Comprehensive Review of Coronary Artery Anatomy Relevant to Cardiac Surgery.

In order to perform safe cardiac surgery, a knowledge of applied coronary artery anatomy and its variants is essential for cardiac surgeons. In normal individuals, the right and the left coronary arteries arise from the corresponding sinuses of Valsalva within the aortic root. From the cardiac surgical perspective, the coronary artery is divided into the left main coronary artery, its branches (the left anterior descending artery and the circumflex artery), and the right coronary artery.

Modification of the Warden Procedure for Surgical Repair of Partial Anomalous Pulmonary Venous Connection.

Warden procedure is a popular technique for repairing partial anomalous pulmonary venous connection. We describe a modification of this technique for surgical repair of this condition by raising both a superior vena cava (SVC) flap and right atrial appendage flap to create a tension-free SVC-RA continuity (neo-SVC). The anomalous pulmonary veins are routed via the remanent of proximal SVC and baffled to the left atrium across a surgically created or enlarged atrial septal defect using autologous pericardium.

Zoom and its Discontents: Group Decision Making in Pediatric Cardiology in the Time of COVID (and Beyond) : Aurthors.

The emergence of Covid-19 has led to change within hospital-based healthcare. An example, has been to reconfigure clinical decision making meetings from traditional in-person (Face-to-face, FtF) to online video-conferencing (VC) format inorder to decrease contagion risk. Despite its widespread uptake, there is minimal empirical data evaluating this format.

Outcomes of adults with repaired tetralogy of Fallot from the national Scottish Cohort.

Background: The adult population of repaired tetralogy of Fallot is increasing and at risk of pre-mature death and arrhythmia. This study evaluates risk factors for adverse outcome and the effect of pulmonary valve replacement within a national cohort.

Methods: A retrospective cohort study of 341 adult repaired tetralogy of Fallot (16-72 years) managed through a single national service was undertaken incorporating over 1200 patient-years of follow-up.

Blood flow simulations in the pulmonary bifurcation in relation to adult patients with repaired tetralogy of Fallot.

Understanding the haemodynamic environment of the pulmonary bifurcation is important in adults with repaired conotruncal congenital heart disease. In these patients, dysfunction of the pulmonary valve and narrowing of the branch pulmonary arteries are common and can have serious clinical consequences. The aim of this study was to numerically investigate the underlying blood flow characteristics in the pulmonary trunk under a range of simplified conditions.

A Prospective Randomized Blinded Trial of Remote Ischemic Preconditioning in Children Undergoing Cardiac Surgery.

Remote ischemic preconditioning (RIPC) has been proposed as an intervention to protect myocardium and attenuate end-organ dysfunction associated with cardiopulmonary bypass. We investigated the effect of RIPC in children undergoing cardiopulmonary bypass involving clinical outcome, cardiac and end-organ function, inflammatory response, and myocardial gene expression. A prospective, investigator-blinded, randomized, controlled trial was performed.

Larger Centers Produce Better Outcomes in Pediatric Cardiac Surgery: Regionalization is a Superior Model - The Con Prospective.

Regionalization, in the context of congenital heart surgery, describes a process where smaller units close and patients are redistributed to larger centers. Proponents argue this will produce superior patient outcome based primarily on a volume-outcome effect. The potential disadvantage is that, as distance to center increases, access to service is compromised.

Two-Strip Technique to Repair Common Atrioventricular Valve Regurgitation in Single-Ventricle Palliation.

A common atrioventricular valve (CAVV) presents a challenge in single-ventricle palliation (SVP) because of its propensity to leak, with CAVV regurgitation being an important risk factor for repeated operation and mortality. We propose a new technique of CAVV repair in the context of SVP. The method uses the techniques of complete repair of antrioventricular septal defect while maintaining free communication at atrial and ventricular levels necessary for single-ventricle physiology.

Circumflex retroesophageal aorta mimicking aortic interruption: a rare cause of aortic obstruction in a neonate.

Critical obstruction of the aorta presenting in the neonate typically occurs with aortic interruption or coarctation, following ductus arteriosus closure. Circumflex retroesophageal aortic arch is a rare aortic arch anomaly in which a right aortic arch continues as a retroesophageal component and descends on the left of the spine. Obstruction within the arch can occur, usually identified incidentally in older children.

Computational modelling of the hybrid procedure in hypoplastic left heart syndrome: a comparison of zero-dimensional and three-dimensional approach.

