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<p><strong>Aim:</strong> The paper focuses on assessment of the late results and causes of complications when repairing coarctation with distal aortic arch hypoplasia.<br /><strong>Methods:</strong> This prospective randomized study included 54 patients who underwent repair of coarctation of the aorta. All patients were divided in 2 groups depending on the correction type: reconstruction using the modified reverse left subclavian artery flap plasty (Group I, 27 pts) or extended end-to-end anastomosis (Group II, 27 pts).<br /><strong>Results:</strong> A postoperative follow-up period was 26 (21;31) months. Recoarctation of the aorta during long-term follow-up was found in 1 patient (3.84%) in Group I and in 2 patients (7.7%) in Group II (p=0.5). Two patients in the Group I (7.7%) and 8 patients in the Group II (30.8%) had arterial hypertension (p=0.03).<br /><strong>Conclusion:</strong> With modern types of surgical correction used, the anastomotic area tended to proportionally grow in different segments of the aortic arch and did not influence the postoperative complications rate. Endocardial fibroelastosis and ascending aortic wall rigidity could be considered as predictors of arterial hypertension in the late period after coarctation repair in infants. Low body weight before surgery is a factor of aortic recoarctation development in the late postoperative period. Arterial hypertension persistence depends on the correction type. One-stage reconstruction of the distal aortic arch allows for reducing the rate of arterial hypertension from 30.8% to 7.7%. Despite a range of complications in the late postoperative period, the infants’ quality of life was not affected and was high in both groups.</p>

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The Ross procedure is thought of as an attractive option for aortic valve replacement in children and adolescents. We reviewed the basic and latest surgical criteria for graft selection in pediatric population who underwent the Ross procedure. Some positive and negative sides of various grafts in the aortic and lung positions are described. The tendencies and follow-up results of homograft growth proportional to somatic growth of patients are also analyzed.

Background Autonomic nervous system (ANS) dysfunction has been implicated with cardiovascular diseases, sudden‐cardiac‐death, and aging. The pupillary light reflex (PLR) and heart rate variability (HRV) are noninvasive tools of autonomic evaluation. However, the former remains underutilized in clinical practice. Purpose We investigated the relationship between PLR, HRV, and aging to determine the normal distribution of age‐adjusted PLR and HRV measurements and to determine which method is best correlated with age. Methods Healthy participants aged 18–65 years were recruited. Following a dark adaptation period, pupillary reactivity parameters were collected using an automated, commercial pupillometer. HRV measurements were derived using a high‐resolution electrocardiogram. Correlations of PLR and HRV parameters to age were computed using linear‐regression analysis. Results A total of 111 healthy participants were included. Older age was correlated with lower maximum and minimum pupillary diameters following dark adaptation and illumination (R = −0.51, p < 0.001 and R = −0.47, p < 0.001, respectively). Average constriction and dilatation velocity were correlated with age (R = 0.33, p < 0.001 and R = −0.21, p = 0.025, respectively). HRV parameters were also associated inversely with age (SDNN; R = −0.31, p < 0.001 and RMSSD; R = −0.33, p < 0.001). Other parameters showed lower significance levels. Conclusion Pupillary light reflex measurements demonstrated stronger age correlation than short‐term HRV time‐domain indices. Due to its merit in depicting normal age‐related ANS changes, PLR can be utilized to differentiate between pathological and physiological deviations from age‐adjusted norms, seemingly better than HRV. Further research is warranted on incorporating PLR‐based ANS dysfunction evaluation and monitoring the increasingly aging population.

<p><strong>Aim.</strong> To evaluate the results of vacuum therapy and closed irrigation drainage (CID) technique for the treatment of postoperative sternomediastinitis in infants<br /><strong>Methods.</strong> This single-institution retrospective study included 69 patients diagnosed with sternomediastinitis from 2008 to 2018. Patients were divided into two groups: those treated using vacuum-assisted closure therapy (VAC; n = 29) and those treated using CID (n = 40). After propensity score matching, a total of 25 infants were included in each group.<br /><strong>Results.</strong> Age, gender, weight, body surface area, Risk Adjustment for Congenital Heart Surgery score, cardiopulmonary bypass time and the frequency of open chest management were comparable between the two groups after propensity score matching. During hospital stay, no deaths were noted in the VAC group, whereas eight patients died in the CID group (32%; P = 0.004). The median durations of mechanical ventilation were 79 (28; 176) and 154 (24; 356) hours in the VAC and CID groups, respectively (P = 0.38). Moreover, eight patients in the VAC group (32%) were extubated early (P = 0.028). Re-mediastinitis occurred in 1 (4%) and 8 (32%) patients from the VAC and CID groups, respectively (P = 0.01). The multivariable regression analysis revealed that the CID technique was the only risk factor for re-mediastinitis (odds ratio, 13.9; 95% confidence interval, 1.2–152.5; P = 0.031). The median durations of hospital stay were 14 (10; 30) and 23 (18; 33) days in the VAC and CID groups, respectively (P = 0.045).<br /><strong>Conclusion.</strong> VAC therapy in patients with mediastinitis showed better outcomes than CID technique such as lower hospital mortality and re-mediastinitis rates.</p><p>Received 14 August 2019. Revised 8 December 2019. Accepted 10 December 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

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<p>Coarctation of the aorta is a well-studied congenital heart disease. Our understanding of this congenital heart disease evolves every year from simple obstructive aortic lesions to systemic dysfunction of the cardiovascular system. In the past two decades, there has been a progressive decrease in mortality and early postoperative complications of newborns and infants with aortic coarctation. However, these patients with coarctation of aorta have a high risk of postoperative complications in the long-term period, despite successful correction at an early age. This review will focus on the issues mainly related to blood pressure. Arterial hypertension has been reported to occur in up to 90% of patients, and is considered as the main cause of premature cardiovascular diseases. The development of arterial hypertension in patients after correction of aortic coarctation is likely to be multifactorial and may be associated with the changes in elastic properties of the aorta wall, presence of residual obstruction, changes in the aortic arch geometry, immune-inflammatory disorders and changes in the regulation of renin-angiotensin and baroreceptors. Also described are the prevalence and pathophysiology of arterial hypertension in children who have undergone aortic coarctation repair. Due attention is given to the issues of accurate blood pressure measurement at an early stage of arterial hypertension. Although the patterns for diagnostics of arterial hypertension in adults are well established, we highlight the issues of premature cardiovascular events development in children and describe the techniques, which help provide complementary information for cardiovascular assessment in this group of patients.<br />Received 7 August 2018. Revised 6 December 2018. Accepted 10 December 2018.<br /><strong>Acknowledgment</strong><br />We would like to express our gratitude to Sergey M. Ivantsov for technical support.<br /><strong>Funding:</strong> The study did not have sponsorship.<br /><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>