The Annals of thoracic surgery
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A 10-year-old boy was admitted with dilated cardiomyopathy. Before scheduled implantation of a HeartWare ventricular assist device, he experienced a cardiac arrest and required extracorporeal membrane oxygenation for both cardiac and pulmonary support. After 4 days of extracorporeal membrane oxygenation and 126 days of support on the HeartWare ventricular assist device, he underwent successful cardiac transplantation. He is doing well 6 months after transplantation.
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Comparative Study
Ladd's procedure in functional single ventricle and heterotaxy syndrome: does timing affect outcome?
Infants with univentricular hearts often require intervention, such as a systemic to pulmonary shunt, as part of a staged surgical palliation. This physiology is inherently unstable, and interim mortality ranges from 4% to 15%. Heterotaxy syndrome confers a high incidence of intestinal rotation and fixation abnormalities. Controversy persists as to the need for elective Ladd's procedure. The purpose of this study is to review our experience in children with heterotaxy syndrome and functionally univentricular hearts who underwent Ladd's procedure. ⋯ Ladd's procedure in single ventricle heterotaxy patients who are tolerating enteral feeding should be performed after physiologic palliation to a more balanced circulation, ideally after cavopulmonary connection. Symptomatic neonates pose management challenges. Timing of abdominal surgery should be carefully considered, given the significant risk of mortality in these patients.