Previous studies have employed generic 3D-multiscale models to predict haemodynamic effects of the hybrid procedure in hypoplastic left heart syndrome. Patient-specific models, derived from image data, may allow a more clinically relevant model. However, such models require long computation times and employ internal pulmonary artery band [dint] dimension, which limits clinical application.

Apelin receptor (APJ) expression during cardiopulmonary bypass in children undergoing surgical repair.

Background And Aims: In human adults, and animals, the Apelin-APJ ligand-receptor system is emerging as having a role in the pathogenesis of cardiovascular function and heart failure. The aim was to investigate expression, and regulation by oxygen, of the Apelin APJ receptor (APJ) in myocardium obtained from children undergoing corrective surgery with cardiopulmonary bypass for repair of congenital heart defects.

Methods: Western blotting and Real-time PCR were used to determine if APJ was expressed in the infant myocardium, if expression was influenced by the duration of myocardial ischemia and if any relationship existed between APJ expression and early post-operative outcome.

Repair of early left main stem stenosis after switch operation using an autologous innominate vein patch.

We describe the repair of the postoperative left main stem stenosis of a 24-day old male patient who initially underwent arterial switch operation for dextro-transposition of the great arteries. The repair was facilitated by using an autologous left innominate vein patch, while there was a shortage of suitable repair material in this neonate. Postoperative echocardiogram prior to discharge confirmed a satisfactory flow through the left main stem and improved left ventricle function.

Computational modelling to optimize the hybrid configuration for hypoplastic left heart syndrome.

Objectives: Hybrid palliation for hypoplastic left heart syndrome (HLHS) is associated with mortality and late ventricular dysfunction. Increased ventricular workload and coronary perfusion limitation may be the important factors. Using mathematical modelling, this study investigated the effects of differing hybrid configurations on the demands on this single ventricle circulation.

Acute B-type natriuretic peptide response and early postoperative right ventricular physiology following tetralogy of Fallot's repair.

B-type natriuretic peptide (BNP) response early after a tetralogy of Fallot's repair remains unclear. BNP was measured pre- and post-operatively (immediately, day 1) in 18 children undergoing corrective repair with concurrent echocardiography (pre-, post-op day 1) to assess right ventricular (RV) systolic dysfunction, restrictive physiology, wall motion and pulmonary regurgitation (PR). In the first 24 h postoperatively, BNP rose acutely in all patients (mean 34.

Cystatin C: influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery.

Background: Cardiopulmonary bypass (CPB)-associated renal dysfunction following cardiac surgery is well recognized. In patients with renal disease, cystatin C has emerged as a new biomarker which in contrast to creatinine (Cr) is sensitive to minor changes in glomerular filtration rate (GFR).

Aim: We utilized cystatin C to investigate the association of CPB perfusion parameters with acute renal injury after pediatric cardiac surgery.

Myocardial expression of heat shock protein 70i protects early postoperative right ventricular function in cyanotic tetralogy of Fallot.

Background: Right ventricular dysfunction occurs after tetralogy of Fallot repair and may relate to greater myocardial vulnerability to ischemia-reperfusion injury in cyanotic patients. The inducible form of heat shock protein 70 (HSP-70i), a molecular chaperone, is upregulated in response to cellular stress and limits myocardial injury against ischemia-reperfusion. We evaluated the myocardial expression of HSP-70i and its relation to right ventricular function and clinical outcome in patients with tetralogy of Fallot undergoing corrective surgery.

Urgent device retrieval using partial left heart bypass.

Percutaneous cardiovascular device implantation plays an important and increasing role in the treatment of congenital heart disease. Device related complications of malposition and embolisation are uncommon and can usually be retrieved by catheter. We present two interesting cases in which migrated devices resulted in thoracic aortic obstruction; both were refractory to percutaneous retrieval.

Synergistic interaction between right ventricular mechanical dyssynchrony and pulmonary regurgitation determines early outcome following tetralogy of Fallot repair.

Objective: The ability of the right ventricle to tolerate acute pulmonary regurgitation (PR) following tetralogy of Fallot (TOF) repair is variable and the mechanisms that underlie this are not completely understood. We hypothesise that dyssynchronous wall mechanics affects the RV tolerance to postoperative PR with adverse effect on early surgical outcome.

Methods: Twenty-four TOFs (mean age 19.

Tissue Doppler imaging following paediatric cardiac surgery: early patterns of change and relationship to outcome.

In this study, tissue Doppler imaging (TDI) was used to assess changes in ventricular function following repair of congenital heart defects. The relationship between TDI indices, myocardial injury and clinical outcome was explored. Forty-five children were studied; 35 with cardiac lesions and 10 controls.