The Nitinol coil system was recently developed by “PFM” specifically for the transcatheter occlusion of ventricular septal defects (VSD). The device consists of a coil fitted with polyester fibers designated for the closure of perimembranous defects with an aneurysmal septum and some muscular VSDs. We report a case of fatal acute infective endocarditis 10 days following the procedure.

Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary venous connection over a modern era excluding emergent cases to eliminate the influence of associated factors on surgical outcome.  Methods: 70 patients with isolated total anomalous pulmonary venous connection who were repaired electively between January 2013 and February 2018 were included. Results: In-hospital mortality was encountered in 4 patients (5.7%). Upon univariate analysis, low age (P = .003) and weight (P = .001) at surgery, preoperative pulmonary venous obstruction (P = .010), preoperative low oxygen saturation (P = .031), long cardiopulmonary bypass (P = .001) and aortic cross clamp (P = .003) times, long duration of mechanical ventilation (P = .001), chest infection (P = 0.041), postoperative low CO syndrome (P < .001) and long postoperative inotropic support (P = .015) were significant predictors of in-hospital mortality. In multivariate analysis postoperative low cardiac output syndrome (OR: 1.060; 95% CI: 1.008-1.116) and prolonged postoperative mechanical ventilation (OR: 1.772; 95% CI: 1.141-2.751) were independent factors of in-hospital mortality. Conclusion: Surgical repair of TAPVC is now performed with acceptable results. According to our study, postoperative low cardiac output syndrome and prolonged postoperative mechanical ventilation were the most significant predictors for early mortality.

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Background The timing of surgical repair of tetralogy of Fallot (TOF) is a key to alleviate complications and for long-term survival. Total correction was usually performed at the age of 6 months or older under the notion of decreasing the surgical risk. However, avoiding palliation with an aortopulmonary shunt and early correction of systemic hypoxia appear to be of more benefit than the inborn surgical risk in low body weight patients. Our objective was to assess early/midterm survival and operative complications and to analyze patients, surgical techniques, and morphological risk factors to determine their effects on outcomes. Patients and Methods We retrospectively reviewed 152 patients with TOF who were ≤60 days of age when they underwent total correction of TOF. All patients had either duct-dependent pulmonary blood flow or arterial blood oxygen saturation less than 65% on room air requiring urgent surgical correction. Exclusion criteria included TOF with pulmonary atresia, TOF with nonconfluent pulmonary arteries, TOF with multiple aortopulmonary collateral arteries, and associated complete atrioventricular septal defects. Results The mean age at repair was 34 ± 19 days, and the mean weight was 3.8 ± 0.9 kg. Before surgery, 96 patients received an infusion of prostaglandin, 45 were mechanically ventilated, and 32 required inotropic support. Right ventricular outflow tract obstruction was managed with a transannular patch in 112 patients, and all the others had a main pulmonary artery patch. Cardiopulmonary bypass (CPB) with moderate hypothermia was the standard, and the CPB time averaged 48 ± 21 minutes. The postoperative intensive care unit stay was 5.7 ± 6 days, with 2.8 ± 4 days of mechanical ventilation. Early mortality was 4.6% (7 of 152), and actuarial survival rates were 95% at 1 year and 92% at 5 years. Univariable and multivariable analyses of the patients' demographics, anatomical characteristics, and operative techniques revealed the presence of small pulmonary arteries and low body weight to be the only independent risk factors for death. Conclusion Early total correction of TOF during the first 60 days of life can be performed with low mortality and good intermediate-term survival and, from our point of view, “should be the gold standard for TOFs.”

Background: Catheter-based interventions for treating congenital cardiac defects have gained wide acceptance as they reduce the risks associated with surgery. However, these procedures are associated with some complications, such as the embolization of devices or stents and the injury of surrounding structures, which might need a rescue surgical intervention. Methods: Data from 25 patients who needed rescue surgery following interventional catheterization between January 2008 and January 2018 were retrospectively collected and statistically analyzed to review the decision and timing of surgery as well as the surgical techniques and results. Results: There were 24 cases of rescue surgery after device embolization, including 9 cases of atrial septal defect closure, 8 cases of patent ductus arteriosus closure, 4 cases of pulmonary artery balloon dilatation with stenting, 3 cases of muscular ventricular septal defect closure, and 1 case of right ventricular outflow tract injury during balloon valvuloplasty. Median age was 4 years (range, 2 months to 12 years). All rescue surgeries were done via median sternotomy. The mean time interval between the decision to remove the device surgically and the actual surgical procedure was 75 ± 14 minutes. There were no reported cases of postoperative complications or mortality among the patients who underwent surgery. Conclusion: Our single-center experience confirms that early rescue cardiac surgery to correct adverse events after pediatric transcatheter interventions is safe and effective. Surgical strategies should be tailored according to the situation in each case.

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Background: Rheumatic mitral valve disease is considerably less common in North America and European countries than in developing countries, where rheumatic heart disease remains by far the leading cause of valvular diseases. This study was done to evaluate the midterm results over 10y of mitral valve repair for rheumatic mitral regurgitation in term of survival rate and late valve failure and need of redo surgery. Aim of Study: To record mid term results over 10y of our trail to repair the mitral valve with rheumatic pathology that caused uncoaptation and regurge in the mitral valve with special attention to the evaluation of the number of patients survived, delayed failure of the repair done and need of redo surgery. Patients and Methods: This is a retrospective study from January 2004 to January 2014, one hundred and twenty patients with rheumatic mitral valve disease underwent mitral valve repair in our hospital. Age ranged from 15 to 53 years, 80% patients were female. The lesions were pure mitral regurgitation in 95 (79.1%) patients, predominant mitral regurgitation with stenosis in 12 (10%), and predominant mitral stenosis with regurgitation in 13 (10.8%). Ninty patients (75%) patients were in normal sinus rhythm. Results: Follow-up time ranged from 6 to 120 months, mean 55.4±3.2 months. There were 10 late deaths. Survival at 5 and 10 years was 96.5% and 91.2%, respectively. 25 patients (20.8%) patients had mitral regurgitation during follow-up, and 8 underwent reoperation with no hospital mortality. Freedom from reoperation at 5 and 10 years was 93.5% and 82.7%, respectively. Progression of mitral regurgitation at 5 and 10 years was 71.4% and 59.3%, respectively. Freedom from all late events at 5 and 10 years was 72.6% and 54.2%, respectively. Conclusions: Mitral valve repair for rheumatic mitral regurgitation is associated with a significant rate of valve failure and reoperation. However, it has a satisfactory survival rate and is a good alternative to valve replacement, especially for young female patients in child bearing period to avoid the lifelong risks of a prosthetic valve and anticoagulation related problems.

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