We hereby report a child with transposition of great arteries and regressed ventricle who underwent arterial switch operation (ASO) with the aid of cardiopulmonary bypass and “integrated” extracorporeal membrane oxygenation (ECMO) circuit. The significance of lactate clearance as a guide to initiate and terminate veno-arterial ECMO in a post ASO child with regressed left ventricle is discussed.
Background: Fontan procedure and its modifications are established procedures for the treatment of anatomical defects with a single ventricle physiology.Methods: Thirty-two patients underwent extra-cardiac Fontan procedure between Feb 2004 and Oct 2005. Pre-operative cardiac catheterization was done in all patients. All cases were operated on cardiopulmonary bypass with beating heart. ePTFE conduit (Gore-Tex) was used to create an extra cardiac connection between inferior vena cava and the pulmonary artery. A fenestration was created between the conduit and right atrium in twenty-seven patients (91%) Results: The average age was 8.7 years (range 3-21yrs). Ten females underwent the operation. The pre-operative diagnosis was tricuspid atresia (n=15), DORV (n=8), DILV (n=3) and others (n=6). Three patients had PA banding and eight had a BT shunt prior to the bidirectional Glenn. The average pre-procedure pulmonary artery pressure was 11.9 mm Hg (range 7-16) and LVEDP was 10.6 mm Hg (range 7-18). The average branch PA size was 12.6 mm/m 2 (range 8.9-15). 20mm (n=10) or 22 mm (n=12) PTFE conduits were used. Twenty-nine patients (91%) survived the procedure. Postoperative complications were pleural effusion (n=9), renal failure (n=3) and bleeding (n=1). Technical problems during re-sternotomy (aortic injury in one and coronary artery injury in another) and poor PA anatomy were the causes for mortality. Arterial oxygen saturation increased from an average of 76.33% (pre-operative) to 94.5% (postoperative).Conclusions: Extra cardiac Fontan is a technically simple procedure that avoids an atrial suture line resulting in a theoretical reduction in the risk of atrial arrhythmias. However, careful selection of cases is mandatory to avoid early mortality.
Severe persistent hypertension is seen infrequently in newborns and infants, but we came across two infants who developed severe paradoxical hypertension after successful coarctation repair. Treatment of systemic hypertension following repair of coarctation of the aorta is always challenging particularly in infants. Dexmedetomidine was used successfully as an adjunct to the established anti-hypertensive drugs in the immediate postoperative period in our cases to treat postoperative paradoxical hypertension.
Objective: A retrospective comparison of clinical, echocardiographic and radiologic outcome following surgical correction of coarctation of the aorta by subclavian flap aortoplasty or resection end to end anastomosis at less than 3 months of age.Methods: 62 patients under 3 months of age with isolated coarctation of the aorta who underwent surgical correction between 1997 and 2002 (34 resections and 28 subclavian flap aortoplasties) were studied. Age at time of repair was comparable (p=0.54). Weight at time of repair was lower in the resection group (p=0.008). Follow up included clinical evaluation, echocardiographic estimation of residula gradient and left ventricular mass index in all patients and CT Aortography if there was evidence of recoarctation. Measurements of mid-arm circumference, acromion to-olecranon distance along with brachial artery flow velocity and flow pattern in both upper limbs were carried out in the flap aortoplasty group.Results: Mean follow-up was 33.21±14.78 months (range 12-65 months) which was similar in both groups (p=0.26). 12 in the resection group (35%) and 4 in the flap group (15%) had recoarctation. Left ventricular mass index was higher in the resection group (mean 76.50±11g/m 2 ) than the flap group (mean 58±4.77 g/m 2 ) p=0.00. There were no obvious upper limb ischaemic complications in the flap group, but the left arm was significantly shorter than the right.Conclusions: Subclavian flap procedure is superior in terms of lesser recurrence, and also lower left ventricular mass index. Minor differences in limb length were noted though none of the patients were symptomatic.
5Post-operative evaluation of arterial switch by 3D helical computed tomographic angiography
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