Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2009
Pediatric cardiac surgery: a challenge and outcome analysis of the Guatemala effort.
A large underserved population of children with congenital cardiac malformation (CCM) exists in many developing countries. In recent years, several strategies have been implemented to supplement this need. These strategies include transferring children to first-world countries for surgical care or the creation of local pediatric cardiovascular surgical programs. ⋯ We are not in favor of Medical-Surgical Safari efforts, unless these efforts include training of a local team and eventual unit independence. It helps if an experienced (+/- senior/retired!) surgeon leads this effort on a full-time, pro bono basis. Local and international fund raising is essential to complement vastly insufficient government subsidies.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2009
ReviewManagement of older single functioning ventricles with outlet obstruction due to a restricted "VSD" in double inlet left ventricle and in complex double outlet right ventricle.
The occurrence of a restriction of the bulbo-ventricular foramen (BVF) in older patient with double inlet left ventricle (DILV) or tricuspid atresia (TA) with ventriculo-arterial discordance is a well-known condition. Today, the surgical management is to perform a Damus-type operation at the time of the bi-directional Glenn or at the Fontan completion. The ventricular septal defect (VSD) enlargement, associated with muscular resection and a patch enlargement of the subaortic accessory ventricular chamber, is rarely performed but remains indicated in cases with pulmonary valve atresia or regurgitation. ⋯ Attempts at surgical VSD enlargement or catheter-based procedures have resulted in almost constant recurrence. This recently reported complication is in favor of also performing a VSD enlargement at the time of the Fontan completion in complex DORV. It justifies the biventricular repair in complex DORV with two viable ventricles.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2009
Pulmonary atresia, VSD and Mapcas: repair without unifocalization.
The last three decades have seen considerable development in the management of infants with pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collaterals. The technical difficulty of surgical treatment lies in the fashioning of a pulmonary vascular bed capable of providing suitably low right ventricular pressure for repair of the intracardiac defect. With the current trend toward early and complete unifocalization of major aortopulmonary collateral arteries (mapcas), we describe an alternative approach - "repair without unifocalization" - and explain our reasoning for pursuing this technique.