The Annals of thoracic surgery
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Comparative Study
Late results and reintervention after aortic valvotomy for critical aortic stenosis in neonates and infants.
Many centers have adopted balloon valvuloplasty for treatment of infants with critical aortic stenosis because of historically poor early results and a lack of long-term results with surgical valvotomy. We evaluated our results with open aortic valvotomy over the past decade, specifically examining factors influencing survival and reintervention in the current era. ⋯ Current surgical results with critical aortic stenosis in the neonate and young infant are acceptable in terms of both late survival, reintervention, and functional results in the majority of patients. Newer interventions, such as balloon valvuloplasty, should be carefully evaluated for long-term results and should be compared more appropriately to current surgical results to determine the best treatment modality for the neonate and infant with critical aortic stenosis.
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Cardiopulmonary bypass results in inappropriate activation of the coagulation and fibrinolytic systems. Factors such as a greater degree of hemodilution, use of deep hypothermic circulatory arrest, the impact of cyanosis on coagulation, and the immature coagulation system of the newborn will increase the risk of problematic perioperative bleeding. ⋯ The inverse relationship between a small patient's blood volume and the large pump-prime volume requires additional aprotinin to be added to the prime to achieve plasma levels sufficient to inhibit activation of the coagulation cascade.
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We report on a case of an 11-year-old asymptomatic child with aortico-left ventricular tunnel arising from the left aortic sinus. Preoperative transesophageal echocardiography showed a dilated aortic root with mild aortic valve incompetence and demonstrated the course of the tunnel, which originated from the left coronary sinus entering the outlet portion of the left ventricular outflow tract. ⋯ At 10-month follow-up the child is asymptomatic and receiving no oral medications. Control two-dimensional Doppler echocardiography shows trivial central aortic valve incompetence.
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There are a few patients without detectable atrial contraction despite restoration of atrial rhythm after the maze procedure for atrial fibrillation (AF) associated with mitral valve disease. ⋯ Reconsideration of the indications for the maze procedure for AF associated with rheumatic mitral stenosis may thus be reasonable, particularly for cases in which replacement using a prosthetic valve is necessary, but we believe that patients with nonrheumatic mitral valve disease, especially those able to undergo reconstructive operations, are the best candidates for the maze procedure.
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Comparative Study
Growth of the subclavian artery and the anastomosis in Blalock-Taussig shunt: absorbable versus nonabsorbable suture.
We evaluated the growth of Blalock-Taussig shunts placed with absorbable suture by cineangiographic findings and long-term results and compared them with those in an earlier group of patients in whom we used nonabsorbable suture. ⋯ The use of absorbable polydioxanone suture has an advantage in terms of growth of the diameters of the subclavian artery and the anastomosis in a Blalock-Taussig shunt and may improve the long-term results after this shunt operation in infancy.