The following is a collection of featured congenital articles from the Journal of Thoracic and Cardiovascular Surgery (JTCVS). To read the latest issue, browse the feature video library and other journal highlights please visit www.jtcvs.org
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VENTRICULAR SEPTAL DEFECT
Extracorporeal membrane oxygenation as a novel management strategy for interventricular septal hematoma following ventricular septal defect repair
Anusha Jegatheeswaran, MD, PhD, Meryl S. Cohen, MD, J. William Gaynor, MD, Christopher E. Mascio, MD, Thomas L. Spray, MD, Stephanie Fuller, MD
IVSH post-VSD repair can cause hemodynamic instability and death. We present the novel use of ECMO despite the need for anticoagulation, with repeated imaging to assess hematoma expansion.
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Commentary: Rescue is feasible—Prevention is preferred
Nhue Do, MD, David Bichell, MD
ECMO can be successful support for an unstable patient with septal hematoma. Early detection of this rare complication may inform intervention, averting instability and obviating the need for rescue.
Commentary: Postoperative interventricular septal hematoma—Never say never
Harold M. Burkhart, MD, Jess L. Thompson, MD, Klayton W. Buckley, CCP
Postoperative interventricular septal hematoma seldom occurs and can be successfully managed expectantly or, if necessary, with extracorporeal membrane oxygenation support.
VENTRICULAR SEPTAL DEFECT FEATURED VIDEO
Echocardiogram demonstrating interventricular septal hematoma on 4-chamber view.
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ANOMALOUS CORONARY ARTERY
Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation
Wen Zhang, MD, Renjie Hu, MD, Yifan Zhu, MD, Weituo Zhang, PhD, Xiafeng Yu, MD, Yanjun Sun, MD, Hongbin Zhu, MD, Haibo Zhang, MD, PhD
Older age at repair for ALCAPA with impaired preoperative left ventricular function is associated with suboptimal surgical outcomes.
Commentary: Anomalous left coronary artery from the pulmonary artery—Time is of the essence
Elizabeth H. Stephens, MD, PhD, Joseph A. Dearani, MD
Early diagnosis of anomalous left coronary artery from the pulmonary artery with immediate surgery has the best early and late outcomes.
Commentary: Why the difference?
Carl L. Backer, MD
There is a dramatic difference in outcomes for children with ALCAPA when comparing the results from Shanghai Children's with centers from North America. What accounts for this?
ANOMALOUS CORONARY ARTERY FEATURED VIDEO
Surgical repair for anomalous left coronary artery (LCA) from the pulmonary artery by coronary reimplantation technique.
CORONARY
Acute coronary artery obstruction following surgical repair of congenital heart disease
Michael P. Goldsmith, MD, Catherine K. Allan, MD, Ryan Callahan, MD, Aditya K. Kaza, MD, Douglas Y. Mah, MD, Joshua W. Salvin, MD, MPH, Kimberlee Gauvreau, ScD, Diego Porras, MD
Increased time to diagnosis and treatment of acute postoperative coronary artery obstruction following surgical repair of congenital heart disease is associated with adverse clinical outcomes.
Commentary: A high index of suspicion for coronary problems after congenital heart surgery is critical
Emile A. Bacha, MD, Damien J. LaPar, MD
Coronary problems have to be actively thought out and dealt with promptly in cases of atypical postoperative course, even after operations that did not involve the coronary arteries.
Commentary: Time is muscle
Christoph Haller, MD
Early detection of impaired myocardial blood flow is crucial and should lower the threshold for invasive diagnostic investigation.
Commentary: Survival after coronary injury—it's about time
Ibrahim Abdullah, MD, Zohair Al-Halees, MD
Survival after postoperative coronary artery obstruction for congenital heart disease is dependent on timely recognition and intervention.
