The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2011
The lower limit of the pulmonary artery index for the extracardiac Fontan circulation.
In the era of the staged Fontan operation, small pulmonary artery index (<250 mm(2)/m(2)) has not affected the early or midterm results. The lower limit of pulmonary artery index, however, has not yet been determined. We created numeric models of the Fontan circulation to investigate the lower limit of the pulmonary artery size. ⋯ A small pulmonary artery causes a high pressure gradient and a high energy loss. The lower limit of pulmonary artery index, considering the exercise tolerance, was 110 mm(2)/m(2).
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J. Thorac. Cardiovasc. Surg. · Jul 2011
Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease.
To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. ⋯ In neonates undergoing systemic-to-pulmonary artery shunt placement, approximately 10% underwent shunt intervention before discharge. Some factors, such as low birthweight, shunt size, noncardiac congenital abnormalities, and heterotaxy syndrome, may help identify patients at risk. Patients undergoing intervention experienced increased morbidity and mortality.
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J. Thorac. Cardiovasc. Surg. · Jul 2011
Case ReportsTransapical aortic valve implantation after previous mitral valve surgery.
Transcatheter aortic valve implantation is a new method for treatment of very high-risk patients with aortic valve stenosis. Especially in patients who have had previous cardiac surgery, the operative risk can be reduced. Nevertheless, this new procedure has some potential risks in patients with previous mitral valve surgery, owing to the increased risk by direct contact between the 2 valves with inhibition of mechanical mitral leaflet mobility, in view of potential mitral annulus pressure or leaflet damage caused by transcatheter wires. ⋯ Transcatheter valve implantation can be performed successfully after previous mitral valve surgery. Particular care should be taken to achieve optimal valve positioning and not to damage mitral leaflets during manipulation with guide wires.