophy in children with CKD. Material and Methods. The studied group consisted of 65 patients aged 1.4–18.6 (mean 11.2) years with stages 1 to 5 CKD. Serum oxidized low-density lipoprotein (oxLDL), protein carbonyl group, creatinine, cystatin C, albumin, lipids, high-sensitivity C-reactive protein, intercellular adhesion molecule-1, insulin, plasma renin activity, and aldosterone levels were measured. Patients were divided into groups depending on CKD stage. Anthropometric measurements, ambulatory blood pressure (BP) measurements, and echocardiography with left ventricular mass (LVM) calculation were performed. Results. Serum oxLDL strongly correlated with creatinine (R = 0.246; p = 0.048), cystatin C (R = 0.346; p = 0.006), total cholesterol (R = 0.500; p < 0.001), triglycerides (R = 0.524; p < 0.001), low-density lipoprotein concentrations (R = 0.456; p < 0.001), and 24 hour BP values of systolic (R = 0.492; p = 0.002), diastolic (R = 0.515; p < 0.001), and mean arterial pressure (R = 0.537; p < 0.001). A significant correlation between oxLDL levels and LVM z-scores (R = 0.299; p = 0.016) was found. Conclusions. Hypertension and dyslipidemia correlated with lipid oxidation in children with CKD. oxLDLs seem to be valuable markers of oxidative stress in CKD patients, correlating with left ventricular hypertrophy.

Impact of right ventricle–pulmonary artery conduit placement on pulmonary artery development after the Norwood procedure in hypoplastic left heart syndrome

OBJECTIVES The right ventricle-to-pulmonary artery (RV-PA) shunt in the Norwood procedure (NP) for children with hypoplastic left heart syndrome (HLHS) provides stable haemodynamics and improves interstage survival. The aim of the study was to find the effect of RV-PA placement on pulmonary artery development after the NP. METHODS A prospective, randomized study of 60 children with HLHS was carried out between 2008 and 2010. All children underwent the NP in the neonatal period and survivors underwent the hemi-Fontan operation (at a mean age of 4.78 ± 2.8 months). RV-PA was left side to the neo-aorta in 32 children (the first group) and right side to the neo-aorta in 28 children (the second group). Echocardiography and angiograms were used to asses the pulmonary artery size. RESULTS There was a significant difference between right pulmonary artery (RPA) and left pulmonary artery (LPA) diameters in both groups before the NP (first: 4.94 ± 0.27 vs. 4.26 ± 0.22, P = 0.04; second: 4.97 ± 0.23 vs. 4.14 ± 0.17, P = 0.003). This difference was not significant when z-scores were taken into account. The dynamics of the pulmonary artery development was similar in both groups comparing pre-Norwood and pre-hemi-Fontan periods. A slight increase in the LPA and the RPA diameter with a significant decrease in the z-scores was noted. At the pre-hemi-Fontan stage, there was no significant difference in the diameter and the z-score between LPA and RPA in the second group, whereas in the first group, the z-score for LPA was significantly lower compared with RPA (-1.34 ± 1.6 vs. -0.86 ± 1.4, P = 0.016). CONCLUSIONS Placement of the RV-PA conduit on the right side to the neo-aorta ensures more equal distribution of the blood to the pulmonary arteries and better development of the LPA.

Successful surgical treatment of a mycotic pseudoaneurysm of the ascending aorta in an infant after hypoplastic left heart complex repair.

We describe a successfully treated pseudoaneurysm of the ascending aorta in a 2-month-old infant after a previous operation due to hypoplastic left heart complex. After a rapidly progressing respiratory tract obstruction as a first symptom, echocardiography revealed a huge aneurysmal formation originating from the anterior and right lateral wall of the ascending aorta. A patch aortoplasty was employed.