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Patients with a "2+2" pattern of mixed totally anomalous pulmonary venous connection constitute the safe anatomic category for rechanneling, followed by the "3+1" variety. Cross-sectional echocardiography and/or computed tomographic angiography are mandatory to provide necessary diagnostic information and define the anatomy. Patients aged 2 months or younger, obstructive totally anomalous pulmonary venous connection, and perioperative pulmonary hypertensive crises were significant risk factors for death by logistic regression analysis. The risk of death was 5.85 times higher (95% confidence interval: 1.46-35.68; P = .02) in patients with category III of mixed TAPVC. The precise technique adopted in an individual patient depends on the pattern of anatomic drainage, and an individualized surgical approach is recommended.

To the Editor: Stem cell therapy has shown potential benefit in heart failure caused by ischemic heart disease (1). There is no data on the role of stem cell therapy in nonischemic dilated cardiomyopathy. We undertook a pilot study of intracoronary stem cell implantation in patients with dilated cardiomyopathy.From a cohort of 44 patients, 24 were randomly allocated to the stem cell therapy arm and 20 to the control arm. All patients were having dilated cardiomyopathy with an ejection fraction (EF) of Յ35%, were New York Heart Association (NYHA) functional class II or more symptomatic for more than 6 months, had normal coronary arteries, and had no other comorbidities such as chronic renal or liver failure or any malignancy.Patients in the treatment arm underwent bone marrow aspiration (50 to 60 ml) from the iliac crest. Mononuclear cells were separated from the bone marrow using Ficoll density gradient separation. The mononuclear cells constituted 89 Ϯ 2% of the cells, were 28 Ϯ 16 million /ml, and CD 34ϩ cells were 1.6 million/ml. The viability of these cells was 99 Ϯ 1%. The patients then underwent right heart catheterization and endomyocardial biopsy from the right side of the interventricular septum. The coronary sinus was then engaged using a Swan-Ganz catheter (Arrow International, Reading, Pennsylvania) that was passed up the coronary sinus, and the balloon was inflated. This was done so that the coronary circulation was slowed and the stem cells would get more time to transmigrate into the myocardium. Once the coronary sinus catheter was inflated, the stem cells were slowly injected into the coronary arteries by hooking the arteries with a Judkins catheter. Two-thirds of the mononuclear cell concentrate was injected into the left coronary artery and one-third was injected into the right coronary artery. The coronary sinus balloon was kept inflated for 3 min during the intracoronary injection. The patients were kept under monitoring for 24 h with electrocardiographic monitoring and serial cardiac enzymes. Follow-up was done at 1 week, 1 month, and then every 3 months for 1 year. At 3 months, Holter monitoring, an echocardiogram, and an endomyocardial biopsy were repeated. An echocardiogram was also repeated at 1 year. Left ventricular function assessment was performed offline by the modified Simpson method by 2 observers blinded to the underlying treatment. All patients were on the maximum tolerated doses of angiotensin-converting enzyme inhibitors and beta-blockers. Diuretic doses (including frusemide and torsemide, and spironolactone) were adjusted to ensure the absence of pedal edema. Informed consent was obtained from all patients, including control patients. The end points of the study were: 1) change in NYHA functional class, 2) a change in left ventricular function, 3) mortality, and 4) endomyocardial biopsy and histopathologic evaluation.Continuous variables were compared by a Wilcoxon 2-sample test (for within-group differences) and the Mann-Whitney U test (between-group differences). Differences...

Surgery for aneurysm of sinus of Valsalva yields gratifying results, and it should be undertaken as soon as the condition is diagnosed.

To compare different doses of tranexamic acid, 150 consecutive children with congenital cyanotic heart disease were randomly assigned to one of 5 groups of 30 each. Group A served as a control. Group B received 50 mg.kg(-1) of tranexamic acid at induction of anesthesia. Group C received 10 mg.kg(-1) at induction followed by an infusion of 1 mg.kg(-1).h(-1). Group D had 10 mg.kg(-1) at induction, 10 mg.kg(-1) on bypass, and 10 mg.kg(-1) after protamine. Group E had 20 mg.kg(-1) at induction and again after protamine. The control group had the longest sternal closure time, the greatest blood loss in the first 24 hours, and the highest requirements for blood and blood products. Among the 4 groups given tranexamic acid, group D (triple dose) had the best results, followed by group E (double dose). Group B (single dose) had the worst results among the groups receiving tranexamic acid.

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