Many of the factors thought to be associated with the need for delaying the sternal closure had no statistical significance as risk factors. On the other hand, the diagnosis of IAA or TAPVD, an age less than 7 days, aortic clamping more than 98 min, CPB time more than 185 min and a post-bypass central venous saturation less than 51% were statistically significant risk factors that could be used in predicting the need for delaying the sternal closure.

This is a report of a case of the rare ectopia cordis malformation of the thoracoabdominal type without intracardiac anomalies. The patient had a successful single stage repair with reduction of the herniating heart and reconstruction of a cartilaginous cover to protect the heart. The result was very good and the follow up for 13 months was very satisfactory.

Background: Tetralogy of Fallot is the most common cyanotic congenital heart defect. Borderline pulmonary anatomy has been associated with a higher risk of mortality and morbidity. Strategies to manage this condition—namely, single- or multistage repair—have long been debated. Objective: The overall outcomes of patients with tetralogy of Fallot with borderline pulmonary arteries (McGoon ratio 1.3 to 1.7) with regard to the need for a single-stage or multistage repair and the outcome of each surgical management were evaluated. Patients and methods: A retrospective, nonrandomized comparative study designed to evaluate patient outcomes comprised 60 patients with tetralogy of Fallot with borderline pulmonary arteries who underwent surgery at the Cardiothoracic Surgery Academy, Ain Shams University, Cairo, Egypt, between January 2016 and December 2017. After gaining approval from the affiliated ethical and research committee, and informed consent of the guardians, the patients were assigned into one of two groups. Shunt group included 30 patients managed surgically by a modified Blalock-Taussig (MBT) shunt as a part of a multistage repair, and repair group included 30 patients managed surgically by single-stage complete repair. The medical records of the patients were reviewed, and data relating to age, sex, weight, and preoperative oxygen saturation were collected. All patients underwent preoperative echocardiography and multislice computed tomography (CT) with angiography. The follow-up was performed by echocardiography at discharge and at one month and six months after surgery. Multislice CT with angiography was performed in patients who received a shunt once the echocardiography showed acceptable pulmonary arteries. Results: The patients’ age ranged from 5 to 50 months with a mean age of 18.63 ± 9.15 (19.84 ± 12.34 for the shunt group and 17.43 ± 8.54 for the repair group). The weight ranged from 5 kg to 18 kg with a mean of 9.6 ± 2.53 (8.82 ± 2.79 for the shunt group and 10.41 ± 2.63 for the repair group). The mean preoperative O2 saturation was 68.95% ± 7.8% for the shunt group and 87.93% ± 6.18% for the repair group. The median McGoon ratio was 1.4 for the shunt group and 1.6 for the repair group, the difference of which was highly significant (P < .0001). The mortality rate in our study was 10% (10% for the shunt group and 10% for the repair group). The morbidity incidence rate was 26.6% for the shunt and repair groups. The ICU stay ranged from 2 to 31 days, with a median of three days for the shunt group (mean 3.61 ± 1.91) and four days for the repair group (mean 6.07 ± 6.63 days). The calculated P value showed a significant difference between the two groups concerning ICU stay. The postoperative SO2 significantly increased to a mean of 85.58 ± 7.05 in the shunt group and 98.14 ± 3.36 in the repair group (P < .0001). Conclusion: There was no statistically significant difference between multistage repair and single-stage complete repair regarding morbidity and mortality. Regarding ICU stay, patients in the single-stage had a better outcome. A McGoon ratio of 1.5 can be used as a guideline in the decision-making process.

Background Mechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes. Results The median ID and range were (0.43, 0.03-3) NYHA class/day. A higher ID was significantly related to early development of PVT after native valve replacement, younger age, female gender, pregnancy, non-compliance to oral anticoagulation (OAC), low LVEF%, high mean pressure gradient across a mitral prosthesis, raised serum creatinine, and SGOT on admission (P < 0.05). Independent predictors were early presentation after native valve replacement, female gender, and non-compliance to OAC (P < 0.05). ID correlated positively with the need for urgent/emergency surgery, and the durations of cardiopulmonary bypass, postoperative mechanical ventilation, and positive inotropes. ID correlated negatively with the postoperative LVEF% (P < 0.05). Median ID of the 21 mortalities (0.75, 0.1-3) was > 2.1 times that of survivors (0.35: 0.03−2; P = 0.002), and the median ID of the 29 cases with postoperative complications (0.5, 0.1-1.5) was 2.5 times that of the 39 uneventful cases (0.2, 0.03-2; P = 0.011). The ID significantly predicted both mortality (odds ratio 3.87; 1.33-1.29; P = 0.013) and mortality and hospital complications (odds ratio 4.77; 1.49-15.2; P = 0.008). The respective discriminating abilities were AUC 0.734 (0.616-0.852; P = 0.002) and 0.724 (0.61-0.835; P < 0.001). EuroScore II correlated positively with ID (r = 0.571; P < 0.001) but showed better discriminative abilities. Conclusion The simple index of deterioration was useful in monitoring deterioration and predicting hospital progression and outcomes in patients presenting with PVT.

No abstract