Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2002
ReviewRepair of congenital tracheal stenosis.
We have used six different techniques in 61 operations performed at Children's Memorial Hospital (Chicago, IL) between 1982 and 2001 on 54 infants with complete tracheal rings and primary or recurrent tracheal stenosis. Short-term and long-term outcomes are reviewed for all techniques including pericardial tracheoplasty, tracheal autograft, tracheal resection, cartilage tracheoplasty, slide tracheoplasty, and aortic homograft patch tracheoplasty. Patients' ages ranged from 7 days to 72 months; mean age at operation was 6 months. ⋯ Follow-up is complete in all patients. Tracheal autograft is currently our procedure of choice for patients with long-segment tracheal stenosis because of its use of all-autologous material, technical ease of performance, already-present epithelial lining of the autograft, intrinsic maintenance of the cartilage contour, potential for growth, and ready availability. We limit the use of tracheal resections to patients with eight or less rings of tracheal stenosis.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2002
ReviewFontan operation for patients with severe distal pulmonary artery stenosis, atresia, or a single lung.
In the absence of a ventricular pump, the status of the pulmonary circulation is crucial to the success of the Fontan operation. In an updated version (1999) of the optimal criteria for the Fontan operation, several of these criteria address the pulmonary circulation: pulmonary artery pressure, pulmonary vascular resistance, pulmonary artery size, and absence of significant pulmonary artery branch stenosis. This chapter reviews the role of the pulmonary circulation in a successful Fontan operation, with a particular emphasis on surgical techniques to repair severe distal or hilar pulmonary artery stenosis or atresia. ⋯ Severe hilar pulmonary artery stenosis or atresia can be repaired by the technique of intrapulmonary pulmonary artery reconstruction with pericardial patch or tube and allow the successful completion of the Fontan operation. In the selected patient with a single pulmonary artery and optimal hemodynamics, the Fontan operation is possible with good outcome. However, further experience is needed in a larger number of patients to assess the long-term outcome of these treatment strategies.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2002
Management of aortopulmonary collateral arteries in Fontan patients: occlusion improves clinical outcome.
Children with chronic cyanotic heart disease often develop systemic-to-pulmonary artery collateral vessels that can be deleterious at the time of a Fontan procedure because of excessive pulmonary blood flow with resultant ventricular volume overload. We therefore occlude all significant collateral arteries during preoperative cardiac catheterization. From June 1993 to September 2001, 137 children ranging from 1.5 to 18.3 years old (median, 2.4 years), underwent a fenestrated lateral tunnel Fontan procedure. ⋯ Hemodynamically significant collateral arteries are common in Fontan candidates. Aggressive control can result in good early and medium-term survival. After the Fontan operation, the presence of significant collateral vessels may be a marker for eventual cardiac failure; 11 of the 29 patients who required postoperative coil placement went on to transplantation or died of heart failure.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2002
Historical ArticleThe European Congenital Heart Defects Surgery Database experience: Pediatric European Cardiothoracic Surgical Registry of the European Association for Cardio-Thoracic Surgery.
The initial purpose of collecting data on the outcome of congenital heart surgery procedures across Europe was to make possible comparison of results and definition of mortality and morbidity risk factors as well as targeting research activities. The European Congenital Heart Surgeons Foundation, established in 1992, created the European Congenital Heart Defects Database, precursor to today's Pediatric European Cardiothoracic Surgical Registry. In 1999, initiatives of the Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery resulted in a series of conferences aimed at arriving at a standardized nomenclature and reporting strategies as a foundation for an international database. ⋯ As of March 2001, 84 cardiothoracic units from 33 countries had registered in the database and data on almost 4,000 procedures have been collected. Participation in the database is free of charge through the internet for all participants. Development of data validation protocols is a work in progress.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2001
ReviewCardiac surgery for premature and low birth weight neonates.
Congenital heart defects in low birth weight infants are typically managed with supportive therapy or palliative surgery and definitive repair is delayed. However, the morbidity of this approach has been shown to be high. At the University of California San Francisco, our approach to these infants has been one of complete repair in the neonatal period or as early as possible. ⋯ Noncardiac abnormalities contribute significantly to perioperative and late morbidity and mortality. Reintervention rates are comparable to other neonates. Our data suggests that complete repair of simple and complex congenital heart defects can be performed safely and effectively in premature and low birth weight infants.