FONTAN: BASIC SCIENCE
In vivo implantation of 3-dimensional printed customized branched tissue engineered vascular graft in a porcine model
Enoch Yeung, MBBS, Takahiro Inoue, MD, PhD, Hiroshi Matsushita, MD, Justin Opfermann, MS, Paige Mass, BS, Seda Aslan, MS, Jed Johnson, PhD, Kevin Nelson, PhD, Byeol Kim, BS, Laura Olivieri, MD, Axel Krieger, PhD, Narutoshi Hibino, MD, PhD
Our integrated virtual surgical planning and flow dynamic profile optimization prove the feasibility of providing an optimized anatomy and hemodynamic parameter of the 3D printed, customized vascular graft.
Commentary: Something made from nothing—impressive, but will it last?
Ronald K. Woods, MD, PhD
An assessment of the potential utility of tissue-engineered vascular grafts requires longer-term follow-up.
Commentary: Promise of personalized tissue-engineered vascular grafts for congenital heart surgery
Ming-Sing Si, MD
A new milestone has been achieved in personalized congenital heart surgery.
FONTAN FEATURED VIDEO
Objectives and methodology of optimization and in vivo implantation of the customized branched tissue engineered vascular graft.
TRANSPLANTATION
Normalization of hemodynamics is delayed in patients with a single ventricle after pediatric heart transplantation
Elizabeth H. Stephens, MD, PhD, Paul Tannous, MD, PhD, Michael C. Mongé, MD, Osama Eltayeb, MD, Paul J. Devlin, MD, MSc, Carl L. Backer, MD, Joseph M. Forbess, MD, MBA, Elfriede Pahl, MD
Patients with a single ventricle (Glenn and Fontan) demonstrated delayed normalization of hemodynamics after heart transplant compared with patients with DCM, without differences in survival.
Commentary: How long until a new heart is a “normal” heart in transplanted single-ventricle patients?
Nathanya Baez Hernandez, MD, Ryan R. Davies, MD
Delayed normalization of hemodynamics is common following transplantation for failed single-ventricle palliation, but the underlying mechanisms and the impact on graft function and long-term outcomes are uncertain.
Commentary: It isn't easy being single
Eric Purifoy, MD, Iki Adachi, MD
Single-ventricle physiology presents unique challenges before and after heart transplantation. Stephens et al. describe delayed resolution of abnormal hemodynamics post-transplant in these patients.
Commentary: The environment matters: The effects of passive circulation are not quickly reversed by a change of heart
Karthik Thangappan, MD, David L.S. Morales, MD
Single-ventricle physiology creates an environment that is challenging for a new heart to normalize; however, with time, the effects left behind by the passive circulation will eventually improve.
PERIOPERATIVE MANAGEMENT
Abnormalities in cerebral hemodynamics and changes with surgical intervention in neonates with congenital heart disease
Henry H. Cheng, MD, Silvina L. Ferradal, PhD, Rutvi Vyas, MS, Daniel Wigmore, BS, Erica McDavitt, MS, Janet S. Soul, MDCM, Mari A. Franceschini, PhD, Jane W. Newburger, MD, MPH, P. Ellen Grant, MD
Neonates with congenital heart disease (CHD) show altered cerebral hemodynamics versus controls, most notably in single-ventricle (SV) CHD. Neonates with TGA and SV may compensate with increased oxygen extraction.
Commentary: Casting near-infrared light on cerebral oxygen economy in neonatal congenital heart disease
John P. Scott, MD
Multimodal neurophysiologic monitoring utilizing near infrared light may be used to better understand cerebral oxygen supply and demand relationships in neonatal congenital heart disease.
Commentary: The oxygen metabolism of the brain transparent
Manan Desai, MD, Can Yerebakan, MD
Improved noninvasive monitoring of perioperative brain metabolism in congenital heart disease—are we going to know better how much we don't know?
Commentary: Near-infrared technology continues to evolve, but the holy grail remains elusive
Richard A. Jonas, MD
Biomedical optical techniques continue to evolve; however the holy grail of intracellular cytochrome a,a3 measurement remains elusive.