Overall, there is no apparent difference in pulmonary edema, mortality, or length of stay between isotonic crystalloid and colloid resuscitation. Crystalloid resuscitation is associated with a lower mortality in trauma patients. Methodologic limitations preclude any evidence-based clinical recommendations. Larger well-designed randomized trials are needed to achieve sufficient power to detect potentially small differences in treatment effects if they truly exist.

The Melody valve has demonstrated acceptable short-term function. Implantation techniques to prevent left ventricular outflow tract obstruction (suture fixation of the distal stent) and paravalvular leaks (the addition of a pericardial cuff) should be considered. The Melody valve can be percutaneously expanded as the child grows.

The 1.5-ventricle repair can be utilized in patients with severe Ebstein anomaly and impaired right ventricular function who are at high risk for surgical treatment. We believe the bidirectional cavopulmonary shunt may be considered as a planned procedure, as an intraoperative salvage maneuver, or as an alternative to cardiac transplantation in selected patients.

Using a multimodality approach, we observed acceptable early survival after operation in patients with pulmonary vein stenosis, despite the need for catheter reinterventions. Lung transplantation remains a viable option.

Figure. A, Prenatal echocardiogram (Echo).Top, The aorta (Ao) and the main pulmonary artery (MPA) in the long-axis view with a large defect between them. Middle, Short-axis image showing again that the aorta and MPA are normally related to each other and that there is a large communication between the 2 great vessels. The left pulmonary artery (LPA) arises normally from the MPA, but the right pulmonary artery (RPA) arises from the aorta. Bottom, The MPA gives rise to the ductal arch and the LPA underneath. B, Postnatal echocardiogram images confirm the fetal diagnosis. Images are arranged side-by-side and in an orientation similar to that of the prenatal images. C, Part of the surgical repair included closure of the aortopulmonary window (APW) to permit communication between the MPA and RPA (longer dashed line) and aortic root enlargement with a patch (short dashed line). D, Postsurgery discharge echocardiogram. Top, Absence of residual aortopulmonary communication and mild RPA stenosis. Bottom, Unobstructed aortic arch (Arch). Duct indicates ductus arteriosus; and SVC, superior vena cava.

Extubation in the operating room after a modified Fontan procedure seems feasible. This approach is associated with improved early postoperative hemodynamics, earlier time to chest tube removal, and shorter intensive care unit and hospital lengths of stay.

The change in operating room personnel from the day team to the evening team added significant length to the total operating department time in cardiovascular surgery; however, its impact on most traditional outcome measures was difficult to demonstrate. More sensitive outcome measures may be required to assess the impact of teamwork interventions.

Aortic root translocation can be done with low early and late mortality. There was preserved aortic valve function and no left ventricular outflow tract obstruction at late follow-up. The use of a transannular patch had early outcomes comparable to valved conduits, with a trend for fewer late reoperations.